Memoirs of a medical student – A millennial's musings

Millennial ENTP struggles

As a female ENTP, I am a reasonably uncommon breed. It’s not that I think that Myers-Briggs cracked some super important code – I don’t believe the “science” behind it, it’s a little horoscopy, but it is consistent – and they managed to describe certain things with impressive precision. It has been described elsewhere, but I will keep calling it ENTP for clarity.

Having millennial restlessness superimposed on ENTP-ness is tough. In a world where doing one thing really well gets rewarded exponentially well, it’s also scary. I remember being a medical student and shadowing teams in St. James’ Hospital. After a difficult thyroid surgery, I was waiting for the next case and observing the wonderful Professor T., a well-known Dublin Ear Nose and Throat (ENT) surgeon, reading the newspaper in between two surgeries. I was wondering what he was thinking.

I just imagined life as an ENT surgeon: day in and day out taking out tonsils, resecting thyroids and realigning nasal septa – by choice!

I don’t think I could do it. Thank God there are people who can. I respect it hugely and I fully understand we need it. Indeed, if he was even more specialised – and only ever did tonsils, let’s say, that would be even better for the patients. But what would it be like for him? How can one continue to find new facets to something like a standard surgery? He didn’t strike me as the type who couldn’t wait to go home. There must have been something there for him that was clearly missing for me.As you know, I have a strong dislike for self-help books. However, one of my favourite social media personalities (she’s Russian, so she may not be super interesting to the reader), reads Barbara Sher and specifically recommended a book called I Could Do Anything If I Only Knew What It Was. The name did resonate with me. I never thought that a book like this would interest Maria. Maria left her job in – I think – publishing soon after she started to found her own beauty business. She’s married to a serial entrepreneur. Together they make an impressive couple: I think they started with quite little and now they’re running a few interesting ventures – and there’re babies everywhere. It would seem that she knows exactly what she wants. Apparently not.

Once again, it reminds me of how pointless it is making inferences about other people’s lives. Anyway, I am currently reading the book.

It’s not as cringy as I had expected. I skipped a few chapters that seem to bear no connection to me. However, Chapter 6 relates directly to ENTPs, without calling them that.

Sher describes people who want to try everything, to understand how everything works, who feel that by dedicating oneself to X, you are tragically missing out on Y.

Sher argues that our biggest problem here is the belief that there is very little time to do everything, hence, we hysterically push ourselves into a niche hoping that it will fit. I completely agree that that’s true. At the same time, while Mrs. Sher may have an interesting point, I wonder how it related to the exact opposite point made by the Stoics. They argued that one of the worst things you can do is assume that there’s lots of time.

I think the resolution of this dilemma is obvious. Advice is meaningless without context. It’s like those men who teach about business always say: Never underestimate your opponent. For this advice to be useful for me, I have to multiply it by -1. Never overestimate your opponent. [Obviously there are limitations here, but it is a more useful heuristic given my world view.] The bottom line is that it’s impossible to know the beliefs and assumptions of your readers. That’s why therapy works, but self-help books don’t. It’s all in the context.

If you’re reading this and you are an ENTP kind of person, don’t think that time is completely against you. I think we are prone to be hyperaware of some realities like the merciless passage of time – but we get stupefied by lists and all of these endless techniques on how to get organised. We’re already organised. We’re not distracted. We’re aware of the dangers of endless distraction. However, banning ourselves from pursuing them is just against our nature.

With this in mind, Sher recommends to write out the 10 lives that you will you could live. My list includes that of a retail investor, a philosopher, a psychiatrist, a blogger, a painter among others. Her argument is powerful: look at the list and see what can be done in 20 minutes a day – or just occasionally. I underlined this:

“Don’t dedicate yourself to poetry. Write poems.”

This thought was also brought up in a different context in Steven Pressfield’s War of Art and the less interesting Ego is the Enemy by Ryan Holiday. As it stands, I already feel a lot of pressure from society to be able to say “I am X.” A doctor, a management consultant, a journalist – whatever. It makes no sense to add to this pressure by imposing my own restrictions. Furthermore, most of the time, it’s just a way to romanticise what one’s doing. If I like it, I will do it. Labels just aren’t for ENTPs. Of course, it’s not just ENTPs. Richard Branson and Elon Musk don’t have to explain their meandering interests to anyone – because they’ve already won.

In a world that likes to label people, it takes courage – and yields tremendous benefit to remain unlabelled.

If you are an ENTP, or this feels like the story of your life – leave a comment – let’s be friends ❤

What having no idea about psychiatry is like

In all my time in medicine, psychiatry was certainly the steepest and most unexpected learning curve.

The truth is that I started off as a pro nerd who wanted to be a surgeon. When they said medicine is an art and a science, I was just waiting for them to stop. In medical practice, choosing an antihypertensive drug is not an art. Perhaps, looking for new mechanisms of action is more creative, but not the practice of prescribing. There are scientifically rigid algorithms on how it should be done as of today, and the rest is harmful heresy – not art.

When I was in first, second and third year of medicine, I was convinced I wanted to do general surgery. Possibly paediatric. I took serious steps to that effect. I found a family friend who was a surgeon, and aged 19, I was spending my summers doing 36 hour shifts of shadowing surgeons. Scrubbing in on critical abdominal aortic aneurism ruptures, appendectomies, cholecystectomies, you name it. I learnt much faster in those 3 months of summer than surgical trainees in their cursus honorum residency.

At that time, I was shaping up to become a pragmatic and practical surgeon. We all know the kind of culture that is prevalent among surgeons – especially 10 years ago. Needless to say, it rubbed off on me too and I was expecting psychiatry to be a wishy washy waste of time. There was no stigma, no prejudice, no resistance – just an expectation of something I will have no interest in.

Then my college experience of psych began. I recall being late to the first lecture and sitting down at the back with one purpose only: make sure I am signed it. I wasn’t expecting to learn anything other than a bunch of genetics concerning schizophrenia and Alzheimers and be lectured on good communication skills.

I was so wrong.

My attention was instantly captivated by the lecture. It had nothing to do with the lecturer: he was ok, but it’s not like he was ultra captivating, charismatic or whatever. It was the substance of what he was saying. The lecture was on something called phenomenology (the study of subjective experiences). So for example, I learnt what the difference is between an illusion and a hallucination. What knight’s move is. Perseveration. Running commentary.

It was fascinating. It was like a parallel universe just opened up to me. I was entirely unfamiliar with all of these things. No portrayal of these phenomena in films comes close to actually considering what it is like, never mind meeting a person who suffers from such a thing. Maybe A Beautiful Mind is a place to start. But still, it barely, I mean barely, scratches the surface. I was in the industry, I was top of my class and yet until I went and properly exposed myself to it – I was so so ignorant. It is important to realise that the general population, no matter how educated, has absolutely no idea what a person with a severe and enduring mental health problem goes through. Zero.

As a fervent advocate of the scientific method, I would like to point out the role of art in this. It’s not art in some kind of mystical, deeper meaning sense. It is art in the sense that it is creative. Surgery is creative – but in a practical sense. It’s just a more conservative field.

Psychiatry is cognitively creative. It’s not algorithmic like most of medicine. Much of it has never been done before. The DSM differs so much edition on edition, that it is clear that we haven’t even come close to understanding what’s really going on. Paradoxically, the actual practice of psychiatry is quite intuitive 90% of the time.

Ten percent of the time, though, psychiatry requires a doctor to think outside the box in another dimension. Because you cannot MRI someone’s brain and say – this is mercury poisoning, not dementia. This isn’t depression, this is catatonic schizophrenia. You really need to not just think, but rely on something less tangible – does it feel like this person is depressed or does it feel like it’s EUPD? Freud tried putting all kind of names on these intangible feelings. It’s just a first attempt. Is it possible that both of these diagnoses are missing the point of what’s really going on beneath the surface and in another 20 years the DSM will have neither of those in it? If House solves puzzles, this is solving puzzles when you have no idea what the resulting picture is going to be.

What’s it all for if…

I often say on my blog for secondary school students that it’s all about balance. I feel wishy washy about it when I say it, so I wanted to tell this story to explain.

I recall spending some time with a dear friend of mine. She is a hugely successful physician now in one of the world’s top universities. This is way back when we were about 19 – in the throes of medical student life.

My friend, let’s call her Angela, is a particularly classy lady. She grew up in one of the finest neighbourhoods in a nice Irish city, educated privately, fancy extracurricular activities, the whole thing. She’s a gunner though, that girl. Being wealthy doesn’t automatically make you soft, and she’s the perfect example of that.

We were probably the only 19 year olds in Marks & Spencer’s buying things like dark chocolate and fresh linguini while our college classmates were out drinking 2 for 1 cocktails or Dutch Gold and eating frozen pizza. We spent our afternoons watching Gray’s Anatomy, The Other Boleyn Girl, Marie Antoinette, Coco Before Chanel, Gilmore Girls… And studying (her way more than me). You get the gist.

I never judge people for indulging. It would never occur to me to begrudge someone their luxuries or criticise them for being wasteful. So when I remarked on the fact that she has expensive taste, she was relaxed about it and said: If you can’t eat properly, what’s it all for?

This throwaway remark got etched on my brain. What’s it all for if you can’t be with your family? What’s it all for if you can’t sit and meditate for 10 minutes? What’s it all for if you can’t enjoy yourself for even a little part of the day? I don’t think she meant it that existentially. The way I took it was more in the stoic philosophy sense: live every day like it’s your last. As a true medical student workaholic fanatic, who was ready to give up everything for success, I never thought that living each day like it’s your last is about more than just achieving. I think if you work really hard, weirdly, sometimes it is easy to lose respect for yourself in a certain way. You become your own slave, the executive of your dreams, but not the person who actually gets to live them. That’s what I mean by balance.

Doctors and social media

This post came out recommending things that doctors should and shouldn’t do on social media.

So the article sites these 5 things you should never post as a doctor on social media:
1. Inaccurate Medical Information
2. Anything that Violates Patient Confidentiality
3. Your Personal Information
4. Opinions on Controversial Issues
5. Complaints or Rants

Point 1 is universal. It has to do with due diligence and integrity, not with being a doctor. Point 2 – about patient confidentiality – is sacred. 100% agreed.

My questions is:
Must a doctor always continue to be a doctor on social media?

A doctor isn’t a public figure – with a few notable exceptions. Doctors don’t have a responsibility to treat every interaction with another human being (including virtual interactions) like they are consultations with a doctor. Anybody who perceives it that way is misguided. The same way you don’t expect a lawyer who sat down beside you in a coffee shop to give you bulletproof advice or a professional investor sat next to you on an airplane to tell you the next big stock – you shouldn’t expect a doctor to remain a doctor in non-medical situations.

The rules above are coming from a place of fear. While the above is probably meant as a recipe for an easier life, it seems to put constricting expectations on doctors that will ultimately harm them and their patients.

As it stands, doctors aren’t outspoken enough about problems they face. They are the last to complain, the last to go on strike, the last to give their opinions on how their own system could be improved. What if they talk about their problems? Is it going to get controversial? Hell, yeah!

A propagation of fearful attitudes called for by the author of the linked article couldn’t possibly alleviate the global healthcare problems that we are all facing. Yes, information should be accurate and useless rants are… useless. However, given the extent to which doctors like to follow rules verbatim, it seems that the above rules (“don’t speak unless spoken to”) wouldn’t serve them well in the long run.