A medical school dean once told me, "Every year we turn away as many applicants as we admit, who would also make excellent doctors - our class size just isn't big enough to hold them all."
I've had the unique opportunity to spend time with a few Canadians who are attending medical school in Australia, and I've come to the conclusion that what that dean told me couldn't be more true.
The students here have all impressed me with their life experiences, their intelligence, their motivation, their accomplishments, and how friendly each and every one of them is.
In fact, if you had told me that they were students at my medical school, I would have believed you. I can't see any difference between the students here and the students in my class. They're by no means inferior, whatsoever. And while I'm basing this impression on only a limited amount of time with them, I have already spent a lot more time getting to know them than any admissions interview committee does.
I've also learned that just because a Canadian is studying medicine overseas, it doesn't necessarily mean they were denied from entering a Canadian medical school. Getting into medical school is a lengthy process, and if you don't get in on your first try, as was the case for up to half of the people in my class, the process to re-apply takes almost a year (apply in October to find out in May if you are in September's starting cohort). Rather than apply again, and sit out for another year, some of the students who learned they had been admitted in Australia considered it a logical choice to get on with their medical education right away.
In fact, in many ways I look up to the Canadian students studying here. Before I applied for medical school, I always told people my backup plan was, "If I don't get into medical school in Canada after my third time applying, I'll start applying overseas...Australia, Ireland, the Caribbean." But, to be honest, the thought of having to leave Canada to study scared me, and I wonder if I would have had the determination to apply yet again, let alone apply overseas.
The Canadians studying here, on the other hand, have given up proximity to their families, their friends, and everything familiar to them, to pursue their passion for helping people through medicine - many more sacrifices than we Canadian medical students are making.
And at the end of the road, that determination, that willingness to sacrifice, and that unbeatable passion for helping people - if that's what these students have in them, and if they put all that into how they serve their patients, well, you can't deny that's the type of doctor every patient prefers on the other end of the stethoscope.
Monday, June 09, 2008
What about those Canadians studying medicine overseas?
Sunday, June 08, 2008
Vitum experiences medicine down under!
I didn't expect to find myself seeing patients in Australia this week, but there I was, in a general practitioner's office, shadowing as a medical student, just hours after getting off the plane to Australia.
I have a buddy of mine to thank. I've always wanted to visit the Southern Hemisphere, and since he is one of the estimated 1500 Canadians studying medicine abroad (a quick tribute to the limitd number of medical school spaces in Canada) it worked out well to combine a trip here with a visit to an old friend.
Not only that, but his preceptor graciously agreed to let me tag along with him during his placement in her office this week, an opportunity that I was very interested in taking part. It was fascinating learning about the similarities and differences between medicine here and in Canada, identifying some rashes I had just learned about in our Dermatology unit, and actually feeling like I have learned something in the last two years as I was able to pass on some things to the first-year medical students.
Don't worry, I'm not spending my entire break doing medical things...you'll find me laying on beaches and hugging kangaroos the rest of the time I'm here. But it was really neat to see what a doctor does halfway across the world.
What's different?
So, based on my afternoon in a GP's office here, how does medicine in Australia differ from that in Canada?
Well, the first difference that I noticed right away was the layout of the office. In Canada, GPs generally have an office with their desk where they do paperwork, but that is in a separate room from the rooms where they see patients. In Australia, however, the GPs have a large office, one half of which looks like a typical office with a desk and computer and bookshelves, and the other half - sometimes separated by a curtain - is the clinical area where they see patients, with a patient bed, sink, and various instruments hanging on the wall.
Another difference I noticed was the hints of the two-tier health system here. The public system, known as "bulk billing," works alongside the private system, funded by patients or their insurance companies. I've been told it isn't that profitable for a doctor to only see bulk billing patients, and for the most part those that do are more similar to what in Canada is a walk-in clinic - where patients go for minor issues after hours, or mostly to get prescription refills. GPs who have their own patients shake their head at the mention of a patient getting antibiotics from one of these bulk billing "medical centres"... just like GPs in Canada shake their head at the mention of a walk-in clinic. As well, driving through a smaller town in Australia, I saw a large public hospital... and right down the street from it, past the independent pathology labs that contract out to the hospital, was a private hospital - smaller, and much fancier.
Finally, a comment about the public health victories in Australia. Like in Canada, doctors here have had a major influence on smoking rates and seatbelt use - but before even coming to Australia, I had heard that the doctors here have had incredible success with the "slip, slap, slop" campaign - to get Australians to be "sun-wise" and significantly decrease their risk of sun-associated skin cancers by covering up with sunscreen and long-sleeved clothing. Based on their efforts, wearing hats and long-sleeved clothing to outdoor events has become a way of life in Australia.
What's the same?
Indeed, those differences aren't really that major, and I'll go so far as to admit that the thing that stunned me the most was that there are actually many, many similarities between medicine here and how I've seen it done in Canada.
Many of the things I heard the doctor mention - drug names, medical conditions, and investigations for medical conditions (such as a glucose tolerance test, nuclear studies, ultrasounds, biopsies, lab tests) - had the exact same name and terminology we use in Canada, much to my surprise. Even those rashes I had recently learned about in our Dermatology unit showed up, and are called the exact same things they are in Canada. I suppose I had the idea in my head that everything would all be called different things here.
Not only that, but a couple came in to talk about their plans to get pregnant - every single thing the doctor mentioned in the prenatal counselling, right down to the numbers ("you have a 20% chance of getting pregnant each month" and "if you don't get pregnant within 12 months, that's when we'll start looking into the reason for that") and advice ("take a folic acid supplement" and "don't drink any alcohol now that you are planning to become pregnant!!!!") were identical to what I had just learned in my reproduction block.
Overall?
I'll admit that the rumours I've heard about how hard it is for Australian doctors, and international doctors in general, to come to Canada had always given me the idea that the doctors here are perhaps less competent than those in Canada, or that maybe Canada is keeping them out for the protection of our own people. However, having seen these docs in action first hand, this misconception of mine has been pretty much wiped out. From what I saw of the docs here, they're just as competent as any doctor I've worked with in Canada...if not more so than some.
All of the doctors in the office seemed very enthusiastic to have students, and took the time to try and teach me. It was also really interesting to go to class with my friend and meet many other Australian medical students, see that they are learning exactly the same things I am learning in class in Canada, and share perspectives with some more of the Canadians in his class who are all studying here for different reasons.
Many thanks to my friend's GP (and all the docs in the office) who were more than willing to make this unique experience a possibility for me.
One last random thing...
If you want just a normal, regular coffee in Australia, ask for "filtered coffee" - it's not the same as "percolated coffee" (ask for that and you'll get an espresso). That should save you the argument with the barista... which, based on my experience, ends up with them thinking you're crazy, you thinking they're crazy, and you settling for a "tall black" (their name for an Americano). Just a tip.
Thursday, August 03, 2006
Once upon a time in Nigeria...
Fever, nausea, vomiting, diarrhea, shaking, chills, sweating...
It’s a bit embarrassing to leave a blood donor clinic after meeting with the nurse, without giving blood. I assume that people are thinking about me, “Why can’t he give blood? Does he have AIDS? Did he say ‘yes’ to the screening question, ‘I had sex with a man for money or drugs since 1979?’”
I’ve had to leave without donating twice, for none of those reasons, and both were only temporary deferrals. The first time was because I had been to Turkey, which is a malaria-risk country, and yesterday was because I had just gotten my measles/mumps/rubella vaccine updated last week. Should’ve looked up the guidelines before I went.
The funniest part about me not being allowed to give blood after going to a malaria-risk country is that every time I give blood, I already tell them that I have had malaria...possibly.
Back when I was a first-year pre-med, I had the chance to chat with the dean of a med school, since he used to be a neighbour of ours. He told me something that ended up changing my life. “If you want to apply for medicine, you should spend time finding out what it’s like. Talk to doctors. Read books about medicine, such as William Osler or Hardy Cushing’s biography. And get experience doing it – the best way to do this is to go to a third world country and work with a doctor.”
I had never pictured myself somewhere in the slums of an African city giving out medications to lepers, but because of that conversation, that’s where I found myself a year and a half later. Going to Evangel Hospital in Jos, Nigeria (link flickr) was an incredible, life-changing experience. I was able to see and do so much.
One of the themes I picked up on was that people would generally wait for a while to go to the hospital, for a variety of reasons; they were scared or didn’t trust the white man’s medicine, lack of financial means, or transportation issues such as living in the bush. Because of this, I watched a woman with a softball-sized goiter removed, a man with a football-sized tumour on his arm removed (it had grown back after being removed 5 years earlier), a 9-year-old girl with osteomyelitis that had been oozing foul-smelling pus from her arm for 9 months, and a 5-year old boy get a circumcision, to name a few cases. (I felt bad that the best thing that I had on me that I could offer him in empathy was a balloon. I’m no medical expert, but I think he’d rather have his foreskin).
In the lab, they had some modern equipment, but every week you’d have to check the memos to find out what labs they couldn’t run because they had no reagents for them. Blood cell counts were done by staining blood and…you guessed it…counting. And malaria tests were done the same way, as I found out first-hand.
I took my prophylactic pills every day, but slept one night without a mosquito net on a church floor in a village outreach. The DEET dropped the ball on this one. A couple weeks later, I had all the symptoms. I’m not 100% sure I had it because never got a conclusive test, but there were good reasons why the tests wouldn’t have worked, and malaria pills knocked it out four days later. So I tell the blood people that I have had malaria... possibly... and they just don’t use part of my blood.
Back when it wasn’t too volatile and they were still sending pre-meds to Nigeria, supposedly it usually worked out that one decides that there are professions other than medicine that are good for them, and the other decides s/he really wants to do medicine. I was definitely the latter.
I’m about to start medical school where things are going to be very different. CTs and MRIs will be there when we need them, there won’t be open windows in the OR, and we can expect the lights to stay on more than 50% of the time.
To be honest, I don’t know if I could practice medicine full-time in a third world country. Don’t get me wrong, I can’t wait to go back for a few weeks at a time, but it would take a lot for me to do that permanently. I’m pretty sure that over time it would frustrate me not being able to do everything possible for the patient, knowing that if I was in Canada I’d be able to offer so much more.
And I don’t want to get malaria.
…again.
... possibly.
