Cures, curiosity, cash, control: searching for motivation in medicine

By Mozafer Rajabali

Perhaps one of the most important bedrocks of current-day ethics in medicine is the Hippocratic Oath, a series of ethical standards that clinicians have to swear by before they enter the workforce. Medicine by its very nature requires an ability by the clinician to enter into some of the most private realms of another individual on a regular basis. For myself, while I may have initially almost stumbled into medicine, what now appeals to me the most is the ability to care for another individual in a way that requires their ultimate trust. This is not to say that I seek to adopt paternalist attitudes towards those I interact with, but that I wish to be able to work with them in achieving the best possible goals. Here, I wish to point out some of the reasons why & how my motivations for medicine have evolved, and try to contextualise them in a more globally relevant setting.

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A tribute to a palliative patient

By Priya Selvaraj

Laura glanced down at the next patient’s details. There wasn’t much to start with – she had never met this gentleman before, and we were just going to “drop by and check in on him”. We had taken a moment outside his house in the hospital car as she explained to me that the patient we were about to see was currently receiving palliative care for his cholangiocarcinoma. And that’s the extent of what we knew about him. As we stepped out of the car, a pleasantly dressed elderly man opened the door and waved us in. Introductions were made, pleasantries exchanged and we went in.

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To Embrace the Dying Light

By Victor Senthinathan
Honourable Mention, Writing Competition 2017

Prompt 2: Tell us about an encounter with a patient that has significantly shaped your understanding of medical practice or changed your worldview.

I always thought of hospitals as unpleasant places. It was a place where sick and dying people congregated, where white walls stretched out aimlessly and there was the ever-present promise of a registrar quizzing me on something I had just forgotten.

On this day however, my hospital seemed idyllic. It was the type of day where sunlight didn’t just stream into rooms, but cascaded off walls, golden glitter veiling the room. It was the type of day where every ward held smiling patients with easily identifiable differential diagnoses. It was the type of the day where your clinically appropriate shoes can’t help but skip into a room to find a patient for your case report. This is where I met Mary. I would be amiss as a medical student to not mention that the patient has been de-identified to maintain patient confidentiality.

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Changing Climates and Curricula

By Cecilia Xu
Honourable Mention, Writing Competition 2017

Prompt 3: Describe an aspect of medical school or medical practice that we do poorly, and discuss how we could best remedy this.

In 2009, The Lancet published a landmark report declaring climate change to be the biggest global health threat of the 21st century (1). It was the first report published in a medical journal of this calibre to draw attention to the effects of climate change on human health, both now and into the future. These included water and food insecurity, extreme weather events such as heatwaves and floods, and increased burden from infectious, psychological, and cardiorespiratory diseases. In 2015, a follow-up report was released (2). Unfortunately, projected outcomes were even more severe than originally anticipated. We are now in the midst of a global health emergency.

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Memories from the Bed

By Conor McDonald
Preclinical Winner, Writing Competition 2017

Prompt 2: Tell us about an encounter with a patient that has significantly shaped your understanding of medical practice or changed your worldview.

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My wife, Margie, sat to my left as we ate our dinner. A few grey strands peaked through her long dark hair. She had brown eyes and she was beautiful. Next to her was our 5-year-old son George. He looked a lot like me. Blonde hair, blue eyes and a chubby face with flushed cheeks. Our family filled me with pride. Whilst the ‘energy saving’ lights my wife had begged me to get made me feel like I was in a hospital – a place for the sick and dying – we managed to bring life to our cosy little home.

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Speaking the Language of Medicine

By Jason Ha
Clinical Winner, Writing Competition 2017

Prompt 2: Tell us about an encounter with a patient that has significantly shaped your understanding of medical practice or changed your worldview.

“There’s an angsty patient out there—”

“—So impat—“

Over the hubbub in the nurse’s station, I could barely paint out a coherent description of the patient. 82 years old. Surgical Post-Op Clinic.

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OSCE Debut

By Rashid Elhawli

Ask any medical student about exams and two things should pop up; written exams and OSCEs. Most are familiar with the drill behind written exams, but less are aware of the awkward OSCE experience.

OSCE is short for Objective Structured Clinical Examination, which is a fancy way of saying that you are simulating a real-life doctor-patient encounter. The first official experience with this kind of examination was at the end of our first semester, when we had a practice run. The day was set-out so that it would be as similar as possible to the real thing.

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A penny for your lifestyle change?

By Emily Feng-Gu

Everyone knows that if you’re in an OSCE station the first-line management for a chronic disease is lifestyle modification.

Lifestyle choices contribute to many of the chronic diseases that are topping the list of Australia’s causes of mortality, including cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, and some types of cancer.1

Behavioural change is difficult, and a lot of how we approach the challenge of motivating patients is rooted in patient education. We lay out the benefits and risks, we set SMART goals, and we hope that information is enough to spur patients into action. That is, we assume people are perfectly rational – but maybe we shouldn’t.

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