oh Emergency Department Medical Officer!

Many non-ED MOs somehow complain that ED MOs not doing their jobs. Especially dealing unstable patients. Let me clarify:

1. If a patient came in BID or clinically and hemodynamically unstable, it’s the job of ED MOs to stabilize the patient, given that it’s medical cause. If it’s surgical, obstetric, orthopedic causes etc etc we call our respective colleagues to come help out. We can’t do cesars or laparotomy in ED. Sometimes we call up our Anesthesia colleagues to help out with difficult and failed intubation. A lot of times ED MOs were questioned/queried/bambooed/scolded/blasted why they did not call the primary teams FAST ENOUGH, although we can stabilize patients on our own.
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When becoming MO

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Emergency retrieval unit

– Responsibilities increase, a medical officer has to oversee all patients, knowing cases from A-Z. Something gets wrong, the MO will be bambooed, not the houseman. People will look to MOs for leadership.

– A Medical officer has to buck up and upgrade his/her knowledge as well as knowing ward management skills, or in my case emergency department management skills. He or she can no more work like medical students or houseman. Instead, they need to supervise and teach the houseman, so that they won’t kill or do harm to any of the patients under their care. Continue reading

Day 1 Tagging – Sabah Style!

Tagging day 1 as a medical officer in another hospital in borneo is very nice. HOs are plentiful, MOs are nice and approachable, the specialists are only three but great. MO tagging is not as crazy and stressful as HO tagging.

The medical staffs (nurses, medical assistants and PPKs) are friendly and respectful, and not yelling (unlike most places in Klang Valley). Patients are not very demanding. The spectrum of illness in Sabah is a little bit different than in peninsula. On my first day, I saw cases which are rarely seen back in peninsula such as malaria and rheumatic fever.
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Goodbye Emergency Department

Emergency department is the most enjoyable department I went through among all the six postings as a houseman. Initially I wanted to do anaesthesia as my six posting, but it was full, so they sent us to do Emergency Department instead. When I first started at emergency department I was so depressed. I did not like the shifts, my sleep pattern became haywire, one shift can be so busy as if you’re doing a 24-hour shift. Even before I started I already kinda hate emergency department because they keep sending and referring patients over and over again.

Resus or red zone where all the actions are happening and the real business of emergency medicine is here…

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How to present a case?

Obviously I am not the best person to be asking how to present a case to specialist and consultants. But since one of my juniors is asking, I would share what I can with my very limited experience. Presenting cases is quite difficult to perform, but with practice you can get it right. Even MOs are having difficulties to present cases up to consultant’s satisfaction.

Usually cases are presented starting with age/race/gender of the patient. Any known medical illness such as hypertension and diabetis? Any known allergies? Then why did he present to the ward? What are his main complains, what are the relevant histories & associations? What other symptoms does he have? And physical exam shows what (mention the relevants only, don’t have to mention cervical lymph nodes not palpable if the case is diabetic foot ulcer!)
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Where to go next?

At the second year of my housemanship, I should seriously consider what am I planning to do in the future. Although I have at least another 10 months before completion of housemanship, me and my colleagues have been discussing on where to go next. Among the questions:

  • After housemanship, where would I like to be posted? Am I suitable in another general hospital, a district hospital or Klinik Kesihatan?
  • Then there’s the question of location. I heard Negeri Sembilan and Pahang (Bentong especially) are high up in the list for those who did housemanship in Klang Valley. Some people chose Sabah and Sarawak because somehow it’s much easier to get into Master’s program.
  • If one chooses to be posted in a big hospital, there’s a question of which department. Some hospitals have good Master’s program or good path towards master’s program, large pool of specialists and consultants with good supervision. It’s essential to choose the right department as it will greatly effect the choice of candidate in a specialty program. It’s not uncommon for a candidate to be rejected from surgery Master’s program because he is posted in district and never worked in surgery department as a Medical Officer (MO). Continue reading

Medical medical medical

Medical posting

Alhamdulillah after 4 excruciating excellent months, I finished my medical posting. This posting is the most educational of all postings, because the patient load is more, more procedures, more exposures. Being a houseman in one of the most notorious wards in the hospital, I can say I develop a love-hate relationship with medical. I have seen things; people dying, people collapsing, foul-smelling wounds, bodily fluids all over the ward, psycho people shouting all night and etc etc. I have done things; CPR till ribs crack, branula on almost every patient in the ward, running all over the place to cover 7 wards, restrained patients, clerked criminals and psycho patients. If I become MO I would tell my HO about all this proudly. Continue reading