Prof Lukoye Atwoli, Dean, AKU Medical College, East Africa (right) during his graduation 20 years ago
We caught up with Prof Lukoye Atwoli, Dean of the Medical College, East Africa as he marks 20 years in medicine, and he shared 20 life lessons learnt from his medical career so far.
Lesson 1: The difference between life and death often lies in the minutes it takes to take action in the medical world. Medicine has taught me that the proper use of time allows us to build into our day’s opportunities to do as many of the things we enjoy, or consider important in our lives. During the day, I will try meet the people I need to meet, get a scientific manuscript completed, see a patient or two and share jokes with my family. I might even work in some time having fun with friends. Time is precious, treat it that way.
Lesson 2: Whatever we do in our medical world must be intentional, which is to ensure that we have clear goals for our actions, such as ensuring our patients get the best care possible. Being intentional includes thinking about my next move. My actions and words have to facilitate the achievement of these goals. Being intentional is about understanding the impact of your actions, and being able to live with the consequence.
Lesson 3: With every patient interaction, doctors must collect sufficient information and generate goals of intervention that will address the patient’s concerns. This helps us assess the success of treatment, or even to determine whether the patient is satisfied with our care or not. From this, I have learnt to develop and work towards both long-term and short-term goals, which I constantly review to ensure I am still on the right track. Remember, goals do not have to be fixed - as you achieve smaller goals you have every opportunity to expand them, to grow them to match the size of your vision.
Lesson 4: Once in a while, we have situations where we get poor outcomes even though we followed every rule in the book. Those are the times we look at the “Thou must not…” rules and ask, “Why not?” and this is how innovation is born. Exploring new ways of addressing a ‘difficult’ problem calls for one to be audacious.
Lesson 5: Prepare for the worst, even as you hope for the best. Surgery teaches us that no abdominal surgery is minor, and that occasionally we go in expecting a swollen appendix only to encounter a strange mass. Whenever I go in to solve a problem, I often expect that it will be a difficult one, and I plan to handle it as the most difficult problem I have ever faced. A prepared person makes things look easy at the point of execution – or as my seven-year old son says “Proper planning prevents poor performance."
Lesson 6: A doctor who pays attention and is present in the moment connects better with a patient and collects lots of verbal and non-verbal information that leads to a quick identification of the problem and its solution. I am learning to create richer relationships and earn capital that is more social by being present when with friends and relatives, and engaging with them beyond shallow social niceties. By being present, we create memories that last, and form fulfilling relationships that serve us well in our journey of life. Be present, immerse yourself in the moment, and give it as much of your attention as you can.
Lesson 7: The importance of integrity in our broken society can’t be gainsaid, and many of the problems we encounter in our politics, our education sector, in the security services and even in our homes would be fixed if only we were truly persons of integrity. The need to always do the right thing is a constant feature among most doctors, to the extent that we sometimes appear naïve when in the company of our peers in other lines of work. The consequences of acquiring a reputation as dishonest or deceitful doctor are dire, and probably impossible to correct in one’s career.
Lesson 8: Many things we see in medical practice make us despair. We lose patients, we have bad outcomes even in cases we expected no complications. Patients and their relatives will be on our case, and those who employ us may mistreat us. I therefore quite deliberately seek out reasons to be happy, even in the worst situations I find myself in. I convert failures into lessons for future reference, and I celebrate my wins, no matter how insignificant they may seem to others. I find ways of patting myself on the back, even in the midst of the most arduous tasks I have had to deal with. Happiness is enabling, and happiness attracts happy people to you. Be happy!
Lesson 9: I have learned that going out into the world without understanding myself is taking a huge risk, and leaving my fate to chance. I therefore spend some time regularly examining my attitudes, behaviours, thoughts, strengths and weaknesses in order to understand me better. Know yourself, as this helps you determine what tasks you should take on directly, and which ones you should delegate to someone with more ability than you. It is also helpful in understanding how the rest of the world sees you, and in deciding whether you need to change certain patterns of behaviour you may have.
Lesson 10: In all spheres of life, it is easier to criticise from an observer’s position. Unfortunately, the observer’s position is often devoid of important information that is only available to the person in the arena, like the man said. It is only by rolling up my sleeves and getting into the field that I was able to test my ideas and influence the agenda in areas I cared deeply about, and as I did that, I learnt more about my own abilities, and was better able to recognise new opportunities when they came along. Instead of complaining about how dark it is, we can be the light that expels the darkness for everyone else. We can indeed be the change we want to see around us.
Lesson 11: No matter what our dreams and aspirations are, we can only pursue them to our fullest potential if we take good care of our health. I have learnt to eat a balanced diet, to take long brisk walks. I have learnt to build some exercise into my daily routine, like preferring stairs to lifts when I have a choice. I have learnt to have a support group that listens to me as I offload my troubles, and that laughs with me when I need it. I have learnt that to be effective I have to mind my health first. You can achieve all else in your life when you are healthy.
Lesson 12: Every person has a story, and very few human beings come at strangers with unjustified ill-will. I have learnt to ask to learn from strangers about themselves, to give everyone a chance rather than judge them based on their appearance, or age, or background. Respect costs nothing, but pays hugely in the human connections we are able to make in this life.
Lesson 13: I learnt right from medical school to get exposure to a variety of experiences in the medical field, and to choose, as much as possible, the areas that arouse a passion in me. I was passionate about making a difference in a neglected field of medicine, I was passionate about advocating for the less fortunate in society, and I was passionate about contributing to the generation of new knowledge within the medical profession. I chose psychiatry and mental health because the specialty ticked all my passion boxes. I am passionate about many other things, but I ultimately find that I can either make them relevant to mental health, or make mental health relevant to them. Find your passion, and your life’s mission shall be manifest!
Lesson 14: Memories of the time I donate to those that cannot afford medical care often stay with me for long, and bring me so much joy that it might become the incentive to continue doing this! Interestingly, too, unexpected opportunities still arise from time to time from such charitable encounters! Give selflessly, based on your ability, and your life will be fuller than you ever expected. This is a core tenet of the practice of medicine, to give freely of ourselves. The difference we make in the lives of the people we support without expecting anything in return is a huge reward in itself.
Lesson 15: The practice of medicine provides us with numerous opportunities to experience vicariously the suffering of the people we serve. Sometimes we see injustice clothed as disease, with solutions that lie among the political class, or with the bureaucrats in charge of resource allocation across the country. Many colleagues are tempted to throw their hands in the air and say there is nothing they can do about it while others regularly dip their hands into their own pockets to try and assuage their guilt and frustration at seeing so much suffering around them. I have found that it is more fulfilling to take sides and bring the problem to the doorstep of its owner. I have learnt that I can touch the lives of millions of patients by having a conversation with a politician, with a high-level civil servant, with people close to the decision-makers. I have learnt that advocacy shines a light on the problem and helps the owners to know that it exists so that they can do something about it. “We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.” - Elie Wiesel
Lesson 16: A doctor is often called to see patients in the middle of family engagements and many social engagements will get cut short as the call comes in to attend to an emergency. I have learnt that it is possible to schedule myself so that I have time for my family too. I have learnt that I can share my workload with colleagues to ensure a patient is attended to and our families get to see us too. I have learnt that when we neglect our families, our lives at the end of our careers are empty and full of neglect. For no matter how good we are at our professions, those we serve do not come to spend our retirement years with us. Only our families can do that, and only those in our families that feel close enough to us due to our earlier interactions. Keep your family close. Especially those family members that are also your friends!
Lesson 17: Reading must necessarily go beyond what I know in order to provide good patient care. I daresay I learnt that reading beyond medicine enabled me to understand my clients’ reality better, and perhaps facilitated a stronger connection with them. Read wildly, I would say. Read history, read the classics, read biographies, read fiction, read poetry. No matter what you do for a living. Reading opens dimensions in life that are otherwise only locked up in other people’s heads!
Lesson 18: Reminding ourselves to see these positive things around us and to be grateful about them makes the difference between a satisfying career or life and the sense of a wasted life. I have learnt to be grateful for every life I have saved, rather than only moping over the ones I have lost. I have learnt to be grateful for the hundreds of children I helped bring into the world in my years as a medical officer (and before that as a medical student). I have learnt to be grateful for the client who gets back to me and thanks me because they felt better after interacting with me. Being grateful brightens your day, broadens your horizons, and gives you a reason to wake up the next day and go out and do what you do so well!
Lesson 19: Good things, important things, satisfying things in life are not to be chased, but to be attracted. I have learned that when I do the things I love doing, when I surround myself with people who make me happy, when I pursue goals that are in line with my abilities, the things I want to have in my life start coming to me, and I do not have to chase after them. I spend more time figuring out what I enjoy doing in life, and finding ways of doing it. Eventually people find ways of compensating me to continue doing the things I love. Don’t chase, attract!
Lesson 20: We will proudly identify with a senior colleague whose ideas and practices we inherited, or one who took her time to mentor us through our early years as doctors. I have learnt to use the spaces I have created over the years to provide opportunities for colleagues younger in the profession to grow to the same level I have, and to surpass it. So, even as you do great things in this world, go ahead and clone yourself through structured, deliberate, intentional mentorship.
Here’s looking forward to another twenty years in medicine, and twenty more lessons to be gleaned from this vocation!