Sunday, 6 October 2013

#5 : Killer Department

Killer ??? Shouldn't we all be Healer ???

The ugly truth is that, not everyone is professional, even the specialist !!!

Every hospital has killer department at least one. If theres two killer department and you still choose to go there, i can't find a better word to describe you than "Insanity" !!

What makes a department becomes a killer department :-
1) The Head of Department (HOD aka Big Boss)
- eg: very strict, one wrong dose of paracetamol, straight away get extended. Forgot to wear name tag, you'll get warning letters, ect.

2) The Specialist
- eg : have a special request like, HO must remember all cases while presenting the case to him/her, they will take the patient's file away from you. Cannot set up IV line at patient's leg (even if its damn hard to set in the arm). Many more. Some i find very childish & stupid, like i said, not all are professional

3) The Medical Officer
- eg : all orders given by him/her, must be settle before evening round. Some are beyond HO power, like to call the family member to come to hospital to sign consent. Or to make sure the discharge patient go back before evening round. ** i'm not making all these, it happened to me when i was a HO**

4) Lame sister / nurse / attendant
eg : you want to take blood culture, but the blood bottle is not there. You order nurse to give oxygen, but oxygen tank is empty. Ask the attendant to take the blood investigation result at lab, but they only bring back patient's food (although lab and diet department is on the same the way). At the end of the day, you'll get scolded by your superior for "not" doing your job on time.
** some department has very cekap staff, while others, just makan gaji buta, specialist & MO never blame staff **

#4 : Busy Department

Busy.... Busy.... Busy....

Do you know that in United Kingdom, they have rules & regulations saying that the maximum working hours for doctor is 48 hours per week, that includes junior doctors as well.
Which can be translated to, working more than 48 hours per week, is AGAINST THE LAW !!!

Developed country strongly believe that mistakes will only increase if doctors are overworked, thus they implemented such rules. Malaysia, the next promising developing country yet to be classified as developed country, is somehow....
doing the direct opposite. Didn't the West did what we are doing right now years ago and they failed ??? Why can't we learn from their mistakes, they tried everything before becoming a developed nation, isn't it ??

"Those who cannot remember the past, are condemned to repeat it "

Whatever lah, Malaysia Bull-eh, hehe...
Ok, to be successful in HO life, my advice is to choose your department wisely. Most of the HO who quit, are in the 1st & 2nd posting. Most of them can't even endure the 1st month in HO life, then they went missing.
The solution, don't even think of doing the busy department as your 1st posting if you are not well prepared !! Call your hospital admin before duty-reporting date, ask them to change, give them 999 reasons to help you !! 

It is generally known that, Medical department is the MOST BUSY of all, regardless of states, be it in KL or in Kelantan.
In my hospital, the ranking goes like this (from the most busy, to the less busy)... :-

1. medical
2. surgical / ortho
3. o & g
4. paeds

of course Emergency dept is busy as well, but it'll be your last or 5th posting only.
The word "Busy" here is directly proportional to number of patient, i am not talking about some annoying specialist who ask HO to do hourly vital signs monitoring for all patient making you "busy" as well (nurse will be jobless then). The ranking changes, but medical will always stay as the KING !!!

Tips : Find out the number of wards allocated to each department, you'll get a rough idea on which department has the most patient.
Example :-
If Medical has 8 wards altogether meanwhile o&g has 4 wards + labour room, doesn't that tell you something ???

#6 : Old Hospital

New Hospital Is Always Better


The New vs The Old School

New hospital has advantage compared to old hospital. Its the computerized system that makes them superior. Only a computer, whats so special about that???
Thats why i'm here to tell you !!!

Old hospital don't have computerized system. Meaning that every documentation is done by writing, do you think MO loves to write??
Old system makes you tired of writing the same thing again and again. For an example, the same patient that needs 5 different blood investigations. You have to write 5 different forms manually.
Old system makes you tired of walking / running. The only way to know the blood result is to go to the lab and get the result. When Specialist / MO need the patient's old file in 1 hour, you need to walk to the record unit and trace them yourself.

New hospital with computerized system makes everyone's life easier !!!
Patient documentation stored in computer, if there is no new plan added, you can just copy & paste. You can print out the patient's name (sticker) with barcode, stick it to the patient's blood bottle & send them right away. Old files?? Patient previous admission?? Previous medications?? It is just a click away !!!

You can do more field work and spend less time in formality !!!

"Technology is there to make our life better"

p/s : All hospitals should have computerized system by now, if not for corruption, lol

#3 : Live Far From Hospital

Just Apply For the Hospital Quarters / Hostel

Most of HO tend to stay at their parent's house, as they don't own a house obviously.
If you choose to do HO at hospital near your parent's house, thats fine.
But try to get the hospital quarters / hostel also, if possible. Why?
Its easier to go to work without having to wake up so early in the morning just to beat the traffic, or have to drive for 45mins when the clock shows 11.59pm.
Some of my friends got involve in car accident after falling asleep while driving (too tired after working). Lucky that no one was hurt, but still you lose your hard-earned money to repair the damage !!

If you choose to do houseman far far away from your family, then applying for this hostel is a must for you. Don't fall into the society trap, doctor has to life in a mansion, driving BMW.. Thats all crap !!
Just live a moderate HO life, for 2 years only maaa...

Because this quarters / hostels are limited in numbers, they may reject application coming form HO whos parents live nearby.... Thus, making those doing houseman far from their family a STRONG applicant  !!!

Live as near as you can from the hospital, you will save energy, time, money & might as well save you YOUR LIFE !!!!!!  :D

#2 : Less HO in Department

This can only be applied after you have entered the hospital of your choice. Why?
Because Hospital admin will always put new HO (regardless of 1st posters or not) according to the number of HO in a particular department. They cannot allocate all 10 new HO to medical (already have 20 HO there) when Orthopedic only have 10 HO left, right?
They will try to balance the number of HO in each department so that there are no jobless HO in one department when there are overworked HO in the other department.

The point here is, 1 month before finishing your 1st posting, try to find out whether the next department you're about to enter is depleted of HO (ask those in that department). If its not, then you will not face any problem with lack of HO. If it is yes, what you should do is....

1. Go to your hospital admin (normally it's call bahagian sumber manusia)

2. Ask the officer in-charge to change you to another department, normally they will ask which department you want to enter. (again, do some research on which department has sufficient number of HO, if not, you'll end up in the tiger's mouth trying to avoid a dog-bite)

3. Sometimes admin is reluctant to switch you to another department. Just come up with some good & solid reasons. We're all born as liar at some point, why not use it for good reason, lol

Problems related to lack of HO in a department :-

  • +++ workload = one HO covers more patient, need to start your AM round early, go back late, miss your breakfast & lunch & dinner
  • +++ stress = many complaints, tons of issues need to be settled
  • Freeze Leave request = since less HO available, the department cannot afford their "frontliner" to go on leave (cuti), all your request will be rejected. Remember, your leave is not your right !!
  • Shift changed to On-call system = shift system for HO is less tiring compared to on-call system. With less HO available, its going to be hard to create a 3 shifts schedule for HO.  They will end up make HO do on-call system. You're not getting extra salary to do more hours, okay? Only few will thank you for your hardwork
  • Working on Big Holiday = muslim working on raya, chinese working on CNY & so on, while bosses cuti kaw-kaw... lol
  • Have to work even if you're sick = unless you are being admitted to the ward for falling sick, some will not tolerate, you might get extended in the damn department for falling sick. 

 " Do not expect the world to be nice at you, just because you are nice to the world. Its like asking the lion not to eat you, because you do not eat lion "

#1 : Busy Hospital

Rule of Thumb #1

Busy hospital = busy for everyone, not only HO !!!

How busy do you expect HO life is?? You don't until you become one !!!
Thinking back, HO time is the only moment in my life where i write and walk THE MOST... and... eat, sleep, holiday, rest THE LESS !!!  zzZzzZzz...

Since all government hospitals are expected to be busy all year long, what you can do is, use your head.
Since the population in KL/Selangor is bigger compared to Perlis, it is only logic to say, HKL is more busy than HTF. Do some research, if you want to.

Example :
HKL has neurosurgical department, but Malacca Hospital don't. So Malacca will have to refer to HKL if they have neurosurgical patient. Which will result to more patient in HKL.

Although all government hospitals are expected to have all sort of specialist in various field, still they are lacking of sub-specialist in some department. Say Hepatobiliary Consultant, only a few in the whole south region of Malaysia !!!

Tips : Busy hospitals have advantages as well. Such as KKM will allocate more HO for busier hospital, you can learn a lot from different cases. Sabah/Sawarak hospital let HO do some procedures where in Peninsular, they prohibit HO to do so, like LSCS (Lower segment cesarian section)


Life is about choice

"Which hospital is the best for me.."

                "My parents live in KL, whats the best for me...."

    "Do housemanship outside KL first, then come back as MO, hmmm... "


Don't make choices you'll REGRET later  !!

To become successful in HO life, you need to make the right choices, not after you become a HO, but even BEFORE you become one !!
Why am i saying this?? Well... Whats the point of dreaming becoming a specialist, when you can't even endure HO life, isn't it?? There are stages of doctor's life you have to go through to get to the top.
Have you ever read in the newspapers, specialist or medical officer died at work?? Or Specialist / MO complain about their workload??
Most of the complain comes from HO, yes you heard me...
Think again, why do these complaints arise in the first place?
Its like, why do people complaint when the government reduces the fuel subsidy (causes fuel price to increase)??? Why the government NEVER complaint, they are using the fuel themselves also, right??

Most complaint comes from HO because they are at the lowest hierarchy in doctor life and they are being  pressured a lot by MO/Specialist. Pressure is subjective, meaning some people can deal with tremendous pressure where others don't. So look in the mirror and evaluate yourself.

Rule of Thumb
1. Busy hospital = Tired
2. Less HO in a given dept = Tired
3. Live far from hospital = Tired
4.  Busy department = Tired
5. Killer department = Tired
6. Old hospital = Tired

I'll explain them one by one in the next post, these rules of thumb, should at least help you in making decision, on which hospital you should choose to serve as houseman.
p/s : during pre-houseman course, you need to tell KKM which 3 hospitals you're willing to work as a HO. So choose lah from now !!

Saturday, 5 October 2013

1st posting (department)

Almost a year since i last posted??? Walao !!

Then i'll just write what comes into my mind, because if i wait, this blog gonna be history.
Departments can be divided into 2 major categories, which are, surgical based and medical based.
By now, you all should already know which department belong to which category, right?

Based on my experience and my experience ONLY, the choice of department DO play a big role in your HO life. I'll tell you why...

Example :
You graduated from your university, went to the "Kursus Penempatan" or whatever they call it, now you know which hospital you're going to serve. Those coming from local universities have more advantage than those from the overseas (i graduated from indonesia, so chill laa, Malaysia Bull-eh). NOT in terms of level of knowledge (generally speaking) but in working environment.
Local grads, did their clinical years in local hospitals. Everyday they see how specialist do ward rounds, how things were done there, how HO get f***ed up & lots more. So its like ;

"well... i've been to Zimbabwe once with my family, next time, if i go alone also, i can survive one" said Ahmad with one eye closed.

Meanwhile, overseas grads, if they never do attachment in govt hospital during semester break, they will not have any idea on how govt hospital is being run. Its like,

"well... i'm a tip-top student in my university, how hard can housemanship be, sure can laa", said Bidil while sipping his favorite Starbucks' Cappuccino.

When i was a first poster (1st day in my 1st department), i was damn BLUR. I don't know what to do. Everyone is busy doing some work, i don't know what i am supposed to do. People told me to clerk the new patient. I don't even know what "clerk" really means !!! So i took one file, and... started READING for like 30mins, trying to understand what is written on the referral letter.

<<<< Referral Letter >>>
Dear doctor, kindly see this pt, 28/C/F, G2P1 @28w
p/w cont pain since 2am, no leaking, FM good, no show. Documented cont 2:10:15secs, CTG reactive, uFEME leu 2+
Imp : Threatened Preterm Labour d/t UTI
Kindly see her and do the needful. Tq

I was like, WTF !! this is NOT a letter written by human being, this is some kind of alien telegraph intercepted by the CIA.
When they saw me NOT helping at all, they then gave me an easier job, which was, trace the all the blood investigation STAT. Since i went to the hospital orientation before, i knew where the lab is, but still, i don't know what blood to trace, whos blood to trace, bloody hell laa wei... lol
The next day, i became a senior HO's shadow, i switched to mode "watch & learn".

Since you have a lot to learn as a 1st poster, it is going to be a lot harder for you to start in a "busy department" than in a "less-busy department", right?
Medical department is well known to be the MOST busy department of all, applies to all hospitals at all time. So, it is more wise NOT to start in medical as your first posting.

For me, i started in O&G. Still a busy department, but compared to medical, O&G is less busy !!
I have to learn the short forms, how to clerk cases, set up IV line (branula), take vein blood, trace blood & vaginal examination. If i were in medical, i have to learn all these (except vaginal examination), plus how to take & analyze arterial blood, do rectal examination, neurological examination, take blood culture, ECG interpretation and many more. (during tagging time of course).
Learn "one by one" slowly is far much better than" all by one", common sense !!

Remember, less busy = less stress !!

Tips : some hospital "administration officers" understand  1st poster's problem, after getting your "duty-report" letter, try to call your respective hospital admin officer (normally at bahagian sumber manusia), introduce yourself and ask them if possible, not to put medical as your first posting. They are the one in-charge of new HO's department arrangement.

p/s : medical is a big posting, you'll learn alot there, try to do it as early as possible, or if you can, as your first posting. HO always say, if you finished medical, you be more confident in managing a patient yourself.