Close to two years into joining the medical fraternity; the journey leaves much to be desired.

Wild-eyed and curious at entry, weary-eyed and desensitised at this juncture. The extrapolation to the point of exit would almost take on a certain trend, barring any miracles that happen in the midst.

There is a multitude of reasons and not a single tiebreaker, just a slow simmer that brings the stomach to a hasty billowing. The transition from an idealist to a realist to a pessimist, witnessing ever more grotesque behaviour than acts of kindness and compassion. Good riddance, how should the lens of judgement be shrouded by a veil of plain dusky motionless grey?

The time horizon is long and still running, but there seems to be no real point in time to pinpoint. Perhaps it was when I started becoming more vested in passing examinations than in pursuing what’s left of my own hobbies. Perhaps it was when I became always too tired or busy to either keep myself in shape or spend time socialising. Perhaps it was when someone asked me, “Who and what are you, if you are stripped of your profession as a doctor?” and to my horror, I couldn’t answer.

I am but a small change machine in the grander scheme of things. Doing changes at a micro, patient-centred level. Will this ever progress into something bigger?

Of disparity and equity

Inherent disparities exist in every healthcare system. What had come into the light of the discussion in recent times is the talk of pay rises for public healthcare workers, which I think has been long overdue especially for allied health colleagues including and not limited to just the nursing staff but also our therapists amongst many others. The talks of a pay rise appear reactionary in light of the recent COVID-19 pandemic, but subtly too brings up deeper issues of disparity within the healthcare profession locally as well as a comparison between healthcare systems abroad. Could perceived roles and responsibilities, emphasis on other economic sectors, education costs explain the differences in pay grade? How should outcome measures be used in healthcare to ascertain remuneration?

Of appreciation and abuse

These days I don’t ask to and dare not wish to be shown appreciation; such displays might even be superfluous or ostentatious in fact. All I secretly hope for is that patients and their families leave our care without returning unwarranted complaints years down the road. Positive reinforcement is hardly seen at the workplace; the culture focuses on things you do wrong rather than the things you have done right, simply because we are deemed infallible. Even a single mistake could be news spread like wildfire throughout the entire department that leaves a blemish on your records and taints for life. Receiving feedback has never been so daunting and uncertain. Does the altruistic nature of the job render us more merciful and tolerant towards such undesirable behaviours? Does being in a paying class bestow upon you the right to exert dominance by means of abuse? Does giving you the benefit of doubt of being possibly cognitively impaired allow violent verbal, physical or even sexual harassment?

Of knowing and not knowing – Empowerment

A common thread is the mindset of "every man for himself", which had led to complacency, indolence, a sense of entitlement. It stifles the very instinct of mankind to become the fittest to survive, condemns the zest to brainstorm creative solutions to novel problems, smothers the courage to become above and beyond a mere mundane conformist of an economic system. When a problem arises, the solution is not one thing but one other person. When there is a lack of a solution in a protocol, the knee-jerk response is to seek answers from another person. We seek answers all the time, yet the approach to doing so has become as rudimentary as opening your mouth to ask someone else a question, and not brainstorming for solutions to effect change. By means of logic, should those who contribute by providing actual thought and solutions be more deserving of increased remuneration instead of those who merely follow workflows and ask unrequited questions?

That’s for our fellow healthcare comrades. Public health education leaves much room for improvement as well, but that might seem to be too much to expect for a population who leaves the decision-making to the physician, only to return with tirades of insults and blaming if something does not go as planned. There needs to be an acceptance that things don’t always go as planned, even in the realm of healthcare and healthcare provision.

I am a change machine and will always be. For the better or worse, who knows. The kindle remains a tame orange-yellow faint glow, awaiting the spark to be reignited. As it is now, I do still very much enjoy the current state of slow kindling. Stoked to see how the subsequent years would unfold.