Separating the men from the boys – the Rashomon effect

 

From Dr Venugopal Balchand

On April 17, a junior doctor, just 13 days into his housemanship at the Penang General Hospital, fell to his death from a residential building. As a senior member of the medical fraternity, my heart goes out to him and his family. I pray that all of them find the solace and closure that they yearn for and deserve.

Suicide, however, is never unifactorial.

After that tragic incident, much has been said of the whole houseman training programme. People who are not doctors and have never participated in a medical training programme have hurled all sorts of accusations at both the programme and the senior doctors/trainers.

Some senior doctors have tried to say their piece, in defence, but have largely been drowned in the sea of sympathy for the young housemen. Everyone is clamouring for justice but as judge JR Midha of the Delhi High Court said in his farewell speech, “in the court of justice, both the parties know the truth. It is the judge who is on trial”.

In this sad episode, the judges are you, the average Malaysian public, who one day will need the expertise of competent, bold, well-trained and emotionally detached doctors to carry out sophisticated medical procedures which can be life-saving.

I do happen to know a few things about medical training. I have been involved in it for 25 years and have trained many a current brilliant surgeon. Was I bullied during my own initial years? Of course, I was! Did I have to work long hours? Of course, I had to! Did I ever feel like quitting the profession? Indeed! Many a time! Especially when I had spent hours and days trying to save a human life but failed. Did I ever want to end it all? Thankfully never. Was that because of wonderful support systems in place? No. It was because of my own personality and character.

As a trainer for emerging surgeons, I do have only one goal. Separating the men from the boys. And I can, without hesitation, vouch that it is the same with every single trainer in every single discipline in medicine. The singular desire is to produce a doctor who first will do no harm and then will try to treat the illness in the best way possible.

The Rashomon effect describes how parties portray an event in a different and contradictory manner which reflects their subjective interpretation and self-interested advocacy rather than objective truth. The effect is named after Akira Kurosawa’s 1950 film “Rashomon” in which a murder is described in four contradictory ways by four witnesses. The Rashomon effect is now synonymous with the contested interpretations of events, the existence of disagreements regarding the evidence and subjectivity versus objectivity in human perception, memory and reporting.

The loss of even one human life is a tragedy, especially if it was potentially avoidable. Does the houseman training system need an overhaul? It certainly needs a review, in my opinion. You never ever throw the baby out along with the bathwater, do you? The apprentice system of imparting medical acumen has withstood the test of time. Though human anatomy, today, is taught with brilliant 3D reconstructions, believe me, it will never prepare you for the raw excitement, nervousness and sheer exhilaration of doing your first successful appendicectomy on an unsuspecting patient.

For that, you need a stern teacher across the table from you to point out potentially disastrous mistakes in a language that you tend not to forget. I cannot imagine a pilot instructor telling his trainee cadet who has crashed the plane in the simulator “Never mind dear. Please don’t do it next time, okay.”

My dad used to always tell me about how he had to walk 5km to school daily. Barefoot. He did sound a bit, condescending about me having the luxury of going to school in a school bus. Did that one act make him “tougher” than me? I think it did in many an unsuspecting way.

Kabir, my son, is now chauffeur-driven to school. In just three generations, the simple act of going to school has evolved so much. What more about the act of learning? Every generation has its own peculiarities that need to be looked at without prejudice. Am I implying that the junior doctors are sissies? Not at all. I am just acknowledging that just because I was shouted at does not mean that I have to shout too.

As a gentleman who has been an active clinician for 36 years now and done more than a fair share of saving Malaysian lives and training Malaysian doctors, without care for “work-life balance” in the earlier years with much detriment to family life but now fully appreciating its importance, I would still consider myself an abject failure if I put even a single doctor out on the streets who did not measure up to your expectations of skill, caring and empathy.

But to blame an entire system of training or a generation of senior doctors based on a couple of avoidable tragedies is like walking out of a screening of Rashomon even before the intermission. Let us see what the enquiry by the task force set up by the health ministry reveals. I am certain that blatant inadequacies will be addressed and necessary improvements made.

For now, let us all remember that life is a two-way street and the only motive for the entire medical fraternity is to ensure that you fondly remember that journey home from the hospital.

Please do watch Rashomon. It is a superb movie.

P.S The writer would like to acknowledge his good friend Dr Amir Hamzah for introducing him to the concept of the Rashomon effect during their frequent passionate conversations for a better Malaysia and Wikipedia for helping him understand the concept further. - FMT

Dr Venugopal Balchand is an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.