A number of career milestones occurred in 2010. Events which, by all accounts, should've encouraged me to strive for greater achievements.
So it was unexpected - and strange - to come to the realization that I dislike my job. ( On really bad days, 'dislike' turns to 'hate'. )
Not so unexpected: other colleagues sharing the same sentiment. Some blame 'the system' ( i.e. public sector bureaucrats ). Others cite 'early mid-life crisis'. A number of them have already left, or plan to leave, for private practice. Me - not a viable option, for complex reasons.
Funny thing is, I rather enjoyed being a doctor for a whole decade before these negative feelings set in. There isn't a specific tipping point, but more of a slow build-up of unpleasant experiences.
Life was much easier when I was a junior physician. Yes, I was a slave to my seniors, but that also meant I was shielded from office politics, administrative chores and bureaucratic bullies.
With increasing seniority came budget proposals, power struggles and endless public relations debacles. Requests for essential equipment got rejected if you didn't know the right people, not based on the merits of the proposal itself. You started noticing major flaws in fellow colleagues' characters. Patients and relatives rarely show any form of appreciation for your hard work, writing complaint letters to the media whenever it strikes their fancy.
But the thing that really gets to me are the yearly performance appraisals.
It's divided into different categories, e.g. administrative, teaching, research etc. You earn points for each section based on your level of involvement, and it's become quite clear to me over the years that it benefits a very select group of people, often those in the upper echelons of the department / hospital.
How many of us junior physicians get assigned to perform medical cover for VIPs ( something that commands a ridiculous points weightage, considering the fact that the person performing this medical cover is effectively absent from the department, and others have to cover his / her duties )?
How many of us become prolific medical researchers, or get invited to speak at international conferences?
While a small number of doctors may be able to attain such recognition, what then becomes of the rest of us mere mortals? Aren't the powers that be sending a message that drones aren't considered valuable? That if you spend more time doing ward rounds and running clinics, but aren't very interested in research, it's only right that you end up with a lower appraisal grade, and thus, smaller bonus payments.
Perhaps that's one of the motivating factors for those who leave for the private sector. No grading system that penalizes the lack of research or administrative duties. Much higher financial returns for doing ward rounds and running clinics. That, and the ability to have fulfilling personal lives.
If remaining in the medical profession isn't tolerable, a number of my friends have gone on to succeed in non-medical fields, from F&B businesses to piloting commercial jets.
But if switching jobs isn't viable ( yes, dear reader, not all of us can uproot ourselves at the drop of a hat ), then the next best thing is to pursue an activity or activities you love, and not let medicine define your existence.
Last but not least, a suggestion with regards to possible modifications of the appraisal forms - include the number of clinical hours worked per week ( ward rounds, clinics and shifts ), with sensible allocation of points. I guarantee it will level the playing field and make us drones feel a lot more appreciated.
Thank you, Kate Rothwell, for the link. :)
And The Band Played On is a personal favourite of mine. Probably the best medical drama I've ever seen.
I also recommend Awakenings. Bawled my eyes out.
No mention of Lorenzo's Oil and Patch Adams, both of which made huge impressions on me when I was a med student. The former's a harrowing account of a couple's struggle with their young son's terminal illness, the latter an inspiring true story boasting one of Robin Williams' best career performances.
TV shows-wise: nothing beats ER. :)
This news article comes right at the time when we are discussing "alternative medicine" on Singapore MD, which leads me to this video...
It's heartening to see the discussion on the subject of "alternative medicine" continue on the ST Online Forum today.
I am in particularly happy to read this letter from Mr Oon, which I reproduce below (emphasis mine):
...No, but it's the be-all, unlike alternative healing
I REFER to the letter by Mr Richard Seah ('Mainstream doctors shouldn't be insensitive to alternative medicine'; Nov 19).
Mr Seah's polemic against Dr Andy Ho's article ('Sending out the wrong signals'; Nov 6) completely misses the point and grossly oversimplifies the view of allopathic medicine on complementary and alternative medicine (CAM).
Mr Seah's contention that Dr Ho and Dr Ang Peng Tiam ('Food for thought'; Nov 18) displayed 'rudeness and insensitivity' by dismissing CAM as pseudoscience fails to take into consideration the duties of the two medical men.
Medical professionals are accountable only to the health and well-being of the patient. 'Culture' and political correctness take a backseat when providing information concerning patient care. Mr Seah's implied assertion that doctors should permit CAM on grounds of sensitivity thus, holds no water.
Doctors acknowledge that the patient has autonomy in matters of his health and is free to choose his choice of therapy. This does not preclude doctors from speaking out against quackery and 'snake oil' salesmen brazenly promoting a panacea that provides little benefit beyond a placebo effect. Doctors must provide necessary information verified by the scientific process for patients to make informed choices.
Mr Seah implied that CAM holds more value than allopathic medicine is wont to give. However, CAM is a body of unverified practices that have questionable outcomes and doubtful methodologies.
Homeopathy, for example, has long resisted the golden test of efficacy - the double blind trial. Mr Seah's argument that 'qi' and other pseudoscientific concepts in CAM are 'holistic' is a tired argument raised countless times. It is puzzling that the public demands drug trials and testing for drugs but yet does not demand the same rigour from CAM.
Certainly, not all aspects of CAM are worthless. Pharmaceuticals recognise the value of traditional Chinese medicine (TCM) - for example Artemisinin, a first-line antimalarial derived from herbs. However, the fact that once CAM has been accepted by the scientific and medical community, it becomes 'mainstream' rather than 'alternative' seems to fly over CAM proponents' heads.
Singapore has come a long way in the field of science and it is precisely because of its 'advanced medical technology' that old practices that have little footing in science are abandoned.
Oon Ming Liang
The next time you read a defence for a form of "alternative medicine", dig up and re-read this letter - the arguments contained therein will almost certainly address those used in the defence. From what I can gather, Mr Oon isn't a doctor; but I hope he chooses to become one.
I have less kinds words, however, for a collegue, Dr Lim, who wrote thus (emphasis mine):
Mainstream medicine isn't a cure-all...
I HAVE been a practising family doctor since 1994 and seen my fair share of chronic debilitating diseases and cancers causing much suffering and death over the years.
Often, I find myself helpless in preventing the onset of such illnesses or providing relief to my patients even with advanced Western medicine.
Our body has a remarkable capacity to heal itself, much more quickly than people realise, when we address the underlying causes of illnesses. And for many people, the choices they make each day and what they eat each day will determine their health in the long run.
We should not begrudge those who prefer a vegetarian diet and seek alternative treatment. It is their choice and who are we to decide for them when we don't even know ourselves?
In short, we are all learning. I remember years ago when traditional Chinese medicine (TCM) was not recognised by medical practitioners. But now, there is a TCM practice even in major hospitals.
As doctors, we should keep an open mind as there is always more to learn.
Dr Benny Lim Jit Biaw
Well, patients have always had the choice to accept or refuse any form of treatment, Dr Lim, Western or "alternative" - that bit was never the question - but "choice" does not determine whether a form of treatment works or not. Mr Oon, a layman, seems to have grasped that concept despite not having 16 years of clinical experience.
As for the plea of "we don't even know ourselves", well that's a falsehood and an abdication of our responsibility as doctors: we do know a lot about most forms of "alternative medicine" (whether it be a lack of evidence of efficacy or evidence of a lack of efficacy), and when it comes to new forms of "alternative medicine" that has little evidence, we at least know that there is very little evidence to support the claims made by those people who are selling them to patients. Do not, Dr Lim, assume that your ignorance applies to the rest of us; besides, ignorance is not license to condone, but a reason to become educated.
So I am not sure what the score stands, but I am as I said happy to see that arguments like those presented by Mr Oon are making it to an open forum (and doubly so because the letter was written by a layman!). It gives me hope that if scientific literacy has not sunk in to someone who had practised medicine for 16 years, it has at least made an impact in the younger generation.
I think I will sleep easier tonight.
