"Your reason and your passion are the rudder and the sails of your seafaring soul." - Kahlil Gibran

Monday 2 April 2012

Perennial rookie

I was still a student when a school friend of mine banked her first adult salary as an actuarial assistant. When I finally graduated and reached the dubiously honourable rank of intern, she was already an actuarial consultant, in charge of large contracts.
In medicine you're never certain of whether you've actually made it. When I was adressed as "doctor" on my first call as intern and I had to make potentially life and death decisions as is expected of a real doctor, I assumed the nurse had addressed someone standing behind me. The community and one's family think you've really achieved something great if you're a doctor. There is still much respect for the profession.
Amongst other doctors though, an uncompromising ranking system is strictly observed.
As a meagre little intern, you might just feel a bit chuffed with yourself for making a good diagnosis or performing a procedure well. Your students might gather around you, eager to see the signs you've picked up in your wisdom. Be assured though when you present the case to the registrar, it will transpire that you missed the most important sign and the patient is sick from something completely different than what you had just been describing to the students. A good thing the sister knows best than to trust your diagnoses: she waited for the reg to see the patient before administering the meds. Your prescription would have been completely inappropriate.
But soon the house of cards come down again. The registrar who appeared so knowledgeable and accomplished the night before, is brought to his knees by the consultant on the next morning's ward round. As it turns out, the reg himself had failed to address a vital aspect of the patient's management. What's more, and a seemingly and infinitely graver mistake is that the reg cannot quote the specific study which proves that the patient should have been managed differently from the way the reg elected to manage him. This entire exchange between the registrar and consultant occurs on the grand ward round, in front of the patient (!), the students, interns and other registrars. The reg feels so stupid and wonders whether he shouldn't just go straight back to med school, or possibly quit medicine all together because he obviously knows nothing at all. Now he has to return to the patient and keep treating him. The patient, having heard the entire exchange, believes his doctor is useless and doesn't trust him anymore.
Don't make the mistake of thinking you've finally made it once you yourself are the consultant. Your colleagues are bound to raise their eye brows at some ofthe diagnoses you make, and some of your treatment plans. As you become more specialised in your field your focus narrows and as a consequence you become less adept at treating diseases you don't deal with daily. You might not be able to answer a general medical question posed to you at a dinner party. Your friends don't understand the subtle nuances of your speciality. They just think its great that you're a doctor and as such must know everything.
While my non-medical friends are settled in their careers, safe in the knowledge that they know what they're doing and can, with relative certainty, expect the same results from similar situations on a daily basis, I keep riding the rollercoaster of knowledge. Each day brings the chance of feeling completely out of my depth, too junior and unsure. The only certainty is that one doesn't outgrow that feeling.



9 comments:

  1. I have great respect and empathy for this situation! It's harsh, sometimes brutal and uncompromising  and not at  all exempt from ill-mannered communication and theatrics either. Wouldn't it at least be a great day if all this could be done in a civil, graceful, eloquent way- since all are in the same boat and all are equally aware that they're constantly dealing with people's lives?
    How about 'First do no harm' to the, still also and only human fellow doctor, who literally gives all he has for his fellow human beings and often under very inhuman and inhumane conditions.

    And of course, some of these other professions might also be making major mistakes with serious repercussions, and might cause their clients great discomfort or agony, but it would probably not lead to the client's death and the professionals can then possibly also wipe their hands off their mistakes or write it off to human or computer error.

    It might serve as a bit of a consolation to remember that in life, as in Medicine, we all should be perennial rookies too. Have you not found that as soon as you think you now know it all, something happens to make you realise you have a long way to go.
    Perhaps the art lies in the challenge and constant quest to perfect your skills. There-in perhaps, lies the inherent beauty and true accomplishment.
    Was it not Einstein who said we have to keep on learning-if we stop learning, we die?

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  2. Grand ward round survivor3 April 2012 at 20:07

    I agree with you fully, doc Guinevere!
    A memory of such a ward round situation of many years ago comes to mind:
    This particular professor had a reputation for being, let's say, particularly difficult. Preceding the commencement of the ward round junior doctors were hastily scurrying like headless chickens to collect all relevant forms etc.-white coats and stethoscopes flapping in the air. You could cut the usual build up of tension in the atmosphere.
    There was a constant flow of foreign doctors on rotation, either as registrars or as fully qualified specialists themselves- though very much as rookies in this particular department. To complicate matters further for them, not all were that au fait with the idiosyncrasies of the english language at hand, as perhaps we are. The professor was very irritated with these poor fellows and on one occasion could not contain himself after the young foreigner made yet another blunder. 'Now just shut up or I will stick a crunchie up your ass', he said, and continued with the rest of the long-winded ward round. Right at the end he asked his audience:  'Anything else?' To which said young foreigner responded: 'What is the meaning of crunchie, Prof?'

    Needless to say, all the staff members stood there, eyes down cast and not another sound was made.

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  3. Complacency sucks, in life, career, or anywhere else.So keep learning, moving forward,ever mindful of your direction; do one's actions match your intended destinations? If not, redirect....Live's a journey!

    Does anyone know, what percentage he knows, of everything there is to know?
    No,no-one knows; we only know of the things we know of; we're in the dark about what's out there to know about, except for the bit we do know about; and that is usually very little. ....have fun!

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  4. I like your point of view. One is never to old to learn and to broaden your horizons.

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  5. Only a know-all knows all....no actually, not even a know-all knows all.
    I agree, life is a learning experience.

    'Live like it's your last day'
    Learn as if you'll live forever'

    Don't know who originally coined this phrase, but a good philosophy in life.

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  6. True! I recently heard of an 81yr old lady who had gone back to varsity to do her master's degree in languages. Never to old to learn! And indeed hopeful that she'll have enough years left to benefit from the learning experience.

    I'm thinking just now how that 81yr old student must have experienced the opportunity to study further as a true blessing. I'm imagining that the process of gaining knowledge was what drove her. She must have loved the journey. I've complained far too many times to admit that all the hours I've spent studying: at school, university and thereafter, are just a waste of time, months deducted from my young life. How mistaken I am! To be able to gain knowledge and a degree is a rare blessing. I'll try to remember that next time I want to complain.

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  7. Great post - I'm very happy to have discovered your blog. I'm so over that hierarchy of misery I experienced when I was at med school. Not meaning to self-advertise, but I articulated something similar in a post of mine last year, maybe you'd like to have a look at it... http://www.quantumsurfer.blogspot.com/2011/02/pleasures-and-sorrows-of-humiliation.html

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  8. Thanx for you comment, Adalbert. I have indeed read your very well written and spot on reflection on the hierarchical system in some med schools. I think we, who have freed ourselves from its grip either by graduating and moving to private or specialising through some of the more enlightened universities, have a duty to speak out against the abuse of power that is taking place.

    I have very vivid memories of the perpetual system of unearned authoritarianism enforced through the ranks. In some departments a veritable reign of terror kept the wheel turning. I never saw the point of it, rather thinking that respect is earned and that professional adults should be able to conduct themselves in a dignified manner in relation to their colleagues whether of lesser or greater years' experience.

    No one ever did anything about it because everyone was too scared to be the only one to rock the boat. When, as a final year rotation group in Obs and Gynae, we asked the professor if we could be excused from doing an overnight call and attending the next morning's 6 o'clock ward round on the day of our final O&G exams, he became beetroot red in the face, his flabby midgirth vibrated dangerously and slamming his fist on the table, he declared that students had been made to attend the ward round on the morning of their exams for 19 years and that was the way it would continue.

    What I found most amazing is that, although we all found the professor's behaviour and reasoning apalling, many of us would in turn become just like him. I've seen this happen again and again.

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  9. Anonymous, you have made such a wise and potent observation: "...the art lies in the challenge and constant quest to perfect your skills. There-in lies the inherent beauty and true accomplishment." A true academic, a true leader in his field would never sit back and imagine himself an expert. Were he to become complacent, his knowledge would soon be outdated, as is the nature of our ever expanding view of the world. A continuous yearning for knowledge keeps an expert at the top of his field. The accomplishment is a personal one; bridging gaps and taking on challenges improves a person's own self respect.

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