Memory and Instinct

(Picture taken from Google Image)

I should probably write the first article to encourage more to come along.

I'll be the first to admit it. I feel I don't deserve to pass my professional exam. Not that I'm not grateful to lecturers or God, without them no way I would've been able to pass. No, rather, I feel like I lack the knowledge and thinking ability that I've always imagined a third year should have.

When I was a first year, I used to look at the third years as if they're the most amazing people ever and wonder how they ever passed their exams because I was struggling and had convinced myself that coming from Physics stream, I was more handicapped than most since I hardly studied in my years as a student. I remember every time we had a Problem Based Learning (PBL) class, a chief complaint was given, and we're supposed to give a rundown of differentials. And I remember saying to a mate of mine, "I can't wait until I'm a second year and we've gone through all these systems. Then, we can do this PBL thing properly. Time tu dah tau semua, baru boleh diagnose semua benda." Kononnya lah.

Now that I'm a third year, every day is PBL day, and every person in hospital is a PBL patient. And I'm still no better off than that first year girl who feels like she has no clue as to where to start diagnosing her patient. Now I think, "I can't wait until I'm a specialist. Then I can diagnose the patient intelligently." And then I'd wonder about how lost I'd feel like when I actually am a specialist...

Now and again, I have first years coming up to me, asking me, "How do you memorise all this stuff?!"

I wish I knew then memorising is a basic skill, and not even the most important skill, whereby the most important, the crux of a doctor's neurological software is the ability to think. Bak kata Mr. Gee, "Common sense is not so common."

How we used to memorise time tables from two to twelve to be able to do complex calculations properly until the ability to calculate 1897 x 789 becomes a basic function in us as a human being is exactly how we should treat medical knowledge. After being exposed to a certain problem, a brain's structure changes in a certain way so that the next couple of times we try to solve the problem again, the thought process that occurs in our brain is faster, almost automatic, as if by instinct. For example, monkeys solve true-false problems faster when they are taught the concept of one and zero!

Just like how log, calculus, etc is the next step in maths after learning how to multiply and divide, thinking and diagnosing is the next step after knowing all that medical jargon and information. Interpretation of signs and symptoms, prognosticating, treating, referring is the next step after knowing all your values, your facts, your texts. After all, you don't want to examine a sick patient infront of you and still be thinking mainly about whether you're doing the steps correct! It should be a given, and what you should be doing already is collecting clues.

It doesn't matter if you're from the Physics stream, if you're a monkey, you can learn medicine, anyone can. Don't think you're a better human being than most just because you're taking the medical course. (Yes, there are people who act like it!) It just takes unfailing will to continue to memorise and learn until it becomes instinctual on top of a powerful internal drive to be able to think, not just for your sake to pass exams, but for the patients you're facing in the future.

I hope first years remember that. That exams are just exams. That if you pass exams, viva, repeat papers, whatever it is, well done, no-one cares, no-one's looking at your pointer. I hope they know the things they're learning aren't for exams, but for that Holy Grail of a medical career: the development of a professional medical instinct. Here's to hoping that we all reach that point some day in our lives.

Nazirah, 3rdyr 2010/2011