Portfolio

One of the hurdles we have to jump is to write a portfolio for the school. A thousand-word how-does-that-make-you-feel essay about life in medicine from the perspective of a student. Then we have to talk to our assigned 'mentor' about it for half an hour or so. An assigned mentor is like an arranged marriage with an ugly woman with no sexual desires. You don't like her and she doesn't like you. Nevertheless, after 2 hours of pouring my hearts out on paper, I consider my portfolio a literary achievement. One that is so inspiring, thought-provoking and yet humourous, all in the context of fulfilling a mindless task of a ticking-the-box hurdle. All written in 2 hours.

I met up with my mentor today, and it is obvious that he had a glance through my words. Just a glance. If i put two hours of my time into something, I want someone to at least read it. So here is some extracts:

What have you noticed about work pattern and work practices in medicine? What effect do you think these have on doctors?

I have thus far completed paediatric, obstetrics and gynaecology rotation, rural GP placement and finishing my urban GP practice. I am on psychiatry rotation at the moment. I have spotted that different specialities have very different cultures, practices and thus much different timetable and lifestyle for the doctors. I understand that lifestyle is as much a factor in influencing an individual’s choice in specialty as personal interest, if not valued more sometimes.

Generally the life of a doctor at the hospital compose of ward rounds in the morning, arriving earlier the more junior you are; frantically recording all the instructions and jotting down sparse threads of knowledge that slip off of the Consultant’s tongue. Depending on the specialty and ward, this could be done by early morning, in time for a shot of caffeine, or ongoing till your stomach groans louder than the patient writhing in pain. You divide the rest of your day between carrying out instructions on the ward, visiting clinics and sometimes ED, and wait by the phone for the radiologist to call back. Variations are specific to the specialty, your seniority, and of course, your competency. As a consultant, there are commitments to private patients. A registrar gets peppered with stupid questions from worried interns from another specialty. RMOs get to scare medical students who are following them around like puppies. And interns busy pulling their hair out over their newfound responsibilities and overwhelming work.

Being a medical student amongst all the chaos is the most contradicting experience. On the one hand, nobody expects you to know how to do anything save the most basic history and physical examinations; on the other hand, you better have an answer for the question thrown at you by the consultant with a glare. Everyone expects you to commit as much time on the ward as the patients themselves, leaving no time to study; yet also interrogate why you have not read up on the topics you were quizzed the previous day.

Different specialties require different demands based on the nature of work, and these effects are clearly demonstrated by the doctors who work in the specialty. Paediatricians like psychiatrists are very soft spoken, as if not to spook the patients. Both specialties require endless patience. Added to the playfulness, paediatricians can also make opportunistic diagnosis while cooing a crying baby or calming a child tantrum. Psychiatrists are meticulously observational and insightful; and like obstetricians and gynaecologists, they inspire trust and rapport rapidly with patients.

What kind of work stresses exist in medicine? (what kind of stupid question is that?)

All jobs come with a description of stress, with some more than the others. A physician’s work is especially stressful, for we are always trying to practice beneficence.

At my GP rotation, I found that the sheer amount of patients walking through the door can leave a doctor eating lunch at 3pm. Yet GPs are always trying to spend more time with each patient. So there is a constant time pressure. In paediatrics, stress comes from not only the patients but also the parents, as a paediatrician attempts to treat a family rather than a small sized human. In obstetrics and gynaecology, the most stressful situation is seeing a PPH in action. Never in the field of medicine have I seen so much blood pouring out so quickly with so few warnings. The first time I saw one drained the colour off of the patient’s face, and mine. In psychiatry, the traumatic experiences, social issues, and transference contribute to significant emotional stress.

On top of the specialty stressors, there are always the basic stresses over medical stability of patient, misdiagnosis, and general concern for the outcome of the patient. True to most doctors, but more particularly for a medical student; there is the added stress of studying, or the more troubling, the lack of. This is especially relevant for a third year student. Given the chance and time, I would love to spend as much time on the wards and see as many patients and learn as much as I can, but the looming end-of-year exam means that I have to excuse myself from clinical settings. Sometimes the lack of understanding consequent the biggest stress for me as a student.