Documentations do provide protection to the healthcare workers. All of us, houseman, MOs, specialists, matrons, sisters and staff nurses have been intensively trained to document every single detail; list of patients complains and their history, exam findings, what are the specialists findings, investigations required, management plans etc. Every single detail of it.
And honestly I find it quite troublesome. Why? Because it creates a hostile environment at work. For example nurses admitted that they are very apprehensive when pt comes into their wards, why? Lots of documentations, they had to do lots of paperworks just for one single patient who came in for fever and cough. The Houseman are also trying to avoid clerking, because clerking requires lots of documentation. In the end all pt would receive is paracetamol.
The nurses said that only in recent years have the documentations been intensified. I have seen a staff PPK (pegawai pembantu kesihatan) yelling to a houseman in public with sheer anger after being scolded by the lab people for missing out patient’s registration number in the lab form. A staff nurse broke down to tears after being scolded by sister for missing out one dextrostix reading. A houseman was yelled by the specialist because when she was ask to review the patient, she didn’t document it (if not documented means not done). And the thing is, these people are just finding faults instead of rectifying the situations. The PPK should just help to fill in patient’s registration number. The other staff nurses can just help out to do the dextrostix. Why such a big fuss to find someone’s fault?
That’s why in the hospital where I work, I see many of them just work to finish their shift and go home. No extra initiative. They are afraid to help even, because helping will cause them lots of trouble and headache. I have seen in front of my eyes PPK acting as a doctor, saying no need to do coomb’s test because she claims pt doesn’t look jaundice anyway (pt does look jaundice till midcalf level helllooooo!). Hah!
This hostile environment at work would make no PPK wanna move their asses to send the samples to the labs or transfer out patients here and there. The staff nurses would always be afraid to be scolded by sister that they’d bypass a doctor’s order just so that the sister of the ward wont scold them. Houseman would always wanna abscond. Why this happen? The culture of finding faults and blame game. Which subsequently results in very hostile work environment.
I am not criticizing staff nurses or PPK, but they’d hurry us do this and that so that they finish their work and go home after their shift. I heard with my own ears in maternity ward patients treated like prisoners by the PPK “siapa dah dapat makanan cepat makan sekarang! Saya nak kemas lagi setengah jam”. I myself sometimes trying to fight over the patient’s folder for me to do my work while the nurses wanna pass over before ending shift. Staff nurse would hurry me to write discharge summaries although am severely postcall after office hours, because if they don’t ask houseman to do discharge summaries, sister of the ward will screw them hard. I’m not saying I’m very perfect because I also scolded a staff nurse for making me stay back to do discharge summaries. (I’m not proud of it and feel sorry for being rude to her).
All of us never wanna be scolded by our bosses, be it the houseman, staff nurses or PPK. But this has resulted in discoordination and hostile environment at work. In the end, only few are sincere while doing our jobs. This is the dilemma that never ends. We always have bosses to kowtow to and we do only what we’re asked to do thus becoming defensive instead of proactive (in this case practicing defensive medicine). It’s all about hierarchy and seniority anyway. Fingers are always pointed to the junior ones.