A little over two years ago, I heard of an old classmate working on a documentary project about bullying and discrimination in medicine. Longtime readers of this blog will know that I have written about bullying and discrimination before.
The director and brains behind the project, Adil Khan, interviewed a few doctors who came forward to talk about their experiences. Sharing mine was cathartic. Two years later, on 30 September this year, Behind the Frontline premiered to great success. Adhil was interviewed by newspapers and television shows, and I do believe that this documentary got people talking.
Have a look. Consider your own mental health. Perhaps it is time to admit that you need help, or at least, that you need to take steps to protect your wellness. Know that there is always help available.
I’ve been spending a lot of time in labour ward anaesthesia this past month. It’s great, because I get all the gratification of the caesarian sections (I remember it well from internship), without having to wade through blood and amniotic fluid and human excreta myself.
Another thing I remember well, is the tension in theatre when the intern is cutting. I had such difficulty getting my ten caesarian sections for our logbook signed off, because so few seniors were willing to let an intern cut. It’s not only the obstetrician – often, it’s the theatre nursing staff. To be fair, nobody likes to be scrubbed in for a routine caesarean that lasts ninety minutes. Other times, it’s the anaesthetists. Because nobody likes to worry that their spinal anaesthetic might wear off before the surgery is over.
I have had a taste of the same with my new position, too. Not having done anaesthesia in four years, there is a lot I have had to relearn. My “teachers” have been great, and I seem finally to be finding my feet, but there have often been grumblings from surgical teams when I was slow. As an intern, I might have minimised myself and declined to perform the procedure. But now, I need to learn, and quickly. So I have been pushing back harder (when not to the patient’s detriment) – and to my new colleagues’ credit, they have supported me.
Having experienced this, I will always be the annoying medical officer who encourages the intern/student/newbie to perform procedures. Not because I think I’m so wonderful, but because I want trainees to feel as nurtured as I have felt these past few months, and not as burdensome as I sometimes did as a student and an intern.
Sometimes, I think clinicians forget that they were inexperienced and under-qualified juniors once, too. There is nothing admirable about learning to place an intercostal drain on YouTube, without senior supervision, as many of us like to brag. That is a sign of a failing system. We should be taught and guided by others with experience. We deserve that. Our patients deserve that.
I also know that it is a system that fails not only interns. I know that demoralised doctors have little interest in training juniors. (But that is a discussion for another day.)
Interns who are not competent become dangerous medical officers, wherever they may go for ComServe. They have both the right and the responsibility to be trained. We have the responsibility to ensure that they attain their very best, even if they are afraid while doing so. We do it to pay forward the teaching we have received. Or if we were not so fortunate, we do it to improve where others failed us.
Train your trainees. It kind of goes without saying.
Some of the greatest psychological stressors are said to include breakups, death, moving house, and starting a new job. Sometimes we choose one or more of these willingly, and hope to hell that the payoff will be worth it.
For two years, I worked in private general practice in Cape Town. The benefits of this kind of employment were sizeable – I made a living on relatively few hours, and had no overnight calls. I got to sleep like a normal person! I had a flexible schedule, and could always increase or decrease my hours as necessitated by my needs.
The cons, however, were not insignificant. Any leave I took – sick leave, vacation, or for a course/conference – was unpaid. I was paid by the hour (and that has affected my taxes, too). I was often the only doctor at a practice, sometimes one of two. The patient-pressure was immense – I never managed to get a grip on seeing 4-6 patients in an hour. I simply was neither able nor willing to compromise patient care, nor my medico-legal accountability.
On the other hand, I did get to live in Cape Town. Cape Town! Although the city can be scary and inhospitable to newcomers, there is so much to do. I could never tire of it. As Murphy would have it, I made a lot of friends and found communities to slot into during the final few months.
But why did I ultimately decide to pack it all up, and move AGAIN?
Because I was miserable.
I am not going to unpack that misery now (maybe another day), but I soon found myself completely out of love with my work. I missed the sense of a team. I missed being able to discuss cases with colleagues, and having someone with whom to commiserate. I missed the somewhat academic environment of public hospitals. I care a great deal about primary healthcare and public health, but I found that I was swimming against whitewater rapids, and treading water was becoming more difficult by the day. Although I wasn’t working very many hours, I found myself constantly low and tired. Often, I would delay leaving for work until the very last minute, and then arrive late. My career seemed hopeless; I felt heavy and inert.
In short: I hated my job.
I do not use that term lightly. In previous jobs, I had certainly had days when I hadn’t particularly enjoyed working. This was not that. Hating my job is probably one of the worst things that has ever happened to me, and unless you have experienced it, you cannot begin to imagine it (I certainly could not). I have very clear memories of LOVING being a doctor before, so I know that this had little to do with my profession, and more with the direction I was taking and the environment I was in.
So when the call came to offer me a job in anaesthesia, the scales weighed heavily in favour of the new job. There was the matter of the city and the people I would be leaving behind – and I did not make that decision lightly. Ultimately, being unhappy at work was negatively impacting on all spheres of my life. I had to get out, or it would kill me.
And so, I said yes. I packed all my belongings for the fourth time in three years, to move to a small city with significantly fewer resources.
But I think I am happy here. I have completed two months of supervised work, and I am starting to have my own independent theatre slates. It has been extremely high-stress, and my confidence has on numerous occasions hit the very bottom of rock bottom. I often fall asleep on my couch in the early evenings, because my brain feels so fried from all the mental exertion.
But I love my job again.
And I cannot begin to explain what a game-changer that is.
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.
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. Continue reading “My Advice for Your ComServe Application”→
“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.”
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.”
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. Continue reading “General Practice and Emergency Med: A Bad Combination”→
Since 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.
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”→
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.
The 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”→