[Column] Medical training shouldn’t feel like a driving school license test

At a doctors' meeting, I heard young doctors say that the reason they avoid essential medical departments is because doctors often feel they are being treated like criminals in disputes with patients. I had heard this before and didn't think much of it, but the doctors of my age who had specialized in such specialties and were also present at the meeting all said the same thing: “Why did they feel that way? I don't think I've ever felt that way in my entire career.” I have never felt that way. However, if this is the common sentiment among doctors who have only been practicing for a few years, what could be the reason? Why do young doctors feel this way? I am not sure if this is correct, but here is my humble guess.

Young doctors find it very uncomfortable to be in conflict with others. No one enjoys conflict, but it seems to be a characteristic of young people these days. Come to think of it, they have never been scolded because they did well in school, nor have they lived in a small room with siblings.

This may not be a generalization, but it reminds me of a story I heard from the parents of a medical student. Their child gets good grades, but spends all his free time playing computer games in his room. On the day after exams, he comes home early and plays games for 24 hours straight. His classmates don't have the old-fashioned schedule of going on trips or having fun with friends after exams. They never learned to be considerate and make concessions to others by hanging out with friends in groups during their school days. Since they didn't serve in the military, they also missed out on the last opportunity to experience the trials of military life. For young doctors who have grown up in such a sheltered environment, encountering patients with diverse backgrounds—especially those with severe illnesses—can be a very daunting task.

Given that vital care specialties are prone to legal disputes and that Korea is a country where criminal penalties for medical accidents are particularly severe, this must be a source of great fear for young doctors today. It is likely that these personal and environmental factors are contributing to the reluctance to pursue essential medical specialties.

So, what should be done? If we increase the number of doctors, will the shortage of specialists in vital care be resolved, as some highly motivated doctors will likely choose those fields? There are proposals to reform the medical system and change the current situation where criminal penalties for medical accidents are prioritized in the legal system. It is proposed to grant exceptions where proper medical treatment is not subject to criminal penalties, similar to the United States. Will this work? Would people choose major specialties under such circumstances? While environmental factors are an issue, ultimately, it comes down to personal character development. How can this be achieved during the education and training process?

During junior doctors’ training, the most important aspects are, of course, the acquisition of medical knowledge and skills. However, reflecting on my residency days, what was even more important was handling patients in the emergency room—such as intoxicated patients causing disturbances or difficult elderly patients and their families—and calming them down to provide treatment; explaining treatment options to patients with poor prognoses while instilling courage; mediating disputes with physicians from other departments over patient care; and communicating with patients and their families after medical errors, even when the best efforts were made but the outcomes were unsatisfactory. These skills are learned on the job, either through personal experience or by observing senior colleagues or mentors. I believe these aspects are far more important, but unfortunately, there are almost no opportunities to learn them anymore. Why? Because the absolute working hours are too short, and in the ideal training environment that residents desire, such situations simply do not exist. In other words, residents want strict adherence to working hours, and they avoid working in the emergency room or intensive care unit.

While this may be the spirit of the times, the halved working hours compared to the past are absolutely insufficient for acquiring knowledge. Communication with patients or fellow doctors? There’s no opportunity or time for that. It feels like a process where you just get your license, like driving school. In other words, young doctors seem to avoid situations of conflict between doctors and patients. But what fields are there that are free from conflicts? Will there be fewer conflicts in the field of aesthetic dermatology? From what I know, there are no fewer conflicts in that department; there are probably more.

When working with trainee doctors during surgeries, I often say this: “Don’t try to learn techniques from me. Instead, observe how I interact with patients. If you see something you think is wrong, don’t do it. If you see something good, learn from it to become a better doctor. Techniques are something you continue to develop on your own throughout your career.” What are we discussing and contemplating in this era?