My Advice for Your ComServe Application

It’s almost time for the asynchronous community service applications in SA, and shortly thereafter the regular applications will begin. So I thought I’d take a break from dispensing medicine, and dispense a tip I could have used:

Apply somewhere that is going to challenge you.

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Zithulele, Eastern Cape, where I went in my final year for Family Medicine. A fantastic Community Service option.

Apply somewhere that you will be expected to work with a reasonable level of independence. Probably the best place to do community service, in my opinion, is somewhere that you can do emergency medicine, or at least your overtime in emergency medicine. Yes, even if you don’t want to do EM in the long run.

Why? Because EM will teach you independence. EM will teach you how to think on your feet. And EM will give you plenty of experience with emergency situations in whatever specialty. Everywhere I have applied, emergency scenarios have formed part of the interview.

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While at Zithulele, I even got to assist in some basic eye surgeries.

This advice comes from experience. I was lucky enough to get my first choice for ComServe: a highly specialised children’s hospital. But it was also a safe choice. At that stage, I wanted to do paediatrics as a career. I was going to do a Diploma in Child Health, and I’d be set. Except… I’ve since changed my mind. I still love kids, but paediatrics isn’t my first choice anymore.

It’s not just that. Because I was in a highly specialised setting, I was not encouraged to act independently. We always had backup close at hand, and we were expected to make use of it. And while I’m thankful for a great many things during that year, I’ve noticed that in job applications, I’ve been at a distinct disadvantage. I’ve lost a lot of the skills I gained in internship, while my peers have been able to build on theirs. I’ve been studying up as much as possible, but as we all know, theory is a poor substitute for hands-on experience.

fdd3f4239b2c7ad6feb3d86aa29083b5A year in EM would have been especially beneficial to me, because of my self-confidence issues. I know that I know how to do certain things, but my lack of self-confidence often means that I hold back. More experience in EM would have forced me to dig deep and take ownership of situations.

So apply to that rural post with limited resources. Apply to that busy hospital in the township. Apply to that day hospital with an overflow of trauma. (Just make sure you have some support, like a psychologist, for regular debriefing.) It’s one year, and it will only benefit you in future.

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Read This Book: In Shock by Rana Awdish

“If empathy is the ability to take the perspective of another and feel with them, then, at its best, the practice of medicine is a focused, scientific form of empathy.”

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For the past few days I’ve been devouring In Shock in every spare moment I could find. In her narrative, Awdish recounts the experience of severe illness and near-death on the background of being a physician herself. She shares almost “crossing over”-esque insights into how and why medicine is failing its patients, as well as its doctors.

In Shock is definitively part-memoir, succinctly conveying the many complexities of Awdish’s illness and survival. True to its intention, it avoids the traditional stiff-upper-lip clinical retelling, and allows for range of emotions experienced by the critically ill individual. It is a narrative not looking purely outwards, but also in. What Awdish distills from her experience is both poignant and pragmatic.

“Illness is viewed as an aberrant state. It is a town we drive through on a journey home, but not a place to stop and linger.”

In Shock is about medicine’s broken telephone. It is about our inherent, but often unintentional, disrespect for patients and ourselves. It is about seeking comfort in the wrong ways, and about righting our bad medical habits.

“We listen imperfectly, through a fog of ghosts and competing priorities.”

Perhaps an unexpected benefit for me, in reading this, has been clarity. I understand now the dissonance between myself and much of medicine – I think my generation of doctors exists in that grey area between the “old-school” and the “new school”. We’re trying to remain respectful of the giants that brought us here, but have also become acutely aware that the way things “have always been” is not the way things should continue.

While I think that anyone can enjoy this book, I highly recommend it to medical students and doctors. I’m definitely adding this to my growing list of books medical students should read, right up there with Postmortem and When Breath Becomes Air(If you do read it, I would love to discuss it with you.)

Right now, I am absolutely fangirling over Dr Awdish, and I wish to see more physicians like her speaking up. Far from being punitive, In Shock invokes the hope that medicine can be healed – and so, too, can we.

“In that light we can accept that our greatest gift is not in fact healing, because all healing is transient.”

… I’ll leave you to read it yourself to discover what our true greatest gift is.

General Practice and Emergency Med: A Bad Combination

Since the beginning of the year, I’ve been working semi-permanently for a private family practice. More recently, I’ve also started doing shifts in the emergency centres of both private and public hospitals.

While doing each of these separately comes with their own challenges, doing them together has proven to be a demoralising combination, because they highlight the failures of each field, and our inability to fix them.

Being a good general practitioner is damn hard. The pressure to see patients quickly is high, and spending 15 minutes per patient is the norm. This means that a lot of health promotion cannot happen. It takes a while to counsel about smoking cessation, when the patient’s reason for visiting is a stomach bug. Perhaps you tell the patient to come back for a Pap smear (because her consultation time is up), but she never does, because she can’t afford another consultation.

And if you want to do health promotion in the waiting room, all the pamphlets are sponsored by some or other pharmaceutical company, so that becomes an ethical grey area.

Emergent patients come to their family practitioner because they don’t want to sit in a queue at the local hospital. The GP sends them to hospital anyway, and the patient has lost R350 (at least).

In the world of Emergency Medicine, we are often faced by the failures of primary care (in state or private). We see the effects of uncontrolled hypertension and diabetes. We get flooded by inappropriate “green” referrals or walk-ins, because patients are tired of not getting results from their GPs. And seeing these “greens” takes valuable time from the very sick patients. (There’s that “distribute justice” they spoke about in medical school.)

The Emergency Centre isn’t there to fix the myriad problems our patients encounter. So we take their bloods and send them to their primary care physician to follow up – on their cholesterol, their high blood pressure, their smoking, their lack of recent Pap smear, their obesity…

To add insult to injury, their is a strong mutual dislike between general practitioners and emergency physicians. Working these two jobs results in a huge cognitive dissonance for me, despite the insight it offers.

I am increasingly desperate to get a more permanent job in a state hospital, in a department I like. Please cross fingers with me.

Tips and Tricks: Planning Your Elective [Part 1]

Screen Shot 2018-11-20 at 14.17.59Since I’ve kind of started paying more attention to the blog again, my friend Caroline asked me to share some tips on electives. (Hi, Caroline!) You may remember the elective series I ran a few years ago. I haven’t exactly stopped the series, I just am not really in the position to seek out medical students for interviews anymore. (Guest posts welcome, hint-hint, nudge-nudge.)

I’ll give as much advice as I could gather from myself and friends, over a few days. Today, I’ll start off with the process of choosing your elective.

Disclaimer: This will be written with South African medical students in mind. For international students, note that some things might not apply to your program.

First: Start. Early.

If you think you’ve got plenty time, you’re wrong! I have a colleague who went to Oxford for her elective, and she booked her space for the program more than a year in advance. If you have a holiday between exams and rotations, use that time. Do not rely on the hope that things will just fall into place. (I speak from experience.) Continue reading “Tips and Tricks: Planning Your Elective [Part 1]”

The “Good” Intern

The October issue of the South African Medical Journal (SAMJ) published an article, ‘Going the extra mile: Supervisors’ perspective on what makes a ‘good’ intern (De Villiers, Van Heerden, Van Schalkwyk). The paper assesses the opinions of supervisors on interns’ practice readiness, which differs from most research on the subject, which has predominantly researched the interns’ own perception of their preparation.

The study reported on the results of interviewing 27 intern supervisors – a small, but diverse group of consultants, registrars, and medical officers.

What stood out for me was that the interviewees displayed a keen awareness of the challenges faced by interns. They recognise three areas of particular difficulty: transition from student to doctor, adjusting to a new environment, and long/hard working hours. Continue reading “The “Good” Intern”

Questions on Blogging for Readers Past/Present/Future

I started this blog exactly eight years ago, today.

Who I was then, and who I am now, has changed drastically, and often. I wrote as I stumbled my way through new clinical and life experiences. I wrote as my mental health peaked and plummeted. I wrote as my love for medicine died, and was reborn. The first community I found was that of book bloggers, but gradually, I found the medical bloggers, too.

Continue reading “Questions on Blogging for Readers Past/Present/Future”

Global Day for Safe and Legal Abortions

4e1359d8e206b850346e738d142216cdThe young woman left my consulting room after protracted counselling, with a completed J88 (a medical report of assault), a prescription for anxiolytics and pain medication, and a referral to a therapist. She was six weeks pregnant, but would not be for long. Her husband had inserted misoprostol tablets in her vagina, without her knowledge or consent. She was already in the throes of uterine cramps. Continue reading “Global Day for Safe and Legal Abortions”

Stop telling your depressed friend to go for a run

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Gratuitous selfie at the top of Chapman’s Peak. This was a good day, and I DID feel pretty high.

“Go for a run, you’ll feel better.”

If you’ve ever been sad, you’ll have heard this. If you’ve been depressed, you’ll have heard it ad nauseum.

What depressed person has the energy, let alone the motivation, to go for a run? Realise that “going for a run” is a multiplex of tasks. First, you must get out of bed. Then, you must get dressed. You must put on shoes. You must (preferably) eat something. You must unlock the door. You must step into the sun. You may have to greet the neighbour. You must put one foot in front of the other. Then you must do it faster, and remember to breathe.

Continue reading “Stop telling your depressed friend to go for a run”

Anatomy: my big mistake

I had a little giggle to myself while charting the notes of a patient with shoulder pain the other day. Specifically, I was thinking of this post of yore, and my belief that I could get by just knowing what anatomy looked like, and not necessarily its various descriptions and qualifiers.

Boy, was I wrong. (And young. And obstinate.)

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Image via dentalbuzz.shop

Continue reading “Anatomy: my big mistake”