Issue 12 / 7 April 2015

MOST doctors remember the mature-aged student in medical school — the faint whiff of desperation and the “hip” outfit that’s just a little too carefully put together.

They are the ones primed, trembling hand anticipating the lecturer’s next question. “You mean you actually did the pre-reading?” How lame.
 
With seeming inevitability I’ve become what I once despised.

As a medical student beginning my third year, and with my 30th birthday looming, I’m left to ponder the view from the other side. And, mostly, I like it.

As the world of medicine has begun to hungrily swallow me up I’m so glad to have had a life before it.
 
But my advancing age does have its drawbacks, and chief among them is anxiety surrounding the future.

I’ve begun to anticipate pitfalls and prepare for disasters because I’m too aware of my weaknesses and limitations, in a way I wasn’t as a younger man. And though I’m confident I can handle them for now, I’m concerned that might change.

I observe the doctors I meet for clues to my own future. The happy and enthusiastic ones offer me hope, but I’m still troubled, worried I won’t turn out as they have. Perhaps, instead — like some I have met — I’ll come to resent a career that asks so much of me.
 
If I’m motivated to be excellent now, it’s surely because that motivation remains untested. How will I respond, at the end of a long shift, lacking in sleep, burdened with a personal problem, to the challenge posed by a difficult patient?

Now multiply that scenario by a hundred, or a thousand times. I’m no saint. I might have once said my greatest ambition in medicine was to help others, but talk is cheap and people change.
 
These questions have gnawed at me. Acknowledging the potential for failure isn’t easy and medical students, in particular, seem averse to it. There’s just too much riding on the choices we’ve made.
 
I recently found comfort in the pages of a book — Atul Gawande’s excellent Being mortal.

In it, Gawande discusses one of his patients, a retired geriatrician living in an aged care home: what buoyed him, despite his limitations, was having a purpose … to be of service, in some way, to those around him.
 
These words resonated and stirred memories of the years I spent working in restaurants as a waiter. These were times when I lived and breathed a service ethic, driven by a desire to please and a tendency towards perfectionism.

I’ll never forget being told by a customer in an upmarket London restaurant that he’d never had such excellent service.

Medicine isn’t so different. The stakes may be higher but it remains, at heart, a service industry.
 
Service — not a word that conjures glamour or greatness. Yet it retains a quiet, modest dignity, an ideal to strive towards. I once regularly overcame hangovers, tedium, hunger, rudeness, even a full bladder in pursuit of it. If it sustained me once it might do so again.
 
I’ve been looking long and hard for a compass to help navigate a way through the many difficult years ahead.

In a life of service, I’m finally hoping — and tentatively believing — I may have found one.
 

James Dando is a medical student in Queensland.


Poll

Do you think older medical students eventually make better doctors?
  • No - it's about personal qualities (64%, 82 Votes)
  • Yes – maturity makes a difference (29%, 38 Votes)
  • No – it makes no difference (7%, 9 Votes)

Total Voters: 129

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5 thoughts on “James Dando: Life of service

  1. SA Health Library Network says:

    Hardly over the hill at 30 and half way through medical school. My impression was the vast majority of post-graduate medical students in Australia were 23-29yo – doesn’t put you that far out of the curve. I was 2 months shy of 42yo starting my internship. Thought I’d easily be the oldest intern, but an overseas-trained intern at the same hospital was 51yo.

    The way you learn certainly changes with age – you learn and retain information very differently to the rote sponge you are just out of school. It is also likely that current styles of exams that your younger colleagues have been doing well in without interruption since school, have changed dramatically from the last time you were doing exams – pragmatically just a new game with new rules to learn. The biggest lessons though are that you can always learn from others and that failure can afflict anyone at anytime – the best clinicians still lose patients. A cliche for sure, it is not failure, but what you do after failure that determines the mettle of a person, especially in the clinical world.

    Confidence and learning to trust your own acumen is something that comes with time, but both overconfidence and underconfidence can and do kill. Tempered confidence, ability to always embrace learning, plus treating, respecting and supporting others in the manner you would like for yourself are very important characteristics in the highly team-based clinical world. These are skills that you probably learn more about the older you get. Personality also plays a part, but please remember that in the service of others you need to take care of yourself first – burnout is a real and dangerous part of clinical work. Take care of these things and you will have many rewarding years of service ahead of you :-).

  2. Dr Hannah Mendelson says:

    Medicine is NOT a service industry!

    People rarely choose to have an illness that requires treatment, which places us (doctors) in a funny position – we do indeed provide a “service”, ie treatment, but this service cannot be compared to retail or hospitality, the usual “service industries”.

    That is why we have “patients” not “clients”.

    However, this is a very different topic to the one implied by the article itself, ie being an “older” medical student.  At the age of 23, I was a very young mature age student in a  cohort of far more mature medical students undertaking a post-grad medical degree.  It was fabulous!  The variety of lives people had had before joining Medicine was immensely enriching.

    Undergrad medical degrees should be banished…

  3. Roderick Ryan says:

    I started as a medical student after doing a degree very unrelated to medicine. At the end of school I would have thought there was absolutely no chance I would ever want to be a doctor. But people change. 

    Now I have worked for many years as a doctor, with medical students and young doctors from many different systems. I believe that both undergraduate and post-graduate medical degrees should continue.

    Those who do undergraduate degrees are younger and have more energy when they graduate, which helps in any years of post-graduate training. On a community level, they will on average be in the medical workforce for more years and thus provide more “value” back into the system from a health economics point of view.

    Those who do post-graduate degrees certainly provide something extra in previous experience. And often they also have another discipline to fall back on if they want to quit medicine for one reason or another (the thought has occasionally crossed my mind and I am grateful to forever have that possibility, even in retirement). In light of recent publicity about medical training and culture, I think they are less likely to get pushed around and can sometimes be pretty amazed at the pettiness that passes for “leadership” in medicine.

    The down side of older graduates is doing training and exams in your 30s rather than your 20s – it is much harder to do the shiftwork, study and exams when you have partner, children, mortgage etc. And especially hard if you have to do rotations in other towns or cities, or move interstate or overseas to get appropriate training positions.

  4. Leigh McKenzie says:

    Hahaha I giggled at your youthful commentary. I will graduate this year (assuming I don’t become overly stressed by the artifice of the OCSEs) in December. I turned 57 a month ago. So chin up old fella, you’ll be OK. Starting an Internship at 58 will be as challenging for me as it will for my 23 – 26 year old uni friends.

    As for the time left to practice. I’ve already seen more than a few doctors graduate medicine, practice a couple of years and start a family. They then slip into part-time work or a few even leave the progfession permanently. I can pretty much guarantee that won’t happen to me. My mothering bits would no longer allow it. I read that >50% of the cohorts are now women. So, even if I only practice until I age, say 80 that’s a good 20 years. If my brain holds out, I do plan to be like Dr Leila Denmark, paediatrician in Augusta USA who retired age 103, so I might squeak in ~ 45 years 🙂

    While some of my cohort are testing their AMH and planning their futures around babies, I no longer need to consider those huge life events. It is hard living your life the ‘right way around’ I’m lucky I’m living mine ‘back to front’.

    As for training postitions, I am not completely deluded – I may be ‘discriminated’ against, I may be physically too old to be a surgeon, maybe. Life’s a mystery….

    Like many other students, I work, as well as study and I agree exams are hard, but they are hard for us all. If we can give, and get, the same level of friendship and support in the hospital that we as student friends currently enjoy, we will all be OK.  

  5. Anonymous says:

    As a child of one of your recent patients I would like to thank you for your service. So many doctors dismiss so many patients these days as they have either heard the same old stories before and make assumptions, are watching the clock or watching the dollar. You on the other hand went out of your way on occasion just to put myself and my mothers minds at ease when so many other doctors would not of.
    I’ve watched my mother in and out of hospital several times a year for 30 years and you have really stood out with your professional, no nonsense but sincere approach and I truly thank you.

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