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Rhona's Words of Wisdom

Rhona's rules

(on what being a medical student and doctor is all about)

In her last issue as senior editor of the studentBMJ, Rhona MacDonald shares her take on life

Let's get one thing straight from the start. The rules outlined in this article are for me. They are my rules that I have worked out by myself over five years of medical school, eight years of practising medicine, 10 years of being a patient, four years of being the editor of Career Focus and three and a half as the senior editor of the studentBMJ.

Through these various roles, I have learned and experienced more than I could ever have imagined and this has instilled some strong principals and values that guide the way I live my life--"Rhona's rules." So please do not think that I am telling you what to do or how to live your own life--feel free to strongly disagree with my take on things, ignore, or possibly use as suggestions to help you with your own life and career.

Rule number 1: It's all about patients; it's not about you

This is especially for those just considering or starting a career in medicine. There are many different reasons why people want to go into medicine but I would argue that the single most important reason is that you have to want to care for people when they are in poor health. Romantic notions of floating around with a stethoscope round your neck, smiling at patients who will smile back adoringly are not helpful.

When people are ill, they are usually not at their best. They may be stressed and moody. They (and their relatives) may not like you and you may not like them. But that is not the point. You are there to manage them to the best of your ability all of the time no matter what you may be feeling yourself.

So ask yourself:

  • Do you genuinely care about people?
  • Can you put yourself in a patient's (or colleague's) position and imagine how they must be feeling?
  • Will you ever become irritated with people who you consider as "timewasters"?
  • Will you ever become the sort of doctor who ignores the curtains around a patient's bed and tries to take (non-emergency) blood from an elderly patient who is on a commode because you don't have the time/want to wait?

Rule number 2: Don't just focus on passing exams

Of course exams are important, but you are limiting your potential if you opt out of potentially enriching experiences just because it doesn't count towards--or will not help you in--exams.

Ask yourself:

  • Would you ever skive "unmarked" and un-noticed interactions with patients in the wards to swot in the library?
  • Would you ever miss a lecture or teaching session on a subject that does not directly relate to an exam to catch up on your textbook reading instead?

Rule number 3: Keep your other interests; don't become a medical bore

This is a hotly debated topic. The two points of view are:

Either you must do absolutely everything in your power to make sure you get ahead in medicine so that you can tick all the boxes in the "desirable" criteria when applying for jobs (especially national training numbers). So it's head down, aim for distinctions, do research in your holidays and suck up to consultants.

Or, being a "well rounded" person makes you a better doctor as you are more likely to relate to your patients helps you to avoid "burnout," and a long "other interests" list on your CV can also make a good impression.

I am firmly with the second option but to help you make up your own mind I would encourage you to read "Career snakes and ladders" (studentBMJ 2002;10:374-5).


COLIN MACDONALD/DAD
Rhona's rule number one:
love Scotland, live Scotland

Rule number 4: Remember that there's a big wide world out there

Medicine can be very insular and introspective but I would encourage you to:

  • Keep up with the national and international news (and not just the medical news)
  • Take every opportunity to study, work, or do research in other countries
  • Do all you can to experience other cultures (and you don't need to go outside the United Kingdom for this--even crossing the Scottish-English border can be a culture shock)

All these points will help make you a more experienced, worldly wise, tolerant, and empathic person which must be good for your patients.

As you hear what you hear, see what you see, and experience what you experience around the world, ask yourself:

  • Do you want to make a difference?
  • If so, what will you do, how will you do it, and where will you go?

Rule number 5: Question everything

Don't accept that something must be true just because your consultant, tutor, textbook, newspaper, television programme, the government, or the BMA says so

Aim to:

  • Consider all the available options for yourself, and base your decisions on what you find out
  • Learn critical appraisal skills by using resources such as Clinical Evidence, Cochrane, and other reputable databases so that you are confident that you are managing patients correctly

Rule number 6: Learn how to be adaptable and flexible

Career and life plans rarely work out the way you want them to. When you are knocked off course for whatever reason, you may never find your way back to your original path, and it is probably best to accept that. The new path you find (or stumble across) will probably take you somewhere different but it is up to you whether you choose to be content with the resulting destination.

Ask yourself how you would cope if:

  • You develop a serious or disabling illness?
  • You want to start a family sooner than you imagine now?
  • You have a close bereavement
  • Money matters more to you than you expected due to increased responsibilities

How would your plans alter if:

  • Training is shorter due to staff shortages
  • Training is longer as a result of the European Working Time Directive
  • It is easier to change specialties
  • ob opportunities abroad are better and easy to organise
  • War breaks out and threatens stability

Read the BMJ careers workbook My Beautiful Career, a resource designed to help you prepare for the unpredictable (http://careerfocus.bmjjournals.com/cgi/data/326/7383/S33a/DC1/1).

Rule number 7: Look after yourself (note to self--must do better)

The following are clichés but consider...

  • If you don't look after yourself, who else will?
  • How can you expect to look after other people if you can't or don't look after yourself?
  • No one is irreplaceable

In my opinion, the macho culture in medicine is wrong. Take time off when you need it. You owe it to yourself

Rule number 8: Don't panic about your career, but make use of all the resources available to you

There are various career support options of varying importance:

  • Information--absolutely necessary
  • Advice--rarely necessary (that is, someone else telling you what to do)
  • Guidance--sometimes necessary
  • Career management skills--necessary
  • Experience--usually necessary

Just remember that knowledge (information)+knowing how to apply it (careers management skills)+a bit of experience in different specialties=power.

  • Read the monthly studentBMJ (studentbmj.com)
  • Read the weekly Career Focus (bmjcareers.com/careerfocus has an archive of articles, topic collections, special publications, and theme issues)
  • Use our services such as the Advice Zone (bmjcareers.com/advicezone)

To show I am not biased, some other resources:

  • Eccles S. So you want to be a brain surgeon? Oxford: Offord University Press, 2002
  • London deanery careers guide (www.londondeanery.ac.uk/CareerGuide/index.asp)

Rule number 9: Be true to yourself

This is much more than just another cliché.

You will probably have made many sacrifices along the way to get to where you are now but if at some point you discover that it is not what you expect and that you are no longer sure that this job or this specialty or medicine is for you, be brave enough to admit it to yourself first, then to another person. Then do something about it.

Ask yourself:

  • Will you be brave enough to follow your heart as well as your head? Are you courageous enough to go wherever this takes you?