Career Choice: Ambition Vs Family by Lucia Li, Medscape Student

People take different roads seeking fulfillment and happiness. Just because they're not on your road doesn't mean they've gotten lost.

I am ashamed to admit that there used to be a time when, if a colleague told me he/she wanted to be a GP, my first thought would be "you're only doing it because you want to have a family." I was harsher on my female colleagues because I somehow felt that the only proper execution of modern-day feminism was to work hard. I would feel a little sense of masochistic pride that my own ambitions were a little more time-consuming. Now I look back and think how foolish, patronising and downright idiotic those thoughts were.

The concept that medicine, to many others of my colleagues, was simply an interesting and satisfying way to make a profitable living was alien to me. The concept of medicine being a way to pay the bills hadn't even featured on my radar. I guess, somewhat naively, I had looked upon medicine as a calling. I hoped, and still hope, to contribute in a big way to our knowledge about disease and treatment. In the specialty I hope to pursue, I have found a real passion. To me, medicine will never just be a job.

But the whole point is we live in a free society in which we can choose our mode of happiness. No-one should be criticised for wanting to spend more time with family or even for wanting to give up a career to raise one. Least of all, women should not criticise other women for that choice.

The specialty I wish to pursue is not what anyone would call family-friendly. It's a long, hard slog. It's a competitive arena. Because of this, people seem to respect this decision. However, those people wanting to do family-friendly specialties, even if their decision is motivated by genuine interest, may come across derision from people who see it as ‘slacking off' or a ‘cop-out'. I can't help but wonder if this sort of attitude is borne of the need to justify their own sacrifices; they have sacrificed their own family lives for their career and, in moments of self-doubt over whether these sacrifices were worth it, their frustration manifests in ridicule of others.

I confess to being a little bit daunted by how much I may potentially have to sacrifice of my personal and family life in order to be successful in my chosen specialty. Nevertheless, I have my heart set on it, I genuinely believe it will make me happy. And that choice, the choice of what will make you happy, is what is worth celebrating, irrespective of why you chose it. ‘Ambition' is not a dirty word. And neither is ‘family'.

Even as a medical student, I often contemplate on the family vs career dilemma. And yes I'll have to admit that at this stage, career is still prevailing. However by saying that, it's easy to be young and say " I will work my ass off, providing the best for my patients, and I shall put my family planning on hold." But when you are no longer a gung-ho 20 year old medical student or a 25 year old senior medical officer, seeing your colleagues going into a less competitive field, living comfortable lives, will make you think twice about the decision you have previously made. I had a conversation with my dad recently in the car:

Me: I'll be graduating in another 2 and a half years. After completing my housemanship in Malaysia I'll try to further my studies as soon as possible. And perhaps after that join one of the university's medical center for practice and academic teaching.

Dad: Ok, but if you see any good candidates(girls) along the way, just approach them and be friends.

Me: Haiya, no time la. Besides, it's hard for me to settle down. I might get posted to some rural areas in the inner Sabah/Sarawak. Who knows? And I can't afford to be distracted. The amount of money you are paying for my degree should produce an outstanding doctor, not mediocrity.

Dad: Ya la, I know, but don't wait too long.

Me: Don't worry la, some of my tutors get married pretty late as well. Dr Y completed his MRCP at the age of 35 and when he returns to Malaysia, he's still single. Dr K too, he just got married last year. I even know of a professor who dedicated his life to medicine, now still single(trying to scare him)

Dad: That's not success, no matter what, don't put it on hold for too long!

I'm not blaming my dad, I guess he's just a little worried that I will become too career minded. Medicine can be like a jealous mistress- These words were spoken to me by a few wise tutors. I listened to them but still could not fully appreciate the gravity of my chosen career. I'll just let maturity and experience change my views on things.

I don't think its impossible to achieve a great career and family, because at the end of the day, you make your own time. And I believe, one will never be too busy for his/her love ones.

Everybody has their own interest and it's important to respect them. "Ambition" as what the author mentioned is not a dirty word. I admire people who dedicate their life to medicine, serving the Rakyat who really need them. Afterall it is an honor and privilege to be called doctor. This is why I want to have a MBBS after my name. That is why we are allowed to handle life and death situations. That's why we don't mind staying up late in an operation theater for our patients. It's a life, a calling, not a business. And I seriously couldn't imagine how hard it is to do that all, if you do not possess the heart and passion.

Be the best doctor you can be, make time for what you love, the rest are just excuses.

Abstract for Endocrine Society of Australia annual meeting.

Expression and cellular activation of peroxisome proliferator-activated receptor γ in granulosa cell tumours.

Simon Chu, Chee Yong Chuan, Maria Alexiadis and Peter J Fuller

Prince Henry's Institute

Granulosa cell tumours (GCT) of the ovary are rare, hormonally-active neoplasms characterised by endocrine manifestations, an indolent course, and late relapse. Chemotherapy and hormonal therapy have proved to be of limited efficacy. Nuclear receptors (NR) are well defined targets which have a central pathogenic role in endocrine malignancy. They are potential targets for therapeutic intervention. NR have established roles in granulosa cell biology but their roles in GCT remain largely unexplored. In order to more systematically examine the NR family in GCT, we used ABI Low Density Array microfluidic cards to analyse 14 GCT and two GCT-derived cell lines for expression of the 48 NR. The levels of expression were remarkably consistent across the GCT. We found that peroxisome proliferator-activated receptor gamma (PPARg) had greater than 10 fold absolute expression when compared with either the NCBI tumour or brain reference RNA pools. PPARg agonists are regarded as potential therapeutics in the treatment of inflammatory diseases and certain cancers. Given the high expression levels of PPARg in GCT, we investigated whether the use of PPARg and/or retinoid X receptor (RXR) agonists or antagonists have an effect on GCT-derived cell lines. We observed that the PPARg/RXR agonists and antagonists had no affect on cell proliferation, cell viability or apoptosis. Although the use of PPARg agonists is unlikely to be of use in treating GCT, a combination of therapies involving knockdown of NF-kB signalling may be of benefit. We have previously observed that several other members of the steroid receptor family are transrepressed due to constitutive activation of the NF-kB signalling pathway. We are currently investigating whether PPARg is transcriptionally active in these cells using a reporter construct specific for PPARg and whether the non-responsivness to PPARg agonists or antagonists in vitro is due to NF-kB transrepression.