Category Archives: Medicine

I AM A DOCTOR: The myth buster

Image

It is the time of the year again, where the old ends and the new begins. Where we seek reassurance from the baffling resolutions we never meant to keep.

It is also a season for young students to decide the course of their career. Fresh faced and bright-eyed, full of hyped up myths and legends, they will inadvertently have one ambition in mind. A dream they have kept repeating from childhood or rather a mantra that was repeated to them : GROW UP AND BECOME A DOCTOR.

I am here to tell you what your parents conveniently forgot. There are things to consider before foolishly embarking on a journey not meant for you. In short, I am a myth buster. But in reality, I AM A DOCTOR.

 

Myth number one: The hard part is getting into medical school.

This is not the hard part at all. The real challenge is remaining in medical school till you graduate. The numerous exams and assessments will leave most of you gasping for reprieve.

My advice to you is to go to the nearest book store and browse through the medical books. Have you seen them? Do they look shiny and thick? Good. Now imagine spending your weekends with them. For the next five years!

Clinical exams on the other hand are unique to medical schools. Two examiners will observe your every move as you attempt to demonstrate the multiple clinical signs taught only once during your ward rounds. Mass production of doctors by a single medical school is a myth. A significant number would have dropped out by the time you graduate.

 

Myth number two: Internship training is not as difficult as it sounds.

You are absolutely right. It is infinitely much harder. Every decision you make will be scrutinized and criticized. Some senior doctors will humiliate you for simple errors.

There may be times your ignorance might be detrimental to a patient and you may lose a patient during the course of your internship. Recovering from the loss is hard, especially if there is a chance you could have prevented it. The guilt will eat you up, forcing you to drop out of clinical work. And this guilt will stain your conscience for life. It will never wash off.

 

Myth number three: Doctors are highly respected in the society

This may have been the case in the previous centuries but as our society becomes more affluent and educated, they invariably become more demanding.

Walk through the corridors of any hospital in major cities, wearing your white lab coat and stethoscope, you would be hard pressed to find any layman who greets you with a smile or a respectful nod to say the least. Forget about “good mornings” and “good days”.

Since the lawyers are fast becoming the bane of our existence, our daily work consists of evasion tactics to prevent lawsuits. A new form of medicine is being practiced now and it has superseded the “clinical medicine” that was taught to us. It’s called “defensive medicine” and it is being practiced throughout the world.

Unnecessary investigations and treatments are administered, which bleeds our health resources dry, just to protect ourselves from legal attacks. An example would have to be the fast emergence of resistance to most antibiotics due to injudicious use, which if seen from another perspective, stems from the practice of defensive medicine.

 

Myth number four: Patients will always be grateful to the doctors

Before you start filling up the forms to enter medical school, you need to get one thing embedded in your mind.

Most patients will never say “thank you” or “you did your best doctor” if they get better. They will assume it’s their birthright to get better once they see you and it is your duty to make them well as they pay taxes.

I have been in this service for seven years and out of the thousands of patients I have discharged home safely, I can say less than a hundred have expressed their gratitude. Most would be complaining about the time it took for the doctors to prepare their discharge notes and plan subsequent follow-up appointments.

Then when they come back to see us in clinics, they will complain about the waiting time, not knowing you would have been starving the whole morning, just to start the clinics early to reduce the waiting time of the patients. After the consultation, you would be the one thanking them, and they will be rushing for the door to get the next cab home, so that they can be back in time for lunch with their family. And before I forget, lunch is a luxury you don’t often get.

 

Myth number five: Patients always place their full trust in doctors

If I have not deterred your interest in medicine up to now, I guess this will do it.

You are no savior. Remember this, and remember it well.

You don’t walk into a ward with the authority of a royalty and tell your patients you are going to start some form of treatment for them regardless of how they feel about it because they should just trust you. You had better find another job because their lawyers will sue the pants off you.

There is something called “patient autonomy”. It is they who decide to pursue any course of treatment and this is based on the quality of communication between both parties.

You can’t force a Jehovah Witness to receive blood transfusion even if she is bleeding away after delivery and would rather die that see a drop of blood enter her veins. In a bustling labor room, you might get a few requests at the same time for a female doctor to attend to patients with specific religious beliefs when there are no female doctors around. I have had patients who insist on seeing only a particular doctor knowing well he is on leave, while the infection eats away their foot, vehemently refusing other doctors and medical interns to come near them.

Official complaints to the administrators will follow suit if we don’t comply to their every wants and needs. Media bashing and Facebook groups with ridiculous demands are only a tip of the iceberg. The internet age has created many pseudo-doctors who assume they can challenge your treatment plan and knowledge based on a few articles they have read online. They will quote everyone and if possible even their neighbor’s cat which according to them recovered from appendicitis without any surgical intervention (True story!) .Go figure.

 

Myth number six: Sleep deprivation is a thing of the past

Sleep deprivation will remain in your present, brought forward from your past and linger on in your future. Medical interns will suffer the most. Depending on the sub specialty you choose, sleep deprivation will follow you like a shadow. No amount of adjustments to working hours will prevent this because the diseases don’t come with an appointment. As you climb higher up the ladder, responsibility increases exponentially and sleep quality reduces dramatically. Sounds poetic but it’s true.

 

Myth number seven: Doctors are guaranteed a job for life

Get this idea out of your head. Due to the blossoming of medical schools in most countries the supply is fast overcoming the demand. Some countries can’t cope with the number of doctors being churned out every year, that stringent entrance exams are enforced prior to permanent placement for internship. Requirements for specialty and sub specialty trainings are stricter now than they used to be.

Legal ramifications and higher costs in setting up private hospitals and clinics are fast reducing the number of experienced doctors who tend to live on their pensions and lead a relatively stress free life. The only thing you are guaranteed is the title in front of your name, which after a while numbs you and loses its sense of appeal.

 

Myth number eight: Doctors make lots of money

Doctors make a decent living. We don’t mint money if that’s what you’re after. If you are motivated by money I suggest you find another way to earn it. You will never be happy in this field. It’s just not for you. And it’s not your fault if you are motivated by financial riches. Just don’t use the pain and suffering of others for your own gains. There are other ways. Please find it.

 

Myth number nine: Life is easy for doctors in some countries compared to others

I don’t have to travel around the world and speak to every doctor, living or dead alike to tell you this. Life of a doctor is never easy, regardless of which corner of the world you work in. If it’s easy, then you’re not doing your job right.

Each country has its own challenges and any reasonable clinician with a sound insight will tell you the same thing. Perhaps they will venture to add-on some that I have missed out. You can try running but you will eventually end up where you started.

Living conditions and pay structures may change but human nature remains a constant throughout the world. Since our profession deals with human ailments and diseases, handling their behaviors and concerns conjointly falls on our shoulders. This is where the interminable difficulties lie, not in the diseases, but in the unpredictability of human responses.

If you do find or hear of a country where the doctors there have it easy, do let me know. I will swim there or drown trying. 

 

Myth number ten: Doctors are busy but they still have time for their family

Finally, if you have been reading patiently up to now, courageous and steadfast in refuting most of the myths, telling yourself “I know what I am getting into”, then this is the last weapon in my arsenal.

If you love spending most of your time at home with your family, if you see yourself being around your children when they grow up, if you want to be there for your wife when she is pregnant with your children, hold her hands while she delivers your baby, if you yearn to witness the first few steps your child takes, then this unfortunately is not your path.

Medicine will take up most of your time and very little will be left for your family. Many marriages have broken down for this reason alone. Children have grown up blaming their parents for not being there for them during their formative years. You will miss the important anniversaries, dance recitals and football games. Do you think a mere job is worth all this?

For now, this is all I have. I have painted a bleak picture. You have just seen it. And all of it is true.

 

So do you still want to become a doctor?

If your answer is still a resounding “yes” then I will let you in a secret. The important piece of information withheld up to now, meant only for those who truly deserve it. I have no regrets as well. Do you know why? Because we are the select few chosen to ease pain and end suffering. It’s a selfish act of being selfless. For one good day in this profession, I am willing to weather a hundred bad days. For a single smile of gratitude, I will brave a wave of indifference. For a person to be returned to their family, I am content if I only get to kiss my child goodnight.

I wake up every morning with a reason to live. It is profoundly better than those who wander aimlessly in a life of wealth and comfort. There will always be dark clouds. Even if I can’t see the sun, I know it’s there. And this sun is invincible. I hope you see it too someday.

 

Advertisements

The forgotten doctors

Paucity of attention is a serious crime. Lavishing undivided and undeserved attention is a mental handicap. I find it fascinating that there is intense scrutiny over superficial ripples on the languishing plights of a certain group of caregivers but then fails to even scratch the surface of a plight far worse than theirs.

I am a young physician working in the district hospital of Lahad Datu. I don’t blame you if you don’t know where it is. I didn’t too when I received my transfer letter. It’s located near the east coast of Sabah, but I am not here for a geography lesson. Neither am I here for cheap publicity. I am here solely to testify to the working challenges faced by doctors in remote districts of our country. 

District hospitals face the most arduous of challenges daily. Increasing patient load in district clinics and hospitals is just a paltry issue. Population increases exponentially based on the quality of health care. It is the lack of trained doctors manning these centers that should be addressed. The ministry of health took significant steps in addressing this. Medical officers, graduating specialists and senior consultants are transferred from major cities to ease the burden and uplift the services in these remote districts. But the lack of manpower still prevails. Where did we go wrong?

Most doctors have associated district hospitals to career suicide. Slim chance of a transfer back to the main hospitals in bigger towns have also been cited as a reason. Lack of basic amenities to quench their thirst for entertainment is a prevalent criteria. Families, spouses, multiple breeding children are among the reasons quoted in almost all the appeal letters cluttering the desks of the administrators in the ministry. Some have refused and have even resorted to selective memory loss when it comes to reporting for duty. Given the amount of latitude afforded they go unpunished and even obtain cancelation of their transfer on ridiculous grounds. I don’t deny there are genuine reasons for refusal to serve the districts but I am often left puzzled by the difficultly in being away from home for half a year compared to two or even four years of speciality training. The logic baffles me.

The ministry should make its stand clear. All medical officers, graduating specialists and consultants are given a finite time frame to serve the districts. They should be transferred immediately to any hospital of their choice once they have ’done their time’. No pun intended. If it’s their choice to continue serving the districts then so be it. Do not allow them to hold you ransom for promotions later for their conscious choices. If the velvet glove does not work then it’s time to reveal the iron fist.

It must be made compulsory for all new specialists to serve the districts during their period of gazettment. It should be made as one of the criterion for gazettment. A revision on a reduction in the period of gazettment for specialists serving the district hospitals should also be seriously considered. Moreover, these doctors should be given a significant precedence for subspecialty training over their peers who have refused to serve these hospitals, barring of course the consideration towards special reasons and requests. I believe it is a fair deal. With these efforts in place, graduating specialists will be queuing up to serve not only the interiors of Sabah and Sarawak but the deep bowels of our rainforests as well!

Medical officers in the district should be prioritized for speciality training. It is heartbreaking to digest if medical officers in districts have to compete on equal grounds with their colleagues in bigger centers for a place in speciality training. We should give them a reason to believe that their time serving the poor and needy is appreciated.

Why serve the district you may ask? You serve for the very reason of our existence. We exist to serve, to give a sense of orderliness to the chaos of diseases and to bring forth a sense of security to our patients. It is our duty to sweat blood and grind our sinew for this purpose alone. Don’t the people living in the interiors deserve better healthcare? Can you avert your eyes from these humble folks ravaged by poverty when all they ask is to be given fair and safe treatment? What is the use of our government pouring funds for state of the art facilities in these hospitals without anyone to man them? Good clinical practice and safe medicine starts and ends with the clinicians.

Finally, I will bring to your attention an often disregarded fact. In order to produce competent and safe doctors to empower our districts, we need to continue or improve our current training of young doctors. This should best be left to the practicing clinicians without the interference of the compassionate public and concerned politicians. Please don’t make it impossible for us to do our jobs.

I leave with a quote by George Bernard Shaw,  “ I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations.”

So I heard that you wanted to become a doctor…

Most of us live in an ideal world. This world exists only in our minds. If there is a distortion and when reality sets in the truth is pretty hard to swallow for most.
We hear of many talented and brilliant youngsters with strings of achievements wanting to become doctors. Their proud parents no doubt played a major role. This article was written bearing them in mind.
Allow me to introduce myself. I am a physician working in one of our general hospitals. Hospital Sultanah Bahiyah, Alor Setar to be exact. I have been in service for more than 5 years now and in this short span of time I have been forced to swallow and digest many truths about my career. Along with that a great many myths have been dispelled as well. I will tell you all about it.
I was a high achiever in school but I never wanted to become a doctor. There, I have said it. My friends who knew me from high school would tell you just that. I wanted to be a lawyer specializing in criminal and constitutional law. I was that focused from young. Medicine never crossed my mind. If at all I had a second choice it would have been journalism but certainly not medicine. It was due to some unexpected turn of events which placed me in medical school. My father played a major role in this. He has always known me better than I have known myself.
Lets start with life in medical school. The first two years is all about hard work. Make no mistakes. You will not have as many assignments as others but that will be more than made up with the number of exams you will have to sit. Each exam will leave a wrinkle on your face and if you have a part time modelling career planned I dont think acne is the current fashion trend. Depending on the medical schools some will have an exam almost every 4 to 8 weeks. It may just be a simple exam to most but it carries cumulative marks for your finals. Your study materials may weigh more than you at times. And all this to be completed within eight weeks. Sadly, this is just the beginning.
The final three are known as the clinical years. If you are from a respectable instituition you will be expected to examine and learn from patients during bedside teachings. To the uninitiated I will tell you how it goes. You will be brought to a patient during rounds in the morning. Your clinical professor will then proceed to show you and maybe a dozen others how to elicit a clinical sign. Your colleagues will then hover over the patient with some craning their necks to get a better look. With luck it may make sense to you but if it doesn’t, all of you will still nod your heads in unison in fear of being labelled slow, lazy or stupid!  Some of these signs you may never encounter during your daily ward rounds but will miraculously appear during exams without fail!
Your clinical exams are another issue altogether. Two hawk eyed examiners will watch your every move as you attempt to demonstrate the myriads of clinical signs that they presumably taught you during your bedside teachings. Guantanamo Bay may need these individuals. Without uttering a word they can make your heart race and your mind go blank in an instant. Some perspire so much during these exams that when they come out of the exam hall you would think that they visited a waterfall! Failures are common especially if you do not live up to their expectations. Mass production of doctors by our medical schools is a myth. You have no idea how many have been culled and are running around like headless chickens now!
If you are lucky (or unlucky!) enough to graduate there is more in store. After the fuss of graduation (where you will be forced to don dignified clothes the size of Brazil and take numerous flash photos that can sometimes be detrimental to your retina!), you will then proceed to housemanship training. If you thought medical school was bad enough you aint seen nothing yet!
You must have read about house officers. Their plight is often highlighted in the media and are garnering more attention than the presidential race in the United States. House officers training lasts for 2 years. You will rotate among the major departments in the hospital. During this four monthly rotation you will be expected to learn and manage patients with supervision from a senior doctor. Depending on the senior doctor or your own performance life may never be the same again. Your mistakes will be scrutinized and picked upon. You may think of it as a humiliation especially if its done in front of patients but this is the norm. Mistakes in an office might cost someone a fat contract but mistakes in the ward might cost a patient’s life. You will realize there arent that many broom closets in the hospital for you to hide and shed tears when this happens. It may remind you of the many ‘Scrubs’ episodes (where the senior doctors practically devour you for breakfast, lunch and dinner and leave some for supper that night) and its not as glamorous as ‘Grays Anatomy’.  Sleep deprivation is no longer an issue at this point because due to the current change in the training system you will only be expected to work 60 hours a week.
The lesser hours may not be a boon for many. If you do not make full use of your training during this limited time further horrifying events might follow.
I will paint you a scenario. After housemanship training you might be sent to a district hospital with the nearest general hospital a ferry ride away. You will then be expected to work 36 hours straight without sleep, single handedly manning a casualty department of a district hospital. A patient might come in the wee hours of the morning and worse still if its an ill child with a reversible illness. You will then be expected to perform a procedure you have only seen once during your entire housemanship training. Your seniors are conveniently not contactable. How are you going to perform? Its a life saving procedure and you have only seen it once. If you are lucky or talented enough you may get it in your first attempt. But what if you are not that lucky? What if the child dies because you could not do it? Can you look the mother in the eye? Sleep deprivation might become the natural order after that. And thats the bitter truth.
Upon completion of housemanship you might want to further your studies in a preferred speciality. Studying medicine was already bad enough but working at the same time is plain torture. Taking care of young toddlers during this period is not an added advantage. If your training requires being away from your family and rotating among the different hospitals in our country it requires divine-like patience and perseverance. Some exams requires you to fork up exorbitant amount of money for each sitting. Since failure rates are high and the exam fee might cost more than your monthly pay, you might end up being slightly better off than a waiter in the end.
After becoming a senior doctor or a specialist you will then be given many responsibilities. One of which may include training of young doctors. If you are as lucky as I am (most of the time) you will be given the chance to work with bright and enthusiastic house officers. Some unfortunately are not that lucky and may end up in private practice or take up another career path altogether.
Why take up medicine if all that I have painted sounds like entering ‘hell’ and consorting with the demons?
Medicine is a vocation. Its a divine calling. Its a selfish act of being selfless. Its a priviledge bestowed upon a select few to serve mankind and to alleviate their pain and suffering. Gratitude in the eyes of patients and relatives once healed of their disease and ailment is priceless. Your teachers will become your pillars in life. They will pass on to you the time honored traditions of being a doctor which in turn you will pass to the next generation. Thats how it has always been. If you have done your work sincerely and passionately they will proudly accept you as one of their own. Unless you are a soldier fighting side by side in war, the friends you make during this period will become your lifeline. Some of them have done so much for me while expecting so little that I would gladly take a bullet in their place.
You may not have enough time with your family as others might have but you would have returned someone back to their family. You would not have enough sleep at times but when you do, you will sleep with a sound conscience. You may not make as much as your friends in other ventures but your patient’s will consider your very presence invaluable.
Finally, you may ask me this. Do I have any regrets in being a doctor? I do and there is only one. Its that I never realized this earlier. When I wake up every morning I cant think of myself doing anything else but this. I would not change a single thing about my life because it has brought me exactly where I want to be. Its a pleasure to learn, treat, teach and in turn be treated. I count myself blessed to feel this way. The journey so far has been worth the while. And I can still keep on going.

The first pitfall of a first impression

This is new. I have decided to talk about something even if I can’t make sense of anything.

It happened today during work. I was held up by some unfortunate turn of events before I could actually get to do my rounds and my ever reliable house officers told me about a certain ill patient. This is where the fun starts.

The so called patient ( Mr X is so cliche so lets call him Hercules although he looks nothing like a Greek demigod!), came in with severe chest infection. He was in septicemic shock (to the non medical’s reading this it means the infection has pretty much booked him a place in the afterlife) and with Type 1 respiratory failure (which means one foot is already there).

He was unkempt, thin and haggard and looked very ill and worst of all…. he was all alone. I found out that he was brought from a nursing home where he was left in their care about a week ago. His clinical condition along with all the tests we have run so far did not look good. He was 70 and in my eyes was suffering. It would have been easy to let go and tell yourself that ‘going all out’ is only going to add on to his suffering. Something told me to give this poor bugger a chance. I am glad I did.

At that time I  can only think of the worst possible curses for Hercules’s children ( I found out that he had a bunch and none of them were there). One of them involved a pickaxe and his child’s head. Go figure…

To the non medicals reading this I would like to explain a few things as I am so used to comments from my ‘muggle’ friends that when we ‘doctors’ get into the groove we forget the existence of others. It is customary to not pursue active resuscitation in certain patients, among others involving the bedridden (as i heard was Hercules’s state since he was in nursing care), those with poor social support and patients with advanced or irreversible illness. Having said that being old is not a prerequisite to die! I have seen people more than twice my age living a healthier and fuller life than I have ever had (I BLAME THE MEDICAL PROFFESION!)

I wont go into the details of how we stabilized and brought him back from the near clutches of death. Needless to say that as his condition improved within the hour I felt a sense of dread. Have I done the right thing? Am I just prolonging his suffering? Does he deserve this? Where is he going to go now if he gets better? Its more expensive to care for an ill patient in a nursing home than caring for just a senile old man. What about the children? Where the hell are they?

As these distorted thoughts were entering my mind, a young lady approached Mr. Hercules. She held his hand and stroked it with tenderness that can only be born out of love. He eyes shone with tears as she called out to him. Hercules started to look and behave like Hercules! His condition improved by the afternoon and as I am writing this post we are weaning off the medications that supports his blood pressure. Before noon all his children were there and were very keen to know about his condition and progress albeit nothing I told them was particularly a ray of sunshine!

I found out from them that they all chipped in and sent Hercules to the nursing care so that he can be better taken care of. They also take turns to care for their sick mother who until recently requires all their care and attention. They did not want the father to feel neglected at home so they thought he would enjoy the company of people his own age for a while till their mother recuperates. They have not seen him this past week and are blaming themselves for their father’s health.

At this point I felt the pickaxe was better suited for my head.

Fast forward, I realised the essence of my ‘ near fatal mistake’. Had I left it to first impression and denied my gut instinct this would have been a different post. It would have been ‘oh i had a crappy day’ or ‘why does this always happen to me’ (similiar to certain ‘personalities’ updating even their bowel movements on facebook!)

The first pitfall of a first impression is the impression itself. I learnt that today and luckily not the hard way. Dont be generous with your judgement. As corny as it sounds…follow your heart. Gosh…I believe this is making sense after all!

Hercules…you made my day. It is an honour to have met you.Cheers…