A Discussion on the Medical Profession
This conversation delves into the world of medicine, with doctors sharing their personal experiences, the challenges they face, and any regrets they might have.
Dr. Low, a young and energetic medical officer at KKH who graduated from Yong Loo Lin School of Medicine in 2019, offers his perspective as a doctor early in his career.
Dr. Ong, on the other hand, brings a unique viewpoint. As the founder of a medical technology company, Dr. Ong is a physician who uses his background in medicine, science, and bioengineering to create innovative solutions. Dr. Ong earned his medical degree at Imperial College London (after being rejected twice by NUS Medicine) and has a research background at Harvard Medical School and the Harvard-MIT Health Science and Technology Division, where his focus was on medical devices, regenerative medicine, and stem cell therapy.
[The transcript below has been lightly edited for clarity and brevity.]
Dr Ong: My Experience and Insights as a Junior Doctor in the UK
My experience mainly involves training in medical school in London. This might be a subject for discussion because I was rejected twice by NUS Medicine. Dealing with that sort of rejection, especially in your journey, is challenging. I hope you don't have to face that, but given probabilities, it might happen to some of you. It's not the end of the world; it's something to manage and move past.
Observations on UK Healthcare System:
- Dr. Ong found the UK system under-resourced, with better staffing and resources concentrated in larger London hospitals.
- He acknowledges the variation in experiences across different hospitals in the UK.
In terms of working as a junior doctor, I did my training in London, worked on the peripheries of the city, and interned quite a bit in Boston, America, where I also did my electives. This allowed me to compare the two medical systems. In Britain, as Dr. Low has said, the system is often under-resourced. London hospitals can be busier, bigger, and better staffed, but the rest of the UK varies widely.
Your experience will depend on where you end up after medical school. There are small and large hospitals, busy and less busy ones, and you'll work with various people throughout your career.
What might a day in the life of a junior doctor look like?
Dr. Ong describes a typical day for a junior doctor, including:
- Early start (7-8 am)
- Reviewing assigned patients' medical information
- Monitoring patients' conditions and changes
- Being prepared for emergencies
Typically, as a doctor, you start early, around seven or eight in the morning. You check your patients, do a pre-round with your team, which might include your registrar or senior house officer. It's crucial to know what's happening with your patients. Each team is assigned a list of patients, and you must be familiar with their conditions and changes, especially in intensive departments like emergency care.
As a doctor, you need to remember what you learned in medical school. You must know what you're doing at 3 am, whether resuscitating someone or looking after critically ill patients. In my case, I worked in a 900-bed hospital, which was quite large. On some shifts, there were only about eight doctors for those 900 beds. By the third or fourth day, half of the doctors were sick. I remember one consultant managing 120-140 patients during winter, with 16 ambulances waiting outside because the hospital was full.
These are common conditions when you work as a doctor. There's a common thread of serving and helping people, being there because you care. That's the most important thing about being a doctor. Before you sign up for medical school, I hope to provide more insight into both the good and challenging aspects. It's a long investment—six years of medical school, followed by five years of working, and then another six to ten years to become a consultant. You need to be prepared, informed, and flexible in how you view and respond to your environment and patients.
Dr. Low: The Challenges and Privileges of Being a Junior Doctor
The demanding nature of the job, including:
- Long hours
- Understaffing
- High patient load
- Stressful situations
I'm not sure if this is an issue in the UK, but recently there was a strike by junior doctors in the NHS, protesting overwork and pay. This issue of burnout is prevalent not just in Singapore but worldwide.
I'll start by saying it is an incredible privilege to be in this profession, despite the exhaustion and low pay.
However, we are all human, and our work hours are often extraordinarily long to the point of being unsafe. We have on-call duties overnight, starting at around 6 pm and continuing until the next day. You might work until 2 pm if someone covers you, but if not, you keep going until 6 pm. On weekends, it’s even longer.
For example, when I was a surgical house officer in the hepatobiliary team, we had just four junior doctors for 40 to 50 patients. In Singapore, we have many liver problems due to Hepatitis B and fatty liver issues. Once, I finished a call at 6 am, but since there were too many patients, I started working at 5 am and continued until 5 pm. My colleague, who had already worked 24 hours, had to keep going as well. I told him to go home and rest, but he had to continue working. We both kept working until the next day, and then he had another call. This went on for a good stretch until we finished our duties, and by the end of it, I was completely exhausted.
To address the question directly, being a junior doctor involves two parts: physical and emotional/spiritual. Physically, there's only so much you can handle. The best thing we can do is take care of ourselves—if you're sick, rest; stay physically active; and engage in sports you enjoy.
Emotionally, it really helps to have a support system of family and friends. During that challenging time, my family was my pillar of support. Coming home at 8 or 9 pm, having not eaten lunch or dinner, the best thing was a hot bowl of soup.
Before joining medicine, understand that it's not glamorous. It's not about sitting in an office with white walls and helping patients in a pristine setting. Often, the question is, "Who helps me?" As a junior doctor, no one really does—you must take care of yourself first. This is a realistic perspective and a very Singaporean experience as a house officer.
Things do get better as a medical officer. Once you have juniors reporting to you, you have more time and space to think critically about your patients and offer more value to the team. Your hours improve. However, jadedness, both physical and emotional, is part of the job. Experiences like death and traumatic incidents leave scars. The only way to cope with these is through the support of family and friends.
Reflections on the Medical Profession
When we tell the medical committee during interviews that the human body is very intricate and beautiful, we're not exaggerating. From cellular processes to the molecular physics behind them, all of this is happening as we speak. It's hugely engaging from a scientific perspective. When we zoom out and look at how each system works, the body's design is very interesting and elegant.
This might appeal to some of us here. Then there's how we interact with patients, terms like bedside manner, compassion, integrity, and your values as a doctor. These make sense, especially when you're on the shop floor. As Dr. Low said, medicine is a beautiful career. When you've just resuscitated someone, it doesn't matter what time it is.
I remember an 80-plus-year-old patient whose ribs I broke during resuscitation. It took just over two minutes, but seeing the family's relief was priceless. Then there are moments with severe developmental delays, coding blue every half hour, severe pneumonia, and being the only doctor managing multiple critical cases. For instance, I handled a lady with two heart attacks, one stroke, and a swollen thigh due to an undiagnosed condition. Another patient had a severe fever after returning from Africa, and another fell and fractured her skull.
First-year doctors shouldn't be the only ones managing a ward of 30 patients, but when you're there to serve, you do it because you have integrity. Dealing with a patient with severe developmental delays who can't respond to you but is in pain is a test of your integrity. You're the only interface between her survival and demise. This is real-life integrity that you must uphold.
During my time, I faced gut issues due to the stress and poor diet of a junior doctor. Despite the challenges, it was worth it because it taught me about medicine, management, humanity, and myself.
There are moments they don't teach you about in medical school. For example, a nurse refusing to take over a patient, leading me to spend hours arranging a bed for a critically ill patient. I had to rush to catch the last train in icy conditions after midnight, while also managing a startup and sleeping only 2-3 hours a night.
Operating under such conditions, my take-home pay as a first-year doctor was about $1,600 to $1,700. This isn't to jade anyone but to present the facts. Since graduating six years ago, my friends are now becoming consultants. One is working with the elderly, which he finds rewarding and less fast-paced. Another friend, a cardiologist, is doing meaningful work with a significant grant and is heading to Cambridge for further training.
There is much to unpack in this job, and it's challenging to do so in an hour. If we can shed light on anything to help you make a balanced decision, we will. Don't take this as the be-all and end-all; explore other paths in the field of healthcare. It's only the start, not the endpoint.
In reflecting on the experiences of these doctors, both in the UK and Singapore, it is evident that the journey through the medical profession is filled with both profound challenges and unparalleled rewards. The intricate beauty of the human body, the complexity of medical science, and the deep sense of responsibility towards patients form the core of doctors’ motivation.
Despite the long hours, emotional and physical toll, and moments of overwhelming stress, the privilege of being able to save lives and make a meaningful impact on patients and their families remains a powerful and driving force for both.
For those considering a career in medicine, it is crucial to understand the realities of this profession. The path is demanding and often requires sacrifices, but it also offers immense fulfillment and personal growth. Whether dealing with systemic issues like under-resourced hospitals or navigating the emotional landscape of patient care, resilience, integrity, and a passion for service are essential qualities.
Ultimately, while the road may be arduous, the experiences and lessons gained along the way are invaluable. The stories shared highlight the need for a supportive network, the importance of self-care, and the dedication required to thrive in such a demanding field. As you embark on or continue your medical journey, remember to explore various paths, seek balance, and stay committed to the core values that make this profession so rewarding. Medicine is not just a career; it is a lifelong commitment to learning, caring, and making a difference in the world.
