Q&A Part 2

It's Saturday night / early Sunday morning, and I don't know where all the drunks are. ( Not in my ER at least. )

Thank you, English Premier League. :)


This is a follow-up to an earlier post, answering questions from S, who's considering ( and from the sound of it, almost made up her mind already ) a career in medicine, after obtaining degrees in other fields, among them biology.

Readers are most welcome to respond to S in the comments section.


1) How do you keep yourself sane, and deal with these pressures (besides blogging I guess)? Are there good mentors who can guide you in the system ? Do you think you would, or could, have done anything differently in your 10-year career?

We all have our own coping mechanisms. For me, having interests outside medicine is life-saving. While I do know of friends / colleagues who spend every waking moment doing something work-related, I'm not built that way, My blog pretty much describes what I'm up to in my free time, and some of these experiences definitely sustain me when I'm near breaking point. ( Jason Mraz, I owe you my sanity. :))

As for mentors, I credit many from various departments for not only helping me decide on emergency medicine, but for inculcating good work habits and sound ethics as well. I firmly believe in the "old school" mode of thinking, where respect for one's seniors still counts for something, and being reprimanded is a valuable learning experience rather than an excuse for bitching and whining.

As for anything I could've done differently, now that's a very interesting question. If you're asking about my choice of specialty, then no. But if it concerns patient interaction, then of course, there were a few occasions where I didn't see a complaint coming, where I misdiagnosed something. But it's all part of the job and the learning curve. I have no regrets so far.


2) How do you think the doctor-patient relationship will evolve in the future (say 5-10 years from now)? Will medicine become more like a service industry (patients fill out satisfaction indicator forms, and yes, docs rated by stars)?

How should doctors handle the increasing complexities and challenges in patient communication (Are they taught this in school? How does one learn this and adapt to changing times?) ?

To address the 2nd part first - medical students are taught communication skills in university, but obviously, this doesn't always guarantee good results in the real world. There're just too many variables and permutations, and adaptation can only come with experience through trial and error.
I will say this though: a big smile always works wonders ( but use your discretion, especially when addressing a pissed-off patient or relative -- the smile may end up offending them ).

And yes, absolutely, medicine is becoming more and more like a service industry. Hospitals and polyclinics already have feedback forms that are taken very seriously, and compliments / complaints from patients / relatives are included in our appraisal forms. How much of an impact this has on one's performance grade depends on your department / division chief. If s/he appreciates your hard work and knows the complaint is baseless, then you're safe.

However, the administration's unhealthy preoccupation with these feedback forms can be paralyzing to a certain degree. I recall an incident a few years ago where I refused to issue an MC to a patient I strongly suspected of malingering. He turned out to be a lawyer and threatened to write to the Forum, etc etc. I stood my ground and he huffed off to some department that's in charge of complaints ( I can't be bothered to remember the exact name of the office ), after which one of the officers came charging down to the ER, practically begging me to write the MC so the patient wouldn't take the complaint further.
I just stared at her, flabbergasted, then firmly said, "No." I swear, she looked like she was going to cry.
In the end, we never heard from the man again, and nothing appeared in the Forum. But this is a good example of what goes on, at least in the government sector.


3) It appears that there are preferred disciplines for dishing out grant money, buying new equipment, etc. Is this more keenly felt by ER departments? Or just in general, but just less so for cardiology/surgery?
In a similar thread, how are turf wars experienced in the hospital (I have heard patients being kicked around)?
You also mentioned there is quite a number of doctors who would quit for more profitable pastures, but has anyone quit just out of mere frustration with the system (is it so bad to survive in public hospitals)?

Yes, in general, the ER is viewed as non-profitable, and although this isn't officially said, we do get the short end of the stick when it comes to funding.
I don't want to point fingers, because I understand the constraints the administrators face, and sometimes it makes sense to spend hundreds of thousands of dollars buying some intelligent robotic thingie which will make headlines and draw impressed patients in droves ( especially rich foreigners from around the region ), rather than equip the ER with, say, a new ultrasound machine which will help speed up diagnosis and treatment, but won't have any press coverage.

The silver lining though, is that leadership makes a difference, and that funds can be obtained as long as your CEO and CFO are supportive of your initiatives, because there's ALWAYS some money lying around somewhere.

Turf wars - now there's a touchy subject!
There're too many instances to count ( unfortunately ), but yes, they do exist, and the patients suffer greatly as a result of them. Often, it's the subsidized classes which fall victim to the kicking around. It's a practice that frequently requires an ER physician's intervention, and it gets even uglier up in the wards.

And yes, I know of doctors who've quit out of frustration, though some of this stems from inadequate remuneration. Conflicts with colleagues / the adminstration or a high-profile lawsuit are also reasons, in addition to other "compelling factors" which are too sensitive to describe on a blog.

But it isn't "so bad to survive in public hospitals". There's a significant number of "old timers" who remain in the government sector ( most of them are full professors ), and emergency medicine being what it is, many of our department chiefs stay on as senior consultants after ending their HOD terms. I'll probably still be where I am 10-20 years down the road. The idea of a private hospital is too difficult to contemplate.


4) Regarding your fears about whether you'll be able to sustain yourself through those many years of studying, and whether you'll eventually become a competent doctor, all I can say is: if you work hard and don't lose that passionate streak, you'll be fine.

I know it's a simplistic answer to a complex question, but honestly, if you overthink it, you'll go insane. All of us have had doubts at some point in our lives, and medical school is no walk in the park. My year as a houseman was nightmarish at times -- that's when you'll realize what you learnt in university is practically useless -- but if you're capable of learning fast and weathering the stress and exhaustion without making a fatal mistake, you're home free.

It sounds impossible, but it can be done. :)

Family support is helpful, but not essential. Ultimately, the decision is yours to make, and if you feel a strong conviction that this is the path you want / have to take, then by all means take the plunge and don't look back.

Good luck!