Prudence and Madness

In a recent family gathering, my niece asked me if it would be advisable for her to pursue a medical career after college (which meant she has to attend medical school right after she finished college). She’s starting freshman year at DLSU on a course of Early Education.

I think it was a good sign that, even at this early stage, she was considering career possibilities and not limiting herself to simply finishing college and getting a diploma. She seemed intent on making the best career choice, with conscious assessment of her strengths and weaknesses and other factors. This is how each potential college student should think.

So, I asked her, “do you really want to be a medical doctor? As in really, really want it? Do it as a career from the time you get your license until the day you die?”

“Yes!”

“Then that answers your question.”

That was simplifying it but the desire for that particular career and the willingness to work hard to the bone to pursue it is perhaps the biggest chunk of the answer to her question. If her parents would allow her, have the means to sustain her education and the stagnant years after medical school when she still needed financial support while establishing her medical practice, and if she wants it, then why not?

But perhaps the “want” should be scrutinized and evaluated if it really is the truest desire of her mind.

I know there are a lot of potential college students and graduates out there who have the same dilemma as my niece and who may be in a more clouded uncertainty than she is. So, for you, here are some points you need to ponder to make the right decision:

Do you have the intellectual capacity that a lifetime medical education demands?

It is no secret that medical students do have above-average to superior intelligence. NO reason to be humble about it because it is what is required to complete a medical course and to be able to sustain a lifelong studying that a medical career entails. The best medical schools do not take pains on selecting the best students among the applicants for the sole purpose of getting high ranks for the boards. Schools select these students because they know these can sustain the rigors of studying in a medical school. So, if you are aiming to get into the top medical schools, like UP and UST, you need to get good college grades and NMAT score (>85 would be good).

Can you keep up a rigorous, long-time study?

Unless, of course, you absorb what you read in books and hear in lectures like a sponge, you need to have an established working study technique. Also, it would be of great help if you see studying not merely as something you have to do just to pass the exams, but rather as a habit.

Are you willing to go through hell to be a medical doctor?

To answer this question, of course, one needs to know the “hell” that I’m referring to: the hell that every medical student goes through to finish medical school.

The actual hell begins in the clerkship year, which is the fourth year of medical school. Fourth year medical students are called “medical clerks” or, simply, “clerks”. this is the time when there are less time spent in lectures and more time spent doing hospital duties, in application of what is learned in the classroom lectures and discussions. At times you’d get the feeling that you live in the hospital and not at home or in your apartment anymore. Though you go on 24-hour duty only every 3 days, you feel that you are on duty everyday because you still work at the hospital during non-duty days (from duty and pre-duty days), from 7am - 5pm or until the late hours of the night, depending on the “toxicity” of work.

(By the way, the word “toxic” is the medical clerks’ favorite word. It is used to connote difficult or voluminous work, like “I had the most toxic duty” or “Medicine is a toxic rotation”. It can also be used to describe an unnecessarily strict, stubborn, or meticulous person. )

So, what are included in the medical clerks’ “hospital duties”?

These are:

• Carrying out of residents/consultants orders in the medical chart of the patient. A clerk should be constantly up-to-date with what is happening with the patients under his care and those under the care of his “alternates” (co-clerks assigned to take care of his patients when he is absent or off-duty) and must have a general knowledge of all the patients in the rotation he is currently in. Failure to do this would result in “demerits”, accumulation of which could result into additional 24-hour duties or a minus on the final grade for that rotation. Orders carried out by clerks usually are:
  • IV line insertion
  • Change of dressing
  • Checking of patients’ vital signs every 2-4 hours or every hour, if patient is in the ICU (then nurses will just copy the vital signs you took and will reprimand you if you’re a minute late in taking the vital signs)
  • Administering of IV drugs that needed extra precaution or have to be administered slowly
  • Pushing patients’ wheelchairs, stretchers, oxygen tanks and IV stands to wherever the patient is going to have a procedure done (operating room, x-ray department, CT scan department, etcetera). There are no orderlies to do those things and so the clerks have to do it themselves.
• Clerks are also responsible for keeping the database up-to-date (history and PE data, drug lists, problem lists, discharge summaries, etcetera)
• Help indigents in asking financial support from PCSO and other charitable institutions by preparing medical abstract and following up application with coordinators.
• Prepare reports for everyday conferences: admissions conference (AdCon), pre-operation and post-operation conference, mortality and morbidity conference (M&M) or Dr. X’s rounds (replace X with your favorite toxic consultant of choice), and the clinical-pathologic conference (the granddaddy of all conferences where clerks, interns, and residents get culled by consultants and even consultants have a go at each other). Being from duty is not an excuse for a sloppy presentation. Just your luck that you’re presenting for admissions conference when you’re tired from duty.
• Following up referrals to different departments. For example, there is an order for a chest x-ray to be done for a patient in the ward. The clerk-in-charge or CIC of the patient will fill up the form, go to the resident on duty at the x-ray department for approval of the form. Before it gets approved, the resident will ask all sorts of questions like why the patient is for x-ray, why it wasn’t ordered earlier or previously, what is the medical history, and etcetera, that is almost becomes a mini-Revalida (oral exams taken at the end of the fourth year in order to graduate from medical school). When the resident has exhausted the poor clerk with all sorts of questions he could think of, then he’ll sign his name on the form.
• Assist in surgical operations, undergoing another mini-revalida from the consultant to the most junior resident assisting while your hands are already stiff from holding the retractors.
• Become runners for residents asking you to buy food, drinks, paper or whatever or have something photocopied or borrowed from the library. That’s why clerks have their own little notepads, or for techies, PDAs. They are not used just for jotting down new lab results but also for taking down everybody’s orders.

In short, the medical clerk is the lowest form of animal in the hospital.

Clerkship is potentially a danger to one’s health, too. Either you lose so much weight because of being overworked, or you gain so much weight because of being overworked (and you de-stress by eating and drinking).

And on top of all these clerkship duties, clerks still have to find time to study for shifting exams, and the written and oral revalida. The latter is so important because flunking it would mean you are not going to graduate. Flunk it thrice over and you’re doomed to repeating the entire clerkship year.

So, okay, you passed all the exams, finished clerkship, and finally you’re marching down at PICC to get your diploma. Happy ending already? Oh, not yet! It isn’t over. There is still the one-year internship at any accredited hospital. How important is internship? Well, without it you will not be allowed to take the licensure exam. So it is really a BIG deal.

So when the clerk becomes an intern, he is not the lowest form of animal in the hospital anymore. He becomes the second to the lowest form of animal in the hospital. Whoopee. The only good thing perhaps is that you are already a senior to somebody (the clerks) and you can ditch your yellowing v-neck top to wear a white blazer jacket and pants/skirt, which can make you look more like a doctor than a maid/yaya.

I’ve just offered you a preview of medical clerkship and internship. But to fully grasp how it’s like to be one, you can try hearing all the anecdotes, especially from the new graduates. Some are funny, others sad, and a few downright scary. After hearing everything, that’s the time to ponder and decide if you’re willing to go through all that hell just to be a medical doctor.

But, of course, if you really, really want something, what can stop you from getting it? So, if my niece really wants to become a doctor and if it is the truest desire of her mind, then she need not ask for my advice at all, I think. She’ll be pursuing it, whatever people around her will say or tell her to do. I hope that’s the attitude potential medical students will have.