Oct 17, 2010

See The Future

I am the future, we are the future. If everything goes according to plan, I will become a physician. I will be part of the Taiwanese healthcare system, trying to serve my patients in between a rigid national health insurance and patient-friendly medical policies. Expectations and demands are high, patients will be picky, will be hard to convince, and harder to explain to once mistakes were made. Will I be happy? Perhaps, perhaps not.
Seeing we are the future, shouldering the burden of healthcare for the next 30 years or so, medical education nowadays must be comprehensive, innovative, cutting-edge, emphasizes teamwork, and encourages self- and lifelong learning. Wow, this sounds really nice on paper - something a Health Minister or Prime Minister can blabber out easily in propagandist fashion pleasing journalists and the general public. However, the havoc it wreak in medical institution is beyond imagination.
Lessons, more lessons, lessons in different forms - lectures, mini-lectures, discussions, PBL sessions, SPCs, CPCs, chef du clinic, M&Ms, OSCEs, online conferences, sheet reflections. Then comes the training - communication skills, written consent, clinical procedures, everything must be evidence-based, choose the best option for your patient, quality of life.
I might not actually start clinical clerkship yet, but after 4 years of swimming in books I expected clinical years to be more "hands-on". Profs may teach a procedure the hundredth time but a single hands-on practice beats mundane recitation. Yup, I hear you arguing about complication risks and screwing up the patient - not that it doesn't happen with skilled professionals. Human lives are worth more than the chance to practise a skill, but book recitation gets us just there - the rest we must delve in on our own, with guidelines.
There also seem to be a predilection to cram every single medical knowledge into 50-minute sessions and feed them to medical students a la Toulouse geese for foie gras. We are supposed to be *ahem* the creme de la creme. We studied our way into medical school, and the education board thinks we can't study these knowledge on our own? In fact, majority of these knowledge being treatment guidelines, are prone to change in the future. Why do we have to spend 2 months in a windowless classroom listening to boring teachers teaching knowledge they themselves find boring? For some classroom sessions may reinforce confidence before actually approaching the patient, but, forgive me for being harsh - so does repetitive practising and self-study. I prefer to eat on my own than to be fed.
I get angered the most when our teachers, or our board, speak on quality of life. I do not disagree on the fact that modern healthcare should be more patient-oriented with the patient's priority and wishes as prime consideration. However, how can we speak about quality of life and implement it in future when physicians and medical students now have none of it? Currently, an average first-year physician has to be on-call every other 3 days - that means aside the routine 8 to 5 clocking, one has to stay back from 5 to 8 the following day attending to sudden or emergent needs of in-hospital patients. Medical students may have less on-calls but more homework. While students of other faculties are having weekly Friday parties, Saturday shopping and Sunday couch-surfing, the future physician can only "occasionally" enjoy such luxuries. We spend minimal time with family and friends to save up for studies and sleep. We may look and feel geeky not because we wanted to, but because our environment made us. We're constantly sleep-deprived and work-drowned but we still need to appear composed in front of profs, confident and in the know in front of patients, and smarter in front of colleagues or classmates. Quality of life? Forget about it. We're more than glad only to survive till the weekend.
I may appear a socialist or even a communist with this post, but know that I am not opposed to the current swift changes in medical education. Change is good, change makes us more competent and sculpts a better society. We may be physicians in the future, but we will also definitely become a patient not long after. I feverishly hope what on paper will materialize, but not at such rapid pace when the entire system is not sufficiently prepared. It's akin to rushing the second storey when the first isn't even complete. While change is good, change is also slow - it took America 147 years for its first African American president (after the liberation of slaves by Lincoln). There is no need to rush.


yiu said...


REDD said...