In the seasonal spirit of giving, Matt Morgan and Peter Brindley share what they’ve learnt from their time in medicine

When these authors were medical students—several millennia ago—we faced the difficult challenge of finding a quote to accompany our graduation photos. On the one hand, we had received a marvellous state subsidised education. We had learnt from the best informed teachers and we were truly thankful and humbled and excited for more. But medical school had also been a multi-year arse kicking that included some moody supervisors, persnickety colleagues, and patients who didn’t make it. Accordingly, we were exhausted and bruised and scared.

One of these authors eventually landed on the first line of a Tale of Two Cities as his quote: “It was the best of times, it was the worst of times.” Given that he didn’t have a “Dickens” what to write, it seemed as good—or as bad—as any one liner. Twenty years on, that quote still causes a wince. It was trite, self-congratulatory, and pretentious. Fortunately, that same doctor had no “great expectations” of being anything else.

As these aging medics move from Christmas past to Christmas present, we still struggle to dispense wisdom to the latest recruits. This is a problem as our trainees are just as bewildered as us. Likely it is selective memory, but, as junior doctors, we recall being given a hard time left and right. The instructors are gentler now but the students are no less hard on themselves. Their hours are less sadistic but the world sure is not. We were unsure what kind of  doctors we wanted to be but this rarely found purchase in our sleep deprived brains. We simply assumed that “when we grew up” people would tire of reprimanding us, and we would emerge somewhat clinically competent and moderately valued. Contrast this with today’s medical student: up to their necks in worry.

Instead of focusing on teaching young doctors life saving clinical pearls of wisdom, academic instruction seems to veer more and more into “how you can maximise your future.” Students feel pressured to regard university as little more than time to buff the CV and outflank the competition. In this solipsistic pursuit they are robbed of the opportunity to expand horizons, nourish neurons, meet soulmates, quaff pints, and cut parental cords. Both because it’s the holiday season, and because it truly sucks, we want to say “sorry.” We still have time, and so do you.

The talk that welcomed our classes to medical school focused less on “you are the chosen ones,” and more on “I hope you weren’t a mistake.” Just in case we weren’t “motivated” enough, we were introduced to classmates who had won Olympic medals, sung in major choirs, and run successful companies. However, as a coda, we later learnt that if we hadn’t been singled out that they still saw something in us: our job was to discover it and nourish it. We graduated bruised but ready to go.

We fell into intensive care—or maybe it chose us instead—because we wanted to think and to do. More latterly, we understand that above all we wanted to communicate. We felt confident that regardless of our hours or the cash, we would never work more than our parents or earn less. We didn’t know that workaholism would likely increase our risk of premature death, and that our dark humour could reach a point of no return. Hopefully, today’s graduates will navigate this better.

We now know that we want our days to include not only “head and hands” but also “hearts.” For these two doctors, true happiness has become about “making connections” whether with patients, colleagues, or even academic ideas. It means that we stop to talk and listen far more than we used to. We just wish we had known and believed this years ago.

Back to Charlie Dickens for a sec. He also wrote that we should maintain “a heart that never hardens, a temper that never tires, and a touch that never hurts.” A much more useful quote for doctors, but equally likely to make eyes roll in this best and worst of times. Fortunately, it’s Christmas so we don’t have to worry how corny it sounds: “God bless us all, everyone.”

Matt Morgan, honorary senior research fellow at Cardiff University, consultant in intensive care medicine and head of research and development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on Twitter: @dr_mattmorgan

Peter Brindley, professor in the department of critical care medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. He is on Twitter @docpgb

Competing interests: None declared. 

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