It is usually at this time of the year — as chatter about the ongoing Leaving Certificate examinations reaches a peak — that the nightmares come back. I arrive late for my Irish exam, unable to recall a word of Irish or a single interesting thing that Peig Sayers might have once said. Or I’m rushing late, down a long corridor, unable to find the exam hall and then having done so (it is empty), unable to find my pen.
As if the nightmares aren’t enough, the masochist in me has been further reliving the Leaving Cert experience by entering my results into one of those online CAO points calculators. I fear (even allowing for some points inflation over time) that my rather modest 487 points (thank goodness for Home Economics) would hardly get me into medicine these days.
Getting into medicine is hard, but it should be. Just gaining the points for entry demands a degree of intelligence, sacrifice, hard work and resilience that will serve those embarking on the gruelling slog that medicine is. But it often comes as a disappointment to those who secured 600 points in the Leaving Cert (and a relief to those who didn’t) to realise that being good at doing exams doesn’t necessarily mark you as someone who will become a great doctor.
Patients in a 2009 Mayo Clinic study identified the best doctors as those who are confident, empathetic, humane, able to see their patients as individuals, forthright, respectful and thorough.
Despite the crudeness of the selection process (and it seems no-one yet knows how much the HPAT adds), most of those starting out in medicine that I have met tick many of these boxes and start with great promise. They are bright, enthusiastic, curious, compassionate and optimistic. Apart from the occasional psychopath or narcissist (a few still make it through), most who start off on a career in medicine do so for the right reasons — a desire to make people better. At least that’s how it starts.
But along the way something happens. The very processes that help us prepare for healthcare can diminish in doctors the very attributes that our patients value most in us. The study of disease tends to break patients down into their component parts and systems, and can make us sometimes forget that the patient with a disease is a person.
Long hours, sleep disturbance and the stress of working in ineffective or overburdened healthcare systems can strip those providing care of their own humanity and ability to empathise. And yet despite this process, so many make it through, a little bruised and shaken, but with some great battle stories and with their humanity intact.
Those who have done so will have developed a degree of self knowledge and awareness of their own vulnerability, an understanding of the importance of work-life balance, of having friends and lives outside medicine, by not taking themselves too seriously, by looking after their own physical health, and even understanding how exposure to the lives of others through literature, art, film and theatre enhances their understanding of their own lives and those of their patients. They will have realised that keeping up with themselves is as important as keeping up with developments within medicine.
If the raw substrate for good doctoring (a degree of intelligence, diligence and compassion) seems to be present in most of those starting out, perhaps the trick is to assist us all to develop skills that help maintain humanity in a system that frequently diminishes it.
Wish me good luck with my Leaving Cert repeats, by the way.
Now, where is my copy of Peig?
This article was originally published in The Medical Independent