The evolution of doctors' handwriting

Years ago I vowed to be the change I wished to see. The stereotype of doctors having bad handwriting is well established. I put that down to laziness. How could someone let something as important as their handwriting deteriorate? I like to think I have decent enough handwriting and I consider it a unique identifier. After fingerprints and forensic dental impressions, I'm sure it's up there.

I have been on too many a ward, trying to read a patient's notes and have had to skip over large portions of writing because they were pretty much illegible. My first thought has always been "Well whoever wrote this would be in deep doo doo if that patient ever took them to court." Other than being aesthetically pleasing, having decent handwriting actually serves another purpose: it keeps you out of prison with a license to practice. This has always been my motivation to develop good note-taking skills and avoid developing chicken-scratch script.

That is until I was asked to take notes on a busy ward round the other day. On a ward round, senior doctors reviewing patients don't usually take notes themselves. Their juniors act as scribes. I was struggling to keep up with documenting the doctor's plan of action for a particular patient, trying to remember what he said the heart rate was and which side he heard crackles on. Things were going downhill. I was appalled to see the sprawling scribbles I had to put my signature next to. Honestly it was a disgrace. In that moment I understood. In spite of the best intentions of naive medical students-like myself, time constraints and the sheer volume of documentation required can distort the handwriting of even the most diligent scribe. Computer-typed notes are not much better. The most basic of words get misspelled: "Pt complains of abdo pan, O/E SNT, referr for GI inpit." Need I say more.

I leave you with one other anecdote. My mother is a GI consultant. She made a shopping list one day and we were on our way to the supermarket. We spent nearly a hour trying to understand what the last item on the list was: "2ploc? What is 2ploc?" Imagine a huge rounded 'Z' and an 'i' that was too small to see. The word was meant to be "Ziploc"- a brand of plastic resealable bags used for storing food.

Well. There you are.

When did I stop having friends and start having colleagues?

On my first week ever as a clinical student, I showed up for a ward-based teaching session and the doctor leading it asked if we were expecting anyone else to show up. Without thinking, I answered, "Yes, I saw one of my friends in the corridor on the way here." I remember immediately thinking that using the word 'friend' in that situation felt distinctly odd. I now know that there are 2 reasons for that. I have since always used the word 'colleague' in that context.

First of all, comparing the kind of relationships I have with my peers now with those I had in school, there are quite a few obvious differences and these are not unique to medicine. There is a new, business-like approach to the 9 to 5. We all have goals, both personal and generic, that we are working toward and ultimately we are learning to do a job. A job we will have to beat each other to get at the end of 5 years.

It's ok to be just as good as the person next to you but it helps if you were just that much better.

In school, it was all about 'being the best you could be' because we all had different interests and career paths. Now, things are a lot more stream-lined. You learn to be just polite enough and approachable enough to avoid being the one in the group that nobody likes (so people will swap clinics with you when you need time off) but not being so soft that people walk over you (ie take your clinics without asking). It's a fine line. But you learn to walk it well.

Secondly, you develop a private life. It's this thing that adults talked about that I never really understood because the people you spent all day with in school were invariably the people you invited to your house for sleepovers.... Who else would you invite? Duh. I appreciate that for many people, though, this is probably still the case. During fresher year, you make lots of friends and many of those friendships have carried on into our latter years as students.

But what you find is that as you go on in life, you accumulate stuff.

Your stuff: old friends, old stories, interests and hobbies that only certain people would understand. Things that it would be difficult to share with one of your peers when one of you is busy writing in a patient's notes and the other is on another ward trying to find a senior. Time is limited and often it's much easier to simply learn to be content with the friends you already have rather than trying to make new ones. Maybe it's laziness. But maybe it's self preservation. It's nice to have a part of you that isn't completely engulfed by your job.

It's a good idea to be friendly with your colleagues but it isn't always possible to be friends with them. Maybe this isn't such a bad thing?

Why medical students are so insecure

I'm not too familiar with the administrative logistics of medical school in other parts of the world, but here in the UK, when you start a new placement or rotation, your large year group gets divided into smaller groups called 'firms'. These can have between 5 and 10 people and you are often attached to a particular consultant (or group of consultants) and have a similar timetable for teaching. This makes sense considering my year group is made up of about 300 people spread across various hospital sites. How else would we learn anything useful?

The benefit of this kind of small group teaching is that you get to know your group a bit more so you aren't afraid to ask stupid questions (even though we all know those don't exist.... um yes they do, we'll get back to that later) and have more one on one input.

Now enter another phenomenon, less talked about but very well established: Comparison. What can influence the dynamic of a small group is this need we all have to prove to ourselves and everyone else that we deserve to be here just as much as the next person. This often takes the form of relentless comparison of oneself to one's peers and a small group is the best place to do so.

The root of this comes from the fact that once you get into medical school, 

"noone one cares about what you got at A levels"

-according to a lecturer on my first day. And this is true. This level playing field does provide, however, the perfect foundation for a new elite to arise. We are all 'smart' but what causes the cream to rise to the top is clinical placements. Pre-clinically, noone really knows each other's true capabilities but there's nowhere to hide when you get asked a question in front of a patient and your peers.

So back to insecurities and comparison. Part of the reason we all experience the massive highs and lows of medical school is because we constantly compare ourselves to the next person. How do I know this? Because I have heard one too many stories (and told a couple myself) about that person that got that question wrong but they should have known the answer because it was soooo easy. Or the person that asked that stupid question: "like seriously how could you not know what first line treatment for C. diff infection is?" We gloat in this kind of self-made glory because well of course we knew the answer.... that time.

But because we constantly mentally degrade our peers vying for a place on the imaginary heirarchy we have created, when the tables turn, we face this steep descent into despair that we will never be more than average. 

Dreams are crushed everyday. Sometimes just with one wrongly answered question.

Moral of the story? Comparison is the thief of joy. Best to stay away.