Dandelion Fluff

A little bit of advice to those newly starting their medical careers…

(Published in the Australian Medical Association Newsletter May 2015.)

I had no real interest in medicine when I first went into university. This ambivalence didn’t prepare me well for experiencing internship, which comprised bullying, deception, betrayal, and frequent disappointment – and that didn’t even include the nurses. It was
also one of the best years of my medical career.

My experience will almost certainly not echo yours, but many of the pivotal moments are worth consideration…

“What is your reason for doing medicine?”

If it’s “to help people” or “for the betterment of society” – congratulations. There’s not too much I need to encourage apart from reminding you that this should not be the entirety of your existence.

Now suppose your goal is career advancement. You may be disappointed with the hospital you’ve been allocated and cursing that you didn’t stack your preferences. Generally, no one cares which hospital you did your internship in. Plus, don’t be disappointed if you
didn’t get one of the “cruisy” hospitals – an easy term prevents you from learning
anything, a harsh and confronting term makes you a better doctor in the end – if handled well. Don’t be mistaken, you are still here to learn. As a general rule, reading up about at least one patient a day will keep you in good stead, and if you are able to start this habit early enough you will see the benefits pretty soon.

Now, say you entered medicine with a particular specialty in mind. Firstly, can I say that hardly anyone I knew in my batch ended up doing the specialty that they thought they were going to do. Don’t discount other experiences – instead, choose your terms in order to complement and facilitate the decision. If you’re interested in colorectal surgery,
do a gastroenterology term. If neurology, do a psychiatry term. If general practice,
do a surgical term. If cardiology, do a respiratory term. Emergency and intensive care terms are great for rapid acquisition of multiple practical skills, whilst surgical terms actually tend to have you doing more general medical work as most of your time will be spent in ward care. Keep your options open – the best way to avoid learning is to
convince yourself that you’re never going to use information in that domain. It’s not rationalisation, it’s laziness combined with self-deception.

And when it comes time to choose? Find a second year registrar in the specialty you are thinking of, and then ask away. Don’t ask consultants – we’re all keen to have protégés to boost our egos and will always provide an idealised version of our field. You only
know your specialty decision is correct after the first year of the training program, and never before. Lastly, do not make the single most common mistake and choose a specialty based on a charismatic individual. You probably want to become that doctor, but not
necessarily in that field. And if you entered the field for money… oops.

“What is my life’s passion going to be?”

If your first response is “not medicine”, congratulations. You’re on track to a healthier attitude to work. Medicine is a profession – that is true, it shapes us as we try to live in it. But there actually is an outside world, and if ignored it will disappear by the sixth month of traipsing fluorescent-lit linoleum.

It is crucial to maintain a life outside of medicine – your relationships will now
be far more important to you. Family, friends, love, hobbies – any interest beyond the hospital will be harder to maintain, but must be done in order to centre yourself. If you haven’t already, take up a sport, something reasonably scheduled that you can afford to miss occasionally (depending on overtime rosters).

Holiday preparation will also become harder, and you’ll find that often the initiator for holidays comes from your family and friends rather than yourself. Allow time for yourself as well – use your ADOs and remember to explore the world. I don’t remember too much
stitching from my surgical term in the country, but I have an irreplaceable collection of photographs of sunrises over the foggy fields that I still treasure.

Why is the social dimension so important? Well, unfortunately I’m too aware of the literature regarding mental illness and strain for house officers. It’s
not going to be helpful to go into it here, but it is worth thinking about…

“How bad is it going to be?”

I had a nightmare registrar once who made it his personal mission to belittle every resident he had out of earshot of his consultants. As a young doctor without awareness of boundaries of practice, but also aware that I was still early in my career, I did not realise what my rights were until after he was fired for gross misconduct. I would have
dropped out of medicine if it wasn’t for my then-girlfriend cushioning the mental blows and helping me to reorient myself. But I still kick myself now for not responding differently – not just for myself, but for my patients.

Likewise I had a difficult term with responsibility for several teams. It was a never-ending juggling act of haemodynamically unstable patients and a profound lack of support. But my strongest memory from that was going out for drinks with friends from high school, sitting there thinking, ‘I am talking with an accountant and a manager, and for the entirety of tonight, unlike every hour of the last eight weeks, I do not need to think at all about medicine’.

Be aware of your rights and responsibilities, and also about workplace codes of conduct. It actually does matter to know the difference between performance feedback and bullying – but it is useful to have a first response to criticism as being, ‘is there something about myself that I can improve?’

You absolutely must have a general practitioner, and talk to them or trusted parties if there is any problem whatsoever. Fix problems early, and never, ever suffer in silence.

“How good is it going to be?”


I worked with a great bunch of people who all helped each other out – doing each other’s cannulae, picking up shifts, that sort of thing. We held parties, complained about our experiences, and had this dizzying camaraderie that only happens from people embarking on an incredible shared experience. We fortunately learned early on that we knew nothing whatsoever and got used to asking questions, which worked. We may have been bright, but
we were inexperienced, and everyone else knew more than we did. Amongst our superiors, there were good and bad clinicians, but I received the best advice of my career from a urology registrar who advised me, “You learn something from every person you meet.
Sometimes, you learn what not to do.” Once you work out that your career – and life – is about growth, and becoming a better person every day, it’s amazing where things will go.

So enjoy your internship, and make the right decisions early. And hopefully it too will be one of the best years of your career. Because it will mark the point at which every following year becomes even better.

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