What it takes to be a doctor

OFTEN the topic of young doctors, namely housemen, crops up in the media. As a parent preparing my children for university, I would like to offer the following feedback to other parents and university admissions officers.

There are at least two types of university courses: Vocational/professional courses that prepare and certify a student for a particular profession, and academic courses that impart knowledge for its own sake.

Many professional courses are also regulated by the government and require a practising licence thereafter. Practitioners usually provide some sort of direct or indirect service to the public. There is also an element of public liability involved as the public is going to be reliant on expert knowledge ordinarily possessed only by professionals to make decisions. Examples of professional courses are teaching, medicine, law, aviation and engineering.

For the purpose of university admissions, vocational/professional training is further divided into those where an “informal sector” exists and those with no informal sector. For example, a student with a passion for teaching can get a “feel” of the profession by teaching their siblings or neighbourhood children. On the other hand, a student with a passion for medicine cannot diagnose or treat their siblings, and likewise a student with a passion to be a pilot cannot hop into a parked plane and fly it around for practice. At most, they can passively “tag” a member of the profession or join related societies like the Red Crescent.

Hence, the protestations of students who say that they have a “passion” for medicine have to be taken with a pinch of salt. This passion may very well be short-lived once the realities of the profession intrude.

This brings me to the vexing question: What form should the filtering/assessment mechanism into university courses take?

When “passion” cannot be relied on, we have to fall back on aptitude and attitude.

Using medicine as an example, the following may be core requirements for the “aptitude” component. These, hopefully, answer the question, “Is this candidate trainable?”

Firstly, intellectual ability: Being a doctor involves being able to read, understand, evaluate, retain and apply knowledge. This is usually reliably assessed by standardised examinations.

Secondly, physical ability: Training to be a doctor involves sleepless nights, standing for long hours and intense physical activity. In short, a young doctor is part of a fighting force.

So being merely healthy is not enough. One has to be as fit as a member of the paramilitary or police forces. This has to be tested on a yearly basis, preferably until students complete their postgraduate training.

Thirdly, mental fortitude: Doctors work under extremely stressful conditions with very little time to make life-and-death decisions. A strong mental frame of mind is essential.

Unfortunately, there is data to indicate that events such as suicide are higher per capita among doctors than the general population. Substance abuse is not unknown either.

How do we ensure that only the strong-minded are selected to train as doctors? Perhaps the aviation industry could offer us some solutions, as pilot training is known to be one of the most rigorous professional training programmes, with periodic recertification.

The issue of “attitude” is a far more difficult one to tackle. The university has no prior knowledge of the student in this aspect. Ideally, feedback from impartial observers such as teachers, residents’ association presidents, village chiefs and organisations where the student volunteers should be taken into consideration. However, because of the possibility of bias, this is not a popular option.

Moral (and ethical and legal) fortitude: This is perhaps one of the most essential parts of being a doctor and saving lives.

In the Dr Hadiza Bawa-Gabra case in Britain, the moral (and ethical and legal) turpitude of the senior doctors who were aware that the hospital was operating under dangerous conditions and yet allowed the young Dr Bawa-Gabra to fail by contributing to the death of a young patient cannot be overlooked.

There is a lot of hanky-panky in the practice of medicine, including of the criminal variety. Young doctors must understand that it is their duty to alert those in charge when they observe such instances. Keeping quiet does not mean one is a “team player”. It means one’s moral, ethical and legal compass is pointing in the wrong direction.

Finally, as parents, we have to accept that since students are taken in sight unseen and the course is mentally and physically demanding, attrition rates are high.

It would be of great comfort if the university system could prepare a graceful way to exit unsuitable students into less mentally and physically demanding courses without too much loss of time and money for the student concerned. This will make students more willing to leave a course rather than struggle along unhappily.

DR MANIMALAR SELVI NAICKER Histopathologist and Statistician