Speech by Dr. Ouma Oluga to Medical Students and Young Doctors
‘When you learn teach, when you get give. That is the true purpose of life’ ~ Angelou Maya
At some point in medical school, one strict professor teaching us Krebs’ cycle gave us the general rule of getting through medical school. ‘Do not fall behind and do not fall in love. Those are the two rules for success here,’ he quipped. Being disciplined and hungry for success, I was not going to jeopardize my only chance at being a doctor. By the way I still remember the mnemonic for that cycle waiting eagerly to apply it in the life ahead, if i ever do. As fate happens, I fell behind. As for love, I really attempted to follow the old professor’s advice.
Medical School has so many of these and other myths. And the myths morph into a culture that has become the identity of medicine and the career that follows. Defining medicine as difficult, cut throat and not for the ‘weak’ in personality. And medicine in deed is difficult. Students and the doctors that they grow into – molded in a culture of tense need for survival, become competitive instead of collaborative. Individualism has pushed students to want to suck in the glory of being the only success. And often this turns to be the Achilles heel for many doctors. Hardly celebrating the success of others. Hardly even celebrating their own success. Often impossible to please. Often broken by the slow pace of their own success. And breaking down by the society’s lack of appreciation for their efforts. Wanting more and more of themselves and believing that they are the only ones who can. The ones who know. The self-begotten ‘neurosurgeon of all neurosurgeons’. The doctor who understands the disease better than all doctors. You can tell your own example by the specialty you desire. And while obsessed with self, very detached from their surrounding and the changes happening around them. Your cheese moved.
This tradition has equally created the other truism for doctors. A doctor running away from tension and competition. And the doctor running away from the whole experience of medicine as a career. And the third category of doctors stuck with lack of fulfillment and depressed about how to make their careers and their practice satisfactory. Without mentorship. Without support. Without teamwork. All alone.
All the high expectations, cruelty of thought and limitations of medicine did not start in medical school. And it not merely Kenyan. Perhaps they were transported to medical school by the caliber of persons who qualify for medicine courses. But it is at Medical Schools where it must change because the patient of today demands value. Value that can only be delivered with team work and a new mindset of less individualism, less competition and more complementary support, more unity for all doctors. Here is how the millenials will change healthcare, if they want to:
The Road Not Taken
The thought of not being a great doctor after several years of studying often creates unprecedented anxiety. Many students do not envision it but many doctors are exactly not what they wanted of themselves. Yet medical practice all over the world is changing at a front not controlled by the doctor. Robotic surgeries, Artificial Intelligence, Commercialization, Telehealth and more are disrupting the place of the doctor. Corporate and consumers have influenced how care is delivered and more so how care is paid for. Will the doctor of the future remain holed in a clinic waiting for society to get sick and look for him/her? That would be the road retired. Millennials have been known to be versatile, impatient, unsettled and easy goers. And while employers have complained about the inadequate capacities of millennials to stick it at one job or one location, this could be healthcare’s greatest potential for a revolution. Mobility, innovation, team work and adaptability of the youth should help the younger doctor blend with society easier than their senior colleagues may have done. They still must hold true the sacred nature of medicine to get ahead.
Communities have long suffered lack of information on health. Technology companies are frustrated with medicine’s snail paced uptake of innovation even where patients could tremendously benefit. 90% of health technologies fail because the doctors do not embrace them. Your opportunity lies in taking ownership of these initiatives.
The rigid culture of medicine must be changed by millennials while keeping intact the human relations that make medicine noble. The doctor of the future will have failed if his/her narrow focus remained to practice in the ‘solo sorrow of a solitary clinic’ with unchecked standards and a string of suffering clients usually labeled as ‘my patients’. Millennials must embrace less conventional ways of teaming together with other professionals, technology experts and society to directly solve the problems facing healthcare today. The E.N.T surgeon of the future must find a way for the deaf to hear. The cardiologist of the future will make more value preventing heart attacks even as he is marvelously skilled in threading out the clot clogging the coronary.
Medicine is in itself changing faster than the generations change but it is the younger doctor who must catch up with the pace of change in medicine if their careers are to make meaning to anyone especially them.
Often, patients have been viewed as third parties whose interaction with healthcare is far removed from the daily goings-on in society. No wonder, medicine has struggled with stigma on particular conditions such as mental ill-health. Most stigma stemmed from health providers treating patients as not part and parcel of their own care. To mean medicine was only for the people who treat. Some argued quite convincingly that patients are not empowered to know enough. The place for patients in their care has remained that of fear. Health professionals themselves fear to seek care when sick. And often delay until it is too late. How then should patients not fear? How then should society not stigmatize?
Humanizing healthcare starts with the understanding that patients are actually us – not them. Millennials have the chance to fully integrate the patient into the healthcare system more than older folk who entrenched a culture that elevated the doctor ‘only in theory’ but left patients with no options to question or seek second opinions. Then patients started to be their own doctors. Finding fault in the system and losing trust in the doctors. This hurts patients as it hurts even doctors more. The cycle continues. The regulators manufactured faked business solutions for it. Indemnity covers, litigation, more tests, more interventions, more costs. To what end? This culture is lowering the place of the doctor in society. And what an opportunity for inviting the everyday basic need for doctors to individuals. Provide help. Reassure. Make life possible, again. We must invite the everyday pursuits and passions of society such as music, art, writing, politics, poetry, etc into the company of patients. Healthcare must be humanized in all aspects. Millenials please do it.
It is encouraging that doctors have become producers of movies. Instead of actors and journalists struggling to play the part of a doctor, millennials must make it their way of career to play both doctor in the hospital and perhaps doctor out in the society in order to humanize healthcare. At Kenyatta University, I encouraged medical students to keep performing wonderful orchestra for their fellows, to other doctors and in public functions. This way they change the image the society has of a doctor as one detached from and incapable of living humanly. See next.
Take Up Leadership
Any doctor is a team leader. Team leaders create a vision and encourage their team members not only to deliver the best of care but also to be the best of themselves. The role of physicians as healthcare leaders has been absent in most of healthcare yet patients know the doctor as the barer of quality, the determiner of treatment modalities.
Australian Medical Association has long encouraged all doctors worldwide to take up leadership. The challenge for the younger doctor thus is to know what to do with leadership. Because leadership is already thrust upon you.
Moi University medical students once asked me how to be a leader in healthcare given the few positions in policy, administration or management. The answer is that first take the role of patient advocate and then advocate for the best terms and conditions for the team of other doctors, nurses and support staff that works with you. Patient advocacy is the highest form of healthcare leadership. But patient advocacy must not devoid of what patients need. Patients need more skilled, safer, empathetic doctors supported by a whole litany of other professionals and facilitated optimally in a health system that responds to the needs of the workers as it does to the needs of the patients. And then they need the diseases prevented. And their families and themselves educated. And their taxes used to treat them. Can that really be the work of a doctor? It must be.
The tragedy of today’s decision makers in healthcare is that they neither have the patient’s interest nor the interest of the people who deliver care to patients. And this is because we have students who study medicine so that they become policy makers without grasping the details of what care patients need. And doctors who out of frustration by colleagues or the system as often blamed or the need to exit from tensions in the workplace, lack of career growth or inability to practice enter into policy or administration without the frame of thought to solve the very problems they ran away from. It is noble to go into policy when you understand the core practice for which you want to make policy. Not to busy oneself with boardroom meeting after another making decisions more destructive to patients. There are doctors who have recommended community health volunteers as primary care givers to whole villagers when they would never allow even their own dogs to be treated by anyone less than a medical specialists. Policy must make sense for your own consumption. Doctor please take leadership. Wherever you’re is the place of applying leadership because leadership is not a title.
Be your doctor, Not literally
Finally for all millenials, The doctor must be the doctor that they would want to see if they were to be a patient. The old way of medicine is beaten and it is up to the millennials to usher in new medicine that would first and foremost work for them (and all of us) should they find themselves as patients.
In a very competitive world, being a doctor is such a valuable calling card. The most valuable still. It will open the doors for millennials to be CEOs, TV talk show hosts, Governors, Senators, Great Researchers, Nobel nominees but more certainly excellent doctors. There is no shortcut to being an excellent doctor.
‘The challenge of life is to build a resume that tells a rich story of not just ‘what’ you would want to be but ‘who’ you want to be. A story that goes beyond a collection of titles and roles and degrees to the why you hold them, ‘ Oprah Winfrey advises.
Find your ‘why’ for being part of healthcare.
Dr. Ouma Oluga is a Consultant Physician, Secretary General of Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU), and Global Co-Chair of Health Workers For All Coalition.