Professional procrastination

One of the traits which has been going away from me has been my motivation. For particular things -  especially regarding my family medicine higher training - they have been put off so many times. Even this blog entry has been put off for several weeks, maybe even months. It has come to the stage that my psychiatrist had to add bupropion (Wellbutrin), an anti-depressant usually used to help people quit smoking, to improve my motivation. Although this has helped a little, there is still stuff left to do.

So why am I so unmotivated to do anything about my family medicine higher training? Probably it is the lack of drive which is a factor. My family medicine higher training is not compulsory to be completed. I can still practise in Hong Kong without it. My level of pay won't be as much as doctors who have completed the family medicine higher training and passed the exit examination but the money is still nothing to scoff at. It is comfortable to live on, I have no debts and no-one that financially depends on me. My chances of promotion within the department will be zero without the resident specialist title but I'm not worried about that - I would hate the added responsibility and doing stuff such as seeing patients in specialist clinics and attending meetings.

Even getting up in the morning, knowing I have to go to work and see patients, requires serious willpower and motivation. There are many times I lie in bed thinking if I can pull a sickie today and then I realise the reason I have gone part time is so I don't want to do this.

To be honest I fulfilled most of adult ambitions in becoming a doctor. When I was a teenager, I was naive to think I could fulfil most of my goals: 16 A*'s at GCSEs, 6 A's at A Levels, get into the University of Cambridge to study medicine, get married at 25 years old, have children by 28 years old and win the Nobel Prize for Medicine and Physiology by 40 years old. During my depression years, when I was deferring studying and repeating years, all I wanted to do is graduate and become any doctor. Now that I've achieved that, what is left to do in terms of big goals? I don't expect even to have sex, let alone hook up, get married or have kids.

There are other goals which I want to do, which strangely I am more motivated to prepare for: take a 3 month European trip, get a Diploma in Tropical Medicine and Hygiene so I can volunteer for Medicins San Frontieres and, finally, do the research so I can emigrate to Australia or go back to UK. But even then the motivation is not immediate.

For my family medicine higher training, I have still got to record my consultation videos. This is the part I am most dreading, since it requires me to converse in Cantonese at length, something I'm not comfortable doing. I have to enter 600+ patients' data for my clinical audit and I've only done 100+ patients. I have still got to prepare for my practice management assessment, which I haven't even started. This requires me having to fix any problems with my clinic settings, such as making sure the cardiopulmonary resuscitation drills and fire drills paperwork is in order, which it isn't and I have been sitting on this for the past year. The lack of drive goes in hand with the lack of consequences - there is no punishment if I don't fulfil my higher training.

I think it is an effort related matter regarding my motivation. There are some things I don't want to do. Going out to gatherings on Meetup such as "British Born Chinese and Friends" and "Social Scrabble Club" requires me to hop on to public transport for one hour or more, which I find hard to do. Yet going to volunteer for Hong Kong Dog Rescue is something I do regularly, probably because it is only a 15 minute drive from home and I can park for free.

Probably I should give in and say, "Look, I don't envisage me staying in Hong Kong in the near future. Completing my higher training and taking the exit examination, which I will probably fail, will be pointless."

At a crossroad

Back in February, I was in a poor state psychologically. My depression was still in remission but I kept on having acute episodes of depression. I would feel low for a few days and then, in the morning, I would wake up and was depressed plus anxious about the day ahead and challenges that it would present. I would become more depressed plus anxious, having my arms ache, my chest tighten, having difficulty breathing and feeling that my heart was racing. That situation came to the point I was taking sick leave one day every month. I didn't want this to continue, as it was unfair for the colleagues who had to deputise in my absence  the community in general since they paid my wages.

Something had to change - I discussed my problem with my family and then my boss about what I was going through and brainstormed some options. I decided to go part-time, which I only started recently. With the time off, I hope to sort out the rest of my higher training in family medicine and decide what my options are regarding my future.

The main reason why I have gone part-time is that I don't like my job as a family medicine doctor in the Hospital Authority's general out patient clinic. There are a lot of problems, from patients, other doctors, the health care system and society itself. I will elaborate about these issues at a later date, most likely when I leave Hong Kong since I will be burning a lot of bridges when I do that.

That's another problem I have as well - I don't like living in  Hong Kong. Or rather I feel I don't fit in here. Whether it is still the language problem (I'm not very fluent in Cantonese) or the cultural integration is still being resisted by me, I still spend a lot of time at home and not want to go out. Appearance wise, I'm Chinese but culturally, I attach myself to Britain - I enjoy British cuisine (stop sniggering, there is actually good parts about it), I follow mainly British sports and I watch mainly British TV shows.

I have gotten a lot of grief and ridicule when I describe myself as English or a "banana" (yellow on the outside, pertaining to my Asian looks, while being White on the inside, as I think like a Westerner). Mainly this comes from my parents, who often say "Why do you want to be British? They hate Chinese people and they don't want you as a citizen!" and some of my colleagues, who find it funny I like things like British food and the way of life, such as shops not being open on a Sunday - a totally foreign concept to them.

So with this time off, I'm hoping to finish up my family medicine higher training, although I may not need it. If I was going to stay in Hong Kong, it would be probably best to complete the training and take the Exit examination but it is not absolutely necessary. It just means I get paid less than the people who have passed the exam and I'm already well paid in this job already - why do you think I have the luxury of going part time?

I'm trying to find out if I can go back to UK or head off to Australia to practise medicine. I know I can go to Australia, since I'm already a Fellow of the Royal Australian College of General Practitioners, which means it would be relatively easy to work there. For UK, I might need to take a language proficiency examination and a medical knowledge examination but I don't think that is too much of a hassle. My only worry is that I need to pass my Exit examination here in Hong Kong in order to be able to practise in the UK. If that is the case, I'll just head to Australia instead.

Another option is doing my dream job and heading off to volunteer for Medecins San Frontieres for a while. I know that entails needing a Diploma in Tropical Medicine - again, another excuse to get out of Hong Kong.

I know I'm not going to make a lot of people happy about my decision and remarks - parents, friends, colleagues - but this is my life, my opinion and if they do like me, they respect the choices I have made in my life.