‘After the exam’ is a special place junior doctors strive for when they can finally achieve a tiny amount of free space in their lives, on top of their usual 80 hour work weeks.
So it’s little wonder young doctors were in distress following the cancellation of an exam, writes reconstructive plastic surgeon Neela Janakiramanan.
Last week, over 1200 young doctors fronted up for a career defining exam that they had spent two years preparing for, and a series of ‘technical failures’ resulted in a cancellation of the exam part way through.
These doctors were then booted out of exam centres around the country, many in extreme distress.
News of this has ricocheted around the medical community, social media and the mainstream media, with various state health ministers demanding answers from the Royal Australasian College of Physicians.
Most disappointingly, many of these doctors have come under scrutiny for their ‘emotional’ response to this series of events, with comments ranging from “its just an exam” to “if they can’t cope with this, how can they cope with real medical emergencies”.
This highlights the degree of misunderstanding the general community has about medical training and, in particular, the disproportionate burden borne by women in medical fields.
Undergraduate medical training takes six to eight years, full time at university, with a contact hour load that far exceeds any other university course.
The junior doctor years become more intense. 60-100 hours a week where we assist new life, hold hands, break bad news, manage the critically unwell and unstable, and bear witness to death. And then go home to study further, in order to pass these intensive and expensive exams.
We retreat from our family and friends – and in the specific case of women – return to work earlier than we would like after childbirth, give up early years with our children, feed our babies formula or express furiously in a toilet between seeing patients, while also often managing the thought load at home.
Many women acknowledge the impossibility of working 100 hours a week while pregnant or with a young baby at home, and delay their pregnancy plans until “after the exam”.
“After the exam” is a magical place that all junior doctors aim for. When life is ‘just’ working double the average work week rather than working eighty hours and also studying another twenty hours every week.
“After the exam” is when we can do simple things, like have dinner with family rather than eat sludge in the hospital cafe before heading back to the library.
“After the exam” is when we have proven our competence to our superiors and peers, and the administrative tasks at work become that little bit easier.
“After the exam” is when we can go on a holiday and read a work of fiction rather than the never ending index cards, where we try and distill facts about every disease that can affect humanity.
“After the exam” is when we can take a moment of the day to celebrate or mourn our patients’ wins and losses, rather than suppress our own emotions deeply in order to go back to the books.
“After the exam” is when we can actually plan our own family, take our kids to the park, buy them an ice cream and not care if they eat it so slowly that it melts and runs down their chin and collects in puddles, and it doesn’t matter that this will mean another load of laundry.
The young doctors who work in our hospitals are well trained to run resuscitations or save someone’s life if they bleed during surgery. We are trained to handle life and distress and death. We are trained to hold our emotions together so that there is room for yours.
We don’t need to have these artificial stressors to build resilience – we have enough real life experience every day.
So forgive these doctors their moment of emotional distress when, after years of sacrifice, they realise their booked holiday will be canceled, their reproductive plans delayed, and they will have to tell their spouses and children to hold on just a little bit longer, because they know what holding on has cost everyone.
This does not mean that they are not good doctors, capable of managing the stress of a medical workplace.
Indeed it means they are all the better equipped for it, because they are still truly human.