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Thursday, July 10, 2008

Surviving Med School

Written by Jeff Wonoprabowo --

Throughout the year, one question loomed over me, haunting me like a bad dream: "Do I really want to go through all of this to become a doctor?" It's a question I think is harder to answer now than when I was in college, especially now that I’ve started to see what I am getting myself into.

One day while I was in high school, I was sitting on the couch in front of the television. I’m not sure what I was watching. I do remember my mom calling me away from the tv set. She called me into the living room because she wanted to talk. I found it rather odd; it seemed totally out of the blue. But, I suppose, this shouldn’t have come as a surprise. Conversations with mom sometimes seem, at least to me, to come right out of left field. That evening my mom defied the stereotype that all Asian parents want their children to become a doctor or a lawyer. She sat me down to tell me she didn’t want me to become a doctor. That conversation was in high school.

The thing is, I was never the child who grew up with dreams of becoming a doctor. When my mom found out she was pregnant, she decided that in order to stay at home with me she would have to start her own business. She started a data entry business. As a result, I grew up around computers and decided that one day I wanted a career that involved computers.

But here I am, now a medical student. Although I have only completed the first year, I’m on my way towards earning the right to add the initials M.D. behind my name. Not that I need any more letters; my last name is long enough.

It’s scary, though. I have put myself on a path towards becoming a physician -– a path that is long and quite expensive. Should I continue down this path, I know I will find myself in a very rewarding career with enough money to keep a roof over my head and food on the table.

It's a frustrating journey. There's a ton of information that is force-fed during the pre-clinical years. At times it's a challenge to see how some of it is even relevant to patient care. More than once during my first year, I wondered if I really want to do this. It was almost a monthly cycle; it coincided with exams that came about every five weeks. I hated exam weeks. Actually, I still do. But those were the times when I wondered, considered, and longed for being somewhere else. I enviously think about friends who have finished school and are earning a good paycheck. Then I take a look at the numbers on the statements I receive from my lender. It is always a little shocking to see how quickly those numbers grow. Sadly, the balance of my checking account has the opposite trend.

Yet there are times where I am truly grateful for the chance to be where I am. And there are many more times where I am excited about the possibilities of where I’m headed. Because medicine -– being invited into the depths of patients’ lives –- is exciting. I wouldn’t blog about medical school if I thought it was boring, depressing, and monotonous. On second thought, I probably would. But if you're reading this site, you probably wouldn't be my target audience.

Sure, it can be hard and time-consuming. Obviously it can be very frustrating. But after having spent six weeks in the wards with attendings, residents, and medical students (2 at the beginning of the school year and 4 after), I think I have found a source of inspiration and motivation. It's not about the prestige; I don't think all the training is worth what prestige is left in the profession. It's not about the money; there are easier and shorter paths to earning a decent living. It’s not about being your own boss; the current medical system has made that terribly difficult. It's all about the patients.

And now I think I've found the answer to that looming question. I just hope my answer doesn't get lost in the deluge that will come in the form of my second year...

Notable Replies :

As a person who initially wanted to be a doctor (and went through all the pre-requisites, the MCAT, etc.) and who then decided instead to become a nurse, I have to say that in my practice, neither medicine nor nursing has much to do with the patients and has everything to do with insurance companies and attempting to manage patient care with inadequate and dwindling resources. I work in the ER and when we admit patients to the hospital and I speak to admitting doctors (who often don't even know the patient and are chosen to take care of them based on which insurance the patient has), it turns my stomach to think of being the MD on the other end of the phone having to come up with a plan of care for a complete stranger that he or she may or may not meet for another 24 hours depending on their schedules. It's sick and it's scary from a professional liability standpoint. Dealing with our aging population and their 10 chronic illnesses day in and day out is not fun, it's not mentally stimulating and it's not glamorous- it's work. The bottom line is that once you get through your learning curve, work is still just work as it would be in any other job. I had to ask myself how much I was willing to sacrifice in my personal life for something that ultimately would end up still being just a job at some point. Life is very short and at the end of your days, where do you want your memories to come from and where do you want your life to have been spent?

I hate to be the cynic, but is it about the patients? As you can see from the replies, the more time someone spends in health care the less it becomes about the patient. I keep thinking it is going to get better. It certainly isn't about patients in med school. In the first ridiculously painful year there was always second year to look forward to when I got to barely talk to a patient. Then there was third year when I got to touch a patient, however pointlessly in the learning like a leech phase. Finally, I'm a fourth year where my contribution is actually minimal and if I wasn't here then someone else would do it more efficiently and probably better. These thoughts don't go away once you "hit the wards" as some have suggested. Yet, I will keep hoping that eventually this medicine stuff actually allows me to be in service of people. But yes, I'm doing this blindly and with the faith that it will someday matter. I may never enjoy medicine (memorize stuff you don't care about and apply occasionally...it actually isn't challenging...who knew!), but the hope is that it will someday matter.

I've been waiting for this article for a very long time. Since my first year in med school 6 years ago actually :). In the Caribbean we have 5 years of Med school then we graduate as medical doctors with the MBBS (bachelor of medicine and bachelor of surgery). We have one year of internship afterwhich we go from provisional registration to fully registered medical doctors, unleashed to the public ;)

I just completed my internship year and have been recently unleashed :) Our days/months/years in med school are quite a lot different to those in the US and other 1st world countries. We have patient interaction and contact from as early as our 2nd semester in 1st year on the wards!! i remember in my 3rd year, i was very competent in basic procedures as iv cannunlation, incision and drainage of abscesses and removal of chest tubes. in 4th year my colleague and i, (under direct supervision) applied our first skull traction on our orthopaedic rotation....applying the Steimann pin was petty stuff for us then.
So, basically we had a lot of hands on experience and really got our hands dirty throughout our training. Having completed my first year as a Doctor and applied all that i learned as a student, repairing episiotomies, delivering countless babies and actually doing an above knee amputation (having scrubbed in countless times as the assistant), it became quite clear to me why doctors either make or break in their profession.

"there are some things in this life that money just cannot buy!!!"

...and the satisfaction, pride and overwhelming joy that the privelege of assisting another human being where they cannot assist themselves is most definitely one of them. Too many doctors focus on the money! hands down!!

Dont get me wrong, there were countless days and nights i'd cry because of stress....i was broke with, sleepless nights, lack of food, disappointing results after my greatest efforts, crticism, condemnation and harsh words from my seniors and most of my high school friends were buying their first cars or home and living "the life"....the list goes on. I now realise that this journey cannot ever be compensated in financial rewards/returns and that i must seek that elswhere. Hence, i started my own business and now have money coming in to me whether i'm there or not, whether i'm sleeping or awake and i have this peace of mind now when i go to "work" and have to deal with all the stress and the "heirarchy". Now, the moment when i truly opened my eyes was when i decided to volunteer my medical skills at a free health clinic in a rural community where access to health care and availabilty of doctors and medical services is dismal. But it was "that feeling" when the patients left all smiles because they got free advice, counseling, medications, ultrasounds, eye tests, you name it...it was that feeling that gave me inner peace and removed all doubt and panic that i'd chosen the wrong path. the money will come (esp if you diversify your income) but peace of mind must be earned and you will cherish it forever.

Thank you for your article and everyone's comments. No one or way is right or wrong yet each comment has so much emotion attached....why are some negative and others positive? because we all live the struggles day in and day out but some choose to face them and find ways to overcome whilst others choose to run for fear that they've made the worst mistake of their lives......what do you choose??

For me. The answer still isn't clear. I never wanted to be here and the stress is killing my relationships... is it worth it? I don't think so.
But what the hell. No turning back so I'll do what I can.

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