What would you advise your younger self back in medical school?
When you’re a young student or just graduating, you tend to think that your future somehow relies on being in a certain place in a certain time. I think it actually relies more on your character, I think character is destiny. I see a lot of medical students worrying about, oh what if I don’t get into this program or that program. Then I see them 5 years later and they are so happy with how things turned out.
Training is the big thing at the moment, but it always seems like people end up where they need to be. I don’t really meet people who say they wish they’d done something different. You always tend to find that niche for yourself. There’s so much potential to do so many different things. Don’t worry too much about doing something in a particular order. If you’re really passionate about what you do, if you really care about something, you will always find something really satisfying in a career sense.
When I was a medical student, even up until I was a senior doctor, I was perpetually afraid that people would find out that I really don’t know that much. As a medical student, everywhere you go people seem to be telling you things and teaching you things. You feel as if you’re the person with the least knowledge. Whereas the people coming to you are the people who are very specialised in what they know. When I was younger, I thought I was a fraud, I don’t know enough to do this. It wasn’t until I was older that I realised that everybody feels that way – except some people are more honest about it than others. Everybody is afraid of being revealed as somebody who doesn’t know something. We are by definition, a group of people who like to convey the idea of mastery, it’s the nature of what we do. In order to reassure patients, we have to look as if we’re in control. I think the mistake we make is when we carry that over to our colleagues. We always make out that everything is fine, but we should be more open with our colleagues.
I feel that you guys do so much more about being open, on mental health and support networks. Far more than there’s ever been. There’s enormous awareness of mental health issues within medical students and health professionals. And yet the one thing you don’t see is individual people who put up their hands and say – ‘I’m vulnerable’. But the real people in danger are not empowered to stand up. And that’s in spite of all the forums and things.
Look; the things you’re afraid of, that you’re worried about – everybody else is afraid of them too. It’s hard to believe when you’re younger and the med student culture makes it harder to reveal because it’s such a competitive business. If you reveal your Achilles heel to someone, even your close friend, they might get one up on you. Because you guys, above all else, are competitors; you’re hard wired to compete. It’s that same nervousness that makes it hard to show true vulnerability.
When I was younger, I used to think that the people who taught me were the people who owned that knowledge. That they were the keepers, and they were giving it to me and it was fantastic. But now, all the knowledge I have, that’s been given to me. I don’t own it, I didn’t discover any of that stuff. I’m not that great, I just want to pass it on. I would like people to feel empowered by learning. It’s hard for young graduates who haven’t felt empowered by that journey. And if you don’t feel empowered yourself, it’s hard to empower your patients in health care. The way we transmit knowledge is very important. There I didn’t want to be embarrassed by not knowing something. Giving people permission to not know something is incredibly important, because medical students have got a lot to learn so why would they hold onto my specialist knowledge anyway! I can’t expect them to walk into my clinic and know all my stuff.
How have you felt, trying to empower students?
The medical cohort is always terrifyingly smart. It seems to be very good at generating a whirlpool of stress. On one hand you have all the mental health stuff, we’re going to look after everybody, everybody calm down. And on the other, you have this academic stir up. You create stress inside yourselves. For a lot of these kids, they come across these real power groups, doing extra classes, doing extra revision – I mean I see them come in on Friday nights. On the one hand that’s very good, but if you’re not in that group it can be very hard. It can be very easy to get caught up in that super-competition and think “I just don’t have what it takes”. “I can’t keep up with that level”, in maintaining that intensity of performance, like Olympians.
But when you graduate, half the people who get the highest marks go off somewhere into practice and you never hear about them again. It was always the cohort effect. When you practice, nobody ever asks you “did you get an HD in medical school”. No patient ever asked me “where did you rank in the year?’, and no colleague of mine has ever asked that of me. So competition – while it’s a wonderful thing, I mean, I just love excellence – but in a big cohort trying to stay at the top, it can be very detrimental. It marginalises some people and it prevents people from expressing their true vulnerability. Unless we authentically acknowledge this vulnerability, it doesn’t matter how many excellent support programs peer or otherwise we set up, people will be at risk. I wish that I could empower people to authentically express this vulnerability and give people permission to accept that they are ‘good-enough’.