The Road to Finals

I am going through an anticlimax. It was not a short battle, so I do not expect this to resolve in a blink. Let’s recollect.

Finals. Every final year medical students start worrying well before the beginning of final year. This is the most important exam in medical school. Everyone know it, the students, the teachers and even some of the patients!

I started thinking about it much earlier. For a while in my third year, I was very confident with my own ability. Although I was just as disorientated as my fellow friends who have just started the clinical year, I worked much harder then many of them. I was often ignored in wards and clinics but I persevered, always with the endless questions and getting excited over new things I learn everyday. The effort paid off. I was better than my friends and even some junior doctors. I thought I would pass finals easily even if I was thrown into the final exam then. But I also felt increasing alienated by my friends for being different. I was always alone because no one shared my enthusiasm.

So although I still see patients more often than my friends, subconsciously, I toned down this obsession in my forth year. The relationship with my friends improved. But the medical side of things suffered. I was average and did not always have the extra bits to contribute in group discussion like I had in my third year. All in all, fourth year was a fantastic year, although by then I was no longer boosting with confidence like I used to.

Fifth year started badly with disappointment over my research project not being accepted for presentation in a meeting that I was really looking forward to attend. I felt crossed because people were full of praise about my work. Have they just been lying to me all these while to make me feel good? For a whole month, I buried myself under the duvet. There was a background worry about finals but I just did not have any motivation to revise. My supervisor’s ex-students had always managed be accepted for presentation in those meetings in the past, I am the only stupid one. I felt as worthy as a piece of dirt on the floor. I hardly told anyone about this because I felt so humiliated. Then, on the next placement with the geriatric firm, I was surrounded by patients again and felt better as I was a valued member of the team.

The GP placement made me rethink my clinical knowledge. I saw many patients on my own but was only confident with the diagnosis and management in less half of them. I would never forget the instance that I made a diagnosis of biliary colic even though in the history I knew that she had lost 20 kg in a short space of time. My GP was critical that I have not referred her urgently to the hospital. How lucky she was that I wasn’t yet a real doctor. I saw her scan later - she had widespread cancer all over her liver. I used to think ‘worst-case scenerio’, but in GP land, as common things are common, I sometimes forgot to think through the wider list of differential diagnosis, instead I tried to make it fit into benign story. It scared me and rocked my confidence level big time. To imagine that I have to be able to figure out what’s been wrong with every patient that comes through the door and be able to initiate treatment is horrifying. I am not ready to be a doctor. I am not going to pass finals and maybe I don't deserve to.

On the other hand, the gap in knowledge in the whole year group narrowed and we all knew the same thing more or less by then. My extra effort in the early years was null as everyone else have caught up. I was definitely not top of the class anymore. I didn’t know what else I could do to raise my game. So, well into my fifth year and I am well blended with the rest of my friends academically and socially, yet I am not a bit confident to be a doctor.

TO BE CONTINUED…


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