There I was, almost at the end of the night, having spoken to a few hundred hand-picked, talented high school students about my life as a doctor. Their youth was no barrier to their determination to be the best – I met budding astronauts, focused scientists, concerned environmentalists, and as usual, a horde of kids who dreamed of becoming doctors.
The students asked penetrating questions about everything from the ethics of million-dollar drugs to whether children compromised one’s career. These were teenagers! With each question, my admiration grew and I briefly dreamed that one day, in my household, there might be such questions to replace, “Have you seen the remote?”
I was signing books when I noticed a girl, who hovered on the side, waiting till the crowd had cleared.
“I don’t know how to ask this without being rude,” she ventured, before my silence enabled her.
“My parents really want me to do medicine but I’m not interested. How do I say no?”
It was the curliest question of the night.
“I think I can get in but my heart is not in it.”
“It’s great that you recognise it,” I said. “Have you tried talking to your parents?”
“I’ve tried and tried, but they have invested their whole life in my brother and me.”
“What would happen if you said no?”
“They would be really disappointed in me. That would break my heart.”
“But if I did medicine, I wouldn’t be honest to myself. And I’d take the spot of someone who really wanted it.”
She faced a wicked dilemma: whether to obey the urging of her parents or rely on her own, admittedly young, instinct. A momentous decision hung in the air, the sort parents can help address, but of course, the parents were the problem. And though she relaxed at the opportunity to voice her dilemma, I knew that the knots in her stomach would return soon.
I wished that I could sweep away her problem; I wished I could convince her parents that a child of her poise and humility would do well in whatever she chose. I told her to see the school counsellor again and I reminded her to be true to herself but when she left, I felt hollow, musing whether she would one day be the troubled student or the depressed intern I encounter.
Although I don’t know her parents, I meet them regularly. I meet them at social events and medical talks. I meet them at seemingly benign movie nights and picnics when the conversation turns to medicine.
“He’s got the marks, he’s all set with the entrance test, all he needs is a coach for the interview,” a mother breathlessly explained. “Do you know anyone?”
“No,” I deadpan.
“I just want her to be happy,” says another. “You’re happy, aren’t you?”
“I am but she isn’t me.”
Another time an acquaintance of an acquaintance knocks on my door, a tired son in tow. “We want last-minute tips for his interview.”
Students pondering a career in medicine, I have always welcomed. Parents who do it on behalf of their child, I am increasingly wary of. The students are largely altruistic; the parents aspire to status, money and job security. I don’t blame them but what they don’t realise is that in the hyper-competitive world of medicine, even those with the marks and motivation battle to get in, so there is even less room for those with the marks but scant motivation.
Some years ago I interviewed a young man who was obviously bored, even in our eight-minute high-intensity interaction. His opening salvo: “Can I just tell you that I want to be an accountant?”
“Wrong interview then,” I said lightly.
“I got the marks and my dad made me come. My dad is a doctor.”
“Did you tell him you aren’t interested?”
“No point, but I hope to fail the interview.”
I was left reeling but I was told that no selection process can filter out pushy parents; we wait for the students to find their voice.
Doctors are often asked if they would recommend the profession to their children. A survey of American doctors by the Physicians Foundation found that more than half say no, citing the triumph of paperwork and bureaucracy over time with patients.
When I talk to my Australian colleagues, I hear similar sentiments. Doctors sign up to help people but are faced with growing mountains of paperwork, mindless compulsory modules and maddening meetings to satisfy performance indicators that make a mockery of patient-centred care.
Many doctors are burnt out, bullied and demoralised. Work is stressful and demanding. A 2013 Beyond Blue survey put paid to the notion that these are merely the groans of a self-indulgent, richly rewarded profession. Australian doctors have a substantially higher rate of high psychological distress compared to the general population and other professionals. An astonishing quarter have considered suicide, double the comparable figure in other professionals.
These figures are not just statistics – they are my friends and my residents. My professional landscape is strewn with doctors in trouble with alcohol and prescription drugs, doctors with broken relationships, sick of work and exhausted at home. I attend funerals and wonder how no one ever knew and I learn that no one is immune.