Doctor, doctor…are you replaceable?
Beyond the white coat and calm that you see in a doctor is a person toughened by rigid schooling and training.
To become a doctor, one has to go through years of physical, mental, and other forms of stress. While there is a shorter equally difficult seven-year course, the regular or standard medical course in the Philippines takes at least 10 years to finish.
Pre-medical course is usually a natural sciences or biological course like nursing, medical technology, pharmacy, biology, biochemistry, and physical therapy.But nowadays, even engineering and other courses are allowed as long as the student has completed the additional required units.
Medicine is a four-year course. The first three years are spent in college studying the science and theories of medicine. One learns the basic courses like anatomy, biochemistry, physiology, and pharmacology. There are regular written examinations – quizzes, preliminary, midterm, and finals. Practical examinations are also conducted. For example, in anatomy, students under time pressure are asked to identify the parts of a cadaver. The waking hours of a student are spent studying, reading, analyzing. During the second year and third year levels, aside from lectures and medical examinations in the college, the student is gradually exposed to actual patients. He is taught to apply the basic principles of medicine in the management of actual patients.
Fourth year is when the student rotates in the different sections of a hospital – this is called clinical clerkship or junior internship. The student becomes the youngest member of the clinical team. He/she goes on an eight-hour or 24-hour duties. And duty can be longer than 24 hours if he/she has to attend to unstable patients or unfinished tasks. He/she is guided by a senior intern, a medial resident, consultant, and other mentors. The clinical clerk is expected to take care of his/her own patients under close supervision. He/she studies and presents cases during medical conferences, during which he/she is questioned (grilled) on diagnosis, treatment, and plans for his/her patient.
At the end of every department rotation, he/she has to pass end-of-rotation tests. Finally, at the end of the year, he/shehas to pass the final comprehensive oral and written examinations. The clinical clerk is now qualified to graduate and is ready for a one-year medical internship in a hospital.
During internship, the future doctor again rotates in different clinical departments for clinical exposure, similar to clerkship but is now given more responsibilities and independence. In each department, the intern prepares for medical conferences in which he/she presents clinical cases, updates, and lectures. He prepares to answer questions about his/her presentations. While doing these tasks burns his/her eyebrows to review for the national licensure examinations. The intern does not receive compensation.
After passing the licensure examinations for physicians, a doctor either goes to general practice, residency, or direct subspecialty training.
For residency training examples of specialties are general surgery, orthopedics, internal medicine, ophthalmology, geriatrics, and pediatrics. Compensation starts only during residency and the amount varies depending on whether the institution is private or a government agency. It ranges from meager to manageable.
During residency years, the doctor faces the same and even more physical demands of daily and/or 24-hour duties. Training also entails written and oral examinations, case presentations, and research studies. Passing these examinations and completion of research studies are required before a resident may be given a certificate. With the certificate of completion of residency training the doctor is qualified to take board-certifying oral and written examinations and once he/she passes these he/she becomes a diplomate and after a prescribed number of years, he/she can apply as a fellow of the specialty society. The doctor is now considered a specialist, a consultant in his specialty.
The specialist can now opt to undergo subspecialty training also called fellowship training. For example, a general surgeon may go for subspecialty training in cancer surgery or vascular surgery. A pediatrician may go for further studies in diseases of the newborn (neonatology). During fellowship training, the consultant continues go on eight-hour or 24-hour duties, take examinations, and constant grilling by mentors sometimes even by co-trainees.
What does it take to be a doctor? A lot: physical stamina to endure duties, mental and psychological preparedness to cope with stress. Younger doctors who err are reprimanded by senior colleagues. Personal and family time is sacrificed: time lost for their children and family. A doctor excels in being absent from most family functions – they miss birthdays, anniversaries, and weddings. Sometimes they do not have time to celebrate their own birthday if they happen to be in the operating room doing a difficult surgery, or in the examination hall taking those day-long tests, trembling in fear of the questions that will be asked by the examiner. Do they even take regular meals or get adequate sleep? From day one of first year medical school the answer is no.
Every doctor is tough material. One may on the surface appear to be strong, but inside he crumblesand feels sad when he loses a patient or the procedure, he/she did was not successful. Self-doubt, sometimes guilt, and frustration are feelings that may occur. It has become an instinct to drop what one is doing if an emergency arises and the life or safety of a patient is at stake.
Every doctor is tough material. When we lose a colleague, we all lose a comrade – a brother, a sister who, though a tough material, is still mortal. Our fallen comrade reminds us too of our own limits.
There will always be an unseen bond among doctors. It knows no race, gender, nor age.
It is probably not just due to the “Hipppocratic Oath” that doctors take before we come full-fledged doctors, it goes beyond that. Somehow lives of doctors are intertwined, literally and virtually. We attend the same conferences, listen to the same guidelines, hone our skills for patients.
Is one doctor worth more than a thousand patients? Yes, and more. He/she was worth all the time and effort of all his/her mentors and trainers, the encouragements of his/her batchmates and friends who cheered on him/her for all his/her victories, big and small. His/her family who stood behind him/her – preparing his/her meals, washing his clothes, waiting on him/her when he/she is tired and hungry. And just always waiting for a free time with him/her. He/she is worth all the younger doctors he/she could train, the lectures he/she could give to educate his/her patients, and the endless capabilities he/she could do to help others. When a doctor dies, he/she brings with him/her all the unique and irreplaceable skills only he/she has developed. Services that only he/she could render.
Please stay at home, you can save the life of someone who seems to be tough.
Medical questions and concerns may be emailed to [email protected] or [email protected].