The medical profession

What is it really like to be a doctor?

What is it like to be a doctor? John Erik talks about studying medicine in Poland, everyday life as a GP, meeting patients, responsibility, and advice for future doctors.

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What this covers

  1. The road into medicine
  2. Studying medicine in Poland (Warsaw)
  3. Everyday life as a GP
  4. Meeting patients, and communication
  5. Responsibility and uncertainty in medicine
  6. Psychiatry
  7. Pay and working conditions for doctors

What this covers (cont.)

  1. Study technique and memory technique

A choice that was never a single moment

He does not remember deciding. It was something he had settled on fairly early, and from lower secondary school onwards he worked deliberately towards the grades he needed.

What it actually takes to get in

There is a distinction many people run together, and it is worth making clearly: the formal subject requirements are one thing, the points threshold is quite another.

Two requirements that are not the same

The formal requirement

Subjects you must have

  • General university admissions certification
  • Mathematics R1, or S1 and S2
  • Physics 1
  • Chemistry 1 and 2

The real requirement

Enough points to make the cut

  • Very high competition for places
  • The threshold varies between institutions
  • The threshold varies between quotas
  • The threshold varies from year to year
You can meet everything in the left-hand column and still not get in. The subject requirements open the door to the queue; the points decide your place in it. Requirements and admission rules can change, so applicants should always check current information with Samordna opptak, the Norwegian central admissions service. (Source: Lovdata)

Why Poland

The answer is not the one you expect. It was not about points.

Studying abroad and Norwegian authorisation

  1. No advance approvalThe Norwegian Directorate of Health does not pre-approve foreign health education programmes. You do not get a yes before you go.
  2. You complete the degreeThe whole programme is taken abroad, in the language it is taught in.
  3. Then you apply for authorisationThe application is assessed under the rules in force at the time you apply.
Poland is in the EU/EEA, and medical training is covered by European rules on professional qualifications. That still does not mean Norwegian authorisation can be taken for granted: rules and programmes can change over the course of a six-year degree. (Source: the Norwegian Directorate of Health)

The degree, and the worst of it

The hardest subject was biochemistry.

What the subject covers: chemical processes in the body, amino acids, and how the body converts energy.
The example he singles out: the Krebs cycle, also called the citric acid cycle – the body's central loop for energy metabolism.
A curiosity from the work on this episode: the machine transcription heard something else entirely. It is a good reminder of why technical terms have to be checked against a source rather than against an audio file.

What it cost

These are numbers that are easy to underestimate. Tuition at his university was around 110,000 Norwegian kroner a year. On top came loans for living costs.

Six years of tuition

One yearAround 110,000 kroner in tuition
The whole degreeSix years of tuition – living costs come on top

One academic yearQualified doctor

The point is not the exact amount, which is historical and approximate from his own studies, but the order of magnitude: this is an investment on the scale of a house in rural Norway, taken on before you have earned a krone in the profession. In return, food, eating out and ordinary living costs in Poland were considerably cheaper than in Norway while he was there. Electronics, clothes and international brands showed smaller differences.

The biggest shock after graduating

Not the workload. Not the responsibility, really. Something far more fundamental:

Exam against reality

At university

There is a right answer

  • The question is set so that one option is the most correct
  • The information you need is given
  • You are measured on whether you hit it

At work

Several answers can be defensible

  • Two doctors can choose differently and both act correctly
  • Experience and probability come into it
  • The patient's situation comes into it
  • The risk of waiting is weighed against the risk of treating
This is the core of the whole conversation. The move from study to work is not primarily a move from theory to practice – it is a move from looking for the right answer to handling the fact that there often isn't one.

Five questions instead of one diagnosis

The assessment that comes before the name of the illness

  1. Could this be dangerous?The first and most important filter.
  2. Does it require treatment?Not everything with a name should be treated.
  3. Does it need rapid investigation?Is it urgent, or can it wait?
  4. Is watchful waiting defensible?Waiting is an active decision, not the absence of one.
  5. What should the patient watch for?What should make the patient get back in touch?
Notice the order, and you see that the diagnosis is not the goal in itself – it is a means of answering these five. The last point is also the one the patient should take out of the door with them.

The day

He starts around eight. His appointment book is set up with roughly 20 minutes per consultation, with some slots left open to absorb delays.

Why the GP runs late

What happensWhy it costs time
The appointment develops differentlyThe symptoms are more serious than expected
More than one problemThe patient has brought more than the booking said
Need for acute follow-upSomething has to be handled now, not later
Calls and test resultsThey arrive between consultations
Contact with the hospitalOften has to happen while the patient is still there
None of these are the doctor dawdling. They are what happens when an appointment book is a plan, and a plan meets reality once an hour.

The work that is not in the appointment book

  1. 1Patient notesWritten and checked.
  2. 2Test resultsRead and assessed.
  3. 3PrescriptionsRequests processed.
  4. 4ReferralsWritten.
  5. 5Discharge summariesRead and followed up.
  6. 6Messages from hospitalsHandled.
  7. 7Electronic enquiriesAnswered.
  8. 8Sick notesAnd other documents.
If this does not get finished at the surgery, some of it has to be done in the evening. This is the part of the job the patient never sees – and a major reason a GP's day feels denser than the number of consultations would suggest.

When the doctor does not know

He answers no to the question of whether doctors always know what is wrong. Rashes, symptoms and presentations he does not immediately recognise do occur.

The ladder when the answer is not obvious

  1. Examine furtherMore information before more action.
  2. Watch and waitWhere it is medically defensible.
  3. Ask a colleagueLow threshold, and entirely normal.
  4. Ask for a second assessmentThe colleague sees the patient themselves.
  5. Contact a hospital specialistWhen the problem calls for it.
  6. Refer onwardsThe investigation is taken elsewhere.
"Asking for help is a normal part of the work." That is perhaps the most reassuring sentence in the whole episode – both for patients and for anyone considering the profession.

Do doctors google?

Yes, but not the way you do. The difference is not that the doctor avoids looking things up. The difference is where they look.

The reference works he names

SourceWhat it is used for
Norsk Elektronisk LegehåndbokGeneral medical reference work
LegevakthåndbokenAcute presentations
The antibiotics guidelineAntibiotic use in primary care
The driving licence guidelineHealth requirements for driving licences
Hospital procedure manualsProcedures and local guidance
RELISMedicines, side effects and interactions
The point is not that the doctor should remember every detail. The point is knowing where reliable information lives, and how to weigh it. That is a skill in itself, and it transfers to most professions.

The patient who has googled

He is gentler here than you might expect.

When searching helps, and when it does not

Useful

You learn about your own body

  • Can this be handled at home?
  • Should it be raised with the GP?
  • Does it need faster help?

Problematic

You have landed on a diagnosis

  • The conclusion came before the examination
  • The diagnosis is often rare or serious
  • Forums and language models list possibilities without weighing probability
The line is not between searching and not searching. It is between getting oriented and concluding. The doctor still has to make an independent assessment, and that can mean the patient does not get the test, the medicine or the referral they wanted.

Why more tests do not give a safer answer

This is the most counterintuitive part of the whole conversation, and it is worth doing the arithmetic.

The chance of at least one deviation in a perfectly healthy person

1 test 5.0% 5 tests 22.6% 10 tests 40.1% 20 tests 64.2%
The calculation is 1 minus 0.95 raised to the number of tests, and it assumes the tests are independent of one another – a simplification, since several tests in a panel are related. The order of magnitude holds all the same: take enough tests without a medical reason, and you will find something. Such findings can cause worry, further investigation and in some cases unnecessary treatment. The doctor should therefore consider whether the result will actually change what happens next. (Source for the reference range and the reasoning: legeforeningen.no)

A few other myths he clears up

How to get the most out of your appointment

This is the most directly usable part of the episode, and it costs you five minutes in the waiting room.

Eight questions to have answers to before you go in

  1. What is the main problem?One problem first, not all of them at once.
  2. When did the symptoms start?A date, or roughly when.
  3. Better or worse?The direction often says more than the state right now.
  4. What makes it better or worse?Activity, rest, food, time of day.
  5. What have you tried yourself?And did it work?
  6. Medicines and supplements?All of them, including over the counter.
  7. What worries you most?Say it. It is often what the appointment is really about.
  8. What do you want help with?Get the expectation on the table early.
If you have several problems, prioritise the most important ones – or ask the practice whether you should book a longer appointment. That is an easier conversation to have at reception than halfway through an appointment that is already running.

Who the profession suits

Two lists worth reading honestly

May suit you

This sounds like you

  • Interested in people and health
  • Can take a long and demanding education
  • Can work in a structured way over time
  • Wants responsibility
  • Enjoys continuous learning
  • Can live with there not always being a right answer

Think twice

This is your motivation

  • You are mainly after status
  • You are mainly after a high salary
  • You are choosing medicine because of pressure at home
  • You do not enjoy working closely with other people
You do not need to know which specialty you want. But you should genuinely want to work with medicine and with people. The qualities he lists – communicate clearly, listen, work in a structured way, learn a lot, decide under uncertainty, carry responsibility, handle conflict, ask for help, separate the urgent from what can wait – you do not have to be best at from the start. But you do have to be willing to develop them.

What he wishes he had known beforehand

Not more medicine. Study technique.

The memory palace, in three layers

What you need to rememberThe material itself – names, sequences, systems, connections.
A place you know wellYour childhood home, the walk to school, a route you have taken a thousand times. The rooms are already stored.
The linkThe information is placed in the rooms as images. Retrieving it becomes a walk through the house.
John Erik found visual methods and the memory palace particularly useful, and wishes he had learned them earlier. He is equally clear about the caveat: there is no single study technique that works for everyone. You have to experiment and find a method that fits the way you learn.

Would he choose it again?

Yes. He thinks the training has given him an interesting profession, a secure job, a good income and plenty of options. Had he not become a doctor, he might have considered becoming a pilot.

Key points

  • Medicine is as much about handling people as it is about medicine itself.
  • There is often no single right answer – a large part of the job is handling uncertainty.
  • Asking colleagues for help is a normal and important part of the work.
  • Choose the profession because you want it, not for the status or because of pressure.

Key points (cont.)

  • Good study techniques, such as the memory palace, make a demanding degree more manageable.

Questions this answers

  • How do you become a doctor in Norway, and what subjects do you need from upper secondary school?
  • What is it like studying medicine abroad?
  • What does an ordinary working day look like for a GP?
  • What does a doctor do when they do not know what is wrong with a patient?
  • Who is medicine right for – and who should choose something else?
  • Are status and a high salary reason enough to become a doctor?

Questions this answers (cont.)

  • What should you consider before applying to medical school?

Spørretimen

Read the whole thing at

www.sporretimen.no/en/episodes/john-erik-legeyrket/