The making of a doctor

Children, when asked what they would like to be, are wont to answer “I want to be a doctor!” without batting an eyelash.

Many young people, indeed, look up to medicine as a glamorous profession. But it is definitely not for everyone. For one thing, it requires a great investment of time, effort and money. Not only is it one of the noblest professions; it is also a calling, not unlike priesthood.

Just recently, I came across this post on Facebook about being a doctor: “It can’t be inherited, it can’t be bought. I have paid for this with my youth, my sleep, my blood and my tears!”

Yes, imagine time away from home, and the reunions, holidays and important family events one would miss because of the grueling schedule in classrooms and in hospitals. The first few things a would-be physician should learn are discipline, perseverance, diligence and the ability to read and comprehend thick volumes of medical books.

It takes almost two decades to really become an accomplished physician. If one is really intent on becoming a doctor, he or she should do well in high school in order to get into a good undergraduate college for the preparatory medical studies concentrating on the sciences. Once through with the four-year course, one has to take and make sure to get a good enough score (at least in the 90th percentile) in the Medical College Admissions Test. This is designed to assess the aptitude, problem-solving and writing skills of the applicant. One who does well in this examination is almost certain to get into a good medical school.

Once admitted to medical school, students are expected to give undivided attention to their studies for the next two years, as they go through the intricacies of physiology, anatomy, biochemistry, neuroanatomy and pathology, among other medical subjects. They need to open and read those thick medical books religiously, day after day, in order to pass the written and oral examinations.

Later, the specialties like surgery, internal medicine, obstetrics and gynecology, pediatrics and others would be introduced to the beleaguered medical student. A really good memory would help a great deal in passing the almost daily exams. In fourth year, students go through the rigors of medical clerkship in the hospital, where they’ll now work with patients under the close supervision of clinical consultants.

After a year of rotating through the different departments of the hospital, one is ready for another full year of rotating internship through the different specialties, where the student should be able to get a feel of where he or she should go for his residency training. The final hurdle is the dreaded “revalida,” where one has to face a tribunal of examiners who would grill the student on any medical subjects under the sun. This is the final requisite one should pass before graduation, before he or she can be finally conferred the degree of Doctor of Medicine.

After passing the licensure exams, the newly minted doctors would take their oath before the commissioners of the bureau of civil service. The full-fledged physicians are now ready for their residency of choice, which would entail three to six years of rigorous training. Once done with residency training, they would have to pass the specialty board exams in order to be a certified specialist. Some others would still go for subspecialties for another year or two, but most would go to private and hospital practice after residency.

Once in practice, a good physician should have empathy, compassion and clinical acumen, to be able to succeed  in his or her chosen field of specialty. He or she would need extraordinary skills in diagnosis and proper management,  and proficiency with specialized tools and technology.

The great medical writer Dr. Felix Martí-Ibañez admonished generations of medical students that their duty to their patients is to act toward them always with kindness, courtesy and honesty. “In medicine, there is no room for amateurs or dilettanti,” he said. It’s “a noble career in which we must all aspire to be masters of whatever we undertake, for the mistakes of medical carpenters and prescriber’s apprentices can have tragic results!”

So there. Do you still want to be a doctor?

Floriño A. Francisco, MD, 79, is a freelance feature writer and a Harvard Fellow in adolescent medicine. He is a 2010 TOPICS (The Outstanding Physician in Community Service) awardee.