Dichotomies abound!

When you’re a medical student, two things are certain.  The first is that you’re going to be some sort of uber-specialist and either cure cancer or rake in the prestige or both.  The second is that you have absolutely no clue about how the profession works.  You’re also told you must be very clever, and this continues when you’re a junior doctor and someone asks you what you do and you say ‘doctor’ and they ask you what you want to go into and you say you don’t know.

Now that it’s getting toward the end of my internship it’s becoming uncomfortably apparent that it’s time to pick something.  All through medical school I was going to be an oncologist.  I’d had family members with cancer, I’d had a healthy enthusiasm for all things cancer molecules in medical school and dammit, physician training was in some way noble, like you were becoming one of the guardians of humanity.  Simple right?

And then I started working.  Doctors are expected to put up with a lot of things because they’re paid reasonably well.  And the way we’re bashed in the media as Mercedes-driving, rich, corrupt, minions of the big pharmas with no ones best interest at heart means we don’t garner much public sympathy.  So we’re expected to put up with a lot of things.  Like when you’re on sick relief for the night shift only the night shift person doesn’t call in sick until 6pm when you’re just leaving your full day of work for the day which started at 8am, meaning you have to stay at work until 6am the next day.  You’ll be fed a line about how you should go home and sleep which makes you wonder if they’ve seen the traffic outside because by the time you get home, it will be time to turn around again.  And there’s nowhere for you to sleep in the meantime.  Apparently there are rooms but no one knows where they are and they sure as hell don’t tell you during orientation.  So you stay up for 24 hours and in your 22nd hour of being awake the nurses call you to ‘just come and review this guy’ and you get there and find that the guy is really sick and your brain is an unholy fog but somehow you manage to call a MET call and convince the blood bank to give you a bag without their results yet.  And then once the guy is stabilised you sink into your chair and realise just how close he came.  Or the fact that in your contract, you get a half hour break.  For the whole day.   And how you essentially change your entire job every ten weeks and while your contract says you’re supposed to get a roster for the afterhours work (which you do on top of your dayjob), two weeks beforehand, you invariably never do and simple things like planning a trip to the GP becomes impossible and suddenly a year has passed.  But alas I digress, there’s a lot of good about the job, I just had to let that out.

Suddenly things like bucketloads of prestige, nobility and curing cancer get lost in this mire of tiredness and endless collections of blood, and missed birthdays and Christmases.  So you start thinking about what’s really important to you.  Things like time.  And no nightshifts.  And fewer weekends.  And actually seeing your patients faces instead of their med charts and notes aside from a cursory ‘can I just have a quick listen to your chest?’ because in your head there are a million more people who need reviewing. All that bullshit as a medical student about certain specialties being more ‘worthy’ than others evaporates.

So you start thinking about becoming a GP.  And this amazing dichotomy presents itself where people say things like “oh it’s good for women” and “oh you’re just going to be a GP?”  I’m sorry?  Just a GP?  Suddenly you’re not as ‘clever’ as anyone else who wants to do say, neurosurgery, or renal medicine.  You’re certainly not going to earn the same money.  A family member told me they were disappointed I didn’t want to be a surgeon after a few surgery bosses had encouraged me into it.

But what if the ‘clever’ people decided they wanted something else?  That they knew they were perfectly capable, and hell, even interested in those so-called higher specialties but for the purposes of life satisfaction (as opposed to job satisfaction) went down a path that was just as satisfying and gave them more time?  What if that was perfectly okay?  This is blasphemy in medical school.  And the idea that you should want normal working hours and a good life is almost laughed at, it means you can’t hack it.  Or in my case, don’t want to.  And shouldn’t have to.  I have a friend, whom in medical school, was a quintessential overachiever, perfect in every way, and really really nice.  And going to be some sort of superspecialist.  She turned to me recently and told me she was considering paeds or GP because physician training was a shit life.

The social pressure to not be a GP, this idea that you are in somewhere not clever anymore (what, did I just get lobotomised overnight?) because you pick this path (which by the way is it’s own college and own specialty training program now, it’s not a matter of finish med school and hang out a shingle), is just status anxiety at it’s ugliest.  If I were the sort of person who put more weight in how I appeared to others and less to myself, I might pick a really hard specialty, kill myself passing it, and become the sort of hardened doctor everyone hates.  I tell you this now – that uncaring doctor everyone has met was not always like that, once upon a time they really did care until something burned them out.

I got into medical school.  I passed the GAMSAT spectacularly.  I didn’t fail any exams while training, I kept up with my cohort, I beat them in some areas.  I graduated medical school and now I get great feedback from each rotation.  Surely that’s enough?  Suggesting that GPs are in some way lesser because their college has their shit together in terms of good hours for training and fair exams is the sort of howling insecurity that pervades the field.  But it is as it is and in spite of all this, the idea of it is growing on me more and more every day, in spite of what anyone else thinks.

And really, if you don’t define yourself, someone else will and you wont be you anymore.

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5 comments

  1. I’m in my final year of medicine and I’ve noticed that too, JUST a GP. It usually follows someone asking me what I’m studying, when I reply medicine an awful lot of people then say oh so you’re going to be a nurse? No that would be nursing, I’m going to be a doctor. What are you going to do? Just GP?
    Drives me nuts and even though I think its an amazing and difficult thing to be a truly good GP I do feel like if I went into it I would still have that social pressure feeling like somehow I had failed and let down my gender. I know its silly but its there, I do hope though that if I decided GP was where I really wanted to be that I wouldn’t let it stop me.Its not top of my list at the moment but its definitely in the top three.

  2. Hello! Really enjoy reading your blog. Definitely don’t let anyone turn you off GP because it is not prestigious, it will be as pretigious as you make it. And lifestyle is important. However, as someone in their 4th year out and just passed my fracp exams, i can also say that physician training is by no means as impossible as it might seem at the start. Yes studying for the fracp is hard, it does mean sacrifice, but it is also incredibly cool to see yourself becoming a better doctor. Especially preparing for the clinical exam. Im about to start advanced training in a specialty i love and am passionate about. Life is looking very rosey! So i guess if physicianhood or oncology is a passion for you, don’t feel you have to give up because of the impossible hardness. Believe me if i can do it i really think any doctor can.

  3. Hi a PGY2 here. reading your blog reminds me of internship which is not that long ago yet feels likes ages ago. I was considering a few diff specialties and eventually decided on GP training this year – partly because I like abit of paeds, women’s health and psych, partly for lifestyle reasons. I’d be lying if I say I’m not looking forward to never having to do nights again 🙂

    I found that when I’m overworked and fatigued, esp when doing nights, my care factor goes down and irritability goes up, which I find quite alarming and unfair to my patients. I’m hoping that when I’m a happy and well balanced person outside work, I’d be a more empathetic and “clever” doctor. And I’m hoping one day when I have a family, being happy at work means I’ll be a better family member.

    I guess this is just a round about way of saying that I feel there’s no point being in any specialty, inc GP, if you’d feel miserable at or after work coz ur dissatisfaction will affect your work. Good luck with it all!

  4. Hi! I work in a health field but not medicine. I didn’t ever want to go into medicine for the reasons you cited above – I know internship is just a short phase in the grand scheme of things, but that sort of work pattern is just not for me and I think the system can be pretty soul-crushing. My mother’s a physician and her training was hell at the time and not something I cared to emulate.

    Good GPs are GOLD in my opinion: they work to prevent as well as treat, keep up with the literature and research, and really get to know their patients, as they tend to see them throughout their lives. As a GP you can also specialise (as I’m sure you know) – my GP has a special interest and is very knowledgeable in the area of women’s health, for example.

    I don’t think there’s anything wrong with wanting some semblance of actual work-life balance (that’s not just some HR catchphrase), to want free time to do whatever after all those years of work and study, to spend time with kids if you have them and partners and family and friends. You’re not a bad person, a bad doctor, or somehow not as smart for wanting these things and it’s just shit that there are so many people who want to make you feel like this. Not to mention how awfully sexist the whole thing is – ugh. Everyone should be entitled to these things, and you shouldn’t have to half-kill yourself to get there.

  5. Hi,
    I’m a final year radiology registrar about to sit my last exams… I am SO envious of you! You’re settled down and have a lovely husband… That’s all so much more important than a job and moreover how you think other people (really only other doctors) regard being a GP. Honestly some of the best doctors (including uni medallist) are now working as GP’s and enjoying their lives.
    One day you’re not going to look back and hope you did more work/research/on call i promise you!
    also being an intern is hideous- I think I probably cried every day- just feeling so nervous I was going to do something wrong- next year will definitely be better if you go on to do residency- although I remember my last ever 15hr ward overtime shift as still one of the happiest days of my life!
    take care
    and do what is right for you and your family
    😉

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