Health Science Reviews

By Alexander Sittmann

Leaving Medicine:

In late 2024, I made one of the most difficult decisions of my life. I chose to leave medicine. I had never been so unsure of myself, had never before been at the junction of so important a metaphorical crossroads. At the time, what I was doing felt like a betrayal; a not-so-small part of me believed that I was letting down my friends who had endured three years of clinical medicine with me, my family of doctors excelling in their fields, my future patients, and the students who, despite their passion and diligence over the years, had been rejected from the UCT MBChB programme so that I might have a spot. But most of all, it felt like a betrayal of the self: what would the wide-eyed teenager/aspiring neurosurgeon who had broken his back hunching over books to put me where I was think? Or the anaesthetist-to-be? Or the boy who dreamed of saving lives in an emergency unit? What happened to the young medical student who, despite crippling imposter syndrome, innumerable sleepless nights spent studying, and thousands of hours dedicated to becoming a world-class health professional, absolutely and wholeheartedly loved what he did? Why would this young man, who lived for the smiles of patients he had helped make healthy, whose heart raced at the gentle whoosh of a stenotic aortic valve, who took and lived by the Hippocratic oath, leave the clinical space he so loved?

Rediscovering curiosity:

The truth is, I had become dissatisfied with my education. That is not to say that I do not recognise that I am incredibly privileged to have been afforded such an opportunity, nor that I did not appreciate the quality of teaching and availability of resources at UCT’s medical school. But as I progressed in the degree, what was initially a subconscious, nagging unease grew into a roaring frustration at the absorb-regurgitate-repeat approach to learning being instilled into the country’s future medical practitioners. As we tackled increasingly challenging and voluminous concepts in second and third year, which forced the inevitable scrambling, cramming learning strategies so often associated with medical students, I picked up a recurring pattern: whether unconsciously or by design, we were being turned into glorified integration centres. Our approach to medicine – to treating real people in clinical settings – was unbelievably algorithmic. See this diagnosis? Treat with that drug. That complication arises? Perform this procedure. And when the algorithms we’re taught fail, and we’ve run out of options from the textbook, we flounder spectacularly – and in the wrong setting, people die as a result. This is what makes how medical students are approaching their learning so dangerous – we are being taught to remember facts, procedures, drug classes, but not critical thinking and vital problem-solving skills. This stems, more than anything, from a loss of inquisitiveness – we no longer ask WHY we prescribe this drug, HOW this patient died despite our best efforts, WHAT mutation is rendering our current antiretroviral regimen useless. We follow the algorithm instead of questioning it, and move on – not because we don’t care, but because that’s just how the system works. We often blindly accept ancient guidelines without a thought about whether there is a better way – without even bothering to read recently published works showing that there is one. It was these revelations that lead to my leaving medicine, so that I could learn how to ask questions again.

A call for change:

I’d always been an inquisitive child – I had grown up wanting to be a theoretical physicist before the biomedical world caught my eye. My hand was – rather annoyingly – always up in class and I loved learning about the world and how it worked. The rediscovery of my younger self drove me to apply for the Intercalated MBChB/BMedSci (Hons) programme, consisting of an extra course in Molecular Medicine concurrently with 3^rd year MBChB, followed by a year out of medicine to do a Biomedical Sciences Honours. At the time of my writing this, I’m about halfway through my Neuroscience and Physiology Honours year – and I know now that I made the right decision. We are learning, bit by bit, how to think differently, critically. To question everything. To engage with differing opinions on a topic. How to keep up with ever-growing fields. Most importantly, how to go about bridging the enormous chasm between the Bench and the Bedside. For too long, the gap between the worlds of clinical medicine and research has seemed insurmountable, not only because of the deep-rooted aversion to the other field seemingly held by many professionals in these spaces, but also because the divide is entrenched at the systems-level. We cannot expect a marriage of the clinical and research spaces until there is change at the level of the health sciences curriculum. The Intercalated programme, and others like it, are certainly a step in the right direction – but it is not enough. No more than a dozen of classes of up to 250 medical students are afforded this opportunity to engage with the research space. Our universities, and South Africa at large, should strive to have ALL medical students bridging this gap – even if it isn’t physically working in a lab, they should at least be engaging in current advances, working with researchers, participating in clinical trials, etc. However we go about doing it, the narrative must change. If not for ourselves, then for the patients who will benefit from such change.

What next?

As I reflect on the year so far and look forward to my return to 4^th year medicine next year, I think it prudent to mention what I’ll be walking away with. The content I’ve learned? Sure. Techniques I’ve picked up like immunohistochemistry and approaches to bioinformatics? Definitely. New connections with prominent researchers and my peers in the Honours programme? I would say so. But by far my most important takeaway from this year will be the change in how I think. More than any single skill or piece of knowledge, this year has reshaped the way I approach problems, ask questions, and navigate uncertainty. I’ve learned to sit with ambiguity longer, to let curiosity lead before conclusions, and to see the clinical and research worlds not as separate spheres but as complementary parts of the same pursuit: improving human health. As I return to the wards in 2026, I’ll carry with me not just new techniques, but a new lens – one that looks beyond the immediate diagnosis to the broader landscape of unanswered questions, and one that sees every patient encounter as both a responsibility and a source of discovery.