Preface
Recently, I came across an article “How to Learn Traditional Chinese Medicine (TCM) During Residency”, which was very well written. Today, I will write an article titled “How to Learn Western Medicine During Residency” as a counterpart. Mr. Ziyu Chuan Shang’s article is aimed at a small group of ambitious and highly motivated individuals, while mine is written for the majority who lack strong opinions and tend to go with the flow (myself included).
Why do I specifically divide the readers into two groups? It’s not to create opposition but to help everyone recognize the fact that they are ordinary people. As ordinary people, we are often shaped by our environment, and only a few have the perseverance to break free from environmental constraints and pursue their original intentions.
How to tell which group you belong to? Recall your last week: aside from the time that must be spent on work and other essential tasks (like writing medical records), did you spend your free time playing on your phone watching Bilibili, or reading and studying (any book counts, as long as it requires thinking)? If over 80% of your time was the former, what reason do you have to say you are ambitious and have strong execution? If you have no reason, then honestly admit you are an ordinary person and then consider how to make the most of residency as an ordinary person.
Main Text
It’s common for TCM students to hear the admonition, “As modern practitioners of TCM, you must understand Western medicine.” Obviously, this admonition has succeeded: Western medicine is understood, but TCM is lost, to the extent that we have given up our own territory. When seeing a patient, the first thought is what Western medicine can do. If Western medicine has a solution, then TCM isn’t needed. If Western medicine does not have a solution, then TCM also has none.
— Ziyu Chuan Shang
These words from Mr. Ziyu Chuan Shang are heartbreaking, but what’s even more painful is that not only has TCM been lost, Western medicine is also not well understood.
In the daily routine of residency training, we have many opportunities to practice Western medicine. For example, the most common tests like CBC + CRP are basically done for every admission. Can everyone understand them? My standard for understanding is:
- Knowing the physiological and biochemical mechanisms behind common indicators (this determines the false positive and false negative rates of the indicators)
- After seeing the patient’s condition, being able to independently decide whether to order a CBC and knowing what indicators are intended to be checked (ordering tests with a purpose)
- After results come back, checking if the indicators match your expected results (using the results to verify your hypotheses)
- Understanding what new problems abnormal results indicate and the underlying mechanisms (knowing various common diseases)
Including myself, many students do not meet this standard. Often, once admission tests are done and results come back, they don’t know how to handle them. They just tell their mentor, receive several orders as instructed, paste information in the medical record, and that’s it.
This is the everyday life, day after day. Complaints never stop, but learning never begins. Eventually, this turns into what some department heads call “students coming from TCM colleges, double diploma holders in TCM and Western medicine”[1].
Don’t teachers know about this? They can tell who is slacking off and who is serious even after only two or three days of contact—just as you can feel each person’s attitude after meeting them for a few days. But teachers just smile and say nothing. Today’s students cannot tolerate lectures; more talking often leads to conflicts.
The final outcome after joining the department is:
- The more proactive students chat and joke with teachers, get scolded sometimes and praised occasionally; although they do more work, their clinical thinking and operational skills improve daily. It’s tiring but both painful and joyful.
- The less proactive students sit in front of the computer, occasionally glancing at medical records or their phones, moving only when pushed, from morning to night, complaining that today was another brutal day, then going back to play on their phones in the dormitory.
If you can’t learn TCM well in a Western medicine environment, it would be understandable to blame the environment. But if you can’t even learn Western medicine properly in a Western medicine environment, where is the problem?
- Is it because you write too many medical records and have no time? If so, why does writing so many medical records still not help you master the clinical thinking of a disease’s onset, progression, diagnosis, and treatment?
- Is it because teachers are unwilling to teach? Is it that teachers don’t answer when asked, or are you not asking at all and just waiting to be spoon-fed?
If these problems don’t exist, writing medical records thoughtfully and asking teachers questions while writing—how could there be no progress every day?
If you have no reason otherwise, honestly admit you are an ordinary person and then consider how to make the most of residency as an ordinary person.
Conclusion
I originally wanted to write about how to do it, like Mr. Ziyu Chuan Shang’s article, explaining how I learned Western medicine during residency. However, as I wrote, I found that pointing out the attitude issue naturally leads to finding one’s own solution (everyone probably already knows what they should do but just haven’t done it). Therefore, I deleted those specific details. If anyone truly doesn’t know, I will write another article as a supplement.
Every man carries Two Bags about with him, one in front and one behind, and both are packed full of faults. The Bag in front contains his neighbours’ faults, the one behind his own. Hence it is that men do not see their own faults, but never fail to see those of others.
Every person is born carrying two bags, one in front and one behind, both packed full of faults. The bag in front contains others’ faults, while the one behind contains one’s own. Therefore, people always fail to see their own faults but never fail to see those of others.
— Aesop’s Fables[2]
Dié Jiǎ: This only refers to skill level, not to judge superiority or inferiority. Undergraduate students should not have a sense of superiority. ↩︎