It took me 14 years of schooling - 11 of them of which I knew I wanted to be a doctor. Then 5 years spent as an undergraduate at Medical School, 1 year as a house officer (intern/foundation year 1 - what ever they're calling it now), 3 years as a SHO (senior house officer) before going to work in Australia as a registrar for 2 years (with a couple of expedition medic outings on the way), another year of being an SHO before a year as a middle grade in emergency medicine (slipping in a diploma in tropical medicine & hygiene & my Membership exams). Finally I got a training number for emergency medicine for 5 years & came out with my fellowship exam & sub-speciality training in paediatric emergency medicine, a diploma in child health & very nearly a MSc in child health (dissertation pending). I worked for 14 months as a consultant in the NHS & it took me precisely 11 months in Cambodia before on a bus journey down to Phnom Penh I turned to J & came out with the classic freudian slip, "When I was a doctor..."
I have spent almost my whole life wanting, studying, training & working to be a doctor but in less than a year I had reached the point where I don't even consider myself to be one any more. This is what I like to call 'de-skilling'.
How, I hear you cry, can 21 years of medical education & training be lost in less than a year? Well the grand canyon was worn away by just water & the dripping tap of mistrust & disbelief has been eroding away at my self confidence over the last 15 months. Admittedly quicker than the formation of the grand canyon, I have now reached the point where I doubt myself over the most basic medical knowledge.
Example: at a recent ECG workshop following an ECG lecture, given by a delegation from a famous American University, my group were debating the tricky concept of QRS length & what is normal. I told them it was less than 3 small squares which represents 0.12 seconds. The 6 male Cambodian doctors in the group refused to believe me - I double checked with the lecture because I've only been teaching ECGs in ALS for 9 years now.
"You are wrong!" I was confidently told by a doctor whose hospital does not have & has never owned an ECG machine. ON (my deputy director) finally got to the root of the problem - I had been referring to small & large 'squares' where as the Americans had called them 'boxes' in the lecture. This it would appear had put my whole credibility to read ECGs into disrepute. I thought it was a little pedantic to point out that a 'box' is a 3-dimensional shape where as a 'square' more accurately describes the grid pattern of ECG paper. Instead I went for the more rational approach of asserting it was less than 0.12 seconds but again I was dismissed. The lecture quite clearly stated it was less than 120 milliseconds - this it would appear is completely different & I am therefore just a semi-literate & semi-numerate fool. It was at this point I gave up.
Which is odd as what usually happens to a lot of people in development is more, what someone I respect very much calls, 'up-skilling'. Non-medical people become medics, nurses become doctors, GPs become neurosurgeons etc. etc. etc.... you get the idea?
And I'd be lying if I said that this hadn't from time to time also happened to me, but I hope I have the self awareness & insight to recognize & moderate it. So for example since being here I have been deemed an expert in children with disabilities. A couple of volunteers have asked me to go out into the community to see children, it gets me out the hospital. Although I can manage an acutely sick child I wouldn't say I knew an awful lot about chronic problems, but I side step this by referring on to NGOs & hospitals that I know are experts or at least can help the children more than I can.
At a recent clinical case review of a child with Dengue recently, when I was asked for my opinion on the management, I deferred to the local doctors who have treated more cases of Dengue than I have had hot dinners.
Last Friday J & I found ourselves on the Paediatric ward advising a young mother, with her severely malnourished 2 month old, on re-lactation & breast feeding. J's last job in the UK was working as a ward manager of an adult medical ward, neither of us are midwives or breast feeding experts (J at least has done it once!). We both could see the funny side of stood in the middle of a ward squeezing our breasts & embarrassing R (Cambodian & male) who was translating for us. The first time mother from a village on the Thai border had stopped breast feeding after one month because of a breast infection & had fed her baby on soya milk & water. J & R found the child being treated for pneumonia at the CPA 2 hospital they visit once a month & had pointed out to the staff there that baby also had severe kwashiorkor & required transferring to Battambang - J isn't a paediatric nurse either but sometimes up-skilling comes out of necessity.
I have spent almost my whole life wanting, studying, training & working to be a doctor but in less than a year I had reached the point where I don't even consider myself to be one any more. This is what I like to call 'de-skilling'.
How, I hear you cry, can 21 years of medical education & training be lost in less than a year? Well the grand canyon was worn away by just water & the dripping tap of mistrust & disbelief has been eroding away at my self confidence over the last 15 months. Admittedly quicker than the formation of the grand canyon, I have now reached the point where I doubt myself over the most basic medical knowledge.
Example: at a recent ECG workshop following an ECG lecture, given by a delegation from a famous American University, my group were debating the tricky concept of QRS length & what is normal. I told them it was less than 3 small squares which represents 0.12 seconds. The 6 male Cambodian doctors in the group refused to believe me - I double checked with the lecture because I've only been teaching ECGs in ALS for 9 years now.
"You are wrong!" I was confidently told by a doctor whose hospital does not have & has never owned an ECG machine. ON (my deputy director) finally got to the root of the problem - I had been referring to small & large 'squares' where as the Americans had called them 'boxes' in the lecture. This it would appear had put my whole credibility to read ECGs into disrepute. I thought it was a little pedantic to point out that a 'box' is a 3-dimensional shape where as a 'square' more accurately describes the grid pattern of ECG paper. Instead I went for the more rational approach of asserting it was less than 0.12 seconds but again I was dismissed. The lecture quite clearly stated it was less than 120 milliseconds - this it would appear is completely different & I am therefore just a semi-literate & semi-numerate fool. It was at this point I gave up.
Which is odd as what usually happens to a lot of people in development is more, what someone I respect very much calls, 'up-skilling'. Non-medical people become medics, nurses become doctors, GPs become neurosurgeons etc. etc. etc.... you get the idea?
And I'd be lying if I said that this hadn't from time to time also happened to me, but I hope I have the self awareness & insight to recognize & moderate it. So for example since being here I have been deemed an expert in children with disabilities. A couple of volunteers have asked me to go out into the community to see children, it gets me out the hospital. Although I can manage an acutely sick child I wouldn't say I knew an awful lot about chronic problems, but I side step this by referring on to NGOs & hospitals that I know are experts or at least can help the children more than I can.
At a recent clinical case review of a child with Dengue recently, when I was asked for my opinion on the management, I deferred to the local doctors who have treated more cases of Dengue than I have had hot dinners.
Last Friday J & I found ourselves on the Paediatric ward advising a young mother, with her severely malnourished 2 month old, on re-lactation & breast feeding. J's last job in the UK was working as a ward manager of an adult medical ward, neither of us are midwives or breast feeding experts (J at least has done it once!). We both could see the funny side of stood in the middle of a ward squeezing our breasts & embarrassing R (Cambodian & male) who was translating for us. The first time mother from a village on the Thai border had stopped breast feeding after one month because of a breast infection & had fed her baby on soya milk & water. J & R found the child being treated for pneumonia at the CPA 2 hospital they visit once a month & had pointed out to the staff there that baby also had severe kwashiorkor & required transferring to Battambang - J isn't a paediatric nurse either but sometimes up-skilling comes out of necessity.
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