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Showing posts with label Housemenship. Show all posts
Showing posts with label Housemenship. Show all posts

Sunday, July 10, 2011

Tips for medical students entering intern year


by Elizabeth Breuer, MD

As intern year winds down and all of the giddy 4th year medical students are shelling out 200 dollars to rent that a robe for one day of pomp and circumstance, all of us interns are impatiently waiting for the fresh meat to arrive.

Having just experienced every single emotion under the psychological rainbow this year, I am going to give a few pointers (or not really pointers but just some anecdotal evidence that it’s ok to feel the way you’re feeling). I am stupid enough to admit to all of the silly things that I did. This is not to prove that I’m an idiot, but to allay the fears of anybody who finds themselves in my shoes starting July 1.



1. You might have been a good medical student but you now know essentially nothing. You also have much more power and ability to screw things up than you ever had. This, however, is ok because you are being very closely watched by every single nurse, medical assistant, older resident, attending, even the lady who empties the trash, and you will not really do anything so stupid that you could actually hurt somebody (hopefully). You will do really dumb things though, for example, a wet prep is called a WET prep for a reason…you need to put a few drops of water on it. Somebody, not to name names, did a DRY prep. The whole point of residency is to do dumb things. The dumber the thing you did, the more likely, if you’re smart, is to not repeat the dumb thing.

2. Accept the fact that you will dumb things and you might hear about it. It might be a change from being a protected doe-eyed medical student to be paged by an older resident or attending to ask you to explain why you did such a thing. Don’t argue. Just say, I’m sorry, cry in the corner for one second and get over it. The whole point of residency is to do dumb things. You are not a bad person or incompetent because you made a mistake.

3. Having a pager sucks. The only profession ever that still uses an outdated contraption invented in the 1970s for drug dealers, residents and all doctors for the rest of eternity are given pagers which need to be worn and answered at all times. This cannot be turned off and have the potential to bring bad news at any time. However, I must add that having a pager is also something that becomes normal very quickly and grows more annoying than scary as time goes on. You might start to feel naked without the two pounds of buzzing plastic with two lines missing from the screen.

4. It’s ok to be absolutely terrified. I was so nervous when I did my first speculum exam as a resident that it took me five minutes to realize that the speculum was actually broken and that I wasn’t just a complete idiot that didn’t know how to use it. Being nervous reminds us that we are taking care of people who are sick and we shouldn’t be nonchalant about it. When I did my first delivery, I think I almost vomited. Being scared is totally normal.

5. If you are completely over your head, ask for help. Seriously, even if it might seem dumb to somebody older than you. Because, back to point 1, you are stupid and everybody knows that. Don’t pretend to be smart because that is dumb.

6. Things that seem scary will become second nature. The most awesome thing about being an intern is that while I almost vomited during my first delivery, I now am comfortable in the delivery room and can handle many different situations. Lots of bleeding, ok! Bad laceration, ok! (to a point, then same thing, ask for help). I’ve done enough deliveries now that I have fun with them. You will develop your own style and you will learn. Everybody does it. Something that helped me get through all the nerves is reminding myself that almost everybody that graduates from medical school survives residency and graduates to be a competent physician. So, if they can do it, why can’t I? You can do it too.

7. It’s ok to complain. Residency is full of sacrifice. You will miss holidays with families, weddings, birthdays, weekends off, dates with boyfriends. You will be grumpy. You will be exhausted. My advice though is to complain to your co-workers. Complaining at home and to your family doesn’t really work as well because they are also suffering your hours and your holiday-missing and they really don’t understand how much your job sucks. I have completely failed to follow this advice. Fortunately I have an understanding family and a wonderful, exceptionally tolerant husband. (And on a completely personal tangent, avoid getting married as an intern. The wedding was great but planning ruined my life.)

8. Step back and realize how totally amazing your job is. You get to help people at their most vulnerable moments. I get to use needles and knives, scissors and suture as everyday tools. I bring life into the world. Wade through all of the crap, the hurt feelings, and just appreciate how great it is to be a physician. Even though the field of medicine is changing probably to the disadvantage of all of us, there is a reason people are willing to sacrifice so much to do what we do. Medicine is rewarding, stimulating, complex and most of all, really fun. Residency is a great community and an awesome bonding experience. Enjoy it.

9. Most importantly, work hard, keep your head down, take care of your patients and take responsibility for your actions.This is by far what will get you through and all that people really expect of you. Just keep going and you’ll be fine!

Summary of the points she brings up:
1. You might have been a good medical student but you now know essentially nothing.
2. Accept the fact that you will (do) dumb things and you might hear about it.
3. Having a pager sucks.
4. It’s ok to be absolutely terrified
5. If you are completely over your head, ask for help.
6. Things that seem scary will become second nature.
7. It’s ok to complain.
8. Step back and realize how totally amazing your job is.
9. Most importantly, work hard, keep your head down, take care of your patients and take responsibility for your actions.
The last point is the most important. The worse species on earth are HOs who will shirk their duties, abandon their colleagues and patients, be dishonest in their clerking and work.
Source: here.

Friday, July 1, 2011

SURVIVAL TIPS FOR HOUSE OFFICERS / INTERNS


by Dr Harlina Halizah Siraj

A compilation of survival tips for new medical doctors. I started writing these tips on my page since June 23 and dedicated them to my students  -  Medic Alumni UKM. I pray that these words could reach out to those who are really needing support and strength to continue the struggle.

Love from Dr Harlina Halizah Siraj, alumni HO General Hospital Kuala Lumpur (GHKL) - Aug 1991 to July 1992

SURVIVAL TIPS FOR HOUSE OFFICER: Tip no. 1 - Set your intentions right. It's neither about the money, the highly respected position and the power. It is about PUBLIC SERVITUDE, serving those who are in need of healthcare. Only after you have served well, then only you could deserve the rewards, privileges and rights allocated for medical practitioners! Welcome on board!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 2 - Have the right attitudes. Being the most junior officer in the team, you really have a lot to catch up and learn. Never pretend that you know all. Never hesitate to admit that you do not know, to ask questions and assistance. Respect those who are more experienced than you. People with the right attitudes are welcome wherever they go, always...all the time! 

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 3 - Put on your best smile and outstanding manners. Greet everyone with a cheerful salam. No matter how busy you are, don't forget to move your temporo-mandibular joints and carve out a big smile. It will stimulate a fountain of endorphins in your neuron synapses, and aha...the feel-good feeling will set in. Don't believe this? Just try....just do it.

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 4 - Work extra hard to convince people that you are reliable, responsible, accountable and able to complete tasks and meet expectations - within the first two weeks! Once people know you're committed, you'll gain their trust, respect & cooperation. Just mark my words!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.5 - Refresh your inner self with daily, constant and effective spiritual input. For Muslim, don't ever neglect your 5 times daily prayers, no matter how busy you are. You really need that 5 -10 minutes regular breaks. It acts as a cooling oasis for you to rejuvenate.

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.6 : Mend your bruised heart and dented self-esteem, quickly and effectively - each time you received unpleasant reminders of your incompetency & shortcoming from your seniors. It's a part and parcel of the job. Admit your mistakes, but PLEASE, try hard not to repeat them. To err is human, but to keep doing the same error is a major blunder!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.7 : Keep in touch with your loved ones - parents, spouses, close friends, teachers etc. Don't shut out your life, which mainly linger around your wards, call roster and private room now. There is more to life out there than just work or crashing into bed to recover from sleep deprivation.

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.8 : Make friend with the nurses. Never ever be their enemy. Life would be much easier if you know how to win their hearts. Dr Meena (Paeds MO) gave me this very precious advice : Harlina, be nice to these people (nurses). They will decide whether you will have your meals or not during your calls. Yesss, I later realized how true that advice was!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.9 : Forgive those who raised their voices at you. They might be angry patients, stressed-up MOs, overwhelmed colleagues, frustrated consultants, irritated nurses etc. Nobody had ever shouted at you before,eh? Being a HO, anticipate your first experience here. Forgive them, forget them and live on. After all, we're all just humans living in the same pressure cooker!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.10 - Thank God for the honour of being His instrument/tool of Mercy to mankind. A great opportunity is at your doorstep to catapult your good self to be bigger than life. Grab that opportunity and seize the golden moments. Nothing compares with the feeling of satisfaction whenever your patients & relatives say : Thank you, Doc

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 11 - Handle yourself well when dealing with difficult people. Feeling victimized, bullied and discriminated? After reflecting on yourself, I suggest you pluck some courage to meet face-to-face. Clarify, admit your mistakes and make peace. InsyaAllah, things will be fine.

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 12 - Treat your patients as if they are your own parents/relatives. Just as how you would like any doctor to treat your parents, that's exactly how you should treat your patients now. Remember, what comes around, goes around! Motivate your patients always, you'll feel the positive energy seeping into you too.

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 13 - Express your love to your spouse everyday, using his/her love language. Let him/her know how much his/her support & understanding means to you. Share your ups and downs, laughter & tears. Thank Allah everyday for sending you this special person. Those who are still unmarried, what's keeping you, guys?

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 14 - Be sincere in treating your patients, be gentle and caring. Control your anger and frustration, avoid explosive emotional outburst in front of your patients. If you really need to release the steam, do it in the washroom with the tap running (peace, Mother Earth)- I consider that as an effective form of anger management!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no. 15 - Keep abreast with what's happening around you - medical & non-medical, locally and globally. Read the papers, journals & magazines, listen to the news bulletin, engage in general discussions. Have your own opinions. You're a doctor now! People wanna know what's going on in your brain.

See the article here.

Monday, May 16, 2011

After 2 years of HO training- Being a Medical officer

November 11, 2010 by Pagalavan Letchumanan


For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1) Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2) District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.



General misconceptions of being a doctor !

The Truth about Medical Field in Malaysia
Taken from MMAa

For Future Doctors: General Misconception of being a doctor PART 1

November 11, 2010 by Pagalavan Letchumanan

1) Guaranteed Job and Good salary/can make money

Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already. 

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

2) Medical degree recognition

If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from. 

3) Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4) Hard work and post graduate training

20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG - Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.


Saturday, May 14, 2011

Dr Fauziah - Obstetrics and Gynecology sharing

HOusemen Story




JMO --> Medical Officer


Life couldn't have been any better when I'm finally given the position of Medical Officer-ship whereby I can get the weekends off and go back earlier on weekdays. After having experienced my housemanship and JMO-ship for 15 months, I'm grateful to have survived it through and through and finally, appreciate more on the weekends. As a doctor practicing in Malaysia as a house officer, and I could probably generalize this to other parts of the world, one has to carry out not only clinical work but all the other secretarial work to the core; yet the other term of office-clinical boy. And if I could reminisce on the past that I have so long endured, and why house officers should be allowed a better pay... here goes:-

(i) Work 7 days a week, fortunately the concept of 7-11 is not applied here, or we would be dead

(ii) No clocking out at 5 pm on weekdays or 12 pm on weekends, unless if you have finished your work, and in our setting, you usually clock out 3-4 hours after the stated time

(iii) You are expected to do calls at least 3 times per week depending on the amount of house officers available

(iv) Work more than 100 hours per week, my record was 118 hours in a week

(v) Take all the bloods, set all the lines, do all the ancillary procedures like central venous lines, chest tube insertions, pleural or peritoneal tapping, catheterization, peritoneal dialysis, clerk all the cases, memorize the patient's progression, remember all the investigation results, attend to emergencies as front-liners, document all the trivial things, do most of the things first-hand despite having no idea what you are doing

(vi) Refer all the cases and most of the time not really knowing what the purpose is for

(vii) Getting hammered for not knowing what you are referring and not including enough data

(viii) Run all over the hospital to get the blood results, rush for the blood, then run to the theater to send the blood, run back to the ward as your staff may have forgotten the preoperative antibiotics, and run to the radiological department to get the CT scans your surgeons want to have a look at before operating (this did happen to me before)

(ix) Be the scapegoat most of the time during ward rounds, everything goes wrong is because of the house officer forgetting or can't recall

(x) In each mortality presentation, the house officer will in any way, be nailed for something he did, be it documentation or examination

(xi) Be ridiculed for the meager amount of knowledge he or she has, sometimes in front of the patients

(xii) Overworked and underpaid, people do come to you and ask you why the heck is your face so gloomy, and that you look like a piece of garbage with unidentified stench emanating from goodness knows where

(xiii) Expect the unexpected as difficult patients pose you a tough time just because they know someone up the ladder who happens to be your most nastiest boss, and so that you should treat them extra extra nice, or else you face extension (aaahh... this happens so often I couldn't even count it with my ten fingers)

(xiv) Having been overworked, you are expected to display a compassionate look and portray your patience to patients despite knowing for the fact that you can see up to more than 50 patients in a day (both in or outpatients); and that's only see, what about the procedures and the secretarial work that comes with it? 24 hours in a day is simply never enough, and I recalled that every moment when I am the only house officer in a ward managing all the things from head to toe

To have survived this drafty period of hard-core work, as many would have proclaim, would make the better out of you, would make you stronger and make you more durable. Yet, seemingly, with all of these ongoing grill, I found myself being admitted 3 times in the ward and multiple times in the casualty bed; and I don't literally find that as a very comforting thought.

Falling ill is common as one fights his way through housemanship. Yet, the way paved for a house officer is not at all encouraging. When a house officer falls sick, there is no such thing as a medical certificate. It is not applicable to them as they have to repay back the sick leave that they take for an extension on their 4-month long duration. And to add things worse, they are counted into the annual leave, despite having true certification on how sick you are and that you are admitted to their ward. Anyway, I was fortunate to have additional leave to my pocket to spare even after I spent the most of it hanging dry in the hospital bed. The process may be cruel in its own sense, and it couldn't have been made more nasty with certain individuals who are slightly higher in rank who are the least in their mind, thoughtful or caring.

But all of that changes when I went into the Paediatrics posting. I was appreciated for the work that I do, and to put on the sugar and spice, I was continuously showered with words of encouragement and support for my skills in computer. The staff nurses in the ward that I work in commented on the speed of my work which made everyone's life a comfort zone, and the head of department together with her underlings actually cared for once, about my welfare. Never had I been to a posting so far in my year in housemanship whereby the head of department would actually call me (a nobody) up on my handphone to discuss matters pertaining to my welfare. They cared so much that they were the true apple of my eye. Aside from the long hours in working and the amount of workmanship poured into the posting which is as vast as the ocean, one could possibly work tirelessly in view of the ongoing support and care that they will give you. Though there are times that certain rules ought to be altered for the sake of some other's welfare, there are also the certain tacts of simplicities when you can approach the big boss and discuss issues. This occasion occurred towards the end of my Paediatrics posting, and that alone made me think twice with regards on staying onwards as a Paediatrics MO or to wait for the tide to sweep me to another place.

I was certain through some words shared by the boss that I should give it a try as I have no idea what I wanted to do; and as well as the other piece of advice that I should at the same time follow the tide as it will bring us to places that otherwise, we will never have a chance to see or experience for ourselves. I gave in to the last piece of advice as I have already have other things in my mind. You see, becoming a clinician is a rough and grueling process to which many would think of it as something general. There are so many specialists and consultants nowadays that to become another specialist is equivalent to just another freshly passed out house officer. One has to dig in deeper to earn his respect, and the new breed of subspecialties are breeding everywhere. Things like Cardiology, Cardiothoracic Surgery, Respiratory, Urology were once the subspecialties that many would take a jog on and carve a name and a fame for themselves. But the demands are getting greater that no soon enough, we'd probably have a specialist on just Heart Attacks all by themselves, and Congenital Heart Disease specialist all by themselves.

The tide has turned, the future is yet but coming, and the demands are taking a toll on everyone that the clinicians are wondering whether should they continue to upgrade themselves or just stay on the same track which probably would put them off the radar. Glad to say, I am comfortable to stay on track with what comes and what goes, and staying in Cardiology for now would be something afresh and perhaps grant me the opportunity to grasp whatever knowledge that I can before I venture on another totally different dimension.

Back to the current position that I am in, I am still enjoying the luxury that comes with the promotion to MO status. Aside from accumulating more knowledge from the books, journals and updates that I am now obligated to; I get to enjoy at the same time the weekends off, reporting to work later than a house officer, having the laurels to go back earlier, and having people to work under me. Of course, with the higher position, comes greater responsibilities and I have to now depend on my cerebral rather than my spinal efforts to get things done. That worries me, well most of the time when a decision comes to point and whereby making a wrong one would yield disaster. Tagging thereby becomes a vital point, getting to see fresh cases as it comes to casualty and discussing with a senior colleague on what to do as a first-hand experience.

One, especially me, begins to now see a different light of dimension as I take a seat on the medical officer's chair and assumes its backbone of relinquishing and relegating responsibilities to house officers (within their realm of knowledge and capabilities) while at the same time, ensure the stability of the patient before handing it over to the underlings to manage it. Anything wrong goes to your head but knowing at the same time, learning is a curve filled with many sharp corners and that leaning onto one may be painful at first but it soon will stick into your mind as hard as it could to make you feel the importance of it. But... setting that aside for a while, as I will soon begin my tagging later; I am for once, after 15 months getting to finally enjoy my first weekend break. It is a relatively good change as I can now look forward to more trips back to Penang over the weekends and more relaxation period for me as I can now concentrate more on accumulating knowledge on ECGs and Cardiology cases so that I will not look dumb when people (even patients) start asking me about things in relation to the heart.

Somehow, God is gracious, and I am grateful to be posted into Cardiology. It was my first love as I started that similar posting when we all moved to the new hospital. The coronary care staff nurses were very well-trained and kind and helpful in many ways. And I could still recall the close friendships that we had when I was a first-poster house officer. Even then, I was respected as a doctor in making decision and being the front-line decision maker in the absence of my superiors. I handled myself well and I am glad that I was granted that life-changing event to which gave me the opportunity to like General Internal Medicine. But, I guess, things change as time goes by, and having tread my sole onto O/G, General Surgery and Paediatrics as a house officer, the stress in life has peaked and to earn that same love again for the posting that I enjoyed so much, that would probably take a longer duration than one could possibly fathom.

Suffice to say, my stress level seems to be taking a downward trend as I am now granted the comfort of doing the things that I enjoy. As I completed the last day of my housemanship, and walked back home with the thought at the back of my mind that seemed to linger on the whole day, the words "It is over" were all painted in all the corners of my brain. I was glad to close the chapter that I have no intention of reopening it. I am in no favor at any single time to discuss its occasions of austerity to any others, the practical rigidity that I was imbued with for all these past one year. The stringent kowtows and fear of being extended or put up as a scapegoat is no longer a picture to experience and for once, I could live a better life and breathe the clean air, while exhaling, through my mouth. The past life of swallowing all the unhealthy air and only have the toilet bowl to complain my rants and grunts to are finally over. I could finally, for once voice my opinion and let them be heard; but of course, that don't mean that I should go looking for troubles.

Right about now, prior to me starting my real tagging calls, I guess I should take a long desired break, which explained how early I collapse last night and how late I am finally able to wake up to today. That luxury had escaped me for the past 15 months, and now, I am glad to have it back by my side.

Doctor's Life & Challenges

YouTube - MCD '11 - Doctor's Life & Challenges

Monday, May 2, 2011

ETHICAL ISSUES IN HOUSEMANSHIP



PROF ZABIDI – HUSSIN FRCPCH

CONSULTANT PAEDIATRICIAN AND PROFESSOR OF PAEDIATRICS

SCHOOL OF MEDICAL SCIENCES, UNIVERSITI SAINS MALAYSIA

dr.zabidi@gmail.com

zabidihussin@blogspot.com

LECTURE DELIVERED ON 11TH DEC 2010 UNIVERSITI SAINS MALAYSIA




· Ethics is linked to morality and judgments associated with it

· Everyone has his own moral values which has been nurtured over a period of time

· Every person’s moral values is unique and is normally determined by a number of factors including gender, culture, religious belief, environment and personal upbringing

· A medical student does not normally have an opportunity to exercise his moral judgment in dealing patient. Even if he does, that judgment does not influence the clinical management and care of his patient

· Ethical issues during period of studentship probably links to moral issues relevant to his personal conduct and its association to whosoever he in contact with. This may include issues such as truth telling, plagiarism, time-keeping, honesty, courtesy, empathy, respecting rights, communications and exploring insights of patients (MERCI checklist)

· Many of the issues of morality during the student days do not really matter to patient care

· The situation quickly changes as a student graduates

· Granting of a medical degree immediately empowers a student and unveils the cloak of uncertainty that has been covering him for at least 5 years

· He is now ready to make his own decision. Some of these decisions have to be made while he is at the front line of patient care, receiving patients at first point of contact and dealing with all the emotional issues surrounding a patient and his relatives

· This is the time when his moral judgments matter

· At the same time as he makes his judgments in his professional behaviour, his patients also judge him according to the scale of their moral judgments

· Judgment and evaluation of one’s moral standing can be gauged through a number of manifestations; from the way he dresses at work, the language he uses, gestures and body language, manner of interaction with peers and colleagues at work, note writings and phone calls and degree of urgencies in his actions. All of these carries significant weightage

· A patient who sees the first doctor on the scene who appears disheveled and unkempt would have a certain assumption and belief. Care of a sick person usually comes from an environment of clean and tidiness

· A houseman whose language lacks sufficient empathy and speaks in a language quite foreign to the patient he is in direct contact would transmit a certain message that can be adversely interpreted. Adverse interpretation may wrongly lack of interest and care, feeling of worthlessness, trust and confidence in the clinical management (remember the case of the doctor, declaring to his colleague that the hospital lacks fund, in full view of his acutely ill patient and his relatives). Casual statements such as “ I am only a houseman” or “My boss is not here and on holiday” would convey certain message to patients

· Patients normally take note the demeanor of the first doctor on the scene. Gestures and body language matter a great deal in transmitting sense of urgency and feeling of being taken care of. Most of these hidden issues relate directly to response to treatment and thus the speed of recovery from illness

· The environment within which a patient is being handled also carries significant value. Spilled bloods, and stained bed sheets, numerous indisposed used sharps would convey a situation of lacksidical approach to patient care, instill fear and reinforce negative values. A treatment room in full view of patient would also convey lack of sensitivity especially when painful procedures are carried out. An unnecessary large bandage over a small puncture mark would inevitably give a message that a big incision has been inflicted!

· A ward unguarded with laughter from doctors and health professionals would convey a sense of insensitivity and sometimes humiliation. This is especially true in situation of bereavement in an open ward

· A houseman is sometimes faced with ethical dilemma especially when his moral judgment may contradict that of his superiors. This can relate to issues in history-taking, physical findings and plan of clinical management. ( remember a case of a houseman who refuses to assist his consultant in a procedure as he feels that the procedure was unnecessary and unethical)

· Cultural and religious beliefs may also influence a houseman in his conduct. Care must be taken that these do not convey a negative connotation to his patient. Examples include statements such as “ I don’t work on certain days”, “ I am here now, even when I m not supposed to work”

· A houseman has to deal with colleagues (medical, nurses, support staff, administrators). His moral conduct will be transmitted to all those in contact with him. In an environment of close associates, judgments of others spreads quickly within an institution

· Ethical issues will also be relevant in dealing with those with financial interest in the clinical management of a patient ( insurance, pharmaceutical , companies dealing with equipments)

· Above all, the conduct of a houseman should exude a certain sense of flagship and icon for the medical profession, exhibit maturity and sensitivity that gives some reflection of humility between a care giver and those he cares for.





ZH

Dec 2010
 
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