This is what we have chosen

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Being a doctor. A white coat and a stethoscope over it. It looks so lucrative. In our part of world, doctors have good respect as well in the society. Most parents want to see their child being a doctor and living their life with honour and pride easily. That’s the main reason that thousands of young guys and girls are found to be appearing medical entrance examination every year. Nowadays, I see a huge herd of students in queue to submit the entrance form in our medical college. I was one among them few years back.

Today I am not telling my story. I want to discuss a small part of Doctor’s job. That is frequent and fast discoveries in medical field.

Doctors are the professionals who need to be updated most frequently. This is interesting, correcting yourself again and again, being better day by day. But that’s not easy to cope with.

A drug u use most, might be suddenly seen to be creating some irreversible side effect, new research might claim it to be teratogenic (teratogenic= substance that interfere with growth and development of foetus in mother’s womb) and can’t be given to pregnant lady. Suddenly a research study proves that Diabetes can be cured. Health ministry might suddenly change the national guideline of TB treatment. You always need to be prepared and need to be up to date.

Let me give you a practical example. Oral Contraceptive Pills (OCP) which come in Brand name of ‘Nilocon White’, ‘Sunaulo Gulaf’ etc. in Nepal, is one of the widely used contraceptive (birth control) measure worldwide. OCP has some side effects to consider like Breast cancer, Venous Thromboembolism (blood clotting inside vein and occluding it), Myocardial Infarction (decreased blood supply in heart resulting in destruction of heart tissue), stroke (Decrease in O₂ in brain causing unconsciousness) etc. Let’s talk about the first one, The breast cancer...

In 1996, Collaborative group on Hormonal Factors in breast cancer released metaanalysis of 54 worldwide studies. Metanalysis is statistical procedure that integrates the result of several independent studies. It was published in Lancet which is one of the world's best known, oldest, and most respected medical journals. Conclusion of this study was, there is slight increase in breast cancer risk, the Relative Risk (RR) being 1.24. Which means chance of having breast cancer to an OCP user is 24% more than normal population. And after stopping OCP, Risk decreases to year by year.

In 2004, A cochrane review (Cochrane is another trusted and well organized collection of clinical studies) of 51 epidemiologic studies in 2004 reported almost similar finding. Concluding OCP doesn’t significantly increase breast cancer.

In 2006, The oxford family planning study published another finding from a very large cohort study. In cohort study, females taking OCP and females not taking OCP are identified and then observed for the occurrence of certain health effects (here breast cancer) over long period of time. They followed more than 17000 women for 16 years and concluded that there is no risk at all. This was published in British journal of cancer.

With these examples I just mean to say that, things are changing and changing and changing again and again. The things our professors are teaching us is entirely different from what they learnt. The thing we are learning will be changed by the time we graduate to be a doctor. What we are learning will be only background knowledge, and we will require reading further to know the latest options available. And soon, even they will become out of date. This is how the medicine is. It is really good that new, better and more accurate options are being available every next day. But you should be able keep yourself updated. Medicine is a profession for constant learners. You need to read and rectify yourself regularly for lifetime, if not lifetime then at least as long as you practice. Let me tell you, this is one of the major lessons that medical schools teach the students.

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I have seen doctors, who use library, keep on studying, even more than students. Frankly speaking, medicine is not lucrative at all within itself. You need a strong motivation to not to get frustrated. “This is what we have chosen.” would be the only sentence to counsel yourself. There are plenty of doctors who are frustrated for coming in this profession. People want their children to join medical school hoping that they will be regarded as respected member in the society. Many students joining medical school unwillingly, because of parent’s pressure or some other cause, end up ruining their life. These things are more common than you think.

Let me add something more than I know. Since, facts on medicine are changing rapidly day by day. The books, curriculum, syllabus of a medical school should also be changed/updated regularly. The books we read are western, which get revised regularly. New edition is available within 3 years in most of them. What about our collages?? What about the Medical Council?? It’s doubtful. Newspapers and other press publish the news of the officials of council, being shamefully accused of corruption. I wonder if they are regulating about the updates in medicine. I don’t know anything at all. They are my doubts and guesses.

Tribhuwan University (TU), the biggest university of Nepal, has turned out to be a place to practice politics and is a good example of mismanagement. The same is with the Medical Council. Kathmandu University (KU) which has almost same number of medical schools under its affiliation as TU, has turned out to be a place for making money alone. The medical schools being most attracted towards it. I doubt they are regularly revising and updating the curriculum. Most probably they aren’t. If someone says that KU and TU have not updated their medical curriculum even once till now, I won’t be surprised at all. This is how things goes in Nepal. I wonder how will our PAHS be doing after 10 years of time???

I hope, not only PAHS, all the universities and schools in Nepal will be doing better than any part of world by then.

And to those to young aspirants who will be joining PAHS soon as our fourth batch, and everyone who are getting in a medical school soon, please be prepared for rest of your life and BEST OF LUCK!!