The Learning With series explores how different professionals learn. Through various interviews with inspirational people from different disciplines and all walks of life, we hope to uncover different insights and perspectives that can help us to learn, to live, and to love all the wonders that life offer. In this article, we share insights from Dr Christopher Lien who is a senior consultant with the department of Geriatric Medicine at Changi General Hospital.
Failure and deprivation are the best educators and purifiers – Albert Einstein.
It is difficult to enter any profession, but it is even harder to stay in a vocation. Perhaps none more so than the medical field where medical students must study and understand great complexities of the human body and mind before finally earning the right to be called a doctor. Being a physician to every patient, however, is much more challenging.
Dr Christopher Lien has been a physician for over 33 years. During our conversation, I had a glimpse into how difficult it was to learn to become a doctor and how much more painstaking it is to learn to be a doctor every day.
The early struggles
While reading an article or a book, do you find yourself repeatedly rereading the content or doubting what you had read previously? Do you find it difficult to absorb all the information, organize it, and synthesise it as fast as you would really like to? If so, you are in good company because Dr Lien struggled with this for many years.
He recalled how he had a way of learning which compelled him to read every single detail before being able to zoom out to see the bigger picture. However, this was very challenging because of the sheer volume of the content in medicine. There were times when he felt that if he couldn’t learn everything properly, he couldn’t learn because there was insufficient context to attach the content to. Thus, it was challenging for him to switch between analysing the finer details and looking at the broader picture where the details would fit in. As a result, he often procrastinated because what he wanted to do far exceeded what he had time to do. It also meant that he struggled to pass many of his exams in the first few years of medical school and even failed some of them.
Awakening the learner within
Failing in his first year of medical school forced Dr Lien to confront some painful realities. While many of his friends were away on holidays, he had to take some of his examinations again.
This experience, however, revealed something very important about the way that he learnt.
Away from many of the distractions and having the time to learn what he wanted to learn, the way that he wanted to learn, Dr Lien discovered a deeper love for medicine. At the start of his learning journey, for nine months, he was going in and out of lessons without much direction. However, armed simply with time and curiosity, he was able to read all the books he wanted in great detail and contextualise them on his own. He discovered the simple joy of spending time at the anatomy museum, where he could correlate the 3D nature and functions of various parts of the body with the descriptive texts. In short, he was learning at his own pace and finally able to experience learning by observation, contextualization, and reflection.
Failure had not dampened his spirit of learning. While it certainly hampered and humbled him, it also honed his methods to chisel away what was ineffective and molded his innate strength of inquiry. Its redirection unlocked an immense joy of learning.
The winding learning journey
One of the biggest risks in any learning journey is to think that one has ‘arrived’. The elation and celebration after the success of graduating from one institution is quickly tempered by the realization that one must now apply and keep growing to stay effective.
After toiling for years, Dr Lien finally graduated as a medical doctor. As with many other undergraduate students across various disciplines, it marked the end of one phase of learning and the beginning of another. However, it was not long before he met with another steep hurdle – specialist training. He recalled expecting it to be just as onerous, but he did not fully anticipate many of the challenges that lay ahead.
The exponential growth of medical science meant that no one person could fully grasp all the information available in any subject at any given time. However, professional practice at a specialist level is much more than the incremental acquisition of facts.
The workplace became the de facto living classroom. Learning was in part self-directed but also an apprenticeship journey. Working in teams inspired synergies but also presented conflicts which sometimes could not be resolved. There were mentors who nurtured and inspired, but also seniors who judged and admonished.
Gaps in understanding and experience invariably led to omissions or errors. These difficulties caused much anguish, but they were also transformative in learning how to deal with the voice of skepticism that questioned one’s worth in the wake of each failure. The voice that asks whether one is good enough and whether the journey is worth taking. To this, he started to accept that despite his many personal limitations, it was still a duty (and privilege) to offer what he had.
At times, it may not seem enough for everybody. However, it is important to recognize that there is a little flame within each of us that drives us forward.
Learning to serve
As a doctor, it’s important to understand the science and research behind various treatments amid the large number of published studies. However, Dr Lien highlighted something else that was equally crucial.
He shared that at the subject matter level, it is about appraising the medical evidence. However, when facing a patient, it is about understanding what matters to the patient.
In most disciplines, the initial phase of the learning journey involves acquiring the fundamental knowledge and skills to be a competent practitioner. But to truly understand the impact on another person is a lifelong endeavour.
At times, this also includes understanding the effect on the person’s family and surroundings. Helping each patient also involves being aware of the concerns of their family members particularly when there is a serious illness. These difficult conversations help families come to terms with not just the medical condition but also the patient’s considerations and preferences.
Yet, despite one’s best efforts, there are many factors that are beyond our control.
Learning to have faith
In every profession and vocation, practitioners try hard to be responsible for their actions. However, these actions may have consequences that are beyond the control of the practitioner. Even for the responsible practitioner, it can result in great heartache because of how an action led to unintended or unforeseen results. For example, in a sudden emergency, a judgement call may lead to someone having a second chance in life or slipping away into the night. It may even lead to someone living but with regret and enduring an impeded quality of life.
There is a point where one sometimes has to accept that there is nothing more that one can do. You might be called to a certain profession or vocation, done all that you could to prepare for the role, and yet, it may not be enough to make a difference to your patient.
"To cure sometimes, to relieve often, and to comfort always." Sir William Osler
To this end, many doctors embrace the wisdom of the beloved physician Sir William Osler. Dr Lien shares how he constantly reminds himself with gratitude for having been given the opportunity to be a doctor. To be able to learn, to serve, is encouragement in itself to continue forward.
Dr Lien’s parting advice was particularly inspiring:
No matter what difficulties lie ahead, remind yourself from time to time that you are here not because you chose but because you were led.