What does it mean to be a good consultant? Is it slicked hair, pleated pants and a freshly ironed blazer? Is it knowledge that spans the Pacific Ocean, from the individual branches of the splenic artery to the prevalence of measles in Somalia? Is it a polite and courteous demeanour, with just the perfect distance to avoid emotional attachment to their patients? Is it efficiency, always checking off patient lists in record time, or perhaps, is all of the above required in the making of a good consultant?
On the first day of my community rotation, I am greeted with none of the above. Just a warm smile from a frizzy-haired, middle aged man who donned a lime-green padded vest, baggy jeans, polished with a pair of… hiking boots? He offers me some coffee and grabs his wallet from the table, signalling for me to follow him. I trail behind, somewhat bewildered.
He takes a left and crouches down next to what I make out to be an old blue sleeping bag. To my shock, an elderly man emerges from the dirt-stained pile, draped in rags and as thin as sticks. He seems startled to see me, but seems reassured by the doctor’s presence.
He trembles, wincing in agony while pointing to his wound. His words are mumbled, but I make out a few words: attacked yesterday, big wound, money stolen. The doctor furrows his eyebrows. For an instant, that friendly, cheerful face vanishes beneath a mask of cold anger. He asks the man to drop by the clinic later to redress his wound. Without hesitation, he also pulls out a twenty dollar note. “Come grab lunch with us later,” he says, as if it is the most normal thing in the world for a consultant to have lunch with a homeless person from off the street.
In medical school, we swear by Hippocrates’ Oath, to “offer those who suffer all my attention, my science and my love.” Yet, for some of us, they live in a different world incongruous with slicked hair, pleated pants and freshly ironed blazers and blouses. A world that may demand more than just a polite and courteous demeanour. A world without systemic healthcare and education issues that rob us of our attention, science and love.
Hospitals are evolving to be more overloaded by the day. Interns, hospital medical officers and consultants are paged before they even get a chance to say “hello” to their patients. As such, there is a heavy reliance on medical charts. These charts are now digitalised, thanks to constantly improving “cutting-edge” technology, and we now quickly identify patients as, “ah yes, the one with the high lipase - wait, no, the one with the high calcium score.”
In general practice, up until recently, the Medicare rate per minute for short consultations was higher than extended consultations. Whilst preventative health lectures in medical school push us to address the social determinants of health, how can we do so in less than 20 minutes each time? In that time, it would be impossible to truly get to know the wounded man in the blue sleeping bag, let alone make the necessary referrals to social support services and groups.
There is no time to get to know a patient, let alone a man who fears for his life on the cold, hostile streets.
There is also a fundamental flaw in our education. Medical schools instil the concept of “empathy” into their students, yet the majority of marks in assessments are awarded to the number of questions covered and whether students were able to come to a provisional diagnosis. All this without having to show a genuine interest, the ability to hold a genuine conversation, or respect for the patient without interrupting them within the first minute.
And how can speaking to a homeless man be the norm if we are never exposed to homeless communities in medical school? We are only exposed to a maximum of 2 compulsory community rotations from our 5, 6, maybe 7 years in medical school. Fear of the unknown is derived from such limited exposure. Fear of what they are like, fear of what they could do and fear of not knowing what to do.
Moreover, there is no incentive. Consultants can bill for the ECG they conducted, the procedures completed, but not for the effort they invested in getting to know their patient. Going the extra mile for a patient does not guarantee progression or advancement in a training program. On the contrary, it blurs the lines of professionalism and duty of care.
However, with a paradoxical healthcare system and a flawed education system comes a set of opportunities for personal growth and development.
Medical students and doctors choose to go into medicine for the intrinsic rewards of caring for and looking after patients. As medical students, we should constantly re-evaluate our goals, values and priorities to ensure that we haven’t lost sight of the humans behind the medical charts. In spite of the increasing burden on healthcare and rapidly evolving technology, we should stop for just a moment to listen. A moment to remember their faces and stories, not their lipase or calcium scores.
We should take initiative where we can – to seek out more opportunities for community involvement, to advocate for assessments to focus on self-development rather than pure academics, and to step outside of our comfort zones more and have a chat with the terrified man on the street.
Most importantly, we should continue to strive to be a better person than the day before: more genuine, kind-hearted and empathetic, not just with words, but also with our actions. Perhaps this is what it truly means to be a good consultant.
Submitted to the 2022 MIGA Essay Competition.
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