“Nakaka-disappoint nga Sir, eh. Kaka-declare pa lang na suspended ang klase bukas dahil sa ulan, tinatanong na agad ako kung puwede bang half day sila. Nung (medical) clerk ako, kahit gaano pa kataas ‘yung baha at kahit gaano kalakas ‘yung ulan, pumapasok kami.”
“You have to realize, not everybody sees the world the same way you do.”
“Pero kapag doktor ka naman Sir, wala ka nang nalalamang holiday at suspension. Kailan pa nila matututunan ‘yun?”
I was assisting my consultant in the operating room when we had this conversation. It had been almost a year since I was designated resident-in-charge of the rotating interns in neurosurgery; an unexpected break during the operation provided an opportunity to vent my frustration. I had been receiving negative feedback from the section’s consultants of late.
The clinical rotation in neurosurgery lasts only a week. The interns would go on 24-hour duty in the ER once or twice during the rotation; the rest of the week, they only needed to report during office hours, 7 am to 5 pm during weekdays and 7 am to 12 noon on weekends.The only major requirement is to examine one patient and to present the case to the consultant-of-week in a two-hour discussion. In the dichotomy of clinical rotations, this would definitely fall under the benign or easy category.
But almost invariably, the consultants would complain to me that the rotating medical interns performed way below expectations. Often, I could not say anything in defense of the students.
Despite ample warning, many of the interns would show up for their preceptorials with a crammed PowerPoint presentation. Only one or two from a group of four or five would actually take time to get a detailed clinical history and perform a comprehensive neurologic examination. Fundoscopy, mental status assessment, and gait testing are often forgotten. Once, a consultant walked out during the discussion when the interns presented a case of spinal cord compression without doing a detailed sensory and motor examination. Presentations are copied and pasted verbatim from the Internet or from basic neurology textbooks. And only the assigned member would actually review the cranial CT and MRI plates.
What’s more bothersome are some interns who neglect their basic responsibilities: reporting for duty at 8 am, not reporting at all during weekends, failing to complete clinical abstracts and discharge summaries despite repeated requests from nurses and patients’ watchers, going to the operating room to play with their handheld devices or chat with co-interns rather than to actually observe surgeries, and lack of genuine effort to monitor critical patients conscientiously. Of course this is not true for everyone. But in the hospital which exposes medical students to the most number of neurosurgical cases in the country, outstanding interns who impress consultants and residents have become the exception rather than the norm.
“Baka naman kasi masyadong mataas ang standards mo,” one of my co-residents remarked.
I understand that not everyone will become a neurosurgeon after medical school, but students should at least strive to learn core concepts in neurology and neurosurgery, so that when they practice as general physicians, they would know how to manage emergent cases and refer as necessary. I daresay nobody would disagree that there’s a problem when interns do not know how to do a complete cranial nerve examination or give an accurate Glasgow Coma Score.
Perhaps part of the blame lies in the current medical curriculum, such that seven days in the section is too little time to review what one should have learned in the last four years. Do the interns expect didactic lectures at this stage of their medical education? Do they realize that after medical school, it is self-directed learning that will serve as one’s constant source of new information?
Excuses for failing to do one’s basic responsibilities do not even merit a discussion.
It is possible that the students do not feel the need to exert extra effort in a relatively benign rotation, compared for instance with the Big Four (internal medicine, surgery, pediatrics, obstetrics-gynecology). Benign rotations are seen as time to catch up on the more important things in life. Students seize the opportunity to spend quality time at home, book weekend getaways with friends, or party all night without having to worry about patients decked to them. Minimum necessary effort is exerted to be able to get by and pass the rotation, and there is of course no absolute fault in doing just that.
In my time, I was a diligent medical student regardless of clinical rotation. Hence, I often find myself thinking, “Natutunan ko naman ‘yan nung estudyante ako,” or “Ginagawa ko naman nang maayos ang trabaho ko nung intern ako.”
Is it too much to expect more from future doctors training in the national university hospital?
Medical school is no place to nurture mediocrity. Good enough should never be good enough.
As a doctor, to make a patient feel better is the minimum necessary requirement. That is our implicit obligation when patients entrust their lives to our care. But what patients and their families appreciate is the extra effort we make to fulfill this promise:
Sitting down when we listen to them narrate the events and enumerate the symptoms leading to their hospitalization; staying an extra hour to follow up results of blood tests done during the day, and to update them, so that they would not have to stay up all night wondering if everything was all right; dabbing the Micropore tape with alcohol and gently peeling away rather than yanking out the sticky tape from their skin; negotiating with radiology so that imaging studies could be done earlier in patients who need them immediately; not hesitating to take over as nurse/nursing aide/utility worker (e.g., push the stretcher and oxygen tank, inflate the Ambu-bag, transfer patient to the stretcher) when there’s a shortage of hospital personnel; giving a genuine smile and a promise of hope as we leave their hospital room to go see our next patient.
But before one can go further, one needs to be able to fulfill basic responsibilities. As a medical student, that responsibility is to study well. The pervasive nature of mediocrity is such that medical students who get by with “Puwede na,” “Ayos lang iyan,” and “Bakit ko ba pahihirapan ang sarili ko?” later on become the doctors who deprive their patients of the opportunity to receive the best possible medical care at the soonest possible time. Remember that every minute of delay translates, not just to inconvenience at your patient’s end, but to another minute of unnecessary pain, anxiety, or hopelessness.
By choosing to become a doctor, you make a commitment to pursue excellence, to go above and beyond expectations whenever possible. That commitment starts, not when you pass the licensure exam, but on the day you turn to page one of your anatomy book.