So, you want to be a doctor

I’ve had a few readers emailing me, wondering about my life and journey as a doctor. They were wondering if it is indeed as glamorous and great as it is made out to be by certain tertiary centers.

If you are one of them, then this article is for you.

A few years ago, a close friend committed suicide by jumping from his apartment on the fourth floor of an apartment complex. He was a jolly good fellow, but faced a few bumps in his years as a medical student.

And throughout the years I worked as a houseman, two of my colleagues broke down and are under psychiatric follow-up, another four quit the profession while two others left for Australia. Many, many more left the profession, opting instead to run non – medical related businesses.

I shouldn’t start this piece on such a negative note, but those are the realities facing young doctors back then.

My consultant used to call them “collateral damage.”

The ‘Good’ Old Days.

I had my ups and downs back then. Some days I worked 36 hours straight, no rest, a Snickers bar and a can of chrysanthemum tea in between, and at the same time was expected to be sharp, smart, alert, and confident to make the right calls. At one time, I remembered going home at 7pm, after 36 hours of working, only to be called back to the ward at 11pm because of someone else’s mistake.

And in some wards you don’t even have a proper place to sleep in. I remembered myself in my paediatric posting where there was no proper place to rest. On my first day there I asked the staff where can I rest at night and she replied nonchalantly, ‘Aiya doctor – there’s the couch, and there’s a sleeping mat in the store. But for your information you’ll be too busy too sleep tonight anyway.’

How I survived through all those times was, and still is beyond me.

No human should be treated this way. Expecting us to make the right decisions, and to treat patients well while depriving us of sleep, rest is ridiculous.

As if that was not bad enough, we were often subjected to verbal abuse in the wards, at times in front of patients and their family members. Some of us were even employed as security guards to chase away family members during non-visiting hours, and as a dispatcher running around searching for old notes.

I’m not sure what it is like now but those were the “good” old days.

Different times.

Ten years back, we were short of doctors. But now, we have an oversupply of them in the hospitals. I used to take care of 16 patients in the ward and, now, from what I gather each houseman takes care of five to six patients only. And since some of the hospitals are computerised, they are no longer running around dispatching notes and results.

If this applies to most of the government hospitals, it must mean that their workload is markedly reduced.

And about two years ago, the Ministry of Health started the shift system for the house officers. This is to limit the number of housemen in wards to ensure adequate clinical exposures in hospitals, at the same time address the issue of overworking among junior doctors.

Nowadays, housemen rarely work more than 12 hours at a time even when doing night calls.

I suppose the Ministry of Heath has begun to realise that doctors learn, think, respond better when they are well rested. I would rather have a few energetic, well-rested doctors treating me rather than more of those tired, sleep-deprived doctors at my bedside. On that note kudos to the Ministry of Health.

But then, as the working hours become shorter, and workload lighter, the quality of doctors we produce may now be an issue.

Professional disillusionment

While measures are taken to provide a more humane working environment, the Ministry of Health should nevertheless ensure that it is not done at the expense of producing reliable and disciplined doctors. Those who do not perform or with an attitude problem should not be allowed to practice as medical professionals.

Revoke their title, bar them from practising if necessary, because what is worse than a tired doctor is one with a bad attitude and knowledge.

As much as housemen deserve better treatment, it should not be at the expense of our patients.

It is a good idea to make compulsory SPM/STPM leavers do community and volunteer work in hospitals, nursing homes, orphanages before applying to take up medicine. Aptitude and attitude tests are also a good way to judge someone’s character, but it is by no means a conclusive test to vet a person.

I mention all this because I do not want houseman to suffer from professional disillusionment. It needs to be addressed before they even step into medical schools or we may end up spending hundreds of thousands of ringgit training doctors, who at the end of the day realise , “Hey, I do not want to do this for a living.”

Which is what we are beginning to see in our young doctors.

You may have a string of As in your exam but the passion you have in helping a fellow human being is the one that determines how good of a doctor you are.

A privilege

Patch Adams said, “Our job is improving the quality of life, not just delaying death.”

It is a privilege that not many have.

A good working environment, and a good attitude is important in any profession especially medicine. And when the government is taking steps to improving their working condition, housemen should learn to count their blessings that they have been given an opportunity to serve humanity.

If all fails, then perhaps our SPM leavers should ponder on this quote by German born American physician Martin Henry Fischer before taking up medicine, “A doctor must work 18 hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.”

Because when the going gets tough, it is the tough who get going.

So, do you still want to be a doctor?

DKA