Balancing professional and personal goals in a medical career*

Doris Young黃至生

HK Pract 2005;27:197-201

Thank you, Mr President.

Distinguished guests, medical colleagues and colleagues in family medicine from Hong Kong and Australia, and other guests and families of Fellows graduating today. Thank you, first of all, to the Hong Kong College of Family Physicians for inviting me to deliver the Sixteenth Dr Sun Yat Sen Oration. I feel very honored and privileged to have the opportunity to share with you a topic that I have been thinking about over the past few years. I can see you all wondering where I came from. I am Chinese, born in Shanghai, grew up in Hong Kong and then I went to Australia to do my high school and then my medical course. So you can imagine how honored I am to be able to deliver an oration that is named after Dr Sun Yat Sen, the Father of the Chinese Republic. My parents are very proud too as they felt that it's particularly honored for an overseas Chinese, to be able to be invited back to Hong Kong to deliver the oration. Even though I am Australian trained, I am not a stranger to the practice of medicine in Hong Kong. As I was telling Dr William Ho sitting next to me, I have been in Hong Kong for 2 weeks already. I have also accompanied the President and other family medicine teachers from the College to Beijing to deliver Family Medicine education in The Capital University there. So I do have some understanding of the Hong Kong health care system.

When the President, Dr Chung, asked me to choose a topic for the oration, I thought I will share with you some issues I have been thinking about over the last few years both as an academic general practitioner, and also as a doctor who has been involved in a doctor's health program in Australia, the Victorian Doctor's Health Program. I chose the topic "Balancing Professional and Personal Goals in a Medical Career".

David Lodge in his book "Nice Work" quoted Bailyn (2003) who said that academic work, like those performed by myself and my colleagues and distinguished guests here, is characterized by overload. "We do many different things at once. Indeed we do many long-term things at once. Our work is never finished; we never have nothing to do. So the perfect academic is one who gives total priority to work and has no outside interest or responsibilities". This could apply to me but I resisted, I felt I had to balance my own life, give time to my career, my family, my children, my parents, my siblings, my profession and my community. I constantly juggle and struggle to achieve it. Well, how did Dr Sun Yat Sen, the Father of the Chinese Republic balance his professional and personal career? I looked up the websites and noticed that he studied classics and history first, the art of medicine, and then biomedical medicine. He, as you all know, practised medicine for a very short time, because his personal goals far exceeded his professional goals and he devoted himself entirely to unify China. I worked out that he only practiced for about 2 years after he graduated from his medical course. He certainly didn't obtain any postgraduate Fellowships and we are proud to say that he was one of us, a general practitioner because in those days there was no specialization.

Before I talk about balancing the goals, I'd like all of you, distinguished guests, medical colleagues and new Fellows to reflect for a moment on the demands of a medial career. What have we got ourselves into? Remember how competitive it was to get into the medical course and then into specialty training posts. For those of you who work in government out-patient clinics and in private practices, there is a high patient load. Some of you have shared with me the large number of patients you have to see per hour and this is also true in Australia, patient demand and pressure is incredibly intensive. At the end of the day, we realise that we are in a service industry, we service the community, we earn money by providing a service to our patients and if we go away for a holiday, we really don't get an income. We also have to run an efficient medical practice, a skill which most of us have not been trained and yet we all have to do it. This is in addition to keeping ourselves up to date for whatever specialty we chose to practice in. It is not unlike a marriage, the day you get married, it is the day you try to work to keep the marriage going. The day you graduated or were awarded the Fellowship, it's the day you start keeping up to date to maintain knowledge in family medicine. This would be similar to our other colleagues here, in surgery, in endocrinology, cardiology and even with medical services administration, which requires constant updates in hospital management and policy development skills. Another pressure medical practitioners face, maybe not so much in Hong Kong yet, is litigation. There is a growing fear amongst many of us and we start to practise defensive medicine. Making money is of course important too and most of us work hard to gain financial security for ourselves and our family but how much money do you think you need to make without compromising your personal goals?

The demands and pressure of a medical career keep piling up but I argue that this is more so for those of us who are general practitioners or family physicians. We have to balance, first of all, our professional skills, unlike our specialty colleagues; we have to balance between breath and depth of medical knowledge and skills. Striving for this balance causes most of us great stress and worry. Do we know enough? Could we just keep doing the same thing or should we start to develop some special interests. What about meeting the patient's needs and demands versus available resources. As a general practitioner, I always ask myself, do I really need to order that extra test? When do I refer patients to specialists? When do I refer them to hospital? Because every time I do so, it generates heath care costs and add extra burden to my patients. I also notice in Hong Kong that 90% of doctors work in solo practices, it must be professionally isolating when one doesn't have a colleague of equal intellect to share with some of the dilemma and joys of discovery. I'd like to leave you to reflect and see whether this is really what you want to do in year 2005. There is another observation I'd like to share with everyone in this room is that GPs in HK are constantly being undermined and overlooked by the specialty colleagues. I am putting my head on the chopping board here in saying this even though I am sitting amongst specialty specialists colleagues and the Head of the Hospital Authority. I am passionate like a lot of you here about family medicine/general practice, in particular a general practice-led primary health care system. I think we are devalued for the skills we have and the contribution we can make to provide a cost efficient and cost effective health care for the community. In Hong Kong, the GPs have extra competition with other specialties delivering primary care services and the traditional Chinese medicine practitioners. The stress and the challenges that family physicians face are understandable. You need to decide how you are going to deal with it.

What about our personal goals? Have we got time to achieve them? What are some of the demands put on us by our families? Do you have time to build relationships with your life partners, wives, husbands and children? What bout caring for our aged parents? Some of you might have partners that have equally demanding careers, how do you balance each other's careers? I was told that the education system in Hong Kong is tough and that many of you sent your children overseas to boarding schools, I hope they will appreciate the sacrifices you have made. I personally believe that it is important that we try to get involved with our children's upbringing and watch their growth and development because we can learn so much from them. By being involved in my children's school sports, I learn about cricket, football, and hockey and share in their joys and disappointments in wins and losses. I think we all need to put more quantity and quality time aside for our children because they need our support and encouragement.

Finally, I think it is the last demand, the neglected self that we miss out. As a doctor, you give so much to the patients, the profession and then to your family. For women doctors, they are often carers for their children, husbands and parents. If you are not looking after yourself, how can you look after others? You constantly have to balance the professional, personal and family demands. In order to do that, you have to ask yourself, where do you want your practice, your career to be heading in the next few years. How can you achieve the goals you set for yourself at this stage of your life? I mean, professional as well as personal.

There is a buzz term at the moment in the lay medical literature talking about doctors setting up a PPDP, yet another acronym. It stands for personal and professional development program. In the UK it means re-licensing, performance appraisal, renewing your license every five years. In Australia, it means quality assurance and continuing professional development (QACPD). I believe it is more than that. The PPDP is about providing a clear career-focus and maintaining a work, life style balance. Don't forget the other P; it is not just professional development program, it is Personal and professional development program. If you don't include that P, you will be of no use to your patients or your family because you will be bored or worse still - burnt out. In order to avoid becoming burnt out, you should ask yourself "do I need to take time out because I am doing something that is repetitive and I am bored. Do I need to change direction?" Don't quit, don't retire. It just means you need to combine general practice with some thing else that will keep you refreshed and passionate.

Dr Sun Yat Sen's passion to unite China was so strong that he actually gave up practicing medicine. I don't think we are going to be all Dr Sun Yat Sens. I also know that a number of the distinguished guests on the podium here have been involved in politics, in healthcare system changes and in teaching medical students. One of the doctors I met last night told me that he is doing sports medicine as he feels that he needs to develop a special interest in family medicine. You need to keep the fires of general practice burning. For the Fellows graduating today, if you feel that after a while you start to be bored with general practice, just seeing coughs and colds all day, you need to diversify your clinical interest and ask yourself whether you should be looking at acquiring further skills in geriatric medicine, women's health, drug and alcohol services, adolescent health etc? Some of you will know from my CV that I spent 3 years training in adolescent medicine in Seattle in the US because in the early days of my career I was working in an area with a lot of young people with different health care needs. I decided that I needed to develop special skills to look after them better but I remain a general practitioner throughout my career.

I believe that in order to keep the fires of medical practice burning, we have to change the way we practice. If solo practice is getting you down, join up and form a group practice. Don't be afraid about competition, I think the new "C" is about collaboration and co-operation, not competition. Another activity that I recommend to you is, of course, my invested interest and that is to teach medical students and trainees. I know many colleagues including some of the Council members sitting in the front row and those sitting on the stage, have said to me that teaching medical students kept them in touch with their own medical schools and that it is challenging. Students asked for evidence when we do certain tests or prescribed certain medicines and I would say to them what evidence? I just know that this is the way I always do it. But the students would ask why, how do you know, what do you mean? These enquiring minds made us look back through our textbook or search the web for new knowledge and evidence. Teaching students keeps the fires of learning burning. It keeps the knowledge base growing and keeps you interested in practicing medicine. It will inspire and motivate you to take on some continuing medical education and they may even read the "Hong Kong Practitioner" (marketing the Journal for you David!).

As an academic, I also have a passion for doing research. Research in general practice and primary care is sadly lacking and lagging behind because we do not research into what we do and the medical conditions we see. Specialists treat the tip of the iceberg conditions but GPs manage the common problems and chronic illnesses, for example, depression and diabetes. Most of the patients we see with depressive symptoms are probably different from the ones that psychiatrists see; yet we use the same treatment as they use. The term "neurasthenia" means weak nerves and perhaps means depression. It is important that we do research on these common presentations as the more the research council value general practice research, the more health gain would be attainable by the community. In Australia, the Department of Health and Ageing has recently invested A$50 million into developing primary health care research capacity building because they believe that a good primary care system with good research and teaching benefits everybody in the community.

To broaden your professional and personal goals, many of you here today give your time generously to advance and support the medical profession. You gave up a precious afternoon to attend this ceremony and for the Fellows, do consider give some time to serve the College because there is still a lot of work to be done and often such contributions receive very little reward, especially financially. I know for a fact that Professor Michael Kidd, President of Royal Australian College of General Practitioners gave a lot of his time and energy to help to reconnect the College to grass root GPs and to ensure that the discipline of general practice stay strong.

Therefore we always need revolutionary doctors like Dr Sun Yat Sen. As I look around, I realized that there are many Dr Sun Yat Sens in this room and your mission is to unite general practice, to bring about a revolution in the health care system in Hong Kong. You all have the common aim to provide a more efficient equitable high quality primary health care service to the community. The time is right to work together to improve the health of our patients. As Winston Churchill said "we make a living by what we get, but we make a life by what we give'.

I now refer to this symbol, Yin and Yang balance. In Australia, most people sort of know about Yin Yang balance of contrast and that it is a dynamic process. The Chinese people talk about health conditions, energy and food in terms of yin (cold) and yan (hot). I need you to think about achieving a balance in your professional and personal goals. If we consider a career in medicine is yang, hot and burning then the personal growth side is yin, quiet time for ourselves. It is time for exercise and relaxation, time to eat proper nutritious food, time to look after ourselves, time for reflection. Catch up with old friends and engage in your hobbies. Remember at the end of day, practicing medicine is only a job and it must not stress or distress you and cause you ill health. I have been involved in a number of doctors health support program in Australia. I was part of a team that looked into GP well being examining their stressors and coping skills. Over the last 3 years, I have been on the Board of the Victoria Doctors Health Program, a joint initiative of the Victorian Medical Practitioners Board and AMA supporting impaired doctors and medical students and became alarmed at the isolation and pressure some of them face. As a teacher and mentor of medical students I am aware of the pressures we put on them and special programs must be put in place to support medical students and doctors. Doctors as a whole do not seek help and many do not have a GP and tend to seek corridor consultation or worse still, self treat and medicate. Doctors deserve a proper consultation when they are sick enjoying the same treatment as their VIP patients. They need a GP/family doctor for regular check ups and provide the whole person and family care. In Victoria, we have been trying to establish a doc for doc program, that is, training doctors to look after other doctors and is gaining momentum.

What can you do for yourself to relax? How to re kindle your hobbies and interests outside of medicine, the passions in your lives which have been lost as you have been too busy practicing medicine. I had to discover this for myself too and found renewed interests in cooking after my travels to Italy. Beware of the competitive and neurotic tendencies in us doctors as we strive for relaxation. Avoid doing what this cartoon says, "I am learning how to relax, doctor, but I want to relax better and faster. I want to be at the cutting edge of relaxation". We have to learn to slow down, take up running but not have to run a marathon or dancing and not to have to be a ballroom dancing champion. We can do the easy Tai Chi movements and not the complicated 18 movements. We need to give ourselves permission to "chill out" and enjoy life.

So in summary, there is no one rule to achieve the ultimate balance of personal and professional goals in a medical career. We are as different as the way we look and we need to individualize and plan ahead. It is like playing chess, a step at a time. You know where you want to be professionally in three to five years time and these are the strategies you will use to get there. You then need to match that up with your personal goals involving your interests, your family and children. These goals then need to be fine-tuned to different phases of your life. For instance, in your 20s or 30s you may want to build up your medical interests and practice while your children are young and obtained further training. In your 40-50's you may want to slow down and involve in student teaching or pursue a special interests personally or professionally.

Towards retirement age, you may want to give something back to the Profession or change direction professionally. As Professor Peter Lee hinted to me about my next career phase, may be I should go to China and teach family medicine there. Indeed in Australia, some of the older doctors sold their practice and work as locum in rural area where there is a workforce shortage. Be reflective about what you have achieved and if you are not happy, then diversify, do something different. When faced with a lot of personal and professional demands, prioritize them, just like what you do as family doctors. If your children and family need you to spend more time with them, you may have to compromise your professional career and may be work part-time for a while. Don't be afraid to change direction and that requires a lot of courage and make sure you consult with your significance others as you need support from them. At the end of the day, I think the key to life is about balance. Thank you very much for the honor to deliver this oration.