To MO-ship

Alhamdulillah I just finished my final assessment in A&E department yesterday. I have learnt a lot more than when I first started in this good department and when I first started my humble housemanship.

To be honest, I enjoy doing housemanship in the hospital I am working in. I like the patient demographics, from the very poor and homeless to the very royal and rich. I like to sympathize to their bad and dark history, although at times I judge them. I like their spectrum of illnesses for me to examine and analyze. I like the procedures they let me do here. I like that it’s busy around here, but at times I curse it. I also like the dynamic relationships of the specialists and medical officers of various specialties. Continue reading

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Referrals – are we having too much of them?

Working in my hospital, the national dumping referral center in Malaysia, making and receiving referrals are quite a norm. As a houseman, I don’t personally accept referrals, but I have to keep making them. Now that I work in A&E, I have no choice but to refer, refer and refer.

Why do we refer in the first place? We refer a patient when we can’t manage the case further. For example, we refer to surgeons for intraabdominal injury because you can’t expect an emergency physician to perform laparotomy. We refer to neurosurgery for intracranial bleeding. We refer ortho for irreducible fractures. Sometimes we refer to get a specialized-care beds for example we refer to Coronary Care Unit (CCU) for myocardial infractions, we refer ICU for intubated patients. The MOs in charge will always say their beds are full, but we have to refer anyway.

Are doctors becoming more like postman, referring patients here and there?

Continue reading

Through the housemanship

1st posting in Surgery – I loved surgical procedures ever since medical school. I started off as a humble houseman in surgery department. The first time I introduced myself in ward rounds, I was laughed off by the MOs and Specialists. I went to work before sunrise and go home after sunset for the first few weeks. I was so depressed because I didn’t see daylight in a while. The surgical procedures were nowhere near cool as I’d hope it would be. Neither are the surgeons. The rounds were harsh. Getting blasted, belittled and constantly harassed is a norm. Although there are not so many work here, but if the surgeon asked you to stay late, say till 11pm, then you have no choice but to do as you’re told, even if you’re post-call! Else you will be threaten with another 3 months extension in this hell-ish department. Continue reading

Accident and Emergency posting

Accident and Emergency posting is my final posting as a houseman, three weeks into it, I have seen and learnt quite a lot. I have to apply all the knowledge and experiences I had for the past 5 postings into this department.

I have not seen something really epic yet. Simple cases like UTI, URTI, AGE, AEBA, and all other boring short forms are so common. Trauma cases are plenty. I am still considered new, still not going to the red zone yet, where all the actions are happening. Continue reading

Human touch and humility

Since I am about to finish the O&G posting, I’d skip all the whining about why I hate this department. I’d like to share a couple of things that I learnt during my O&G posting, the ones not related medically. As for the medical part, you just have to go through it yourself.

Human touch 

Doctors don’t save lives. Statistics show that toilet and good sanitation save more lives. Thank those who invented or improve our sanitations, a lot less people dying from unwanted infections. However, doctors do save lives a little bit, here and there, when patients are at the verge of life and death. Here’s the thing, what can you do when you can’t save lives? Continue reading

Snippets

O&G posting

  1.  I have not wrote a single blog post in two months. I have not been that busy at work, just nothing much to write about.
  2. I do not find O&G inspiring. It’s true I help deliver new lives and new hopes for the families, but I am uninspired by the system failure.
  3. O&G is the department which has high medicolegal cases, not just in Malaysia but all over the world as well. Thus everybody in the department is playing defensive, being extra-careful. It’s downright annoying when the nurses call me just for me to call up my MO to manage patients. Continue reading

Stand up for yourselves

Working at a KKM hospital is satisfaction 5% and heartache 95%. It’s not because we got no satisfaction treating the patients, but from up top to down bottom, rotten apples are everywhere. In government service, everything is about seniority. Everything is about hierarchy. Everything goes by what the boss says.

This system of hierarchy actually serves to protect the main KKM clients – the patients. A specialist with 15 years of experience certainly would give much more accurate and decisive treatment than a one-month old houseman. But the system also opens up another door – bullying. Bullying has been a culture of KKM doctors since forever. The main reason for this bullying – for YOU to learn. Whether it’s really the best teaching method, nobody can say.

A houseman does not outrank the nurses. The nurses rule the ward, they know how the works are being done all this time while the houseman keep changing every few months. They determine whether we had done things correctly or not, whether this form and that form are filled in correctly, whether our work is complete or incomplete, whether we can have meals or breaks during our shifts. I certainly don’t remember myself outranking the PPK because last I heard, I was told to “Jangan kacau saya boleh tak? Kalau doktor nak urgent, pegi hantar ABG ke lab sendiri lah! Saya banyak kerja ni!” Continue reading