Eric Tian

“So, the next step in the history taking process is to define the pain. You start this by asking for site, with questions like, “Where are you experiencing the pain? Can you pinpoint the site or is it more general? Does the pain radiate (spread anywhere)?” And if the pain is on one side of the body, remember to ask about the other side – this is important. Got it? Okay, the next step is severity…”

As the tutor speaks, the flurry of medical students typing notes is oddly reminiscent of a waterfall, with myself and 11 other first year medical students taking part in its creation. The class I’m in is called Clinical Skills Tutorial (CST), which teaches the more practical skills of medicine such as taking histories or doing patient examinations – this week, we are being introduced to the history taking process. But while it is exciting to learn what a doctor does, I can’t help but feel a different, uninspiring feeling rise up within me as I type. A twinge of… disappointment. The disappointment initially surprises me but after a while, it fades away. I soon realise why.  

When I was little, I thought doctors were a special breed of people – those blessed with levels of intellect, observation and analytical thinking far beyond that of the general population. A ‘superhuman’, if you’d like. I always marvelled how a GP, upon never seeing a patient before, could diagnose the cause of chest pain using a few questions, tests and some poking around and then prescribe the perfect drug, where the patient would then live happily ever after (hooray!). I imagined doctors had flashes of superhuman genius which told them what questions to ask, what diagnoses to make and what decisions to make in critical situations – a process mere humans could never understand.

But of course, doctors are human and have limitations like the rest of us. Doctors often get things wrong, with diagnostic error rates estimated to be close to an alarming 15% [1]. And from my first few weeks of medical school, it seems unlikely that wild ‘flashes of inspiration’ occur at all. Rather, medicine seems more mundane, more formulaic – a process of extracting the same pieces of information from each patient and recognising particular groups of symptoms. Almost like pattern recognition, like a game. Nothing too superhuman at all.

It’s somewhat disappointing to reach the conclusion that doctors probably aren’t too different from the rest of the population. I imagine the notion of the ‘superhuman doctor’ is something we hold for our own sake – we want doctors to be infallible, incapable of getting our diagnoses wrong, when in fact doctors can get sick, miss their families and become exhausted just like the rest of us. Despite all this, the ordinary doctor tries their best to repair a patient, knowing full well that they share the same limitations of energy, time and need for social connection.

But perhaps it is exactly this that makes doctors and other allied health workers superhuman: the constant exertion of effort to reach an unattainable level of perfection for the sake of the poor, the injured and the broken. It’s taking potential burnout, imposter syndrome and unmet social commitments and temporarily moving them aside to make space for the patient’s needs. Caring: perhaps this is what makes healthcare workers superhuman – not some transcendence of IQ or memory, but something more subtle, more internal: the prioritisation of others’ needs above your own. Now that is pretty extraordinary.

Sources:
1. Graber ML. The incidence of diagnostic error in medicine. BMJ Quality and Safety. 2013 Oct; 22(Suppl 2): ii21-ii27.

Three weeks have officially passed for my first year in the Doctor of Medicine (MD) at Melbourne University. According to older and more experienced students, MD1 is a precious time in the context of a medical career: you have the most time you’ll ever have, there are zero expectations of you and you’re only there to learn. Over the next few years, I’ll be documenting this journey ahead – everything from the bright and beautiful to the dark and demoralising, with this post marking the start. I don’t really have a plan of what I’ll be writing about, so here goes nothing.

INTRODUCTIONS

“Hey there, I’m Eric – what’s your name?”

Of the 359 students in MD1, most of the faces are new but there are some familiar ones. Through ice-breakers, orientation activities and lunch breaks, I’ve slowly begun to meet some of the new faces who I’ll be calling colleagues over the next few years, and catch up with old friends.

The act of mingling was draining in the first few weeks, but things are slowly settling down. Groups are beginning to form, with clusters in lectures and circles in lunch breaks taking shape. Without a doubt, getting to know new faces throughout the next few years is something I’m looking forward to.

Most people seem friendly and relaxed, making it easy to forget that many of these individuals are likely straight A students, accustomed to topping their classes and acing every exam. I wonder what will happen now that these students are now all together – how and if their expectations will shift throughout the years given the competitive nature of this course. On the other hand, not seeing faces who I’ve become accustomed to seeing during undergrad is a little strange; friends who have moved to different states, who have gone down different paths. But things like this happen, and I have faith they’ll do great things no matter where they’re placed.

RESILIENCE

Some of the themes of the first week of MD1 included resilience and developing a ‘growth mindset’ – stuff like if you ever fall, fall forward. Within these talks, the idea of imposter syndrome came up frequently as a reminder that yes, imposter syndrome happens to everyone and no, don’t listen to those thoughts – you absolutely deserve to be in this course.

There are many arguments that could be made against doing medicine. You are studying for a long time (essentially your whole life), you will probably experience some form of burnout in navigating patients and hospital systems, leading you to almost certainly work long hours whilst trying to maintain a healthy personal life. On top of that, you are in an inherently competitive field with a vast number of brilliant minds vying for a limited number of specialist positions, of which many exams stand along the way. It is no wonder imposter syndrome and burnout are such big problems in this field.

But of course, these are also reasons why one would decide to go into medicine. The thrill of lifelong learning, the opportunity to meet patients’ health needs as another human and the opportunity to work in a team of like-minded, capable individuals must surely be worth the inevitable struggle to receive these gifts or going to medical school would be nonsensical.

Things may change and I may drop out of med school in the future, but for now, I’m content on this path that God has placed me on.