While seeing an ophthalmologist can cure eye diseases, there is something that this article can do that a consultation with an ophthalmologist might not be able to do.
And that is, opening your third eye.
Sounds eye-minous, doesn’t it? We swear, this pun sounds way better mentally. Though fear not, as we are not diving into religious cults or beliefs (that’s another article for another topic for another day). We were very lucky to have invited Dr Tiffany Woo, who (unsurprisingly) is an ophthalmologist for an interview about the wondrous world of ophthalmology and medicine as a whole. Just like any other articles, we are telling you that by reading this, you will broaden your horizons and all your worries will dissolve into nothing but fine dust that goes into your eyes, causing irritation. But in all seriousness, if you are considering to take on medicine as a career path or just feeling curious, continue to scroll down and let’s yank open our third eye for better foresight!
I T W A S A L L F A T E
Graduating from medical school in 2012, Dr Tiffany Woo is currently an associate consultant at Caritas medical centre, specializing in ophthalmology and sub specializing in retinal surgery. In her years of studying surgery in medical school in Hong Kong, Dr Woo did masters of research alongside Dr Philip Li during the intercalated year between year 3 and year 4.
Yet the journey in becoming a ophthalmologist hasn’t always been that obvious for Dr Woo until, in her intercalated year of research, she was introduced to Professor David Wong from University of Liverpool, an ophthalmologist from the United Kingdoms that was invited to become the head of HKU and Queen’s Hospital Ophthalmology Department. As described in her own words, Dr Woo stated that, “This decision was very random.” Wanting to take a break from the intensive studying at medical school and explore the academic stream to see what best fits her, Dr Woo was given an interesting topic to conduct research upon by Professor Wong, and the topic that ignited the passion and interest within her? Ophthalmology.
T O B E O R N O T T O B E?
Having explored both the academic and medical stream, Dr Woo’s experience and advice on either choosing research or clinical work are naturally quite fruitful.
Of course, the first and utmost apparent point would be which direction you would like your career to take, and Dr Woo couldn’t stress more that to make a solid and sound decision, exploration in both fields is very important. As she points out, “If you like patient contact, which although at times can be frustrating, the sense of gratification and satisfaction you get cannot be received in research.” There is a clear distinction in the working environment between research and clinical work, and the sense of personal touch should be a factor that is taken into consideration. With that being said, Dr Woo also acknowledges the difficulty in entering the Hong Kong academic/research field due its numerous restrictions; she provided the example of how many international journalists that are often American or European tend to favour their own institutions and regions more Hence, it is quite challenging for people in the Asia-Pacific region to have their work published.
It is also notable to mention that the research conducted in the Asia-Pacific region can differ greatly from that of European research, as a population study in a particular geographical region may not be applicable to the rest of the world. Funding is also a critical factor. Due to the insufficient amount of funds, the scale of all Hong Kong research will find it difficult to rise up to the level or scale that they do in America and Europe. In research, lab and clinical studies are both required to perfect your discoveries, and while you can work with petri dishes, animals and test tubes during lab study, you have to work on humans during clinical trials. Yet the population size in Hong Kong is far less than that of America and Europe, thus causing immense difficulty in matching the numbers in terms of sample size.
“It is recommended that if you want to excel in the academic field, you should consider going to America or Europe.” Dr Woo suggests. However, she also notes that if you decide to study abroad, you will be undertaking a very different stream than studying to become a doctor in Hong Kong because the license you receive abroad would not be applicable in Hong Kong. By doing a medical degree in the UK for example, the patients one encounters would be predominantly white and the diseases you learn will be predominately white. “Of course there is a considerable overlap on heart and lung diseases,” Dr Woo also states, “But if you want to practice in Hong Kong and come back for your licence exam, you will have to learn another spectrum of Asian diseases. And the license exam is not easy to pass.” Hence it is advised to stay in Hong Kong to study medicine if you are more inclined to practicing in Hong Kong.
However, in recent years, HKU has been offering medical students the ability to conduct research abroad in their third year. The syllabus Dr Woo had undergone did not offer such programs but rather, in order to do research, students had to take a gap year. Yet for someone who did research in one year, Dr Woo found that people often underestimate the duration it takes to conduct a proper research. It’s very tight to come up with an experiment on a research topic one wants to do, do data analysis and experimentation, and to top it off, write an essay or report in your findings. Although going overseas to a renowned laboratory sounds advantageous, it will take a few years to grasp the lab techniques and do something meaningful with it. Hence, Dr Woo emphasizes the importance of having a good supervisor to teach you the knowledge you need. “If you want to pursue an academic career,” she concludes, “1 year would not be entirely sufficient.”
B U T W H Y ?
When being asked the reason why she decided to become a doctor, Dr Woo confesses that she was quite conflicted after finishing high school. Although she wanted to study medicine, she also wanted to have a good college life by studying in the US; thus to solve her dilemma, Dr Woo decided to take a gap year from studying in the US and try out HKU medicine. Her mindset was simple: “If I enjoy it, I will stay in HKU. If I hate it, I will leave for the US.” After an exploration into US medicine and a good amount of consideration, she decided to stay in Hong Kong and finish her medical degree. As Dr Woo comments, “I didn’t regret it. I had a very good time and I love my work, so it all worked out.”
Inspired by Professor David Wong, Dr Woo decided to pursue a career in ophthalmology and almost immediately, she fell in love with it. “There is limited exposure to this area of field in medical school,” Dr Woo explains, “It only consists of 3 to 4 lectures and teaching clinics. But Professor Wong was very nice, I got to see a lot of surgeries and he brought me to the UK to attend conferences about retinal surgery. It was really eye-opening.” Furthermore, she expresses in the interview that her most favourite part of being an ophthalmologist is the surgeries and how intricate they are. “It’s really wonderful to see such a small organ can have so many surgeries, it’s so fine, so small and you have to do it with a microscope.” Dr Woo carries on saying, “Most of these surgeries don’t involve blood, it’s very clean.”
Other than the surgeries, it’s the people in the working environment that has made Dr Woo fall in love with her work, as she comments, “If you find a good boss and good colleagues that are willing to teach you, it makes a huge difference.”
F O R E V E R G R A T E F U L
Dr Woo’s line of work consists of dealing with numerous retinal detachments and retinal surgeries daily, yet she recalls one of her most memorable surgeries, which involved a patient having an industrial accident during work and a nail flew into his eye, impacting his retina. After 5 hours of hard work, Dr Woo successfully removed the nail from his eye and the patient could see once more. “He was the breadwinner for his family,” she recounts, “The look of gratitude on his face, and the happiness and relief of his family, it made me happy. That’s what I love about my job, I need to do surgeries and have contact with real-life people to know I am making an impact.”
As Dr Woo provides, it is rather difficult to make an impact in research because it takes years and years for an experiment to work out, and the results are often dependent on luck. “It’s another reason why I chose clinical work over research,” she explains, “You don’t get to see immediate results. But I like immediate results.” However, it is not only research where you can’t see instant effects, for specialites like chronic or oncology, they mostly deal with the ending of life. “Some people like it, others don’t. It may take a toll on them. So that’s why you need to make an informed decision.” Dr Woo advises students to look into everything before making a sound decision, and believes students should not by default take on law or medicine simply because of their academic results, but consider different careers in different industries such as technological development.
M Y M E T H O D A N D Y O U R S
Most of the time, an ophthalmologist’s surgeries and treatments are isolated from other specialties as collaborations are not possible in terms of laser treatment and surgeries. Because the eyes are a part of the central nervous system and very closely associated with the brain, collaborations with a neurologist or a neurosurgeon may be necessary if there is a compression of the optic nerves due to the presence of a brain tumor in the perpetuary glands. And in uncommon cases, surgeries are done together but usually in the occulplasis team where complicated orbital surgeries are done by opthamologists and plastic surgeons, or head-and-neck surgeons.
Despite being of the same specialty, each surgeon will have their own operating methods that are developed in their 6 years of specialist training. And through your journey, you will follow numerous seniors and each of them will have their own preferences and teach you their own methods, but for you, it will be a process of experimenting.
“You will look at different seniors and you will look at different practices,” Dr Woo clarifies, “And you’ll pick one that you think is best suitable for the patient and you. When you start doing your own surgeries, you will try out different methods from different seniors to know which method are you and the patient most comfortable with.” Evidence-based medicine was also recently popularized, and thus, there are a vast database of journals from seniors in all parts of the world that act as reference for the development of your own surgical method. Most of the time, however, different practices can give you a similar outcome, but it emphasizes more on the trainee’s comfortability with the particular technique.
Rest assured that although this process is a “trial-and-error”, there is a safety net during surgeries that are conducted by trainee doctors. “When things go south,” Dr Woo asserts, “The seniors will take hold of the situation and save the patient. In the public system, the patient doesn’t have the choice to choose whether or not a training doctor will perform the surgery on you, but there will always be a senior specialist supervising the surgery to ensure no faults. If you want to choose, you will have to go into the private system.”
B U R N O U T S
Just because a person is a doctor doesn’t automatically mean they don’t make any mistakes. When asked how she deals with failure and burnout, Dr Woo accentuates the importance of communication between the doctor and the patient. “Doctors who get sued don’t have poor surgical skills,” she states. “They have poor communication with their patients. Doctors that have bad surgical skills but good communication with patients generally don’t get sued.”
Good communication with patients involves managing the patient’s expectations for the surgery, “As no surgery is 100% risk free,” Dr Woo states, “you have to really lay out to them what can happen.” Furthermore, it is essential to handle your own mentality and ensure that you are going into the surgical room with a clear mind, having a hangover or lack of sleep is not acceptable. “Just do your best,” Dr Woo advises. “Even if you do everything perfectly well, things may not go as planned. You’re a human being, not a God. So do your best and the rest is in God’s hands.”
For ophthalmologists, Dr Woo and her colleagues have a 9 to 5 schedule, and even when they are on call, there are very few emergencies, hence she finds her work hours to be not so bad. Apart from being an ophthalmologist, Dr Woo is also the captain of the CIS Alumni Dragonboat Team. “I enjoy exercising in general,” she comments, “I went to Marymount before transferring to CIS but I am more close with my CIS alumni group. They are super nice and it’s a really great team-building event, you get to know so many alumni from different years.”
L O N G Q U E U E S
In the line of Hospital Authority, as Dr Woo acknowledges, the queues are extensively long, to the point in which patients have to wait for 2 to 3 years to get an appointment. In terms of the structure of Hospital Authority, Dr Woo mentions in the interview that there’s a huge hierarchy with superiors above you making decisions for doctors, with elaborate structure and even more elaborate rules.
However, in her day to day work, Dr Woo witnesses the unfortunateness of the imbalance between the huge patient load in Hospital Authority and the limited availability of doctors. Consequently, the quality of care is sacrificed. As she states, in a normal morning, there are 12 to 15 doctors at work but with 600 to 700 patients to consult, meaning each doctor will see 50 patients in the span of 3 and a half to 4 hours with each consult under time conditioned of 3 to 5 minutes. Due to this hecticness, there is little to no time for explanation to patients on their eye condition, the treatment options they can consider and answer their families or their own questions and ease their concerns.
As Dr Woo comments, this is a pitfall in the system and more doctors are needed to help support the vast amount of patient load every single day. Without more doctors, the limitation is very restrictive and it jeopardizes the quality of care. “We need a more structured and organizational change to retain doctors in the public system and triage patients that are less emergent to the private system.” Dr Woo emphasizes.
Yet Dr Woo also understands that this matter can only be solved by the Hospital Authority and the superiors at higher levels. “As an individual doctor, you just have to give your patients more time and do your best to humanize them,” she advises. “It’s very easy to lose touch with the human sides of things when you see so many patients every day. Everyone starts looking the same, their eyes look the same, their families look the same; so it’s really important to remind yourself that each patient has feelings and treat them all with respect.”
In Hong Kong, as Dr Woo mentions, training as a specialist can only be done in the public sector and it requires 5 to 6 years of training to get hold of your specialist administration. “Once you are a specialist,” she says, “you can go work in the private sector. But I really like ophthalmology, so I stayed to complete my training and work in the public sector.” But Dr Woo also suggests that if you are aspiring to become a GP or anything else, you can directly work in ED centres such as Neoderm or Dr Reborn, with the salary being quite handsome.
T H E T H I NG W I T H A I
Despite Hong Kong’s medical system being seriously overburdened, there are cases in Mainland China and in other parts of the world that utilize Artificial Intelligence (abbreviated as AI) to conduct diagnoses. When asked about its effectiveness if AI is ever used in Hong Kong, Dr Woo believes while it may work with the line of work in GP, it will be challenging for her job. “There are few companies that I know of that are trying to roll out AI diagnosis and management schemes,” she states, “But tech-wise, Hong Kong is still a bit behind the US and China.”
As she continues, Dr Woo explains that it is understandable to find the probability of an AI replacing your occupation to be a daunting idea, as humans often desire to be needed. “Skepticality is normal,” she states, “You’ve never seen how it works or how well it does your job. And we can’t afford to make big mistakes as any fault in diagnosis or surgery can be huge and blinding for patients.” Dr Woo also offers another mentality when it comes to handling AI. “We should start accepting that this is the new norm,” she proposes, “You don’t have to jump into it immediately but there will be a transitional period. Let’s be real, the population is aging rapidly and no amount of new doctors can catch up to how many diseases and the elderly we have. So we need more help.” Dr Woo also points out that while AI has not been used to see patients in Hong Kong, it has been involved in interpreting data and flagging important results.
She also reassures that despite the AI development requiring a massive pool of data from different hospitals, patients’ private confidentials will not be affected. To ensure the patient’s private confidential information, encrypted emails and USBs are used, alongside with the enforcement of numerous protective policies that hospital staff has to follow. “If a doctor ever loses or leaks a patient’s information,” Dr Woo states, “It splashes all over the news. Hence, it’s pretty fool-proof.”
F R O M O U R H E A R T S
For tips on enhancing empathy and communication, Dr Woo understands that it is really easy to forget that to forget that you are helping the sickly and making an impact on the world when you are assigned with countless patients starting from the early morning. “You will get tired and people will start looking the same,” she says, “Especially when you have so little time with each person, you don’t remember them anymore. And when you don’t know enough about your patient, you lose your personal touch. You don’t understand where they are from, who are their family, what’s going on with their lives...they don’t feel human anymore.”
To avoid this from happening, Dr Woo encourages the humanization of everyone and treats each of them with respect, even if they are in a bad mood. “They are people with stories, they have feelings and they have families.” As she carries on, “Always treat everyone the way you want to be treated. It’s very easy to forget when your day to day work consists of people yelling at you and you being very busy. Everyone’s really rushed, and Hong Kong people are often quick to lose their temper.”
She also explains that this is another reason many people like to go into family medicine as you get to stick to the same patients and the reports remain the same. “When you are a family physician,” Dr Woo describes, “It’s all about the whole personal care. Some people like the feeling of getting to know people and building relationships, hence they choose to be family doctors. It’s very admirable, really. Other specialties really can’t afford the time for such things.” However, she also believes that it isn’t mutually exclusive to be an ophthalmologist and not have any relationships with patients, it is just easier for family doctors to connect with their patients.
I T H I N K I A M L O S T
From what she has observed, Dr Woo realizes there are numerous people that are lost, unable to find their true passion due to the restrictions implemented by society due to reasons like lack of exposure to other career fields. “In my class of 120 people,” Dr Woo comments, “How many people do I think want to be doctors? Less than half. How many people enjoy being a doctor? I can’t answer that. But usually, 90% of the people are forced to become doctors due to their parents.” In Hong Kong’s local schools, communication isn’t a top priority and students often find themselves within “the box” metaphorically. We are spoon-fed with information and regurgitate them in exams, we are taught to be disciplined and follow every single instruction told; most of the time, people that excel are those who spent the entirety of their lives studying and dismissing any form of communication or extracurricular activities.
“You would be surprised by how many doctors that have poor communication skills,” Dr Woo states, “They are too used to regurgitating things they read from textbooks. Often there’s a stereotypical belief that if you succeed academically, you will be a great doctor. But that’s a fault in the system. Do people with the best grades make the best doctors? It’s not for certain.”
As the interview concludes, Dr Woo reassures that it is okay to not know which career path you are going to undertake. However, rather than confining yourself to medicine because of your “good grades”, don’t be afraid to ask questions and never feel ashamed for exploring different roads and options.
Of course, it is equally alright if you truly are zealous about becoming a doctor. With the number of deadly illnesses skyrocketing, more help in healing the world will always be welcomed and appreciated greatly. But remember, do it for yourself, for your passion, for your dreams, for your goals and not for anybody else.
Your eyes may be tired after reading this rather lengthy article, so close your eyes.
Close your eyes and count from one to three, let your entire body relax and your mind to be clear, digest the information you have just intake and listen to the beating of your heart. Allow yourself to retreat back into your inner mind and listen to what your heart is telling you, your dreams and goals and passion.
After that, open your eyes. And go chase that dream of yours.