Mountains

It's 4am and I just had to purge my brain of the thought that has been clanging about for weeks. The idea is this: the task of becoming a good doctor is a lifetime's work, and an honourable aspiration. It is also something I am still not sure I can accomplish, because to be a good doctor is to juggle mountains (to use a totally obvious metaphor).

On one hand, you must master the vast body of scientific knowledge, numerous disparate fields of both ancient and developing knowledge. Anatomy, biochemistry, embryology, physiology, pharmacology, pathology, genetics, microbiology, immunology, histology. Whole careers are dedicated to subspecialties in these domains; you have to know them all, at least to a basic level. Many things make sense, others must be hammered into your memory by sheer bloody-minded force. You need an almost obsessive thirst for facts and an innate logical wiring. In first year I thought that medicine was in some ways less intellectually rigorous than the humanities which require critical thinking, generating ideas. That's still true, but now I have greater respect for the many fat detailed books that have to be crammed into my small head with its penchant for big-picture intuitive concepts.

On the other hand, there are clinical skills, that ambiguous art of learning from touch and hearing and observation, distinguishing and integrating subtle signs, recalling obscure connections between them, matching them to the sciences, keeping your mind open to rare possibilities while honing in on the most probable, decision-making in the face of uncertainty based on epidemiology and evidence and experience. At the moment I don't trust myself; it all seems so subjective.

Finally, there is the human side. All the above facts and skills must be internalised so that you can see the individual patient as a whole, not a cluster of symptoms but as nothing less than a fellow human being with all the dignity and vulnerability that term implies. You must connect, empathise, reassure, instruct, question, attempt to understand the landscape of their lives. You must see them clearly with both objectivity and compassion, and respect them. What's more, acknowledge your own weaknesses and fears. You have to keep an eye on ethics and its scarier big brother, Teh Law. You have to maintain humility while projecting and indeed having self-confidence. You are privileged to have contact with people in extremis and experience a broad spectrum of the human condition. This is the bit of doctoring that convinced me to take the blind leap from BA/LLB to BMed. We'll have to see if it's good enough.

It is a rare doctor who manages to keep all three aspects in the air at the same time, even in the higher echelons of the profession. Common in our tutorial rooms are the well-intentioned doctors, certainly caring, but a little sloppy with factual details. In our lecture theatres and in hospitals, often you find doctors who have conquered those first two mountains and even create new knowledge - but who lose sight of the person behind the clinical problem. There is also a thread of self-pity among medical students and doctors, I've noticed. Hell, I've been guilty of it myself. The training is difficult and long, the price of mistakes are high...but all the same, as I read elsewhere, it's nothing compared to being on the cold end of the stethoscope or scalpel. And it's an honour to be trusted with someone's health or even life.

I have seen doctors I can admire, though. The latest is a professor I am crushing at the moment (intellectually only!). He teaches eloquently - it's not grandiose, just lucid and precise - and has dry understated humour, but most of all has that indefinable humane quality. It manifests itself in the way he talks to, and not merely about, a patient in a clinical presentation; how he touches her arm gently instead of manipulating her like a lump of meat. I have learned to identify good doctors. Becoming one? I still have many doubts and fears, but insha'allah that's what aquackening will chronicle.

Course, there will also be posts consisting of lists, rants, annoying alliteration, navel-gazing, swearing, pretentious rhetoric, indecision, woe-is-me whining, groanworthy jokes, and abuse of the English language (et français o español si j'en ai envie, porque tengo que les practiquer), etc. Just so you're warned.