Before you start your career in clinical medicine...

What every medical student should know about practicing medicine at the bedside

I meet a lot of parents who say to me, “You should talk to my daughter, she wants to be a doctor like you”.

Sometimes, these meetings don’t materialize and I never get to speak to these aspiring doctors but I often think about what I would say if I were to meet them.

To start with, I wouldn’t recommend anyone starting a career in Medicine to please their parents. Medicine is a rewarding career, but it’s only rewarding for those who voluntarily choose it.

It’s also a difficult career.

When it gets hard, it’s a lot easier knowing you deliberately chose this path. The difficulty multiplies when you have to endure it knowing this was never your idea and you’d rather be doing something else.

When I first expressed interest in doing Medicine, I was told all the usual reasons why one should not become a doctor - “it’s hard”, “doctors don’t rest”, “doctors don’t have time for family”, “doctors go through a lot of stress”…and on and on.

The first career talk I ever attended with a group of friends also aspiring to be doctors was given by a renowned professor from the medical school. The opening words for his talk were - “I won’t lie to you, the path you want to take on is hard.”

Many years of practicing Medicine later, I agree with these people who warned me about this career being hard because it truly is hard. The only difference now is having gone through it, I know the exact extent to which it is hard. I am also able to articulate in what ways exactly it is hard.? I also know, having gone through it, that it is a rewarding career for those who are genuinely into it.

The biggest rewards being a doctor brings are intrinsic and not necessarily in big money or status. This is particularly true in this part of the world where you find some of the least-paid doctors. Going in for the money alone would inevitably result in a disappointing career. Having said that, if one is after the money, there are ways to be creative and get paid in other activities related to mainstream Medicine.

For the right people, the intrinsic rewards are many and hugely satisfying. First, is the reward of knowing you have genuinely helped others and done a good job. This satisfaction multiplies when those you’ve served appreciate your service. This appreciation comes in bucket loads in this part of the world, where because the service is so lacking, most patients are genuinely grateful even if you just do what is expected of you.

Second is the fact that most doctors genuinely love knowledge and learning. For the lifelong learner, there is an inexhaustible field to play in and endless opportunities to learn new things.

Most doctors get a kick from cracking complex mental problems. There is great satisfaction in finally figuring out what seemed to be an elusive disease - getting the diagnosis right, starting the right treatment on time, and seeing the patient get better.

Thirdly, most doctors genuinely want to help other humans and make a difference, and they are happy when their help genuinely makes a difference.

Lastly, for those fascinated with humans and human behavior, being a doctor gives you a daily opportunity to interact with humans in a way no other career will get you to.? In my country, where people are mostly pleasant and genuinely warm, these interactions can be deeply enriching.

Coupled with all these rewards however is the intrinsic difficulty embedded in this career.

Medicine is all-consuming. When you join the training, you quickly get struck with how much material you have to cover and the unrelenting pace at which you have to cover this material. You never really finish revising everything to your satisfaction before the exam.

As a student, you must rotate through many clinical specialties. In each of these specialties, the expectations placed on you even as a student are high. Senior doctors with many years of experience in their narrow niche expect you to have a fairly good grasp of the field - even though you are only new to this.

When you qualify and begin to practice, you find that to serve well, you need more than dedication. During your early years of practice, you may get less sleep than you need, skip or delay meals, and spend many nights, weekends, and holidays away from home. When you are that involved with patients, you cannot take your mind off what happens to them. Your ‘chats’ with your colleagues away from work still are about what happened to this or that patient and how things could have been done differently.

Practicing medicine in a low-resource area, in particular, means the needs are endless. You can work as hard as you can but there will still be plenty of work to do. This, coupled with the fact that most doctors are sympathetic and genuinely want to serve, means you will always be working hard. And you will always have a compelling reason to keep working.

Most workplaces in the clinical area still operate military style. Commands (and expectations) go down the chain from the most senior down to junior doctors and medical students. In such an environment, it can be difficult to openly air out grievances towards seniors or get fair consideration afterward. It sets the perfect environment for coercion and bullying to be sanitized as “training”.

In many ways, doctors try to take on superhuman roles. They push themselves to keep others going. They maintain physical and mental expectations of themselves that they simply never do of other humans. Knowing all they know about the human body, doctors would naturally be the first to adopt habits that promote optimal performance of the human body. The demands of their work, though, may not always allow them to do that.

Beyond medical school and the early years of practice, however, many saving graces come once you have settled in and begun to learn how to create a career that works for you.

After some time, you learn about nuance and make an effort to select work that will also serve you. Part of this is understanding yourself as an individual and finding a field that aligns with your preferences and personality.

Knowing which specialty to pick is not easy when there is a lot of pressure to pick the popular or high-paying specialties. And those who take on less than ‘mainstream’ roles may be looked down upon for not doing ‘real’ Medicine.

The truth is Medicine is broad and there are plenty of routes to cater to different preferences. Many aspiring doctors are trapped thinking they must follow one particular path that is heavily promoted by their mentors. There is no single one-size-fits-all route for everyone. Instead, there are many ways to get to your type of satisfying career and there are enough career routes to suit different personalities.

Even more liberating is understanding that bedside medicine is not for everyone. So is research, or whichever route that is being promoted as “the way”. You can only thrive in work you genuinely enjoy and look forward to.

Even if it is the right career for you, you may have to vary what and how you work in different phases of your career. I know many people who are a lot happier having made big career changes or left mainstream Medicine altogether.

The work also gets easier once you start to see your blindspots and the unrealistic expectations you may have of yourself.

It may take years but at some point, you understand that you cannot pour yourself out continually without consequences. Exhaustion, mental and physical, creeps up on you and the work you once were so passionate about becomes a drag. The demands don’t stop - it is entirely up to you to decide when and how to take a break, when you need to stop, and when you need to change course altogether.

When you begin to understand how you as an individual operate, you are more likely to make choices that promote your mental and physical health. Allowing yourself to be human and enjoy all the other things you still are outside work helps you to have a balanced life.? Feeding your other passions grounds you and helps you perform even better when you return to your work.

All in all, for the right person, who’s learned how to manage themselves and their expectations, and who's on the right career track, Medicine will remain one of the most rewarding and fulfilling careers. Managed well, there are no bounds to the meaningful ways you can make a difference for yourself and others.