10 If the ax is dull and its edge unsharpened, more strength is needed, but skill will bring success.
Our calling to be doctors requires us to be life-long learners. Most of what we have learned in our time in medical schools will be out of date by the time we graduate. We are living in a time of digital and genetic revolution. Emerging technology and genomic manipulations will make many changes in our practice of medicine that unless we keep up to date with the changes, we will be left behind.
Aside from learning new things, we must keep sharpening our medical skills as we go along. The lesson from Ecclesiastes is that an axe may start out well when it is new and sharp. Continuous use will blunt the edge. So will our clinical skills. Unless we are care, continuously reviewing and retraining, our skills will deteriorate. Experience may mean the fruit of repetition. It may also means repeating the same mistakes repeatedly. So take opportunity of every learning situation you encounter. Also always strive to be better than you already are. Success in medicine is knowing what to do, when to do it, and doing it well.
An axe may be sharp. It is then only a sharp axe. It is nothing without the skill of the woodsman or woodswomen who yields it. Learning is a whole body experience. It is not just head knowledge. It involves patience, muscle memories, and our transformation. As Christians and as medical professionals, our learning must involve a great appreciation of the Creator of this universe and lead us into deeper worship.
Further reading: 2 Timothy 2:15
Prayer: Lord, help us to keep our skills and mind sharp so that we may serve patients you have given us well. Amen
1 God is our refuge and strength, an ever-present help in trouble. 2 Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea,3 though its waters roar and foam and the mountains quake with their surging.
Mental health issues are very high among the medical fraternity. This is often not noted and highlighted until someone suffers a metal breakdown or commit suicide. Every year, a large number of mental practitioners resigns to seek other employments. This silent pandemic is often well known but not highlighted. Doctors, by their training, are problem solvers. Doctors who share their mental problems are often stigmatized as being weak or not fit to be a doctor. These issues are real issues. Practicing medicine is a high stress profession. Not only a doctor has to deal with helping a patient, the doctor also has to interact with the patients’ families, the senior doctors, and the working environment. A doctor may not have the extra time he/she needs to destress and unwind.
Hence it is vital that a doctor develops a close relationship with the Lord who is our refuge and our strength. No matter how busy we are, we can carve out segments of time to pray and be still before the Lord. It is a means of destressing as we pour out our anger and anxiety to him. The Lord understands out situation very well. The Lord is also our refuge as we seek to rest in him. And he will give us the strength to go back into the wards or clinics.
Having this outlet allows us to deal with our fear and anxieties. It is essential that we remember that we practice medicine but it is the Lord who heals. There are many things that are not in our control. We need to identify those things that are under our control and take care of them. Those which are not under our control, we have to learn to let go and let the Lord takes care of them. We have to deal with our fears and anxieties or they will destroy us.
Further reading: Psalm 46:10
Prayer: Lord, please take our fears and anxieties. Be our refuge and strength. Amen.
3 So I went down to the potter’s house, and I saw him working at the wheel. 4 But the pot he was shaping from the clay was marred in his hands; so the potter formed it into another pot, shaping it as seemed best to him.
Eugene Peterson, a pastor, shared a story about getting his portrait painted by a German artist during his student days. Instead of a handsome, wise, caring face, the artist painted a gaunt face with sunken and sunken eyes! This, the artist who had lived through the Second World years when the church supported the German state, said Eugene look like if continued on his course to be a pastor. In the coming years as a pastor, the work will squeeze the morality and compassion out of Eugene until he will look like the person the artist painted. Eugene kept the portrait, occasionally looking at it to remind himself not to become like that.
Being a doctor is a privilege. It is hard and stressful work with long hours. The price is often very high: broken marriages, estranged relationships with children, little friends, and even less leisure time. The work of doctor is similar to the work of a pastor. If we are not careful, it can squeeze the morality and compassion out of us.
A successful doctor will be crowned with prestige, fame, and wealth. All these are very tempting and there is never enough. We may be tempted to take moral shortcuts at get more. The more successful, the more it demands of us in terms of time and stress. We will have less time to pray, read the Bible, and be involved in a church community. Stress and tiredness make us less compassionate. We became irritable and impatient. Let us resolve early in our career on how much success do we want and to decide how we want to balance our career, family, and church.
Further reading: Mark 8:36
Prayer: Lord, mold us into vessels for your use, and protect us from too much success. Amen.
2 He [Josiah] did what was right in the eyes of the Lord and followed completely the ways of his father David, not turning aside to the right or to the left.
Josiah was one of the good and faithful king of Judah. His grandfather, King Manasseh, was one of the worst king of Judah. He allowed Baal and Asherah worship in the Temple, which he also converted into a sex shrine, and made human sacrifices (he even sacrificed one of his own son!). King Manasseh ruled Judah for 55 years. Josiah’s father, King Amon, was no better and ruled for 2 years. Yet, out of this culture of evil and idolatry, Josiah grew up faithful to Yahweh. One of the mysteries of life that no matter how bad the environment, sometimes, something good may emerge. The axiom that “an apple never falls far from the tree” is not always correct.
One of the challenges of working in a medical environment is that the department in which a young doctor works may be filled with selfish, lazy, and totally unmotivated colleagues. Some may be senior and just marking time waiting for their pensions. Others, not only are they disinterested in caring for patients, but also lacking in any medical skills. William Osler noted, “By far the most dangerous foe we have to fight is apathy – indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self-satisfaction”. Working in such environment may be depressing and dispiriting.
During the dark reign of King Manasseh and King Amon, Josiah and Jeremiah were born. These two, one destined to be a religious reformer king and another a prophet of God, grew up in the dark times. Yet, their souls and spirits remain uncorrupted.
A doctor’s working environment may not be always ideal. Whatever environment you find yourself in, do not allow it to corrupt your spirit and your soul. Do not allow it to lower your standard of medical care. Pray for protection and thrive.
Further reading: 2 Kings 23:1-3
Prayer: Lord, help us to adapt to our working environment but no to be corrupted by it. Amen.
“Before I formed you in the womb I knew you, before you were born I set you apart; I appointed you as a prophet to the nations.”
When I started medical practice after my graduation, it was a great thrill to be addressed as Doctor! Now after fifty years of practice, it has become my name. It feels strange (to me) to be addressed by name without the doctor in front. I am the doctor. Did I choose to be a doctor? Yes! Will I do it again? Yes! Jeremiah gave a new perspective on this. Did he become a prophet? Yes, he did. Did he want to be a prophet? Yes, he did, abate reluctantly at first. Initially, it seems like our choice that made us who we are. On closer examination of what Jeremiah wrote, it seems that it was God who created us, chose us, and send us to be what we are now. So becoming a prophet should not be a surprise to Jeremiah. God created Jeremiah to be a prophet; he equipped and sent him forth to an unwary Israel. What about us. Did God chose us to be who we are now, equipped us and sent us forth? I believe he did. We are not here by accident but by divine planning even before creation. There must be times when we look around our working environment and wonder if we are in the right place, or even in the right profession! Jeremiah must have felt the same way! What we can learn from Jeremiah s that he stuck to his calling with honesty and integrity in a hostile environment, just doing what has created him to do. What about us? Can we do less?
Further reading: Jeremiah 25:3-5
Prayer: God, help us to be who you have created us to be and do what you have chosen us to do.
I have completed one academic year of online teaching paediatrics to year 4 medical students of the Clinical School Johor Bahru, Monash University Malaysia. All institutions of learning were closed with the implementation of the Control Movement Order (MCO) and its various permutations. All teaching has to be done online. Campuses are closed as are hospitals teaching wards. Medical students are not allowed to go the wards in the hospitals and to interact with patients. Monash students are lucky in that the university has the foresight to create an excellent and well equipped online library a few years ago, so the students never lack for reading resources. There is, of course, always the Internet. Online teaching, in a way, is not new to me. I have been involved in moderating online courses in evidence-based medicine, and healthcare for Monash year 4 students for the last 10 years. The changes are in teaching clinical paediatrics which we used to do in small groups in the campus and on the bedside of patients in the hospital. It is a challenging exhausting year. Yet, in many ways, it has been a fruitful year in the many lessons I acquired while teaching online clinical medicine.
Firstly, I have to rework most of my teaching materials. Without face-to-face interactions, lectures needed to rework into smaller, captivating, and digestible chunks. It is not realistic to expect students to sit through an hour lecture watching you speak on a computer screen. I cannot do that, so I do not expect this younger generation that is used to sound bites and shorter demand to their attention span. So instead of giving a lecture, I have uploaded my revised lectures to the university Moodle. I expect the students to view these lectures on their own time before we come together in our face-to-face Zoom sessions. Then the Zoom sessions will only be used to highlight certain main points I want to emphasis.
Reformatting my teaching materials mean, not only my delivery but also considering how students will learn their clinical contents. I teach case-based tutorials. In previous years, the students will clerk a patient in the ward and present it in our weekly sessions. Now, I have to prepare clinical case studies. When I describe a patient to the student, I am sure without the nuanced previous encounter with patients, the students cannot fully grasp the significant of what we are discussing. It becomes just an intellectual exercise, abate an interesting one. Talking about a child with congestive heart failure due to an enlarged heart is different from standing at the bedside of a small emaciated child, gasping to breathe, and seeing the movements of the heart beneath the thin ribcage. None can forget such an experience. The closest I can do is to search Youtube for video of a child with a similar condition.
Secondly, we usually meet on Zoom which is an excellent platform for watching disembodied digital spirits. The technology is advanced enough for us to see each other in real time, share our screens, and break out into small groups. “You are muted” became our greeting cry! I have spent an entire academic year interacting with students who are digital images. I have yet to meet them in real life. I guess, I am to them, another digital image too. I love teaching because I can interact with real life students. I get to know these students. Over the years, they have become, in some ways, my extended family. I believe that more of medicine, or in my case, paediatrics is caught than taught. It is my hope that I convey to my students through my presence who a good doctor should be (or should not be, as my faults will illustrate). This I cannot do through Zoom. I sense I am just another interactive avatar in a game to them.
I am not saying Zoom is bad. As a teaching tools, it is useful to convey information. Transfer of information, as most educator will highlight, is only a small part of learning. It is high tech, but low touch. Medicine is high tech and high touch. It is the human touch aided by technology.
The technology is here but the telecommunication infrastructure in Malaysia is lacking in many areas. All the students are back at home as the campus is closed. Internet connectivity is excellent in some areas, spotty in some areas, and non existence in others. Zoom is an Internet-based application. Some students have Wifi networks while others try to login using only their phone networks. Hence some students are dropping in and out (often not willingly) during a Zoom session. To preserve their connectivity, they often switch off their video. I appreciate their reason for doing so, but with video and sound off, I often wonder whether they are there at all!
Thirdly, going online made us global teachers and students. We are awakened to the fact that there is so much resources in this digital space. There are so many lectures, clinical photos, case studies, videos of surgeries, and information available not only on the Monash website but in the Internet. As a teacher, I realized that I do not have to reinvent the wheel. I can point students to resources by better teachers and institutions. They, in turn, point me to resources I find useful for my own learning. This vast treasure on the Internet is both a blessing and a curse. It is a blessing because there is much information available, a curse because it does not engage the mind in independent critical thinking.
In Zoom session, I often divide the students into small breakout rooms and give each a topic to research and present in 10 minutes. I am often amazed at how much these students can do in 10 minutes. They come up with very impressive PowerPoint presentations. The students are experts in finding information and in ‘cut and paste’. However, they have problems when it comes to sieving through the information to come to a diagnosis for a patient, or to see the underlying medical principle. They lack the deductive logical thinking skills essential for medical practice. They are slave to the algorithms of clinical guidelines.
Finally, in this academic year of living online, I wonder how the students interact with one another. The clinical school is a temple of learning. This learning comes not only from the formal learning but also by informal and the null curriculum. Online teaching helps to fulfil formal learning but not so much in the others. Learning occurs in interactions between teachers and students. It also important between students themselves. We learn from one another. The clinical school is actually a village. For clinical students, the chief ‘enemies’ are the teachers and the university system. They need each other to prove themselves worthy to their enemies. This builds comraderies and relationship. Students’ relationships teaches them how to work as a team, be resilient in stormy times, and be self-directive. All these are part of the system of clinical education.
The pandemic gives me an opportunity to teach medical students online for one academic year. There are advantages and disadvantages of teaching online especially using Zoom. It also offers an opportunity to re-examine the way of teaching and learning in teachers and students in general. We do not know what the following year will bring. Perhaps another academic year of learning online. Or perhaps not. Let us never forget the lessons we learnt this year. Perhaps it is a good year, after all.
You are invited to join me for this Zoom session. Even though it is for Medical and Dental professionals and students, you are welcome to join us even if you are not a healthcare worker. It is open to all who are interested in Christian spiritualities in this pandemic period.