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JUNIOR DOCTOR | VOLUME 2 | ISSUE 1 | 2011 | SOUTH AFRICA www.medicalprotection.org


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How to work as… a specialist physician


Specialist physician Dr Willem Theron describes what it takes to work within this particular specialty


U


ntil well into the last century, specialist physicians (also


known as physicians) were derisively known by their surgical colleagues as “those solemn blokes with their pills, promises and postmortems”. Not any more. Thanks to mountains of robust research over the last 50-odd years, physicians can now step up to the bedside, backed by a formidable body of pertinent knowledge and armed with a gratifying array of effective diagnostic and treatment options.


Who would prosper as a physician? And am I up to it? If you are interested in becoming a physician you should have a special affinity for human physiology; internal medicine is, to a large extent, nothing but applied (if advanced) physiology and pathophysiology. Clinical medicine (as opposed to research) is all about people. To practise internal medicine, you should have empathy for people in distress, be a good communicator and have lots of patience – but you must be able to be quite firm at times. There is an enduring


myth that you can only become a physician if you are an “egghead”. This is presumably because of the rather abstract nature of the subject matter in this field of study. The truth is that if you were clever enough to become a doctor, you are clever enough to become a physician.


Training: what it takes to become a physician A stratospheric IQ is no small asset in this game but, as indicated above, brain power of a more modest degree wiil also get you there. However, hard work, perseverance and courage are not negotiable. As a first step you will


need to apply for a post as registrar in any department of Internal Medicine at an academic hospital. You will then rotate at six-month intervals through the different sub-departments, eg, general medicine, cardiology, nephrology, gastroenterology, etc. The South African College of Medicine is the professional body that is responsible for examinations for all specialists. For internal medicine there are two examinations: Part 1 covering basic sciences and


Part 2 covering the entire field of internal medicine. Some universities offer an M Med examination whith the same status. You will only be registered as a specialist if you have passed all the required exams and have completed four years as a registrar. Postgraduate medical


studies in general are not for the faint-hearted, and becoming a physician is certainly no exception. Working and studying at a high academic level will test your endurance.


Working as a physician: pros and cons Why would you go to all the trouble to become a physician? Job satisfaction. What can be more satisfying than observing a critically ill patient improving after receiving some carefully selected medication? Or clinching a difficult diagnosis after some nifty medical detective work? Surely this is as good as it gets.


Other pros: ■■ You get to meet the most wonderfully interesting people and, if you care to listen, hear true stories that are stranger than fiction. ■■ Because you will almost


invariably be called upon to help surgical colleagues out of tight spots with desperately ill patients, you will usually be a popular member of any medical team.


But all jobs have their preponderance of fairly routine work; the case studies below offer some insight into the usual workday of a physician.


CASE 1 Mrs B, a 44-year-old receptionist, was admitted with dyspnoea of two weeks’ duration. She was very agitated, making it difficult to obtain a coherent history. She had consulted her GP initially who, after being informed of her marital problems, diagnosed anxiety. Earlier on the day of admission, her breathlessness had suddenly intensified and she experienced a sharp chest pain for a few minutes. At the time of consultation, though still short of breath, she felt much better. Her agitation stemmed from the fact that a friend had recently died of a heart attack. Physical examination was within normal limits except for a mild tachycardia


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