The way we're taught

The medical curriculum

The only part of our university medical curriculum I remember having strong opinions about is the lectures in preclinicals where highly respected professors or academics in the field would get up and whiz through a topic we have never heard of with heaps of technical terms we (okay, more specifically I) didn't understand. Which, combined with my own bad sleeping habits, made me fall asleep almost every single day. Which didn't inspire my interest in medicine. Worse still, I realised that they would give the same talk in the first week of first year, compared to several semesters later. Actually, some of them never seemed to care who their target audiences were - the lecturer sometimes stopped in the middle and asked, so what year are you guys in? Hmm, tailoring your talk to the level of your students? Learner centred education?

Aside from that, I actually respect the way the university reviews and revises its curriculum, having a dedicated education unit, and constantly updating and comparing its curriculum with other institutions around Australia and around the world. I liked how the weekly problem based learning correlated with practicals and lectures for the week. How in the microbiology and immunology semester, we learnt about the laboratory tests relevant to the case of the week. In clinicals, I enjoyed the mix of clinical time and tutorials, the focus on long cases to help us learn how to take a good history and examination.

Aboriginal health, racism, and on being Asian

Then recently there was an orientation for the rural health module, where we spent three days having talks and doing cases about rural and Indigenous health issues. Having a real interest in the area, and having spent a weekend at a national rural health conference several weeks ago, I was looking forward to the sessions. And gee, they were bad. At the national conference some students commented that even though they've heard about Indigenous health year after year, this was the only time that they began to take an interest in the area. In their experience, Indigenous health has always been poorly taught at their universities - an Aboriginal person would talk about the stolen generation, in an accusatory tone towards a room full of students, over half of whom were Asian or International students. They thought to themselves, umm, neither we nor our ancestors were even here back then.

I had fairly neutral experiences with Indigenous health teaching until recently. This time, we had a panel of Indigenous healthcare workers, half of whom were of Aboriginal descent, speaking to us about Aboriginal health. The first thing I noticed was that everyone on the panel looked at us without a smile. The talk itself, well it was condescending, it showed a lack of respect towards the medical profession. The very thing you told us not to do - that is, to be disrespectful or talk down on an Aboriginal patient, you did it to us. Whilst most of my classmates mentally or physically zoned out, I was busy jotting quotes down as examples of the tone in which we were spoken to:

"One thing I tell you students when you work with me..."

"I always tell the students, the Aboriginal workers can get so much more out of the patients than doctors ever can." Yes we respect Aboriginal liason officers for their insight into culture and community, but Aboriginal healthcare workers also need to respect non Aboriginal doctors and nurses for their medical role.

"Some have the luxury of having me (Aboriginal liason officer) in the consult."

"I don't like taking no very often."

"We are different to everybody else." How about the refugees from Africa, or the elderly grandfather from South East Asia. Do they not need the same patience and cultural sensitivity as an Aboriginal patient?

"Aboriginal people have a sixth sense, they can pick up when people don't like them because of their race. They (the Aboriginal patients) immediately think - I don't like that person, they are looking down at me." Okay, I can make instant (often erronous) judgments about others too.

I understand that they may have had bad experiences with mainstream nurses and doctors. I respect the work that you do. But talking down to future doctors isn't going to help improve Indigenous health. And yes there are challenges Aboriginal people face that other Australians may not face, such as the trauma of the stolen generation, family and community issues. However, when is it your own perception vs real racism?

What would you say if I were to say, hey I don't like the way I'm treated, people are always treating me different. Do you know, when I go to the shops in the supermarket, as I wait in the deli or seafood section to be served, I always feel that other (white, middle aged) Australians are served before me. And my first thought is, it's just because I'm Asian. Or even when I talk amongst a group of Caucasians, and when some people exclude me from the conversation, I think, it's because I'm Asian. Or when tram inspectors come on the train and scrutinise my ticket carefully I think, look, you only chose to come up to me because I look Asian. At times the racism is real, conscious or subconscious, but at other times it's just the way I perceive people's actions.

This is the scenario we're often given - a nurse or doctor said something insensitive, and the Aboriginal patient never trusted medical staff or hospitals again. I'm sorry if you (the panel) or your patients have had bad experiences. But you can't label the whole healthcare system as racist and evil, or avoid healthcare altogether because of the action of some individuals. When I went to a school camp in year five, a group of us went swimming at the local pool. I vividly remember an Aboriginal kid saying rudely, "Chinese, go back to where you came from!" I was upset. How about if I say, I had a bad experience, I'm not going to a public swimming pool again. Or alternatively, I don't want to have anything to do with Aboriginal people because they're racist.

It's unfortunate that we face racism. We need to respect others. Yet only you (and I) can choose how we respond to unpleasant experiences, and how we move on from those feelings you described of worthlessness, anger, alienation. On a similar note, we need to provide appropriate healthcare for Aboriginal patients, and have resources and funding allocated to close the health gap. But, only patients themselves can choose not to drink and smoke excessively, or to break out of the unfortunate cycle of abuse and unemployment (and that must be difficult if that's all someone has ever known, but whilst people can support these patients, no one else can make that decision on their behalf).

We don't deliver babies

The next day we had a group discussion with a midwife. We've heard and continue to hear all the horror stories about the hostility between midwives and medical students (and especially to females). About how medical students spend hours and hours waiting for the woman to give birth, and in the last minute the midwife gives the medical student a task and ushers in a midwifery student to delivery the baby. I'm sure midwifery students have similar stories about medical students. Ah, the midwife vs medical student rivalry.

The midwife tells us about a woman who chose to give birth "naturally" at home, surrounded by her family. But the evil GP or obstetrician advices her against it, and wants to take her away from her family to the local hospital. And she was upset that the doctor was not supportive of her decision, and even called her birth a delivery ("never say delivery - pizza are delivered, not babies," said the midwife). According to the midwife, he (the doctor) said "oh I delivered your baby," thereby not acknowledging her hard work over the last 9 months.

I hope you don't egg patients on to feel that their decisions aren't respected by their doctors. I believe in patient autonomy, yes it's my body, the birth of my child, and I can choose where it happens. But we are such a self centred society. The world revolves around me. If you choose to have a baby outside of well staffed, well equipped hospital where emergencies can be attended to, please don't complain that the doctors aren't bringing all that to your house. Doctors can be arrogant, dismissive, but they aren't the only evil ones. Patients can be selfish, and have unreasonable demands.

I wish I could say that I learnt much in those few days, but I feel that the sessions have taught interprofessional (unprofessional) hate, and portrayed patient selfishness instead of giving me tools to be a better doctor, or work well in a multi disciplinary team. Do you know why I was angry after the sessions? Medical students are prone to tune off when the topic isn't direct clinical, or science content. I care that we learn about rural and Aboriginal health in a way that inspires myself and my classmates to help, and not to dismiss social and healthcare issues as a "complete waste of time."

Have you been to Facebookville General Hospital?

I recently visited Facebookville General Hospital. Wow, the myriad of doctors, nursing and other hospital staff. The types of medical staff range from junior doctors, to registrars and consultants. Across  all the departments you would expect to find in your local hospital - medicine and surgery, ED, maxillary facial, pathology and more.

With patients (eg. The Malingerer and The Frequent Attender), their relatives (The Intense Relatives) and even the Hospital Ghost! Of course, no hospital is complete without the Painfully Enthusiastic Medical Student! If you ever wanted to know what hospital politics are like, or wondered what your doctors talk about amongst themselves, what they think of you, what they think of each other, what they think of the nursing staff, midwives and so on, Facebookville General Hospital is the place to be.

A satire. A virtual hospital, which seems to be based in London.

How you felt

A psychologist talked to us about feels in a consult. For example, if a patient feels angry about the world, the clinician can subconsciously begin to adopt similar feelings of anger and annoyance. Doesn't that also apply outside the realms of clinical consults?

I'm sure it was awkward for you, and I felt awkward too. I bet you would answer "no..." and give me a weird look if I asked, but were you actually nervous. We exchanged so few direct sentences that it can probably be counted on one hand. Sometimes I think, without the external influences we can still be great friends, but sometimes I think maybe we wouldn't be friends anyway. You tell me that the reason you don't talk is because you don't have time and don't like chatting online, but actually, in your own words you stay up til late, sometimes chatting, sometimes just doing random things online. You're inconsistent, I feel like you're either hiding something from me, or purposely creating distances in our friendship and I hate that.

That's okay, we hardly have contact and when we do I can put that at the back of my mind and be civil. Only thing is, whenever the issue comes to mind it makes me feel sad that this is where we've come, and a bit angry at you for making it happen this way.

Edit: Herodotus has advised to look more into transference and countertransference, so for the sake of using the terms in an accurate way, I won't include references to the terms during this post.

Everyone who has been given much

I spent the past year in a small church, in B. We had a fantastic pastor and friendly church members who always welcomed new people, connected them to others who had similar interests to them, invited us for meals and small groups throughout the whole year. I miss that.

Now I'm back in M. There are plenty of strengths about the teaching, the fellowship here, but a conscious effort needs to be made to include those who are not part of the "core" or "in" group. I know what's it like to grow up in a church, and use the mingling time after fellowship as a time to hang out, tease, make jokes with old childhood friends whilst ignoring that person standing alone on the other side of the room. I know I should... but what do I say, he looks so old and we have nothing in common, oh maybe someone else will go up to her - hmm, I've done that so many times even after leaving D and realising that it can be difficult starting out at a new church by yourself.

As a newcomer to B, I was showered with plenty of undeserved kindness, care, attention, out of each family's love for God and the church. So much so that it would be unreasonable for me not to show the same love to others. So much so that on the weekend, when I wondered how I might talk to, or help the newer people in my current fellowship feel at home, I thought back to all that I've learnt subconsciously through what others have done for me. I've been blessed, and therefore I have more to give.

“The servant who knows the master’s will and does not get ready or does not do what the master wants will be beaten with many blows. But the one who does not know and does things deserving punishment will be beaten with few blows. From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked." - Luke 12:47-48

This time

Who would have thought I would be back so soon. I hope, that I won't leave this rotation thinking why on earth am I living in M.

The second crossing

The first crossing

But the Israelites went through the sea on dry ground, with a wall of water on their right and on their left. That day the Lord saved Israel from the hands of the Egyptians, and Israel saw the Egyptians lying dead on the shore. - Exodus 14:29-30

Everyone's heard of the Red/Reed Sea crossing. We even have the movie/cartoon/musical, the Prince of Egypt, with the Israelites escaping on foot and Pharaoh's chariots closely behind them. Then there is the dramatic scene where Moses splits the waters in two, allowing the Israelites to escape from the Egyptians, from slavery. But have you thought much about the second crossing?

The second crossing

Now the Jordan is at flood stage all during harvest. Yet as soon as the priests who carried the ark reached the Jordan and their feet touched the water's edge, the water from upstream stopped flowing. It piled up in a heap a great distance away... all Israel passed by until the whole nation had completed the crossing on dry ground. - Joshua 3:15-17

The speaker at OCF reminded us of the connections between the Israelites then, and Christians now. The first crossing symbolised the Israelite's freedom from slavery. Sin is often described as slavery, as something that lords over us. And I guess the experience is true - whether it's as obvious as drug addictions and pornography, or something more subtle like greed, lust or hate. Just as God rescued the Israelites, so we too, cross over from being slaves to sin, to being free from sin. That is, we are cleansed from our sins and no longer live in sin when we accept Christ's sacrifice for us.

Don't you know that when you offer yourselves to someone to obey him as slaves, you are slaves to the one whom you obey... what benefit did you reap at that time from the things you are now ashamed of? Those things result in death! But now that you have been set free from sin and have become slaves to God, the benefit you reap leads to holiness, and the result is eternal life. - Romans 6:16, 21-22

The second water crossing led by Moses this time, signified entry into the promised land. Finally, after forty long years of wandering in the desert! In between the first water crossing out of slavery, and the second crossing into the promised land there were many years in the wilderness. Although the Israelites had experienced the power of God in the exodus, many grumbled against God, worshipped idols, and did not hold onto God's promise. God promised the Israelites the land of Canaan, an inheritance, yet it seemed that God had forgotten about the promise, and that it wasn't coming.

Now if we are children, then we are heirs - heirs of God and coheirs with Christ... - Romans 8:17

If accepting Jesus is the first crossing for Christians, the second crossing is the second coming of Jesus, the judgment day. The day feels like it will never come, we don't really understand the value of our "inheritance" (not land in this case, but entering into God's kingdom), and we easily forget the promise. Like the Israelites, we can accept Christ but never make it to the second crossing. We need to always remember salvation, but look ahead to what's coming too.

Who were they who heard and rebelled? Were they not all those Moses led out of Egypt? And with whom was he angry for forty years? Was it not with those who sinned, whose bodies fell in the desert? And to whom did God swear that they would never enter his rest if not to those who disobeyed? So we see that they were not able to enter, because of their unbelief. Therefore, since the promise of entering his rest still stands, let us be careful that none of you be found to have fallen short of it. - Hebrews 3:16-4:1

That means how we live in the meantime matters. We are to live in light of God's promise. And if we truly believe it, above all else our eyes will be fixed on eternal things, on walking and working for God. As the speaker put it, do we live in a way that says to God "I don't believe in your promise"?

Kind strangers

I’ve been told about the strangers who can brighten your day. A kind word, a smile, just asking “how are you.” And I didn’t really believe them. Sure they can politely ask “how are you” – but why does it matter, they know nothing about your life to begin with! Yesterday though, the kindness of a stranger did touch my heart.

Recently I’ve been settling back into the city, and there have been difficulties. The long hours on public transport for a trip that should take ideally less than 10 minutes. The cars, oh the number of cars, the limited parking, with complicated parking signs (9am-5pm 2P ticket Mon-Fri, 9:30-12:30 2P ticket Sat, clearway 4pm-6pm etc). So, I finally found a carpark next to the hospital. But it was a 2P ticket zone, sigh. I only needed 5 minutes to drop off a document. I walked over to the ticket machine and deliberated whether it was worthwhile to buy a ticket… or should I just make a dash in and out of the hospital. Then an elderly man rolled down his window and said, “do you need a ticket, for about half an hour?” He handed me the piece of paper, “it’ll only last until 4:30 though,” he said apologetically. I told him that’s great as I only needed to be there for a little while. I thanked him and he gave me a broad smile and drove off.

It was a simple gesture, just a small piece of paper, and cost him nothing but a little thoughtfulness. Yet it was so kindly given that it felt warm. It helped me to view strangers, and patients specifically, with a bit more optimism. It’s easy to be cynical about patients. If a stranger can affect our mood, our views, then the question to ask is – do I show kindness to strangers? Do you show kindness to strangers?

Want to hear one more story? Back in Singapore, I wrote a short story about another kind stranger.

Singapore has temperamental and excessive weather – from glaring, hot sunlight to buckets of rain that begins to flood the grasslands and pavements. The city has an extensive network of deep open drains and wide canals to deal with the rainwater.

I dislike carrying umbrellas because wet umbrellas wet your bag, and are heavy on the shoulders. Besides, droplets of rain don’t hurt anybody. That afternoon I was walking from the bus stop to the hospital. As usual, cars were jammed because of the downpour, though I’m not sure why cars jam when the rain is heavy in Singapore. Anyway, I waited calmly to cross the road. I waited and felt the rain begin to soak my hair and my long flowing skirt. One car was kind enough to slow down to let me cross.

Reaching the underground staff canteen, a couple of impolite men sitting around a table smirked at me. Perhaps I was paranoid, or perhaps they were really staring at my dripping hair. I ignored them and walked on. Then I came to cross the road, so that I could catch the free shuttle bus back to the train station. The walkways are nicely sheltered, but the crossing was open.

I strolled towards the crossing, knowing a bit more rain wouldn’t make much difference to my current state. I gazed ahead and caught the eye of a young man, dressed well, probably a medical student or a young doctor. He was walking towards me, heading for the opposite direction. He walked towards me, smiled and offered me his umbrella, and I was taken aback. Puzzled I mumbled, ‘oh no, that’s ok’ and he replied, ‘no no, that’s ok’ and changed his direction to offer his umbrella and walk with me. The scene was almost funny. I thanked him and he disappeared with his friend.

Did he pity me? I don’t know. But what a gentleman! I thought. A kind stranger who couldn’t have had any ulterior motives because we were perfect strangers and unlikely to even remember each other’s faces. The experience was surreal.

Those tails

Of the three blind rats, three blind rats, see how they run, see how they run. I love nursery rhymes and fairy tales as much as my little sister does, maybe more. Welcome to my new blog, which is really a continuation of, and "Cheese and Whiskers" (

Do you know I’ve been wanting to start a new blog for almost a year now? And the part which stops me every time is the setting up process, picking a domain name, picking a name for the blog, setting up the layout. I finally picked a name, and oh no, it's rat related again. Sorry. I was tossing up between rat references and something more along the lines of chasing after the wind (Ecclesiastes). Then there was the difficult question of - should I use Blogger, or Wordpress? After a little experimentation, and much frustration with Wordpress, I've come back to Blogger.

Blog writing has really evolved over the past few years for me, from a cautious experimentation to a method of regular reflections and sharing. My very first blog was a joint blog with a friend, in which I was much more excited about creating the website and coding, than I was about writing. Funny, now it’s the opposite – I love just being able to write and not worry about designing or formatting.

Four years has resulted in hundreds and hundreds of posts. Writing online has always been a delicate balance betweeen sharing, but not going into details about everyone, and everything in your life. Over the years you read back on your posts, some which you would love to keep, some which belong more to the diary than an online media.

Starting a new blog is about clearing a bit of space. I will always write my personal blog primarily for my own reflections, but over the years I have an increasing awareness of the “audience” (both the friends and the randoms) and of God. Over the years too, my focus has drifted away from relationship dramas and emo-ness (?depression). Ah don’t worry, I’m sure there will be occasional juicy posts about relationship issues and dabbles of deep dark thoughts to come.

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