A glimpse of a university hospital.

Time flies.

Hmm... I think I've been using this word too much lately. But it's true, times really does fly. So here I am, finished with all the clinical rotations, something which I had so much expectations of just a year ago. Did it meet my original expectations? Well, that's another question. But nonetheless, I did learn quite a few things, was able to see and talk with many patients, and was able to get a glimpse of what a physician's everyday life here is like, working in a 1,000-bed university hospital located in the heart of one of the most important business districts in Tokyo: Shinjuku.

I have believed and still do, that working in a university hospital means you have to take part in educating and nurturing the next generation of physicians, and that is not an option but a responsibility. And until I started my clinical rotations, I had believed that those who don't do too much or refuse to carry out that part don't have enough passion and enthusiasm, and therefore are working in the wrong place. But... that view has changed. Most physicians here, especially those in the upper 20s to 40s, whether an internist or a surgeon, or a pediatrician or a obstetrician/gynecologist, are super busy.

Arriving at work before 8AM, their day often starts with a conference in the morning, followed by a visit to the in-patient ward, and then on to run the morning portion of the out-patient department (OPD), or head to the operation rooms instead if that's a surgeon. The lines of patients in the waiting room are seemingly endless, while some operations can easily take five or six hours, naturally. When do they have lunch? Well, they're lucky if they can get a meal at noon. The schedule for the afternoon doesn't look too much different, except for some more case conferences and lectures by older doctors or advertisement sessions by pharmaceutical companies. When do they finish all that? Maybe 6PM. Okay, can the doctor go home? Not so fast... because all the paperwork and some medical records are waiting to be processed by nobody but the physician. After that is 'free time' for the doctor, where he/she can work on research papers or make a PowerPoint for the next day's lecture for students, etc. It's not rare to see a doctor working well over 12 hours. Or, is he/she on-call for the night? Well, that adds another 10 hours or so, and on to another day. You don't get rests here after on-calls.

And yes, to add to that, the pyramid of hierarchy in Japanese university hospitals is still present. You have to do as your boss (professor) says, and that is often a must. Some would even be too concerned about writing research papers or simply trying to make their daily work appeal to the chief professor of your department, since he/she would be the only person who can help you get promoted to a higher academic status. If the professor doesn't like you, tough luck. Yes, it's all about faculty politics. And then, on the other hand, you also have to help young doctors who have this long list of questions for you to answer. A physician in the upper 20s to 40s are kind of stuck in between the old and the young.

Hmm... yes, a physician working in a university hospital has three major responsibilities; providing medical care, research (often for academic status), and education. But does the doctor really have enough time for all of that? And especially when considering the fact that doctors working in university hospitals in urbanized areas get one of the lowest salaries among doctors in the country, how much would that do to the enthusiasm of the physician? What's the incentive? Now that I have seen some of the reality in a university hospital, I even feel sympathy for some of them.

When doctors start quiting, that is probably a tipping point, a beginning of a vicious cycle; quitting means more tasks for those who are left.

Studying for the CBT.

January was a busy month, well sort of.

4th-year medical students in Japan now have to go through a set of exams called the Common Achievement Tests (CAT), which comprises an objective-structured clinical examination (OSCE) and a computer-based test (CBT). The former tests basic clinical skills while the latter checks to see if you have the essential knowledge that is deemed necessary to begin clinical rotations. So basically, the CBT part is a complete review of the 4 years.

However, like most other tests, studying for the CBT is test-focused and test-oriented. It's not something you should start off by opening your textbook from two years ago, but more like get the unofficial guide and workbook (like the First Aid for the USMLE) and study based on that. Why unofficial? Because there's no such thing as an official guide nor workbook. All they give us is a handout with a brief explanation of the exam, and the exam itself is not made public. So what this means is the quality of the exam does not improve. The unofficial workbook is made up of questions that have been remembered by past examinees, and so though it is not the actual past exam, it is the closest one available, and at a glance, there are tons of questions that are not clear and some just lack explanation to the extent that we can come up with more than one answer.

Finished the OSCE two days before Christmas, and now the CBT. One of my biggest concerns is whether I would be able to keep my concentration through the exam, most notorious for its length of seven hours. The unofficial workbook is what I along with everyone else is doing, but there are six volumes to the series totalling over 3,000 questions. Since I'm the kind of person who can't concentrate for long in his own room, people would find me studying in a Starbucks or a McDonald's for hours.

By the way, it's been a pretty cold winter, and Tokyo, which seldom gets snow much less any accumulation of it, has so far had 5 centimeters of snow twice this year.

Lunch time in Japanese med schools.

Lunch time in Japanese medical schools is interesting.

Our university is in a highly-developed area, a very urban area, so most of the students go out and buy their lunch. We have an extensive selection to choose from... many kinds of food, meaning a wide range in prices too. Students with relatively more cash don't hesitate to and tend to hop into relatively high-class restaurants, while the ordinary (like me) are always trying to find the cheapest food around. Sometimes is fine, but sticking with with those affluent people for lunch everyday would easily put me into bankruptcy in a matter of days.

So what happens is, rich students tend to hang around with rich students, and ordinary students tend to hang around with those of its kind. And they become good friends... not that it is causing any problems (so far), but I just thought it's an interesting phenomenon... :-)