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I often tell my medical students, “ I will not teach you compassion. I will not teach you something you already know. I will teach you however something new. I will teach you how to box up your compassion. I will teach you to use it sparingly so as not to compromise your objectivity. I will teach you discrimination.”

The mistake of most educators is fearing to thread the unpopular ground. We often try not to go beyond what is written in books. The most current medical book in the market is no younger than five years old. And the medical science evolve faster than books are written and published. 

When I started practice, I was surprised to find out that most that were taught in med schools were not followed. Books are standardised baselines, but with often  unrealistic approaches. 

“ I will not teach you what’s on the books. You know how to read. Read as much, then discriminate. I will teach you how it is in real life practice, when you are paged in the ER in the middle of the night, a baby with morbidiform rash and black patchy lesions, gasping for breath, the parents hysterical and begging for you to save their only child. I will teach you how you should not touch the child without mask and rubber gloves. How you should not intubate without making sure your team is in protective gears. The child will die, they all do in that stage of meningococcal infection. But your team should not. And it’s mortal sin to be the source of further epidemic”.

Cold? Yes it is. We deal with hard facts and data to save lives.  Battlefields are frigid places even when it's scourching hot. Doctors are soldiers. We save those we can, leave those we can not, and move on.  The books shy away from the gross reality of the war ahead. And so the idealistic young doctors go into culture shock early in practice, and leave deflated and utterly scarred. 

Reality bites. And so we bite back.

By Joei MD 2015