When I was younger, in medical school, I wanted to just "know" things. I wanted things to have an answer. I wanted definites. But, of course, medicine is all about uncertainties. One lecturer once said that if you can't deal with uncertainty well then you're going to struggle with medicine. I struggled with medicine. I was either fortunate or unfortunate to go through the post-graduate medicine program where so-called "self-directed" learning was encouraged. What this translates to is "teach yourself medicine at home using these resources, pay the university exuberant fees for not teaching it to you, and then come for the exams". Needless to say, I was not a fan. Some people thrive on that style of learning, but I always felt it was a cop-out. The university kept saying something to the effect of "didactic learning is the devil", but I really craved that devil the closer to exams we got. I understood that you do have to develop your own clinical reasoning abilities, but teaching basic anatomy and physiology facts should be one of the things that the medical schools teach. Yes, we all learnt it eventually, but it didn't have to be as painful, if you ask me.
So as much as I craved instruction, teaching, and protocol (i.e. what to do when) when I was in medical school, as soon as I graduated, "protocol" became my enemy. As an intern in a government hospital one of the first things you will be told about is the protocols - hospitals are full of volumes of them! Sure, a lot get ignored at many levels of the business of running a hospital, but one faithful group of adherents to the protocols were one special group of people that as an intern you deal with a lot every day: nurses. I think nurses have a protocol for everything in hospitals, from their precious lunch breaks to when a perfectly good IV line should be changed. Don't get me wrong, I'm not "nurse bashing" - in fact many of those who have worked with me as the one off the odd doctors who was loves and has a has a lot of respect for nurses. And I do think a lot of nursing and medical protocols are good and they're there to ensure things are done consistently, and also to acknowledge that in emergencies our brains go out the window and we need almost to be reminded almost even to breathe too.
But there were also a lot of redundant and annoying protocols. The hierarchy in nursing circles, as opposed to medical ones, however, is more immediate. So if you don't do things according to the protocol then the nursing team leader is right there on the floor to hold you accountable to it; whereas in medical teams, you'd be lucky to get a consultant/boss who knows the intern exists or has a name. Doctors also have a lot more autonomy to make clinical decisions and can therefore deviate more readily than nurses from the protocols. Nurses in the wards especially hate it when doctors ignore their protocols! One of the more ridiculous protocols a nurse forced me to oblige to was to take from her hand a pack of medication and hand it to a patient personally because nurses aren't pharmacists and therefore weren't allowed by hospital protocol to "dispense" the medication to the patients personally. But doctors also aren't pharmacists, so I didn't understand why I had to walk all the way to the other side of the hospital to pass a box of medication from the hand of the nurse to the hand of the patient standing right next to her. What did I need to understand, though? All I had to do was to "follow the protocol" and obey the ridiculous request. Actually, I found it comical, and I made a big deal about coming up to the ward to carry out this all life-saving task.
Interestingly, now that I am the consultant in private practice, I have entered a quest to find all the protocols for general practice medicine that I can find. Did I suddenly develop an incomprehensible lust for protocols? No, I still haven't, but what I have come to realize is that in the "real-world" (the world outside of the hospital) our legal system requires that we have a good goddamn excuse for deviating from the protocols if something ever goes wrong for one of your patients. And the protocols in the real-world aren't about tedious and mindless obedience of procedure, but about things that actually put patient safety at risk. Let me give you an example, hopefully without revealing too much of what those things I don't want to mention are: Say a clinic owner asks me to do something a certain way to cut running costs; I could do what he says, but if my patient risks suffering because of it, you can be pretty sure I am going to prefer following the protocol that all my peers are encouraged to uphold in order to minimize risk to my patient.
Turns out I still am just like I was in medical school, wanting to just "know". That lust is still alive in me, although now not there just to be able to pass exams but in order to be better equipped to do the best thing for the patients who put their trust in us in their most vulnerable times: when they're ill.
 |
| At my "other" job. |
