Thoughts on becoming a doctor: part 1

I must have been asked why I wanted to be a doctor several times during the process of applying to medical school in the 1970s.   My chemistry teacher advised that this question was sure to pop up in interviews and that a reply including ‘I want to help people’ would be too trite and unconvincing.  At the time, and I was 17 at this point, the answer was because I wanted to work overseas and in a developing country.  But I didn’t necessarily see this as ‘helping people’.  At 17 I had very little real idea of the job of a doctor: what does a doctor do all day?

Of course, there were doctors and nurses on the television in the 1960s in black and white: Emergency Ward 10 and Dr Kildare.  In the 70s in colour there was comedy (Doctor in the House) and also general practice in the Scottish countryside (Dr Finlay’s case book – set in the 1920s so rather ‘old’).   But at age 10 I was more interested in being a nurse, like my mum The fiction that inspired me most was a series of books set in the United States, written by Helen Dore Boylston for adolescent girls (well before young adult fiction was a thing). These featured Sue Barton as she progressed from being a student nurse to a rural nurse between 1936 and 1952.  The front cover blurb of Sue Barton, senior nurse, promised that: ‘A red-headed young nurse meets romance and excitement at every bend of the hospital corridor’.  I remember more about the nursing than any love interest, perhaps because I was only 10. 

I had very little experience of personal health care.  I have no memories of any medical consultations between when I was fairly small until I was a 3^rd year medical student.  What did I know about ‘helping people’ or the medical life?

At school, I was fit and sporty but with awful irregular menstruation.  My first period was when I was 14, and I was well-prepared with towels and understanding.  But not for the heaviness of the bleeding and pain.  At some point in my teens, I went with my mum to see her GP (male).  I remember sitting in the waiting room wondering what I was going to say, how I was going to explain, what might happen, what would be exposed.  What words could I use? How to explain pain and the insecurity of wondering if the blood was visible to others.  Was my skirt stained? Health professionals and educators talk now about health literacy and helping people build awareness and understanding of health and illness.  But there are also more general conversational skills needed – how to describe pain, the words needed to convey distress, talking about periods to a male doctor when you have only ever mentioned them to your mum before. 

People in waiting rooms are known to rehearse what they are going to say to a professional when they enter the consulting room.  Unfortunately, the professional frequently interrupts before the story can be told. 

So, my mum and I waited and waited, and the wait was too long and my anxiety grew too great and I asked my mum if we could go and I just put up with the problem. 

Sadly, there are still many barriers for women seeking care, compassion and understanding about menstruation, pain and later the menopause.  The lack of knowledge of conditions relating to the female reproductive system is found in both male and female doctors and is now well-documented.  More on this later but at fifteen periods were presented as a normal part of growing up and, as a Catholic, a necessity for becoming a mother in the future, after marriage of course. 

At secondary school I had an interest in medical physics and the machines that help people and perhaps keep them alive.  I was good as science but my real love was history, and other types of stories.  Then I moved onto an interest in historical buildings and architecture.  And finally at 17 just before I needed to commit to an specific application to university, I decided to choose medicine.  I knew as much about a career in medicine as I knew about one in architecture – very little. 

There is the role of the doctor, a list of tasks and things a doctor does.  But knowing what it’s like to be a doctor was impossible until I became one.   On TV being a medical student and then a doctor looked like fun and doctors cured people.  There were few if any negative role models in those days, unlike more modern programs which create tension because the health professionals are not all saints. 

Do today’s aspiring medical students know more about the profession? There is an expectation that candidates for medical degrees undertake some form of work experience to help them gain an understanding of health care delivery and consider whether the career is for them.  Examples of such experience include working as a health care assistant in an aged care facility, spending time in a GP clinic perhaps in reception,  volunteering in a hospital and observing in a health care facility.   There is even an industry now catering to final year school students who need work experience for their medical school applications.  I found an Australia general practice virtual clinical medicine experience advertised to UK  students which promises supervision by GPs and the opportunity to learn ‘how to take a clinical history from real patients and diagnose medical problems’ for seven weeks. And all for only £520 (AUD 950/US$630).  I presume that students are advised about patient confidentiality and that patients give consent to have unqualified individuals participate in their care. 

I feel that the experience is mainly seen as a student-centred activity rather than a patient-centred one.  Even with such opportunities many medical students, in my own experience, have little understanding of the patient perspective. They are focussing on the doctor perspective. Educators, clinicians and sociologists refer to the patient journey, that is a patient’s movement through the healthcare system from their first encounter with a health professional because of a health concern to resolution or long-term management of a condition.  It encompasses how the individual accesses the health service, costs, referrals between providers, tests, treatments, and their understanding of the processes.  Medical students who are typically healthy young people (like myself in 1975) may have little experience of being a patient and, indeed, little knowledge of how one navigates through an episode of care.   Even the doctor perspective may be cloudy.  A doctor’s day is not only about diagnosis and treatment, but administration and paperwork, chasing test results, hanging on the phone trying to arrange beds or referrals, committee meetings and keeping up-to-date.  No-one answers the question ‘why do you want to be a doctor’ with ‘because I love filling in forms’.