In lieu of an abstract, here is a brief excerpt of the content:

  • A Profession Built on Grace
  • Joshua Hoe Tian Ming (bio)

The clerking medical student is occupied with everything else other than ethics. “Ethics” is just a word — what I mean to say is the humanity of practising medicine, the belief that it is mercy and compassion that underpins the practice of medicine, giving life to the hard science. It seems the universe appreciates irony — we are often confronted by what we least expect, and so I learnt something I would not forget about “ethics”. In retrospect, it is probably why I remember it.

A series of unfortunate events happened as follows. It was the end of a busy clinical posting — test looming, case reports undone, stress response engaged. They were never an excuse, but deadlines are an all consuming monster. It was in this frame of mind that I went to clerk a patient for an assignment long overdue. I pride myself on being fairly used to the process, everything routine, or so I thought. History-taking went well, pleasant young Filipino couple, wife had a pneumothorax, financial difficulties, worries about the future, information processed in bite-sized snippets, gets written down in my notebook, goes into my write-up, a few words of empathy, case closed. Everything is taken in a mode of shallow professionalism that makes empathy a routine nicety, extracting personal information your right, and information-processing your number one priority. This mode of the medical mind is produced by a few things: routine, stress, jadedness, lack of coffee and sleep — all doctors do it, I think.

I return on a Sunday to finish the physical examination. Hurriedly, I ask for permission and come rushing back with a chaperone, mind abuzz with the details of things I had to look for. The husband spoke up quickly. He had to. I was rushing so much I had not registered the clouds gathering on his face, nor given them the space to consider how their time was to be spent on a Sunday during visiting hours. All this I remember with pain. [End Page 236]

He said, with a look of intense displeasure, and some aggressiveness, “Stop, what are you doing? Is what you’re doing helping her?”

I froze, like a deer caught in the headlights, for moments I could not understand where he was coming from, so intense was my focus on the exam. Then shame came pouring in. I looked back at him — and was on the verge of saying “frankly no”, but simply could not say it. His words had interrupted the world of medical knowledge I had been so engrossed in wading through.

And again, “You’ve already asked so many questions. Are you studying her?”. His expression completed the sentence for him, “like she’s less than a person”. What happened next is not important; I stumbled, mumbled and went home straight after.

I was surprised at how deeply shaken I felt. My response seemed incongruent to what had actually happened — after all, patients are displeased with students all the time. My mind went through three knee-jerk reactions in quick succession.

The first was to dismiss the incident. Maybe I had caught them at a bad time, perhaps Sunday was not a good idea. This did not satisfy me for long — I knew there had been something deeply wrong with the way things had gone.

The second was to blame myself. I was ashamed. That I had concentrated so much on learning I had forgotten about the patient, something I had promised myself I would not do. I had not been true to the principles by which I wanted to grow in. I had not said specifically that I wanted to do a report on her — I had failed to respect their rights. Still, the picture seemed incomplete. For one, I had not done anything wrong specifically, I had asked for permission at every step, nothing less than what a doctor in a ward round would do. And even if I were not doing a report on her, I would still take a history and examine the patient for my own experience.

The third reaction was to blame the patient. Surely the...

pdf

Share