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Friday, December 5, 2008

Ladies and Gentlemen, Your Future Doctors! (Part II)

If you haven't already done so, please read Ladies and Gentlemen, Your Future Doctors! (Part I)

The Problem With Medical School "Bookwormindia" (Thanks La Colleague!)

You can sit here for hours and preach to me about how crucial a doctor's knowledge and mastery of the science involved in the medical profession is. In fact, there would be little sense in disagreeing with this statement, and saying that the sheer volume of knowledge expected from us is overwhelming would still be a gross understatement, as any medical student would tell you. That knowledge, however, or rather acquiring that knowledge in so little time, comes at a price... One needs to stop and look back at what this knowledge takes away from us. Outrageous! How can knowledge and learning be detrimental to one's character?
If that's what you're thinking then I need to clarify that it is not knowledge that is doing all this harm. Like I said in part I of this long dissertation, our system inexorably favors the competitive bookworms over the less studious, but very often much more passionate learners, who have come to terms with the notion that there are other things to do in life than sitting and rocking in front of an anatomy textbook, chanting names of muscles and nerves in a trance-like state reminiscent of some of the worst psychotic disorders known to man (oh yes, we've all seen it). And by other things I mean anything, really, anything that would conceivably help build character, that would take the mind away from books, grades, and class ranking for even a few hours a week, in other words, things that would make sure that this or that person would be able to function even minimally well in situations that don't involve regurgitating information on a multiple choice exam answer sheet. But no. Who needs these activities? I mean God forbid someone spend a few hours a week at the gym to keep in shape, a few half hours (you can use this as a unit if hours just seem too long and dramatic for comfort!) relaxing on a marginally comfortable bar stool sipping on some good old scotch with some good old friends, or, at any rate, doing anything they wouldn't be able to put on their CV... And God forbid this knock one a few places down the class ranking!!! How, please answer me, HOW, for the love of God, can one make such an enormous sacrifice upon the altar of well-being, culture and sophistication!!? This is so sad... for I believe it is these mundane, stupid things of everyday life, that stupid senseless motocross hobby you took up, that passion for photography that keeps kicking you in the back of your mind whenever your see a beautiful lady or a stupid leaf, or whatever you can think of, to do in self-administered free time, it is these things that make a person who they are.
So who are your future Doctors? Well, with few exceptions, they are the most self-absorbed, grade/ranking-oriented, cynical hyperlearners you can imagine...

Cynicism in Medical Students... An Early Beginning and a Head Start

What is the image ascribed to a medical student? What image does someone who knows nothing about the inner workings, shortcomings, and catastrophes of our medical system, hold, concerning a medical student? Well that someone should conceivably say that a medical student would have to be someone with passion towards helping others; an at least minimally altruistic, minimally passionate human being with some minimal notion of respect for life, humanity, and healthcare ethics. I mean, these, after all, are good traits -among others of course- for someone to have if they have chosen medicine as a career. Somehow, for us insiders of the medical world and community, however, it is difficult to maintain the idealistic image of medicine that we have developed as teenagers, especially as we progress further and further along our training and pick up bits and pieces of disappointment, mishaps and gaffes along the way. There is absolutely nothing wrong with this phenomenon, and I'm sure that even the most passionate volunteer healers will agree that something is bound to be lost. You see or hear about a patient being thrown out of a hospital in a less-than-dignified manner because his insurance would not cover his expenses, you see a breach of confidentiality here or there, etc... and you start thinking, maybe this isn't such a perfect world after all! Let's call this the theory of disillusionment for later reference (I have a theory! go figure!).
The degree of disillusionment varies among students, depending on character, personality, and personal background... nothing to worry about, as this is a well documented change experienced by medical students around the world. As I've read in a British Medical Journal somewhere on the net, in study results, cynicism arose among medical students most often a result of patient deaths leading to feelings of general helplessness, or of students observing their once idealized mentors and superiors conduct themselves in manners not becoming of their highly respected positions, etc... getting down and dirty, so to speak. But most importantly, feelings of general cynicism tend to begin mostly in med III and med IV, when students are put in charge -under supervision- of patients and become an integral part of the healthcare system. What one really needs to worry about is the end result, the view and status of a medical student's mind as she/he gets ready to begin practicing medicine. Let me explain.
So what's the problem in my class? In my very humble opinion, most students are in the wrong discipline for the wrong reasons. These have chosen medicine as a career for all the wrong reasons, by their own acknowledgment. Here are a few of these reasons as sampled from our proud Lebanese society's norms and standards: Q: why did you choose medicine? A1: I had the grades to get accepted, so why not? A2: It's a good investment, I want to be rich! A3: It's prestigious! and I'll leave the rest to your imagination. The thing is, none of these reasons, when amalgamated with other, more 'legitimate' motives, would be branded the 'wrong' reason to go into medicine. Even a student with high hopes and passion for helping others, for example, can still legitimately relish the prospect of being called a doctor and being treated with the respect associated with this truly prestigious position. After all, it is only fair that recognition be granted to someone for successfully completing the strenuous exercise of discipline, perseverance, and determination that is the medical curriculum. However, it is when the only reasons behind one's choice of career are the wrong reasons, that arise the problems of cynicism, among a plethora of other issues that I will not indulge in enumerating and debating. And going back to the question at the beginning of this paragraph, It is my answer that with the inadequacy of these motives, cynicism among our prided medical students begins to set in as early as, or even before, the undergrad years. Now if we consider my theory of disillusionment to be true, this becomes problematic. When even the most initially passionate medical students come to the end of their training with little, and sometimes no passion left for their chosen career, what can be imagined for someone who has been completely oblivious to the feeling of passion for medicine since their early undergrad years, for someone who had entered the field of medicine with absolutely no passion for it to begin with? Here's what you get: you get future doctors who scoff at even the most simple and basic prospects of medical ethics when they are presented to them. You get future doctors who arrogantly and scornfully scoff at even the most simple and basic of human rights! A doctor who has no sense of responsibility to human rights as basic and primal as a human being's right to choose what happens to their own body after they die, whether they wish to donate their organs for life, or resent the idea of being harvested like a carcass, the choice of wording depending on their own, personal, visceral (no pun intended) beliefs or views concerning the prospect of organ donation. This is just a mere example of the outrage that went on in one of the TWO medical ethics lectures that we were given this year. Just two? yes. Two lecture hours on medical ethics, in grand total. For comparison, our Clinical Parasitology exam in a few days' time is on 22 lecture hours. And that's just ONE of FOUR CP exams. This so clearly illustrates the seemingly deliberate inadequacy of our ethics teaching system, that I will not write another word to explain it.

What's to Hope for

At the end of this long, useless rant that sadly but surely no one will hear, let me just say that I can only hope that decisive action is taken by the Medical Community, and especially Medical Admission Boards, against this phenomenon that is destroying the essence of our profession.
On a more personal note, I can also hope that the more passionate students are rewarded with a better experience in the clinical years, because my one, sole surviving, waning measure of excitement so dearly depends on it.

3 measures of disappointment, 6 of complete and utter disgust, and 1 sole surviving, waning measure of excitement...

Thanks for reading