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Kerjaya Sebagai Doktor

Sunday, June 5, 2011

Assalamu'alaikum Wrmbth,

Kepada adik-adik dan pelajar sekalian yang berminat menjadi doktor, teruskan niat murnimu.

Hari ini, ingin saya kongsikan artikel hasil nukilan doktor muda dalam peringkat Housemanship (HO).

Dipersilakan baca dan betulkan niat ya. :) Doktor bukan kerjaya glamour seperti dalam drama barat seperti House, Private Practice dan Greys Anatomy.

Selamat Membaca

We have 15 fresh graduates from UKM in our hospital.

Seeing those excited-but-scared faces, I can’t help to feel sorry to know what the future lies in them. There is a saying that the most enjoyable moment in a life of a doctor is the period after they graduated (i.e.they are already doctors) to the beginning of their working life; first day of work, their motivation will crush to pieces. In some cases, perhaps most, it is true.

First day I started to work, I regretted to be a doctor.

Honestly, that’s what I feel.

My friend Syazana, who is among the highly motivated, super hardworking medical student during my better days as a medical student said she never enjoy her working life.

So do you know what to expect?

What is the problem with housemanship in Malaysia?

Yes, I mean the housemanship. The system. I don’t want to talk about the housemen per say. Because there’ll be too much to be talk about.

Mr Kamarul once forwarded me these messages from some HOs that he know:

"Imagine having to tag (there is a compulsory tagging period every time we enter a new department, ranging from as little as 3 days to as many as 2 months) continuously from 7 am till 11 pm every day. Imagine if you can only take 7 days leave and no weekend off for the duration of 4 months. Imagine after working non-stop without sleep and quick bites in between jobs for 24 hours you still have a full working day ahead of you. Imagine being shouted at by a disgruntled patient at 2 am in the morning when you are dead tired. Then there are incidents where any MO or specialist can happily snap/shout at houseman or call us 'incompetent, disgusting and unbecoming'."

"Being a HO in Malaysia for nearly 2 years is really disappointing. Graduated from Ireland, I've seen how the intern works and treated in Irish Hospitals. Tough. And I embraced myself for what they say a tougher training back home. But it's not tougher training that we met. It's inhumane, humiliation of the HO to the max. All in the name of training, and wanting to 'teach you' to become good doctors."

Inhumane. Sounds harsh. But too bad that perhaps it is true.

I’m a HO currently in my 11th month of housemanship in Malaysia, doing my third posting. I’ve graduated from a public university in Malaysia. Do you know what is my routine like?

Now I’m in oncology/palliative ward with about 10 to 20 surgical patients with two housemen incharge. Excluding the day care patients who come for day care chemo who need review and some actions too.

Wake up around 5 to 6 am everyday.
Take my bath, subuh prayer, breakfast if I have the time/food.
Drive to work.
Review patients (know the cases, ask the patients, examine, check the investigations, write in BHTs, endorse new medications), take blood if necessary. Etc. E.g. wound inspection.
AM round with MO/specialist.
Ward work. E.g. discharges (discharge note, discharge summary, MC, PS, referral if necessary), new cases (clerk, examine, set branula, blood investigations *to take, to label, occassionally to send/to trace the results ourselves*, plan of management), radiological request for the urgent cases (fill in form, look for boss for countersign, run to radio department, convince MO/radiologist), trace investigations (e.g. from lab, referral from elsewhere, sent-away investigations), consult oncology unit (call operator, connect to responsible hospital/MO, present the case, document plan of management, do it), trace BHT/SOPD cards, reinsert leaking/bump branulas, re-take rejected/insufficent amount of blood for investigations, manage GM high/low, BP high/low, etc.
The list could never finish.
Or clinic duty during clinic days (see old/new cases, clerk, examine, review investigations, discuss with MO/specialists, trace investigations if necessary, refer is necessary, book for surgery if necessary).
Lunch if I could find the time.
Occassionally CME/drug talk in the afternoon.
Zuhur prayer.
Review patients.
Afternoon round with MO
Ward work. The similar lists.
Asar prayer
Dinner if I could find the time.
Review patients.
Maghrib prayer
PM round with MO.
Ward work. Usually the least lists. We go back around 8 to 11 pm everyday.
Drive home.
Isya’ prayer.
Iron clothes to be wear the next day.
Study/facebooking/blogging if I have the time. Perhaps energy.
And the cycle continues.

We have TDS round i.e. everybody has to work until night everyday even though we’re not oncall.
One day off every weekend i.e. we don’t have to go to work at all.
Around eight to 10 oncalls per month.
For oncall person, it means start to work early morning, see cases the whole day, sleep in the hospital if we have time or sleepless if we have many patients, work again the next day until night i.e. PM round finish. They said oncall doctors work 36 hours? Not really. Our working hours are longer.
One oncall for a doctor, but the nurses exchanged shifts up to six times.
And we, the same person as the previous day, are still there working non-stop.

Now I’m in surgery. Last time it was worst. I was in medical for four months. And for the whole four months I had my subuh prayer in the ward. Everyday. Because we work EVERYDAY and we have no day off. NO DAY OFF. MOs started their round at 645 am. So when do you think we start our own review?

Eight to nine days leaves per posting, including MC. INCLUDING MC. And we were told that the leaves are not our rights and we can be denied if e.g. lack of housemen in the department.

Do you know what is the only right that we have?

The right to quit our job.

That was exactly what my friend Amrin did. No intention to be a doctor in the first place. Forced by parents. Smart enough that he was accepted into a good medical school in New Zealand. Have no idea how housemanship in Malaysia is like. Survived his first month with no interest to go on anymore. Suddenly got an offer for an internship from a hospital in New Zealand. Better pay, better environment and of course, better treatment from people. So why not? His parents? He said they don’t mind. The government? The people? Hurm.

He gave 24 hours notice to quit his job.

That was just an example.

Recently I heard there’s another HO in ortho, similarly a first poster who quit her job. “Tak tahan” was the reason.

The other jobs are tough too. No doubt. But we, doctors, work in long crazy hours. And we work with people. Patients. And our co-workers. Of course our bosses. And you know how troublesome human beings are.

Patients pulled out the branula you’ve struggled to insert for one hour because she has low GCS due to her head injury.
Relatives threatened to report about you to newspaper for doing discharge late for his father.
MO scolded you for not informing him about that particular patient when you have no idea that it need to be inform.
Staff nurses were more concerned about their passed overs rather than helping you with your dying patients.
PPKs were missing in action that you have to run to the lab yourself to get the ABG result for your impending respiratory collapse patients while you is the only attending doctor.
Lab staff shout at you “do you think you are the only doctor oncall tonight?” because you request for them to run the BUSE that you’ve sent yourself one hour earlier quickly because your patient has potassium level of 6.5 and you just gave him a cycle of lytic cocktail.
Boss told you to “go and request an ultrasound abdomen urgent for him” even though you strongly feel it’s not indicated. You went to the radiology and got scolded by the MO/radiologist “is it your clinical judgement is so poor that you need ultrasound for every abdominal pain patients?”

Of course, thousand others.

For us, housemen, life has to go on. Of course, life is not bad all the time.

It is a chronically ongoing love and hate relationship.

Perhaps you think I'm exaggerating. It's up to you. This is strictly my personal opinion/experiences.

Hope for the system to change? Maybe. Nabil and Nisa said Hospital Temerloh is doing the pilot project for no-oncall-but-doctors-work-in-shift system. But I honestly cannot see how it’s going to work.

But for the time being, be the changes we want to see.

Work for our patients, not for our bosses.

Two weeks of posting in oncology/palliative ward taught me a lot about life.

43 years old lady had bilateral mastectomy for newly diagnosed breast carcinoma.
60 years old man with colostomy for colorectal ca. Having chronic diarrhea that the smell of his faeces could be detected two cubicles away.
29 years old good looking young man with traumatic paraplegia post MVA. Came in with infected bed sore.

So can we, the *alhamdulillah* healthy young persons complaint?

The above examples are all my personal experiences.

I once read a good writing by a HO who just survived his housemanship. I’ll ask his permission to publish it here later. It’ll make a nice entry by an invited writer :D

Student life is the best. But life has to go on.

All the best, housemen! May we be the changes that we wish to see in the future.

Hati mau kuat. Sekuat singa.