How to tell whether or not you'll make a good doctor

Yes, with these few questions, you can determine whether or not you will have a successful medical career! Well I suppose even by saying that, I've essentially branded myself as a quack selling a "one size fits all" approach to what is quite clearly a multifactorial outcome. However, if you have been following my blog at all, you'll realise it's full of gross generalizations- without which many of us would cease to make sense of the world.

I have what I call 'panic moments' on a relatively frequent basis. These are moments where I have to stop and think about something like how to do a manual blood pressure (the equivalent of tying your shoelaces) because we use the automatic cuffs so often. Or when I have to go back and read about what the spleen actually does. While we're on the topic, funny how it just sits there and seemingly does nothing y'know? Like the lungs breathe and the heart beats, but seriously, spleen, make yourself useful. If you can name more than 3 functions of the spleen without googling it, I promise I'll buy you a BMW. Ok no I'll probably buy you a kit kat.

So back to 'panic moments'. When I can't remember relatively simple things, I often think "Well how am I ever going to make sense of really complex things? I'll never be a good doctor" However, though I may be disillusioned at the time, I try to be objective and ask myself a couple questions:

If I was a patient, would I want to have me (or somebody just like me) as my doctor? Or for the really hard core: If I was someone else, would I recommend my mother have me as her doctor?

Caveat: These questions make a bit more sense in a system where care is primarily provided by doctors in private practice (as it is in my home country). Obviously such a system is flawed, as are all systems, but one thing it does enable is patient choice in exactly who sees them regularly and why. Such patients are, therefore, not afraid to tell their friends (and mothers) which doctors they are happy with and those they aren't.

If your honest answer to these questions is yes, then you can pick out some positive things and remind yourself you aren't a total failure. You can also identify a couple things to work on. And if your honest answer is no, then it gives you reason to do a bit of soul searching.

I'll give you my own assessment of myself: I would like me to be my doctor because I'm a good listener, people generally think I take them seriously if they have something to say, I like wrestling with difficult concepts, I don't crumble under pressure, I like talking things through with people and I get immense satisfaction out of knowing I've helped someone else. Reasons why I wouldn't like me to be my doctor: I can get a bit impatient and then be a bit brusque with others if I have a lot to do and I feel they are being too long-winded, I'm not a huge fan of children so I tend not to give them as much attention as I would an adult patient, and people- generally speaking- don't find me very approachable. It just gives a bit of context when you get caught up in the emotion of the moment.

Hope that helps some lost soul out there. Remember you aren't a failure because you've made a mistake! I think that's something we don't hear often enough.

"Can I wear this to placement?"

Dress code among doctors in this part of the world isn't quite as um.. 'rigid' as it might be in other places. I suppose the boundaries of what one can and cannot wear would be a topic of another blogpost as after 4 years, I am still occasionally baffled by the choices people make regarding their work wardrobe- not always because they dress indecently but because it would not even cross my mind to wear certain items of clothing in a clinical setting.

This post, however, is mainly about the frustration (almost agony) I experience when going shopping for clothes since being on clinical placement. Being a girl brings it's own challenges- in life in general, but right now I'm specifically referring to clothes shopping. Shopping is often a convoluted experience for females, full of highs and lows: the thrill of finding the dress you saw in the shop window last week for half price and the disappointment of realising the only one left is 2 sizes too big. 2 sides of the same coin yet girls can't seem to get enough and our pockets will perpetually be at the mercy of the high street stores.

And as if the process of finding the perfect dress was not complicated enough, let's add another factor: "Can I wear this to placement?" A seemingly harmless question and one sensibly grounded in the expectation that medical students "look professional" at all times. While that might mean slightly different things  to different people given the context, broadly speaking, it means "try not too look like a sex kitten without looking like a drab prude". I think that is a universally applicable principle unless, of course, your profession requires that you look like a sex kitten or, indeed, a prude.

So what does this mean in practical terms? Well since we don't have white coats to cover up creases and unsightly stains, first of all, shirts or tops must be cleaned easily. Splattered blood from a dripping cannula and ink stains add nothing to the aesthetic appeal of clothing. Plunging necklines must be avoided, no exceptions. Bending over to examine someone must never be a display of anything more than clinical prowess. On that note, no dangling bows that hang in the patient's face are allowed either. No low cut arm holes as visible bra on side view is also not acceptable. Sleeves are desired but not always necessary- keep in mind that in winter months, the inside of a hospital is like a furness. Sweat patches have never been a fashion statement worth emulating. Now for skirts and dresses: how short is too short? I have seen a lot of variation on this, but I suppose if you can't sit or bend without exposing unmentionables, then it belongs in the store and not in your wardrobe. Shoes: I have seen people come to work in trainers (sneakers) without having a medically valid reason, so I guess anything goes on that front really. Then you have to think of the price. Does it fit? Do I have a top in this colour already? Do I like the pattern? Argh!!!

But regardless of how you choose your clothes for your professional wardrobe, I think there's one question we all need to answer: "How does this outfit make me feel or look as a student doctor? Do I look like the kind of person people would take seriously and does it make me feel like I am ready to tackle any challenge thrown at me?" If the honest answer is yes, then I think you'll have a hard time saying no.

Medical student syndrome

I'm sat on my bed right now with a sore throat, pressure in my sinuses, possibly a fever and a dull headache. To the average person, that would be the beginnings of a cold. But that didn't stop me considering that I may have meningitis. Yes, that's right. I have been staring at the light on my ceiling for the last 10 minutes trying to elicit photophobia that I clearly do not have and contemplated trying out Kernig's test on myself which may have been a bit of a palaver.

Medical student syndrome is a legit phenomenon according to wikipedia (which none of us admit we use on a regular basis). It is also called hypochondriasis of medical students and is frequently reported in students "who perceive themselves or others to be experiencing the symptoms of the disease they are studying." It can actually get so serious that psychiatric intervention is needed- so if that's you, don't be afraid to get help. But for the 99.9% of us who are really just being a bit silly, it helps to know you aren't alone. The struggle is real. How about a couple more anecdotes then?

There was a time I convinced myself I had bowel cancer. And I mean it when I say 'convinced'. For a variety of reasons, that did not make sense but it didn't stop me from believing it. I eventually had a CT Scan of my abdomen and I am actually an anatomical anomaly! That's my claim to fame now. I have twice as much bowel as the average person which would explain the symptoms I'd been having. It probably isn't appropriate for me to post a picture of it on here. But I always have a copy on my phone. You know, for if ever I have to have emergency surgery after being hit by a bus or something. Always be prepared. If we are friends, I wouldn't mind showing you if you asked very nicely.

Then there was the time I thought I had a brain tumour. A cerebellar tumour to be precise (the part of your brain that's responsible for balance and coordination). I'd been a bit unsteady on my feet during the day. And conveniently just learned to do a cerebellar exam the week before. So I obviously did all the silly tests: wagged my tongue side to side, played patty-cake, walked heel-toe all the way to the kitchen- even did Romberg's test. All negative. Then I remembered I changed my shoes that day and they have rounded soles.

                                       

Then there was the time I thought I had either a slipped disc in my back or cancerous bone lesions. Equally as ridiculous. But I have mild scoliosis (curved spine) and had been standing for 4 hours straight the day before in theatre. So I was having some persistent muscle pain in my lower back.

For supposedly intelligent people, we can arrive at some not-so-intelligent conclusions. I guess knowledge isn't always power.

What it's like being the medic that isn't so great at maths

I'm not doing a Maths degree. But I suppose with any science-based degree, there is the assumption that Math will play a central role. Well, let me tell you, I have done little more than basic addition, subtraction, multiplication and division in all of 5 years. Remember all that mumbo-jumbo we learnt about how to calculate the pH of a solution and balance equations in sixth form chemistry? Yeah, you can safely forget that after exams if you are planning on doing medicine. Probably not such a good idea to forget what the heart does though. Definitely keep that one. Save As.

But let me tell you a bit more about myself: I really struggled with Math at school and needed extra lessons. 'How can that be?' you ask. 'You have to get really good grades in Math and Science to get onto your course!' Yes that's true. And in fact, most medics are Math geeks. I'm not so good with numbers but that doesn't mean I'm not good at understanding concepts and the links between them. That's how I got around formulae and equations in both Math and Science. While my peers could solve a problem in a couple lines- 10 seconds flat to be exact- I would still be trying to figure out what the formula actually meant. I found the concepts very abstract compared to 'the knee bone is connected to the hip bone...' and so on. I would take up a page to do a question everybody else did in 2 lines and would often struggle to understand why my answer was wrong. That would then require a whole other page. And probably another hour. You get the idea.

Fast forward 7 years and here I am- about to be released on to the wards in less than a year. A new paranoia has set in: 'What if I overdose a patient because I calculated the dose wrong?' That might seem unlikely. But with the pressures to see more patients in less time, a mother crying because her daughter was just admitted and your consultant shouting at you because you forgot to ring the lab for another patient's latest blood results, I'm sure you can see how easy it might be to move a decimal point one space too far or put 2 zeros instead of 1. 

In our prescribing tutorials, I'm usually the last to finish because, of course, there are some drug doses calculated as mg/kg/min. Even just looking at that makes my brain panic slightly. (Seriously. Who came up with that? I need to have a word) I check and double-check and triple-check and often need a separate page to do my calculations when some people just do it in their heads. Geeks. And I still get things wrong sometimes which is really frustrating. My error rates are slowly coming down though. But I'm not going to lie: I still leave those questions for last in exams.

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.