Shen-Han Lee

“Midway in the journey of our life

I came to myself in a dark wood

For the straight way was lost.”

Translation from the first canto of the first cantica Dante Alighieri’s The Divine Comedy

Much have been going through my head lately. Apart from my work. About life. About what I really want to become in life. A doctor? A scientist? Or, perhaps, both? (and I haven’t even begun to think what field of medicine I would like to specialise in!)

Pondering aloud has begotten me a wide spectrum of response from the people around me.

On one end of the spectrum, one of my hospital colleague is of opinion that the excellence in both fields are mutually exclusive. That to achieve excellence in one requires the sacrifice of the other.

“A great scientist can never be a good clinician, while a doctor who spends much time with his patients will never produce world-changing scientific work. Are you willing to quit medicine? Are you able to imagine yourself stuck for long hours in the lab for the rest of your life?”

(I should have clarified with her what she meant by ‘world-changing scientific work’…)

On the other end of the spectrum, an old friend of mine feels the other way around.

“The thought of finding something new everyday gives you a reason to live. You don’t want to spend the rest of your life doing the same thing, do you? You only live once, you know?

In the USA, each year, about 1000 of 17000 medical students do an MD-PhD, and go on to become great scientists. And some of the clinician scientist that I have worked with are some of the best clinicians in the hospital.”

(No prize for guessing correctly whether this guy is an MD-PhD student)

A crossroad.

Two paths to follow. One filled with hurdles. The other filled with hurdles, and extra hurdles.

I think I will try my best to prove to the lady-colleague of mine that she is wrong. Even if it takes a lifetime to do that. There is truth in words of the MD-PhD friend. Yet, words from both parties have invoked a deep-rooted determination in me.

One thing which has always intrigued me is the statement that ‘medicine is both an art and science’. Having completed the two years of my preclinical medical sciences and one year of pharmacology as a natural science subject, I have come to understand the second part of the statement – medicine as a science. And now, on the threshold between the preclinical and clinical phases of my medical training, I feel it is timely to ponder upon the ‘art of medicine’.

What exactly is the ‘art of medicine’?

Well, according to Eugene Braunwald, MD et al. (2006):

[quote]

When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination, and to extract the key laboratory results from the crowded computer printouts of data, in order to determine whether to ‘treat’ or to ‘watch’.

Deciding whether a clinical clue is worth pursuing or should be dismissed as a ‘red herring’ and weighing whether a proposed treatment entails a greater risk than the disease itself are essential judgments that the skilled clinician must make many times each day.

This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base

[/unquote]

So, basically, all the amount of textbook medical knowledge will be worthless if a clinician fails to exercise prudent judgment in evaluating the clinical signs and symptoms. Thus, a competent clinician is one who has mastery of BOTH the science and art of medicine.

But does this de-emphasize the importance of having a sound knowledge in the medical sciences? The answer is a resounding ‘no’. In fact, the opposite is true. Without a good grounding in the sciences, the physician is analogous to a person with visual agnosia (well, not literally, but figuratively) – in that, one is able to observe and extract the signs and symptoms from the patient, but fails to relate them to a coherent body of medical knowledge.

Mum, if you’re reading this, happy mother’s day! 🙂 You’re the greatest – my source of strength, guidance, and the light of my life. I don’t know where I’d be without you. In the brightest day, in the darkest night, you were always there for me.
And to all mummies (and I don’t mean the ones in the pyramids) around the world, happy mother’s day!!!!

As the Malay saying goes: ‘syurga di telapak kaki ibu‘. (translation: heaven is at a mother’s feet) Ok, not literally, but you get it.

🙂

Update on my life: I’m done with the bench work of my research project. Now, I’m busy writing up the report, which is in a form of a Ph.D.-style thesis for the biological sciences, only much shorter in terms of length. This basically involves sifting through loads of experimental data, and trying to make sense out of them – this normally involves plugging in the raw data into a computer program which will then fit the data into a curve using a pre-set mathematical algorithm (in this case, a four parameter logistic curve). From the dose-response curves that are constructed, a few parameters such as pD2 values and Emax will be calculated, in order to ascertain the potency and efficacy of my test compounds. If you’re thinking that my research project sounds pharmacological in nature, you’re probably right. And that means, you’re a medic or a pharm major….. hawdy.. har har….. (insert ‘lame joke’ laughter). And it doesn’t end there. I’ve got to sort out my confocal microscope images and figure out which ones to include in my report (and which ones NOT to include!).

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Here’s an excerpt from Joe Martin’s speech to the HMS incoming class of 2009, which I find to be truly inspirationl. FYI, Dr Martin is the outgoing dean of the medical school at Harvard. It describes what it takes to become a doctor, based on the etymology of three words related to this profession.

What does it mean to be a Doctor of Medicine? Lewis Thomas — who was himself a medical school dean as well as a prizewinning author — reflects on the origins of some of the words that will become central to your lives as you embark on your careers. The evolution of these words can be traced back to the ancient Indo-European language that was the ancestor of many of our modern languages, and they have some hidden lessons for your profession  Let’s look at three words that will come to mean much to you: Doctor, Medicine, and Physician.

The word doctor came from dek, meaning something proper and acceptable, useful. It became docere in Latin, to teach, also discere, to learn, hence “disciple.” In Greek it was understood to mean an acceptable kind of teaching, thus dogma and orthodox. “Decorum” and “decency” are derivative words. 

Medicine itself emerged from the root med, which meant something like measuring out, or taking appropriate measures. Latin used med to make mederi, to look after, to heal. The English words “moderate” and “modest” are also descendants of med, carrying instructions for medicine long since forgotten; medical students ought from time to time to meditate (another cognate) on these etymological cousins. 

Physician came from a wonderful word, one of the master roots in the old language, bheu, meaning nature itself, being, existence. Phusis was made from this root in Greek, on its way to becoming two English words: “physic,” used for medicine in general, and “physics,” meaning the study of nature. The first chair at Harvard Medical School was established shortly after its founding in 1782 as the Hersey Professorship in Physic.

(Ed: in Cambridge, it was the Regius Professorship of Physic, a crown appointment founded by King Henry IV in 1540… beat that Harvard! 😉 )  

Doctor, medicine, and physician, taken together with derivative words that grew up around them, tell us a great deal about society’s ancient expectations for the profession — hard to live up to!   

I hope reading Dr Martin’s speech will inspire a new generation of doctors and medical students alike, to take on the responsibility that comes with the profession with dignity and humility. If there are any students out there who are considering taking up medicine, I wish to say that medicine is more than just a job. It is a way of life. And once you embark on this journey by becoming a medical student, it will change your life forever. Life as you know it, will never be the same again. 🙂   

I chanced upon a profoundly-striking advice today. (From the internet, no less.)

This is advice that comes from a man who once stood upon the threshold of possibility that we all stand upon today. That advice:

Occasionem Cognosce: “Recognize your opportunity!”

Thus, today begins our own time of opportunity; seize it!

This piece of advice also came from the same man who said: “Two things are always new – youth and the quest for learning”. “Occasionem Cognosce” has also been a motto of the Lowell family, and is proudly displayed on the arms of Lowell House.