How To Know If You Like a Medical Specialty

So you’ve finished medical school. Five long years of learning different subjects. Examining diverse facets of disease and its cure.

Then you became a medical intern. And went on to get hands-on exposure to stuff you’d learned from textbooks. That was a new experience.

And now you’re wondering…

Do I like this specialty enough to choose it for my career?

In other words, you may be asking:

“Should I be a surgeon?”

Or an obstetrician. Or paediatrician. Or anaesthesiologist.

Or… anything.

How to know if you’ll “like it”?

Let’s explore this…

WHAT ELSE DO YOU LIKE?

Think of other things that you like.

Food?

Okay. Let’s take food.

We all know what you mean when you say, “I like chicken biriyani” or “I like ice cream“.

The experience of eating a delicious, tasty meal is familiar. It delights your senses while it’s happening. And leaves you with a pleasantly comfortable satisfaction when it’s finished.

Or think of a movie.

We’re on the same page when you tell me, “I like this lovely film we watched last night“.

The sensation of pleasure from well-scripted storytelling is one most people have gone through. You enjoy the acting, songs and music, visual effects, ambience in the cinema house, and more.

So it’s natural to think in the same way about… everything you “like”.

Unfortunately, what determines if you’ll “like a medical specialty” isn’t quite the same as watching a movie or eating food.

No.

In fact, not at all.

The pleasurable sensations that accompany a meal or entertainment are FEELINGS which guide you to conclude that you “like” it.

What governs a choice of medical specialty, on the other hand, is much more than just feelings.

Yes, feelings do have a role in arriving at your decision.

But primarily, it is a LOGICAL/INTELLECTUAL exercisesupported by your feelings.

To pick a specialty or career based on how it makes you feel (especially for a very brief duration, such as a rotatory internship posting) can be a critical mistake.

One that could haunt you – for the rest of your professional life!

So if you can’t rely upon the time-tested, familiar concept of FEELINGS to decide a specialty, then…

How to know if you’ll “like it”? Or not?

Bear with me, because this is going to be a long-drawn explanation.

It’s long because it is important to know all of this – and there’s quite a lot that goes into it.

After all, this process will determine the kind of work you’ll do… for the next 20, or 30, maybe even 40 YEARS!

Questions To Help Know If You’ll LIKE It

We’ll explore the tricky question – by asking a whole bunch of other questions, to which you’ll seek answers.

Let’s group them under some heads, to make it easier to follow along:

  1. Downside: Hope for the best, but prepare for the worst‘ is great advice. So what if you saw all the downside of a particular specialty – and still like it?
  2. Challenge:If you’re not growing, you’re dying‘. A career path should allow for growth, and not throttle your ambitions and talents. Does your preferred specialty allow it?
  3. Reward: Humans are rather simple animals. We seek reward, and avoid punishment. Work fills much of our day. Will working in your specialty offer you adequate rewards?
  4. Aptitude: We tend to focus on things we know to do well. And often, when we’re good at it, we begin to like doing more of it. So being competent at tasks and skills in a specialty matters.

So let’s move on to what I’ll call ‘Core Questions‘ in each of these categories.

Answers to these Core Questions can lead you closer to knowing if you’ll like a specialty – or not.

DOWNSIDE

Here are some questions to ask yourself:

  1. Can I tolerate the worst bits – because the best ones are worth it?
  2. Do the less exciting parts at least seem tolerable?
  3. Will I get bored to death by the daily routine?
  4. Is there enough diversity or variation to keep me engaged and excited?
  5. Can I imagine myself doing this for the next 20 years?

Look, the opposite of ‘love’ isn’t ‘hate’… it’s INDIFFERENCE!

You simply stop caring.

The biggest downside from choosing ANY specialty is that the worst, most boring, least exciting parts of it – will drive you nuts!

When you first experience any field or branch, it’s natural to be fascinated by only the best parts.

But stuff grows old really, really fast.

I still vividly remember learning how to tie surgical knots.

For weeks, I struggled with it. And then, the late Dr.Thiyagarajan taught me during a posting in Casualty.

After hours of practice late into the night, I mastered not only the 3-finger technique, but soon could also tie knots using only one… as well as ‘square the knots’ effectively.

At that moment, I was THRILLED!

Years later, as a heart surgeon, every operation involves tying FIVE HUNDRED knots – or more.

I do it automatically, mechanically, without even thinking about it!

So an important element to get clear in your mind is this…

“Can I handle the most dull, boring, routine parts of a specialty – because there’s so much else in it to look forward to, and keep me hooked?

And be fully aware that what seem to be the most exciting, novel, fascinating bits today… may soon end up becoming that mundane routine!

SIDE NOTE: A Funny Syndrome!

Before moving on to the next category, a word about an interesting phenomenon.

You’ve surely seen it before.

A desire to hop and flit… from one choice to another.

  • Today, you’re fascinated by surgery.
  • Tomorrow, a brilliant diagnosis makes you enamored with radiology.
  • And the day after, you see a complex childbirth – and want to become an obstetrician.

In other words, the momentary thrill and excitement of a remarkable or dramatic achievement sways your career choice in a certain direction.

Nothing wrong about that… just as long as it doesn’t keep happening over and over!

This phenomenon isn’t rare, though.

It even has a scientific term for it.

SHINY NEW OBJECT Syndrome!

The important lesson is… to resist it.

It’s where these questions under the ‘Downside‘ category come in handy.

Because no matter how appealing or attractive a specialty seems in the short term, there are very few you’ll still ‘like’ after you’ve addressed the questions in the ‘Downside‘ category.

Now the next set of questions kicks in…

CHALLENGE

Here’s what to ask yourself:

  1. Is it intellectually challenging and stimulating?
  2. Will I have an opportunity to grow?
  3. Will it stretch my limits and force me to keep improving?
  4. Are things evolving? And do I have to keep adapting?

Your work will fill a significant portion of your life. And how much fun, challenge and fulfilment you find in it will determine the overall trajectory of your life itself.

If you’re stuck in a job with few challenges, that doesn’t test the limits of your potential, that won’t keep you on your toes, or inspire you to improve and get better… then sooner than later you’ll get bored with it.

A career which will motivate you to keep improving in an attempt to master your art or craft is the opposite.

You’ll never grow tired of it.

In the broader arc of your life, you want to look back at any point and see how far you’ve come since the beginning.

If, 10 or 15 years from now, you do this – only to discover you’re still pretty much where you began… it can be pretty disappointing.

A specialty that challenges you to give your best will never leave you with this tragic realization.

Because you will have changed as you practice it, and grown in expertise.

Never forget… If you stop growing, you start dying.

And it’s hard NOT to ‘like’ something that keeps you alive!

Okay…

Next, consider the practical advantages from picking a specialty.

REWARD

Here are some questions to ask:

  1. Can I be famous and popular in it?
  2. Will I make enough money?
  3. Does it take me towards my deeper purpose in life?
  4. Are the results likely to give me satisfaction?
  5. Does it align with my other priorities?

Work is an important aspect of your life.

But it is not your entire life.

It fits into a bigger, more complex whole. And your career choices have to be consistent with the rest of it.

Just because something looks like it might be a lot of fun today isn’t a good reason to pick it as your future choice… if it won’t bring you other things you want.

Or need.

And what you need may not be material – like money or possessions.

They may even be intangible.

  • Like respect in society. Fame and celebrity. Recognition by peers. Admiration of other people.
  • Like a deeper satisfaction that what you’re doing has meaning and value to others – and to yourself.
  • Like a sense of making a difference, by doing what you do.

All of these are good reasons to ‘like’ a specialty – even if this involves doing things that aren’t always (or even usually) fun or exciting!

The final category – and there’s a reason this comes at the end – is your unique suitability for the field of interest.

APTITUDE

Here are some questions to ask:

  1. Am I good at the job?
  2. Do I enjoy doing the various tasks in it?
  3. Have I got any skills, traits or strengths that make me better suited than others?
  4. Does it match/fit my personality?

Why does this matter?

Because it’s hard to remain excited about something you realize you aren’t really good at.

Sooner or later, you’ll run out of enthusiasm to carry on.

Or settle for a level of mediocrity in what you do.

If there are few other options available to you, then this is okay. But imagine if your unique skillset was a great match for something else and you’re stuck in the wrong place!

That’s why aptitude is even a factor to consider.

If you find yourself ‘good’ at doing some tasks, or handling certain situations, you tend to like the specialty.

By contrast, if you find yourself bungling jobs, or struggling to acquire some skills, you may not like it as much.

And yet, to decide purely on this basis can also be a mistake.

Because skills can be acquired, honed and developed over time.

With effort.

And practice.

As long as you have a deep INTEREST in doing so.

That’s why this is a non-critical element in deciding whether or not a field is right for you – even though it will deeply influence how much you ‘like’ it!

So What Have You Learned, Until Now?

  1. It isn’t easy to know whether or not you ‘like’ a medical specialty.
  2. This is significantly different from ‘liking’ food or films, because your FEELINGS about a specialty are only a small part of the whole.
  3. To really ‘like’ a medical specialty, it should be one that
  • will challenge you to grow
  • you can accept the downside
  • will adequately reward you
  • you have an aptitude for
  1. Before you can say that you ‘like’ a medical specialty, you should determine if it can offer ALL that you want from your professional life!
  2. To really ‘like’ a specialty, you cannot rely upon short-term gratification provided by feedback, mastery of a few skills, or even a warm glow you feel from working for a brief stint in the branch or field.

Okay, so what’s next?

Clearly, to decide if you ‘like a specialty’, you need more than just a couple of weeks’ exposure in it.

You need a lot of data.

And information.

Only then can you decide meaningfully.

And not rely upon a knee-jerk reaction which is driven by recent, transient, unreliable impulses or experiences.

Broadly, you need information in two areas.

  • KNOW YOUR FIELD
  • KNOW YOUR SKILLS

How To Know Your Field?

Well, you already do.

For 5 years, you have studied enough about the various fields and specialties to have information about some things.

  1. What diseases or conditions will you treat?

An oncologist treats cancer. A cardiologist deals with heart disease. An epidemiologist handles all kinds of conditions. A research scientist could dive into diverse areas.

  1. How will you treat them?

A surgeon will cut to heal. A physician will peddle pills. A healthcare administrator will make policy. A preventive medicine specialist will intervene to prevent illness.

  1. Who are your patients?

A gynaecologist will treat women. A paediatrician cares for kids. A geriatrician deals with the old and infirm. Each derives a different kind of meaning and fulfilment from their field.

  1. How will they be impacted by your specialty?

An emergency physician will very literally keep a patient alive. A palliative care expert will make one’s remaining years more comfortable. An anaesthesiologist keeps surgery pain-free. All benefit their patients – but in starkly different ways.

A few of these will appeal to you. Others will not.

The answers will help guide you towards a specialty you’ll ‘like’ – for the right reasons.

And then, there are questions that will make you pause and consider – to form your opinion based on facts that you already have:

  1. What is good about the way you’ll treat them?

A surgeon might feel a thrill from going right at the heart of the problem and cutting it out. A physician enjoys achieving the same result without blood and gore. A radiotherapist thinks getting there painlessly and remotely is the bees knees.

All specialties have their positive elements.

Something about it should appeal to you deeply – before you can reliably state that you ‘like’ a specialty.

  1. What’s not so good about it?

A surgeon cuts and sews. It’s painful. And invasive. If the same results can be delivered with less intrusion and pain, it would be better. So interventional cardiology may be a step ahead of cardiothoracic surgery.

Every specialty has things that aren’t so good.

  • Emergency neurosurgery may involve operating on trauma victims at all times of the day or night, wreaking havoc with your personal life.
  • Obstetricians deal with the tendency of little ones not to respect your sleep-awake cycle.

You should at least be aware of these things, and consider them as being a part of your life in this specialty – before taking a call on whether you ‘like’ the field or not.

And finally, there are some questions you’ve probably not asked yourself earlier – but already have enough information to address reasonably:

  1. Over the course of your career, what benefit will you deliver by practicing your specialty?

Imagine yourself as a practitioner in this field. Project into the future. Think of what you’ll have done – 5 years from today.

10 years.

Twenty.

Longer!

  • How will you have changed the world?
  • Helped your patients?
  • Improved yourself?
  • Grown in stature, position and reputation?
  1. What price will you pay in other areas of your life by picking this field?

You can’t make an omlette without breaking eggs.

Some medical specialties come with baked in ‘costs‘.

In terms of frustration and hardship you’ll suffer. In time spent away from other things and people. In degree and intensity of your commitment to patients.

And no, it’s not all the same.

A neonatologist in charge of 30-week premies lives in a kind of pressure-cooker environment that’s completely foreign to a consultant dermatologist.

There are many intrinsic dangers in specific fields.

Psychiatry puts you in close contact with the mentally unsound. Anaesthesiology gives you easy access to potent drugs with addictive potential. Surgery exposes you to physical danger in high-stress situations.

Will you really ‘like’ a field after you’ve considered these ‘costs’?

THE ART OF ASKING QUESTIONS

How to discover all this information?

One way is through experience. That might take too long.

Another is through somebody else’s experience.

Yes, by asking them questions, you can tap into their mind for help.

But before going down this path, you must be aware that there’s an art and method to asking questions that will bring you the right answers.

After all, you’ll only get what you ask for!

Here are the 2 biggest things to remember:

Know What To Ask – And What NOT To

Let’s say you’re interested in becoming a surgeon.

What should you ask someone, if you want help or guidance with your decision?

You could ask:

“Hey, ____________ . Should I become a surgeon?”

Or:

“I’m thinking about becoming a surgeon. What do you say?”

On the other hand, you could frame your question differently.

You could ask:

“Hey, ____________ . Why do you think General Surgery is a good specialty?”

Or even:

“What are the pros and cons of being a surgeon?”

At first glance, they all appear similar, as just different ways of asking the same thing.

To appreciate how they aren’t, you should slow down or pause for a moment – and think!

Yes, all of these questions call for an opinion.

But the first set of questions goes further – and requests a recommendation or suggestion.

In other words, you’re asking somebody to decide FOR YOU!

With the second set of questions, you’re asking for more information… to help you decide for yourself.

That’s an important reason to spend some time thinking about what you’ll ask a guide or mentor, a friend or parent, a colleague or senior.

If you word your question optimally, you’re more likely to get a rich source of valuable information… which will help you decide wisely and well.

But ask the wrong question, and what you’ll get back is worthless!

Know WHOM To Ask

When you’re seeking more information, it can seem tempting to look everywhere.

Or ask everyone.

That’s a mistake.

I’ve often said that if you’re seeking investment advice, you want to ask Warren Buffett – not the homeless guy on the street.

Buffett has returned a 23,000% return on his investment over 25 years. The homeless guy, no matter his other redeeming qualities, didn’t.

So picking the right person to ask for advice matters.

When you ask someone who lacks enough experience to guide you, you’ll end up with incomplete information. Or the wrong perspective.

When you ask someone who isn’t successful in a field, you’ll get a tinted view – as seen through the lens of failed dreams and hopes.

Try to ask people who have both experience and reasonable success in a field for advice – because they are the ones you seek to emulate.

You’re not setting out trying to fail!

The rest of the art of asking questions is stuff you’ll pick up as you go along.

As you talk to more people, you’ll learn that certain types of questions extract more helpful information than others.

Use those in future conversations, and you’ll quickly get to your goal.

THE SKILL OF ANALYZING ANSWERS

Ask the right questions, and you’ll get helpful information.

But there’s still one important step left…

Analyzing these answers.

Always remember something. You’re asking for opinions.

Most people will gladly give you one.

But there’s a problem.

It’s THEIR opinion.

And that may not always be in YOUR best interests!

Why not?

Because it will be colored by the other person’s background, experience, views and mindset.

Worse, they may not even be honest – and merely reflect what YOU expect them to say. (Many people do this, to appear popular or friendly!)

So as you think over the response you get, keep in mind the fact that you’re dealing with a set of biases.

There’s Recency bias.

If I ask you which is your favorite movie or book, you don’t immediately scroll back in your memory to every film you’ve watched since childhood!

No. You pick from the ones that spring to mind first.

And many of them will be recent.

We are all biased to recall (and assign higher value) to recent events and experiences.

So if you ask a PG resident trainee or a freshly qualified graduate about her specialty, you’ll get answers that are biased by their recent experiences (good, or bad).

Then there’s Confirmation bias.

If you ask somebody who has already made a decision ABOUT that choice, they will be strongly biased to confirm it.

So if you ask a PG trainee in a General Surgery program, you’re likely to get answers confirming that it is a good choice of specialty.

Obviously. Unless the guy is an idiot, he wouldn’t be in it if he thought otherwise!

There are all kinds of other biases baked into answers you’ll receive – to even your most intelligently framed questions.

But that doesn’t help when you’re looking for balanced information to help you decide.

That’s why you should be aware of bias – and CORRECT for it.

Analyzing the answers helps you do this.

You discount proportionately to the bias you assess, and weigh the information according to your analysis.

And see if it agrees with what similar others say or feel on the issue.

Only then should you factor in that information – to make your choice.

If it sounds as if all of this is complex and difficult, you’re right.

It is.

This is essentially a process of SELF DISCOVERY.

And sometimes you’ll find out stuff about yourself that isn’t what you expected.

Maybe better.

Or maybe worse.

Still, that’s why nobody else can do this for you.

Only you have the time, interest and motivation to explore yourself in such depth and detail.

But then, you’ll also be the one to reap the rich rewards that come from this exercise.

Finding what’s right for you is just one of them!

P.S. –

There’s one final (but important) point to highlight.

In all these factors to help decide if you ‘like’ a specialty, I’ve almost completely ignored FEELINGS.

That’s because if all these elements are not optimally present in the specialty choices you’ve short-listed, then no matter how you feel about it today, you’re making a mistake.

And the corollary is true.

When everything else is aligned with your life goals, but right now at this point in time, you simply don’t FEEL excited or thrilled about the specialty, maybe you shouldn’t dismiss it out of hand.

Because a sense of temporary discomfort, inconvenience and even moderate suffering in the course of working on a career or specialty that checks all of these boxes… is well worth the trade-off.

In other words, the price is worth the product.

And focusing on the cost alone may well get you a worthless item in exchange!

Discipline

It’s easy (and tempting) to end this section with just a simple sentence.

Be disciplined. It will help you tremendously as a doctor.

After all, this is self-evident.

If, at the end of five years of medical college training, you have not yet figured out (or accept) that discipline is an asset, what I tell you in the next five hundred words certainly won’t change your mind!

Still, let’s take stock.

Take your typical day at work as an intern.

You wake up in the morning and leave for the hospital. Before that, you go through a set of rituals. Brush, bathe, breakfast and more.

Imagine if you lack discipline – and do whatever you like or can.

You may show up to work with bad breath.

Or unwashed, wearing wrinkled, smelly clothes.

Or unshaven, and uncombed.

Think about the impression you’ll make with your patients.

And colleagues.

Will you convey a sense of calm assurance to those who have placed their health – even life – in your hands?

Will you project an aura of competence and efficiency to your consultants and staff?

Will you feel the confidence and authority you need to perform your duties effectively?

Now look back to your morning –

And imagine how different things might be with a little more discipline.

You’ll wake up on time. Go through your morning toilet. Wear clean, fresh, well-pressed clothes.

You’ll have a nourishing breakfast to keep you energized for the day ahead.

You’ll arrive at work on time, feeling relaxed, comfortable and confident.

All of this merely from the application of a little discipline… to one tiny facet of your life – the morning ritual.

Now extend this impact across all areas of your work and life.

How do you go about the day’s duties? With practiced and systematic efficiency… or random, scatter-shot chaos?

How do you carry out your tasks? With a methodical approach… or willy-nilly, doing whatever catches your fancy?

How do you organize your time? With a list of things to do that you check off… or rushing from one crisis to the next?

The list goes on and on.

With some discipline, you’ll have more time for tasks, get more done, and even be able to catch a coffee or lunch break in between.

Without it, you’ll always be on a treadmill… running faster simply to stay in one place!

If you still don’t see how important it is to be disciplined… well, go ahead and do your own thing.

But if you’d like better control over your work and life, make a change right now.

Be disciplined. At everything.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Professionalism

It’s a loaded word.

‘Professionalism’ means different things to different people. And maybe you’ll devise your own definition for what exactly it means – for you.

Let’s pull out our trusted dictionary and see what it has to say.

“Professional: taking part in an activity… in order to make money”

Let’s parse this into its parts.

A professional works for money. Automatically, this implies a few things.

She is:

  • fully trained and competent for the job
  • licensed and qualified to do it
  • good enough to be worth paying for
  • going to finish the work… no matter what

A medical doctor fits the bill – in all respects.

You have studied and trained for 5 years. You’ve acquired knowledge and skills that make you capable of treating patients.

You have passed tough examinations, and received degrees. You have been licensed by your Medical Council to practice as a physician.

You are good enough (or soon will be) to justify any fee you charge for your services.

And that brings us to the crux of the matter.

To one other thing sets a professional apart from the rest we call ‘amateurs’…

A professional simply gets the job – no matter what.

It means you don’t let personal or extraneous concerns affect your work.

You’ll delay personal gratification.

You’ll ignore constraints and challenges in your environment.

You’ll focus entirely on the job at hand.

And you’ll get it done.

There will be days you don’t “feel like doing it”. Or are “not in the mood”. Or have “other urgent problems” to address.

It’s at these difficult times when your professionalism comes to the fore.

Surely you’ve heard other senior doctors talk about always “putting the patient first”.

This is what they mean.

When a patient arrives at your clinic or hospital seeking help for a health condition, it’s because of their trust in your professionalism.

That trait which sets you apart from all other non-professionals.

In the sense that you’ll do right by them – regardless of anything else.

There are a few other aspects of professionalism we can address.

Like how you dress and carry yourself – with dignity, decency and decorum.

Like how you talk and behave with your patients – politely, kindly, and with compassion.

Like how you go about your work – with dedication, focus and competence.

All of this matters.

But what overwhelmingly sets you apart – makes you a true professional – is your commitment to get the job done.

No matter what.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Defer Gratification

Today’s world, driven by social media, has become one of instant thrills.

We’ve all experienced the dopamine rush of a fancy post on Instagram, or a little victory shared on Whats App, or a slew of ‘Likes’ on Facebook.

And it’s spoiling us.

We’ve grown to expect instant rewards – for everything!

That’s not real.

Imagine a farmer sowing seeds today, and plucking out shoots a week or two later – to be disappointed at how tiny his veggies are.

In a powerful psychology experiment from the 1970s, kids around ages 4 to 7 were given two options.

They could eat a delicious marshmallow placed in front of them… right away.

Or… they could wait for 15 minutes before they ate it – and get one more extra marshmallow as a reward.

Researchers watched and recorded the kids’ reactions through a little one-way window.

It was hilarious. You can see a similar experiment here:

Here’s the important conclusion they reached.

Some kids were able to resist the immediate temptation – and won their extra treat.

Others couldn’t, and gave in shortly.

Follow up concluded that the kids who were able to defer gratification were more competent as teenagers, and scored higher on SAT scores.

Putting off the desire to indulge your whims and fancies is a job requirement for doctors.

Feel desperately thirsty and want a drink? Wait!

Badly need to go to the toilet? Wait!

So sleepy you can’t keep your eyes open? Wait!

Tummy growling with hunger, craving a snack? Wait!

And that extends to other areas of your work and career also.

Like how you choose to swot over an entrance exam – instead of chilling with friends at a party.

Or spend time at a patient’s bedside – rather than celebrate a brother or sister’s birthday.

Or toil for months, even years, on a unit – so that you’ll be given more responsibilities once you’ve proven yourself.

In all these examples and more, the easy alternative is more appealing, more fun.

But you can pick them… only at a disproportionately high long term cost.

Like waiting for years to specialize.

Or losing a patient or dealing with medical complications.

Or staying just at a junior level, doing scut work.

In hindsight, these ‘punishments’ are not worth the short-lived ‘joy’ of indulging your impulsive urges.

That’s why it ought to become a practiced habit to…

Defer Gratification.

It isn’t natural.

Or even normal.

For a doctor, though, it’s both.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Patience

Doctors want more patients.

What they often need is more patience.

Patience with others.

And patience with themselves.

We’re all in such a hurry. Most of the time.

When you were younger, you were in a hurry to grow up and do important things. Now that you’re done with medical school, and stand on the threshold of your upcoming medical career, it’s natural to feel even more urgency to move ahead.

Get a PG seat. Complete a specialty. Set up a practice or join a hospital.

Begin work.

Treat more patients. Make a name and reputation for yourself. Earn a lot of money.

And do all of this… fast!

That’s a praiseworthy effort. After all, there’s no point wasting time when you can speed up and move ahead.

However, some things cannot be rushed.

It may take some time before you become adept at drawing blood samples, inserting i.v. lines, doing dressings.

It may take even longer to get comfortable with more complex or difficult procedures.

Be patient – with yourself.

It may take a few days, or even weeks, for a rather sick patient to improve and get well.

It may take several attempts before an elderly or confused patient can understand what you’re saying, or to follow instructions.

Be patient – with them.

It may take a while before your chief or consultant trusts you enough to let you do carry out some procedures or take on responsibility.

It may take some effort to get comfortable with translating what you learned in theory to practical use in patient care.

Be patient – with the process.

There will be inevitable delays in your career path. A few phases where things seem to stagnate with little if any progress.

There will be some difficult cases where progress is slow and irregular, with setbacks and complications.

There will be times when people, circumstances and sheer luck seem to work against you, hold you back, slow you down.

Be patient.

Lao Tzu says: “Nature never hurries, but nothing is left undone.”

And remember…

Good things come to those who wait.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Optimism and Determination

Things look bad. The world’s in a mess. All around there’s chaos and confusion.

Does that sound like a description of today?

Well, it always rings true… across history!

Charles Dickens opens his 1859 novel ‘A Tale of Two Cities’ with:

“It was the best of times, it was the worst of times… it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”

So… it has ALWAYS been like this.

But as a young doctor, you need optimism and determination.

Not only to do your own work well, but also to communicate these feelings to your patients.

Healing takes not only medicine, but also mental energy.

A positive, hopeful attitude reinforces any treatment you offer patients.

And it’s especially when things look really, really bad that you have to be more optimistic and determined… for your patient’s sake!

As a resident in surgery, I was once in charge of treating a middle-aged woman with 28% burns.

Anything above 20% was touch and go. Most victims died. A lot could go wrong.

Still I was determined to do my best for her.

Twice a day, for as long as she was in hospital, I personally cleaned and dressed those burns. Even with opiates, she screamed in agony.

But persistence paid off.

Three weeks later, she walked out of the hospital, scarred but alive.

Another remarkable case was a police constable who accidentally shot himself with his service rifle.

Following an emergency left hemi-colectomy, his wound got infected. It resulted in a ‘burst abdomen’.

For six full months, my co-houseman and I painstakingly dressed the wound daily. And fought to nourish him and prevent other complications.

When he finally was discharged from hospital, the policeman had lost forty kilograms in weight… but he was alive!

Neither of them would have survived – without a doctor’s optimism and determination.

Think about it for a moment, and you’ll see why.

If you don’t believe a patient has a chance to survive, you’ll naturally be less involved in your care.

A bit less meticulous with a dressing. A little more casual in prescriptions. Somewhat more dismissive of complaints.

But if you are convinced that this patient will live if you try hard… then just as naturally, you’ll make your best effort to save that patient’s life!

Right?

A lot rides on your state of mind.

Your degree of optimism.

Your level of determination.

The nice thing about this is that – it’s a virtuous circle.

So, you give it your best shot and the patient has a good outcome…

Suddenly, your outlook on such cases changes.

You’ll find yourself thinking about the next case – with more optimism.

You’ll be even more determined to save the next patient’s life.

And so…

You will.

The reinforcement loop just keeps getting stronger and stronger.

Pretty soon, you’ll have an unbeatable belief system.

Every patient deserves your best effort.

So be optimistic.

And stay determined.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Curiosity

Ever since you were a kid, people have tried to throttle your curiosity.

In many different ways.

“Don’t keep asking silly questions,” they’ve said. “Just do what I say!”

Or they preached a pithy homily: “Curiosity killed the cat!”

If you continued to stay curious despite all of this, good for you!

But even if you didn’t, growing up from intern to doctor requires that you rekindle your curiosity – once again.

Being curious about things is a fantastic way to learn and grow.

Unless you’re curious to learn, you’ll hardly ever take the initiative to explore, examine and evaluate.

Let’s say you’re sitting in the out patient clinic, and a patient arrives with an unusual set of symptoms.

You could prescribe something soothing and send him away.

Or refer him over to another senior doctor.

Those are simple ways to deal with the case – but you’ll gain little from it.

On the other hand, if you were curious to learn more about this strange combination, you could:

  • Go along with the patient to ask a more knowledgeable doctor about the problem
  • Look up the symptoms in a textbook or website, to figure out what may be causing it
  • Discuss the interesting case with your peers and colleagues to see if anyone has seen it before

All of this involves making a greater effort. Taking more time. And asking people for help.

But then, it also helps you learn something new about a condition you didn’t understand earlier.

And the next time you see this problem – maybe years later – you’ll be better equipped to handle it confidently.

Being curious about the world around you leads to delightful experiences.

You’ll remain watchful and observant of things happening.

You’ll actually engage with the people you meet, and enjoy the places you visit – instead of blankly staring into your mobile phone!

You’ll experience more of the magic of nature and existence.

And you’ll be more keenly aware of the world and your role in it… and want to understand it better.

This in turn leads you to…

Explore new subjects of interest.

Embark upon voyages of discovery.

Examine fresh evidence critically.

Evaluate theories and hypotheses carefully.

And in the end, you’ll know more.

Become more confident.

Be a better doctor.

So… Stay curious.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Work Hard – But Also Smart

It was post-admission day on the medicine unit.

I had “slept” for a couple of hours in the last 24.

Like zombies, we all went through our assigned tasks.

After all the bloods were drawn, and all the case sheets written, at 8:30 a.m. I rounded up cases scheduled for echocardiograms – and prepared to leave.

“Wait, today I’m going with the echo cases!” said my fellow intern. “You handle the ward chores.”

I was a bit surprised. Turns out he believed that it was “unfair that I finished my tasks” by half past ten.

Today, he wanted to take the “quick and easy” path – while I did the scut work here.

I smiled in agreement.

By 12:30, all our work was done. We were getting ready to leave.

Just then my co-intern staggered into the ward. He looked exhausted and desperate.

“Finished with all the echo cases?” our PG asked.

He shook his head.

“No, sir. They say it will only be done last – around 2 p.m.”

“Then why are you here?” the PG said angrily. “Go back and sit with the patients. Come back with them when you’re done!”

Next week, I asked if he wanted to go for echocardiograms again.

He practically begged me to handle them. I knew the cardiology chief personally, as he was my dad’s friend. As always, I jumped the queue – and finished my scans in half an hour!

Working hard is absolutely necessary.

No doubt or question about that.

But so is working smart.

Tailoring duties and tasks to suit an individual’s skills, interests and ‘connections’ is smart.

Demanding equal distribution isn’t.

Dumping your work on someone else is rude and nasty.

But swapping stuff you’re not good at, for others that you enjoy, can help everyone finish sooner.

Win-win.

Which brings me to one of the most important lessons of all that you’ll learn during internship.

I myself learned it only towards the end, after around 10 months.

So you’re short-circuiting your ‘learning curve’ by reading this today!

An intern should not only work hard… but also SEEN TO BE working hard.

In other words, just getting the work done won’t do.

Other folks must be aware that YOU did it.

You should learn how to subtly slip in such references to your performance, sincerity and responsibility – so that others are aware of it.

Like asking an ‘innocent’ question:

“Sir, what does ‘NPO’ mean? The duty PG asked me in the emergency ward this morning, when I went to write progress notes for our patients.”

Or clearing up a ‘doubt’:

“Madam, when I went to the blood bank to reserve blood for tomorrow’s cases, I asked for 4 FFP… Will that be enough?”

Or sharing an interesting observation:

“There was a crowd in the pathology department when I went to collect our patient’s results. It seems there was a…”

It looks odd if you declare, over and over: “Today I did this. And that. As well as those.”

But you’ll achieve the same result – subtly.

You’ll seed the fact that you’re working hard – into a more general observation!

Now, here’s the bigger question:

Why does this even matter?

Won’t people notice anyway that you’re working hard – and treat you accordingly?

In an ideal world, yes.

This world is NOT ideal.

Your seniors – PGs, APs, chiefs and others – honestly don’t care WHO does the work… only that the work gets done.

If it’s not finished, everyone gets scolded.

If it is done, they’ll simply assume that whoever claims credit for it – actually did the work!

That’s why it’s smart to be SEEN TO BE DOING the work!

You can’t count on luck and chance to handle this for you.

And if you’re paired with a savvy co-intern who knows the tricks of claiming credit… you’re stuffed!

So become that savvy co-intern – yourself.

Take control of your own propaganda.

Definitively stake a claim for credit – to everything you’ve done.

And if you like, try and get some for stuff others did – but didn’t own!

(Don’t worry about this being ‘so unfair’ – because it all evens out anyway. Some things you do will get claimed by others. Net-net, at the end of your internship year, you’ll have got just about as much credit as you’ve done the work for!)

There’s a corollary to this point:

If you see a clown getting away with doing nothing – and yet cons people into believing s/he’s slogging real hard… don’t get annoyed.

Understand this:

Your seniors have all reached where they are after YEARS of experience with this kind of behavior.

We’re good at spotting ‘work shirkers’.

And often can intuitively tell that a certain guy or gal is going to be one of them… even before seeing it happen.

In the short term (days, or a couple of weeks), the lazy intern can get away pretending.

In the medium to long term, s/he won’t. And can’t.

By trying to fool/cheat others (seniors, colleagues, authorities, etc) – you’ll only end up cheating yourself.

And your patients.

Don’t do it.

Internship is a formative phase in your medical career.

A period during which your lifelong work ethic is being shaped and firmed up.

I’m yet to see a lazy, work-shirking intern magically transform in later years into a hard-working, sincere, dedicated physician… and doubt if it could even happen, unless as among the rarest of exceptions.

By and large, the kind of attitude and approach towards work that you establish as an intern – will extend into the rest of your professional life.

Hence the consistent advice…

To work hard, and to work smart.

To be seen to be working.

To avoid shortcuts and ‘cheats’.

To develop discipline and stamina that will last you forever.

Now… get back to work!


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Reduce Unfairness

Life is inherently unfair.

And the world is an unfair place.

If you haven’t already realized this, your internship year will help reinforce the lesson strongly.

Over the course of this year, you will see so many things that cannot – by any stretch of the imagination – be considered ‘fair’.

Kids sometimes get terribly sick; a few even die.

Young lives are abruptly ended by road accidents.

Noble and ethical people suffer the ravages of disease.

Healthy habits don’t seem to safeguard against illness.

And on and on…

There’s so much to destroy any faith you might have nurtured about the world, and its sense of “fair play”.

But as a doctor, you can’t indulge in childish regrets over a shattered illusion of fairness.

Instead, you must focus on doing whatever you can – to reduce unfairness.

If you don’t like the idea that little babies catch bad infections, throw yourself heart and soul into the mission of vaccinating all vulnerable infants to make them immune.

If you hate seeing a ceaseless flow of head injuries into the trauma ward, become a passionate advocate for wearing helmets and safer driving on the streets.

If you won’t accept the idea that cancer is a relentless killer with no recourse for victims, plunge into basic research into the problem and discover a cure.

If the idea of domestic violence or child abuse disgusts you, pledge to do your part to spread awareness about the problem, and offer suggestions to bring it down or help the victims.

No matter what form unfairness takes, or where you see it, there’s a way to fight against it.

To reduce unfairness.

Maybe you won’t always succeed.

But many times you will.

And that will make your profession really satisfying, and make your work deeply fulfilling.

If you’re tempted to believe that it’s all too big for you to make a difference, remember this tale…

‘THE STARFISH STORY’

One day an old man was walking along the beach.

It was low tide, and the sand was littered with thousands of stranded starfish that the water had carried in and then left behind.

The man began walking very carefully so as not to step on any of the beautiful creatures.

Since the animals still seemed to be alive, he considered picking some of them up and putting them back in the water, where they could resume their lives.

The man knew the starfish would die if left on the beach’s dry sand. But he reasoned that he could not possibly help them all.

So he chose to do nothing and continued walking.

In a little while, the man came upon a young child on the beach who was frantically picking up one starfish after another and throwing it back into the sea.

The old man stopped and asked the child, “What are you doing?”

“I’m saving the starfish,” the child replied.

“Why waste your time?… There are so many of them. You can’t save them all so what does it matter?” argued the man.

Without hesitation, the child picked up another starfish, and tossed it back into the water.

Then he turned back to the man and said…

“It mattered to that one!”

Reduce unfairness in the world.

It matters.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Respect Your Patient’s Dignity

I still vividly remember an incident from my days as an intern. Even the young lady’s face.

She was an M.Sc graduate. At the Family Planning OPD. With an “unwed pregnancy”.

In those days, this was taboo.

An aversion to her condition in the broader general society was maybe understandable, given the norms of that time.

But there’s no excuse whatsoever for how doctors dealt with it.

In an open out-patient’s department, right in front of all other patients, the senior doctor loudly asked her: “Who did you sleep with?”

The young lady remained stoically silent.

Enraged, the doctor screamed even louder: “What? You’re not ashamed to sleep with him, but now you’re ashamed to talk about it?”

The girl mumbled her answer.

And this shameless doctor amplified it.

“What? You slept with your autorickshaw driver? Don’t you have any sense? You’re an educated graduate – and you did this?”

The girl sat in silence, her head bowed, staring at the floor.

I glanced around at my classmates. We were around her age.

Everyone was cringing.

We were ashamed – but not about our patient.

We were ashamed of our professional colleague – who was behaving so crudely.

Should ANY patient experience this kind of torture?

After all, she has come to us for help!

That question would define my attitude towards patients ever since.

Dignity and respect for those we treat should remain the top priority for any doctor… always.

They are human beings first; your patients only afterwards.

And they are NEVER your ‘inferiors’ or ‘dependents’!

There is absolutely no excuse to abuse your position of relative authority over them.

Especially at a time when they are so extremely vulnerable.

To behave in a way or manner that degrades their self respect or strips away their dignity is horribly wrong.

It is critical that every young doctor be intensely aware of this enormous responsibility we are entrusted with by our patients.

They believe that we will do our best – for them.

They come to us hoping that we will solve their problems, ease their pain.

It is a criminal mistake to violate such trust and belief. To act in a way that will degrade or disrespect their sentiments and feelings.

There is no excuse for such behavior on your part.

You may have different beliefs and culture from those of your patients. Your own sense of morals, values and ethics may vary from their’s.

That doesn’t matter.

In a professional context, all of that should fade into the background.

Here, you are healer – they are patients.

You have power and authority – by virtue of your position in the relationship.

Always be aware of this imbalance.

Respect it, don’t abuse it.

Give every patient the dignity they so richly deserve – as humans.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.