So you want to be a doctor

The physician's highest calling, his only calling, is to make sick people healthy--to heal, as it is termed.

- Samuel Hahnemann

 

I have noticed that my blog is listed under a doctors' blogroll, by several people, either newly-graduated ones, or those aspiring to be doctors. It's weird, because my posts are far from doctorly. Not exactly writerly as well, but no one is complaining. I am honored beyond measure to have people reading my rants, but to get listed on their pages? Dude, you guys rock!

To show my deepest appreciation, permit me to share some anecdotal tips, especially for doctors-to-be. First, a disclaimer. I am employed under the Ministry of Health, and I am now a Neurosurgical trainee, but this post is personal, and does not reflect my official position and my employers. Also, there is no scientific or factual basis to this post. We clear? All right, let's go.

 

 

Let's talk about the why

So. A doctor. Why? This is a recurring question, sometimes by people around you, and sometimes your inner self will ask you this. Especially when you're up at ungodly hours attending patients who just have to get involved in that frakking accident. I don't think you'll get over asking yourself why you insisted on becoming a doctor in the first place; God knows I still ask, "Why oh bloody why?"

 

1. I want to heal people, and make this world a better place.

Let's face it. This is the standard answer you'll give (and get), while your inner self will say an entirely different thing. Yep. I can read minds. I know what you're thinking. Don't worry, your secret is safe with me.

However, believe it or not, there are people for whom this reason for being a doctor (or a nurse or a paramedic) is real. It's easy to spot them. They're the ones who genuinely care about others--not just patients, but everyone around them. They shine the most when they help others, when they save lives. You can't fake this. Some people have inborn compassion toward perfect strangers, while others can't care less. These people are healers, and a rare breed.

 

2. I want to be like House and those amazing people in Gray's Anatomy, ER, Chicago Hope, and (insert your favorite medical drama here).

Don't laugh. I know you're one of them. Yes, you, the one who's snickering. We grow up drooling over the glamorous lives of these beautiful doctors, who get to save lives between rampant sex (sometimes even during rampant sex. Wait. That's a certain porn that shall remain nameless). We look at the doe-eyed patients and their family members, all gushing with eternal gratitude for saving their lives, for salvaging a limb to near perfect condition, for bonking them when they're about to die--wait...nevermind.

Point is, some people grow up deeply influenced by these medical dramas, and believe that they want to become great doctors like these fictional characters. Yes, they are FICTION. Sure, some doctors are supermodel-good-looking, some do enjoy rampant sex, but then there are people like me. A 30-year-old virgin, whose face only small children love and trust. No, I'm not a pedophile, dammit. Don't put words into my mouth!

When I was younger, I loved watching medical dramas. I liked how they saved lives. I liked how when they cardiovert a patient, the doctor rubs the pedals together, places them on the patient's chest, yells "Clear!", and turns the thing on, and the seemingly dead patient convulses mightily on the bed and then wakes up. Day saved. When I first cardioverted a patient, I knew that rubbing the pedals together is a BIG NO NO, and even though I got to yell "Clear!", the patient just flipped limply on the bed. His heart reverted back to sinus rhythm, but he passed away after 10 minutes anyway. I was left with a sense of disappointment and the sting of burnt flesh in my nostrils.

Needless to say, I stopped watching medical dramas altogether. Yes, even Gray's Anatomy. Nurse Jackie, now that's a different matter. Screwed up doctors and nurses. Now that's more like real life. You should watch it.

 

3. It's all about the money, money, money

Don't be surprised that a majority of those who answer (1) actually have this as their deep, dark secret. To be honest, I don't see why people hide this. You love money. You want to make lots of it. You believe that doctors make moolah, lots of it. You want to buy that certain CLK-550 (drool). You want a penthouse overlooking KLCC Park. What's wrong with wanting expensive things? At least you plan to do it honestly. Be proud of it.

But don't forget about those who want a better life for their family, those who come from a low socio-economic background, who want their parents, siblings, and children to have a living of much higher quality. God, this is one powerful and noble motivation. Never ever be ashamed of this. Make it your strength.

So. Can doctors make money? In an effort to prevent doctors from leaving the public sector, the government has given us a special pay scale that automatically increases the longer we stay in service. I've worked 6 years, and my pay before tax deduction is RM6900 a month. That's excluding on-call claims. Yes, compared to doctors in other countries' public sector, our pay sucks, but among other government staff, that's considered high.

And we have one of the greatest potential to make more. If you work part-time at private clinics, you get paid between RM30 and RM40 per hour. If you write medical reports, you get paid RM40 per report. If you leave the private sector and work full-time at a private clinic as a Medical Officer, you get around RM15,000 per month. If you own the clinic, you'll get so much more. If you work as a specialist in the private sector, you can easily make between Rm30,000 and RM60,000 per month, and that's excluding extra pay from surgeries and procedures. Like other lines of work, it depends on how badly you want to make the money, but unlike other lines of work, the opportunities are more, with numerous options.

 

4. It's a glamorous job. People respect doctors.

Quite a number of such people are influenced by medical dramas (see (2)). Let me get this straight: it ain't glamorous, and people no longer treat doctors like demigods. You save a life, you get blamed for not restoring the patient to his former self. You don't save a life, you get blamed for not doing your best, for being a screw-up doctor, for being a racist (yes, this happens). You give patients information, they challenge you with articles they read from the internet, which are by and large unverified. But they don't care about that. The internet says this, and who is the bloody doctor to say otherwise?

Sure, some older people still put doctors on a pedestal. They entrust their lives to you. They'll give you their house if you ask for it. They'll offer you their unwed daughter(s) even when you don't ask for her/them (yes, this happens, too). But then their children come into the picture and treat you like shit.

Being a doctor is an honorable job, an honest one. Be happy with that. Respect is never freely given, but has to be earned.

 

5. Being a doctor is a challenge. I love challenges.

As long as you don't faint at the sight of blood, by all means, bring it on.

 

6. Doctors have fancy tools and gadgets. I want them!

Buy a set at a nearest Toys R Us. Better yet, train to be a spy.

 

7. My parents insist that I become a doctor or they'll disown me.

I'm saving the best for last. Let me be absolutely honest with you. Most of those who flunk out of medical school belong to this category. Most of those who get mental breakdown belong to this category. Most of those who quit the job and become house-spouses belong to this category. Most of those who still work as doctors but hate the job until the day they die, yep, they belong to this category. And those who don't care about the patient, who just treat the job as a job and nothing more, you got that right. They belong here.

You have to realize from the start that you'll be dealing with human lives here. You'll be dealing with people who have families, jobs, mortgages, a future. You deal with individuals with names and faces. You can end up murdering a patient. If your dream is to become a banker, a teacher, an artist, an engineer, an architect, a horse rancher, a space cowboy, anything other than a doctor, go for your dreams. You'll do so much better doing what you love, trust me. If you don't see yourself as a doctor, and you hate it with all your heart, tell your parents the truth. They'll fume over it, accusing you for being ungrateful, but they'll get over it. Eventually.

Still. If you're totally trapped into doing this, then do your best not to resent the path chosen for you. Open up to the wonders and possibilities that lie ahead. Have fun, will you?

 

 

What to expect when entering Medical School

So you're a fresh high school graduate. Or you've gone through your STPM or A Levels or matriculation, and are one step closer toward becoming a doctor, regardless your reason(s). From the blogs you read, from stories you hear from people you know, from medical dramas (see how much I resent medical dramas?), you must have a few expectations.

I'm quite certain most of you are academic over-achievers. After all, the competition to fill up slots in public universities is beyond tough. Even though private universities are always an option, they don't just let anyone in, do they? Oh, wait. Some of them do, and end up producing dangerously ignorant and unequipped doctors.

God, the amount of things you have to remember, and most of them in Latin, if not French. Here the teaching medium is English, but if you're studying in Indonesia, the medium is Indonesian, and in Russia, you've got to learn a whole new alphabetical system! I have friends, highly intelligent ones, who had a hard time the first (crucial) year because they had a poor grasp for the English language. That, plus having lecturers teaching in English, thickly flavored with Indian, Burmese, Vietnamese, the likes.

I'm lucky in the sense that I use fluent English. I comprehend things fairly easily, too, especially when they come with diagrams. But I'm freaking lazy. I'm writing this instead of studying, am I not? I don't like memorizing things for the sake of memorizing, and I suck at mnemonics. That's why I scraped by, just enough to pass the major exams without hitches.

If you expect praises from lecturers and peers for being brilliant, guess what--to a certain degree, they're as brilliant as you are, if not more. Sure, at school you were the smartest of the lot. Everyone else was scum. But there are thousands of schools in Malaysia alone, and each of them has its own top students. You can always aim for straight As and Distinction Viva, and by all means, go for it, but if you expect people to bow in awe of your greatness, be prepared to be disappointed. There are always bigger assholes than you.

Do expect medical school to be expensive, even with sponsorship. The textbooks can have a pricetag reaching over RM500. Each. Some post-graduate books are over Rm1,000, but by that time, you were supposed to have saved up a lot to be able to afford those books. Yes, I'm berating myself here. Anyway, the food you consume late at night to fuel your midnight studying sessions, they cost money. The monthly trips home, some more money. The long-distance relationship with the significant other who you are convinced will wait for you, it costs a BOMB. And these relationships usually don't last. Trust me.

Expect to alienate your family and friends. Your schedule is different from other schools/disciplines, and you're supposed to be studying anyway.

If you brace yourself for a tough life ahead of you, you'll do fine. Learn humility, and learn it early on. It'll make your life so much easier. Again, trust me.

 

 

...and once you've graduated 

Congratulations!

 

 

 

Eh. That's it?

Of course not.

Life has just begun. Remember high school, when other students were scum beneath you? You're the scum now. If your family has thrown a party to celebrate your graduation, or has rewarded you with shiny toys or that trip to Europe you've always coveted, well, savor them. That's the last you'll feel good about yourself for the next two years.

I've read numerous rants and complaints in blogs belonging to House Officers. I find most of them ridiculous simply because they fail to grasp the enormity of their responsibility. For most, it's their first job. However, unlike any other jobs, one small mistake can kill a patient. You may think that clerking a patient is a silly, redundant task, especially since the Medical Officer has already clerked the patient. But the Medical Officer on-call has to attend to a lot more patients and new referrals. They may glance through the history and examination, only seeking vital information. A house officer has more time to deal with individual patients, or is supposed to, and can find out about, say, a patient's allergic history. If that is missed, and the patient develops anaphylactic shock and dies, that house officer has to take responsibility too. If your first reaction is "Don't blame me. The MO prescribed the wrong medication," then you'll spend your whole life blaming others for your mistakes.

When something goes wrong in the ward, the house officers are the first to be called. Imagine yourself a fresh graduate, attending a patient who's blood pressure has crashed, and whose oxygen saturation is too low to be picked up by the monitor. The nurses expect you to do something. That was my biggest fear when I started working. If you really don't know anything, suck it up and ask the nurses for help. The senior ones know their shit. Don't be too proud, because your pride can kill a patient. Get help from the Medical Officer, from the specialist, and don't be a hero. If you wanted to be one, you should have joined the army. Or the League of Extraordinary Gentleman.

Some complain about ungrateful patients, difficult patients, and patients with poor compliance. We have to keep reminding ourselves that these people are unwell. At the bare minimum, they have discomfiture. When you have a fever or a flu or whatever ailments, you're not your perky self. You're irritable, you bare your teeth. Why would you expect patients to be any different?

I have a pet peeve, and that is irresponsible parents. People under 18 cannot sign the consent form, and parents or guardians who delay or refuse treatment rob their children of their right to seek medical attention. As for others, well, we can only advice them about healthy lifestyle and the importance of medications or surgery. If they refuse, or are not compliant, it's their lives. When they come back with complications, derive the pleasure by telling them "I told you so."

I heard now there are more House Officers than there are patients. I used to take care of a whole ward by myself, and between 3 and 6 wards when I was on-call. I'm not going to be one of those who keep on saying "During my time...". Even with an abundance of House Officers, the workload is still high, especially with the burden of being responsible for the safety of patients. The first time I drove home after a 36-hour day, I rammed into a Volvo, which was static from the massive traffic jam. I had dozed off and accidentally tapped on the gas. Even now, I still have to periodically slap myself so I don't fall asleep while driving home. My family knows not to disturb me whenever I'm post-call, because I bite their heads off.

To make matters worse, some specialists and MOs take pleasure in reminding House Officers that they're scum, simply because they can. If you're dangerous, you're dangerous. If you get extended for this reason, then you have no one to blame but yourself. But sometimes, even when you know you're competent, there are always a certain senior who makes your life miserable. Here's a little insight: it'll never change. There will always be a superior who makes you feel worthless.

How to overcome this? Be the best doctor you can, and manage your patients well. That in itself is a reward. Forget the insults, and cherish the smiles from patients who recover.

Plan you career. I cannot stress this enough. It's never to early to figure out what you want to be, and being a doctor is no longer enough. Whatever your field of interest, prove your worth while you're a House Officer, so that specialists and/or the head of department may back you up and pull you into the department once your tenureship as a House Officer is over.

Don't take too long to take up a Master's Degree. I've been in service for 6 years, but I didn't spend those years reading academia and brushing up my knowledge. As a service Medical Officer, that was what I gave: my service. Sure, I gained a wealth of experience--not nearly enough, though--but I don't have to discipline to study without being pushed. Entering the program is indeed the push I needed to better myself.

 

 

Last piece of advice

Have fun no matter what you do. Have a life. Being a doctor is a facet of your existence; you have lots more to explore. Learn the piano and guitar. Take dance classes. Write stories. Play futsal with friends from your old school. Date the girl and/or guy you've always had a crush on. Go to the movies. Make movies. Use protection. Laugh. Cry. Laugh so much that you cry.

Wear sunscreen.

Comments

[Marhm]

Hi This is the first time I'm reading your blog, found it via 'doctor's blog'.And I love this particular post of yours .It is very honest and true to the core. Those who are pursuing this career should read this...Thanks for writing up this post ..
P/s:love your 'last piece of advice' too.

[Fadzlishah Johanabas]

Heyya. Thanks for stopping by. Can't believe people actually read the whole post; it's long-ish.

[Breanna]

So. How can I force U.S. doctors to read this post? Especially the bit about asking the nurses if they are frightened and don't know what to do? ;) Keep this up and they'll ask you to give commencement addresses.

[Fadzlishah Johanabas]

It's true. The ward sister taught me how to insert a subclavian central line. I still ask the nurses about antibiotic dosage. And if they're worried about the patients, I listen. After all, they're the ones who spend time with the patients.

I don't know how I would've survived labor room posting if it weren't for the midwives.

And my Neurosurgery nurses back in HKL? They rock.

[Dayana]

wow. this is awesome. I have a lot of doctor friends and I could not imagine what they went through during their houseman year, on-calls, post-calls, and whatnots. you gave a good insight of what being a doctor in malaysia is like.

may I share this on my Facebook?

[Fadzlishah Johanabas]

My writings are meant to be shared .

Thanks for spreading the .

[Aida Adnan]

Hi Fadz
Great stuff and timely since we are still in a dilemma whether to allow Dini (my eldest who is sitting for her SPM this year) to pursue her childhood dream of becoming a doctor. I will definitely share your thoughts with her. Thanks again,

Aunty Aida
(Mama's friend)