Every year I meet aspiring doctors who want advice about studying medicine. Here is what I tell them ‘A belief in service is the most potent inoculation we have against the disillusionment, burnout and distress that prevails in today’s medicine’ Each January in the midst of the glorious Australian summer, I interrupt a holiday with my children to undertake a ritual that began well before they were born. For nearly 20 years, I have been interviewing students who aspire to study medicine at my alma mater. I started off thinking of it as a matter of loyalty to a university that had provided me with six years of a fine, taxpayer-funded medical education, but some years later it dawned on me that to meet some of the thousands of students hungry to study medicine each year was in fact a unique opportunity for me to meditate on what it means to be a doctor. My job as an interviewer is to ask structured questions in a neutral tone while hanging on to the nuance of every reply to determine a score. The candidate’s job is to demonstrate a firm passion for, and an unwavering commitment, to the practice of patient-centred medicine. To beat the crowds, the successful candidate must be intelligent and thoughtful, resilient and flexible, confident and humble, and demonstrably so in the allocated eight minutes or so before the bell rings and it’s time to move on to the next station and do it all over again. The routine is as demanding as it sounds and yet, there is no lack of eager contenders wanting to give it a shot. In my younger days as an interviewer, I used to be more dispassionate. But now that I am a mother, I cannot help but see in every aspiring medical student not only the dreams of the child but also the hopes of a parent, scores of whom endure a nail-biting wait all summer. I find myself cheering on so many of them, but the harsh reality is that the vast majority of very good students won’t get in because there simply isn’t the room. But a lucky few hundred do and it should be a cause for celebration, but barely a month later some collapse, imagining they have reached the finish line when the race has barely begun. A study by the Australian organisation beyondblue shows that 43% percent of medical students have a very high likelihood of experiencing anxiety or depression and a staggering 20% have contemplated suicide. More than half experience emotional exhaustion – all this when working as a doctor is still years away. Curiosity In the amazing world of medical facts, figures and discoveries, the learning never stops. Scientific knowledge and understanding are evolving rapidly, and doctors must strive to keep up with the latest information because what they know and how they practice directly impacts lives. Professional bodies mandate a minimum amount of continuing medical education, but to be a doctor is to be innately curious. As a trainee, I thought being curious about disease was enough, but I have since realised that it is even more important to be curious about the person who has the disease. I spend about as much time prescribing chemotherapy to my patients as exploring who does their groceries, tracking the progress of their spouse’s dementia, and checking whether they can afford the bus fare to the hospital. Treating the person is much more satisfying than targeting the tumour and it takes curiosity to get the balance right. The curiosity can be tiring but it’s the price of wanting to make a difference. Empathy “I don’t like that man. I must get to know him better.” I sometimes think of Abraham Lincoln’s words when I struggle to understand the motivation of patients. A septic patient walks out of hospital because he wants to feed his beloved dog himself. A frail and bent woman insists that as long as she lives she will not admit her husband to residential care. An ailing patient would rather attend his grandchild’s first birthday than have more antibiotics. A dying patient chooses a holiday over chemotherapy. The books might say what a patient ought to do but it is empathy that helps decide what a patient will actually do. Being empathetic in tense or resource-stretched circumstances isn’t easy but without this core belief, one can only be half a doctor. Reflection In order to grow, one must reflect. A long time ago, a patient excoriated me for telling her the truth about her dire prognosis. When she dumped me as her oncologist, I was dejected and humiliated, but eventually I figured out one can never be too sensitive or too nuanced when having these conversations. When a dear colleague suddenly died, we squandered the chance to grow old together. His loss was a great lesson in being mindful of my patients at every encounter because there may not be a next one. The majority of healthcare complaints occur around a failure to communicate. It’s tempting to bury patient dissatisfaction and use the fast pace of medicine or the demands of a bloated bureaucracy as an explanation, but the ability to pause, reflect and self-correct is an integral part of being a doctor. Without reflection, we risk distancing ourselves from the human experience and consequently feeling hollow. Curiosity, empathy and reflection – these are just the beginner’s guide to what it takes to be a doctor. There are countless other attributes. Yes, one needs the grades to get into medicine, but what every aspiring doctor must know is that at the heart of all good medicine lies a deep concern for, and interest in, the human condition. Hippocrates knew this when he said that wherever the art of medicine is loved, there is a love of humanity. Source
