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This Week in The Lancet

  • Volume 377 1719 (2011)
  • May 21, 2011

Ben’s TLS 10 Question Challenge!

1. Why did you decide to study medicine?

I chose to study medicine because I wanted to do something that I could see the results of – I wanted to do something that I knew would work. In time, I have learnt that this really meant I wanted to question everything that I was taught – to always look for the reason behind what we are learning. Sadly, this wasn’t always the attitude that was fostered in our medical studies, which became more about rote-learning as many facts as possible. Now that I am taking a year out to study International Health, a large component of which is research and critical thinking, I feel much better prepared to evaluate the evidence that underpins modern medical thinking – which is far from complete!

2. What profession would you be in if you weren’t in Medicine?

I care passionately about global health inequities, and I would like to think that if I weren’t in medicine, I would still pursue a career that allowed me to challenge the injustices that I see in the world around me. In fact, I often wonder if I could do this much more effectively in a career other than medicine – and certainly haven’t ruled that out. While ultimately any care that a doctor delivers is constrained by the social and political environment (you only treat the patients that come to you in the first place), there is some satisfaction that you will at least be helping some people; something that is far from certain for many politicians! However, whether I am studying medicine for my own benefit is something that I frequently need to question.

3. What is your biggest motivation?

The many incredible people I have met throughout my studies – both students, tutors, and others. The outrage that I see so many others share with me at the patent injustices that deny people basic healthcare throughout the world, or force families into crippling poverty to pay for their human right to health. The huge compassion that both patients and carers show on a daily basis. The fantastic energy that many of my fellow students show in advocating for global health equity, particularly through the Medsin network.

4. What are you most interested in so far and why?

I realised after a few years of medical school that I hadn’t really taken up medicine to treat sick people – I wanted to stop people getting needlessly sick in the first place. Public health is a subject that is not traditionally communicated very well at medical school, and so many of my peers find it boring. I find it incredibly exciting, but frustrating at the same time – that so much of the vast cost of the hospital around me, in which I am taught, could be negated by such simple measures to make our society a healthier one to live in. It is so important, as a future doctor, to understand that a patient’s illness is not a product of their rationally-decided behaviour – that they haven’t simply decided to eat unhealthily, and so brought their heart attack on them – but that our behaviours are shaped by our environment, and that only by collectively shaping our society can we open up healthy options for people’s behaviours. Of course, this is much more pronounced in the developing world – it is even more obvious that an outbreak of water-borne disease is not simply bad hygiene, but an inadequate effort by governments and socieites to meet the needs of a community, and the ham-stringing of their efforts by international structures and agreements that ensure the rich stay rich and the poor remain poor.

5. What has been your most difficult module so far and why?

I have always found pathology difficult, mainly because the pink and purple blobs all look the same to me! However, I do find it fascinating learning the cellular mechanisms that lead to the physical signs and symptoms that we experience.

6. Where do you see yourself in 10 years time?

a. The  wishful thinking version:

Working as a district public health officer in a developing country, while working on a research project into the social determinants of health for a PhD.

b. The perhaps slightly more realistic version:

Working as a GP in Scotland, hopefully maintaining links and sharing practices with others in poorer parts of the world through the Tropical Health Education Trust, and hopefully researching health inequalities and the social determinants of health here in the UK as well as abroad.

7. What is the most memorable positive moment in your medical studies so far?

I undertook a four-week placement at the Edinburgh homeless practice in my third year, and met many fascinating patients, whose stories were far from conventional. I sat in on many of the consultations, both with the GP and with the team of substance abuse nurses. Some of these nurses were incredibly empathetic, and managed to gain the trust of patients who had found interacting with formal services nearly impossible. The relationships between these patients and the practice staff was a real reminder of the holistic nature of medicine, and how much more a consultation is than an exchange of a history for a treatment.

8. What is the worst horror story in your medical studies to date?

I’ve been fortunate not to have too many horror stories as yet during my studies; probably because I haven’t had much clinical exposure yet (most of our clinical rotations are in fourth and fifth year). Probably the most embarrassing is being picked out to answer a question in a packed lecture theatre – when I was fast asleep! Probably the most difficult situation I’ve been in is taking a history from a patient who has not been fully clerked in yet, and realising that they are very unlikely to have a good prognosis, but realising they haven’t been told yet. We are taught to break bad news in our course, but it’s difficult to know if it is your place to as a student – or whether it is ethical to mask your emotions.

9. Can you share some things that you wish that someone had told you before you applied to study medicine?

Medicine is not about changing the world; it is about constantly plugging the leaks closest to you. By the time a patient comes to you, much of their health status has already been decided, by their socio-economic status; if you want to help people, that is what needs fixed. Medical education is constantly being re-designed (at least in the UK), and the system which you will pass through is a constant experiment. Many of your lecturers will teach you things that they learnt some years ago; it may have been superceded. If an explanation for the mechanism of a disease or a drug sounds sensible or intuitive, that doesn’t mean it’s correct: only epidemiological evidence can answer that.

10. Can you share some tips/advice for others

a. Wanting to study medicine:

Ask yourself exactly what it is you want to do with a career in medicine – many other careers in life offer opportunities to help others or to change lives. If you do find that medicine is the right thing for you, go for it! But keep in mind why you wanted to do it, when you get caught up in the stress of studying and exams. Medicine opens up a huge array of opportunities – don’t let the tunnel vision of medical school prevent you from seeing them.

b. Already studying Medicine:

Medicine tends to take over your life after a while, so that all your friends end up being medics. Don’t forget to try and find interests and friends outside medicine – and remember that the patients in front of you are almost certainly not medics. Their experiences and worries will be very different to yours, and certainly no less valuable. Keep the motivation that brought you into medicine in the front of your mind throughout your studies, and don’t get too distracted by the sausage-machine that is the medical career ladder – those CV points for a publication, or an audit, or whatever, will come in time, and far better that your energy goes into what you really care about. If you are interested in global health (as most of TLS readers probably are!), there are tonnes of ways to get involved – writing for something like The Lancet Student is a great way to get your thoughts on the page, which can be useful in itself, in reflecting on what you’ve seen or learnt. And just because you’re a student, doesn’t meant that you can’t change the world or speak out against global health injustices – find a local network, like Medsin-UK, and get stuck in!

Ben Warner

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