I was involved in two incidents recently. I'll try to be very open-minded and promise to be as unbiased as possible while reporting them. And take my words, these were not isolated incidents. They happen on a daily basis, not only to me, but to all hospital slaves across the country.
INCIDENT #1
I was on-call a couple of days ago. A patient was admitted with right leg cellulitis, and needed intravenous antibiotics. I prescribed them, and asked the nurse to administer them. Sounded routine enough. Apart from the fact that she, a very senior nurse, was not allowed to give the drugs.
She explained to me that she's new to our hospital and had not attended an in-house training course for IV drug administration. No in-house training, therefore can't give the drugs.
I asked her if she had done it before in her previous jobs. She said, "Hundreds, if not thousands of times. But that was in my old hospital"
I then asked if the equipment and technique were any different in these two hospitals. No, she said.
As there were no other nurses available, I had no choice but to administer the antibiotics myself. The problem was: I have never ever done it in my life. I have absolutely no training whatsoever in administering IV drugs. It's simply a nursing, not medical, task.
"You're the doc, you're allowed to give the drugs" said the nurse.
I reluctantly obliged, following a crash course from this senior nurse.
INCIDENT #2
I am a Cardiology SHO. By rank, I am the third most senior person in the cardiology team, after the Consultant and Registrar.
One day I was asked by my consultant to supervise an exercise tolerance test (aka treadmill test). It sounds straightforward enough, as I have been trained to carry out such a task. I went down to the Clinical Measurement Department where the test would be done. A cardiac technician came up to me, and she asked, "Are you here to supervised the test?"
"Yes I sure am"
"Are you the Registrar then?"
"No, I'm the Cardio SHO"
"In that case, you can't do it then. Only Registrar or Consultant can supervise a treadmill test"
"But I'm the Cardiology SHO" emphasising to her the word CARDIOLOGY. "Besides Dr G (the consultant) was the one who asked me to do it"
"I don't care who you are. But you are not a registrar. Dr G should know better."
"Does it mean a Gastro or Neurology registrar is allowed to supervise a cardiac test, but me, a cardiology SHO, isn't?"
"Like I said, you are allowed to do the test only if you are registrar or above"
I had to concede defeat, and walked away feeling very frustrated.
Tuesday, March 15, 2005
Monday, March 14, 2005
Red tapes
I was cornered by a middle-aged lady this afternoon. As it turned out, she was the niece of one of my patients, Mrs H. Her aunt was admitted with right leg swelling.
She first came to the outpatient DVT clinic towards the end of last week. Under normal circumstances a Doppler scan would be carried out by the DVT Specialist Nurse there and then. But due to some unforseen technical problem she was asked to return today for the scan.
Mrs H however had to be admitted over the weekend due to intractable pain in her right leg. Common sense would dictate that she stays in till today, have her Doppler, and then take things from there, depending on the scan results.
Not really if you're a patient of our hospital.
Mrs H and her niece were informed by the DVT Nurse that since she's now an in-patient, she can't have her Doppler scan. Never mind the fact that she already has a scan appointment for today. The appointment is only valid if you are an outpatient! The nurse went one step further by explaining it would be wrong for her to do the scan! Doppler scan for in-patient can only be done by a radiologist!
The niece asked me to explain the situation. She said she couldn't understand why such ridiculous decisions were made. I duly replied, "Neither can I"
Red tapes! Bureaucracy! That's the reason, if you ask me.
DVT Specialist Nurses are higly trained to perform Doppler. Yet they are only allowed to do a scan on out-patients. Is it technically different to scan an in-patient? Why does an in-patient need to be scanned by a doctor?
The consequences of these decisions are:
1. Mrs H has to be kept in for a few days, while awaiting her In-patient Doppler scan.
2. It costs approx £300 per day per medical bed. Say 3 days she has to stay in, that would be a cool £900.
3. A precious medical bed taken up by a non-essential case, one which can easily be managed outwith hospital. This will potentially preclude more urgent case to be admitted.
4. It's well known that hospitals are not the cleanest place of all. The longer one stays in, the higher chance of him/her picking up a nasty airborne infection. Mrs H clearly did not need to be admitted.
Poor policy-making? I bet.
She first came to the outpatient DVT clinic towards the end of last week. Under normal circumstances a Doppler scan would be carried out by the DVT Specialist Nurse there and then. But due to some unforseen technical problem she was asked to return today for the scan.
Mrs H however had to be admitted over the weekend due to intractable pain in her right leg. Common sense would dictate that she stays in till today, have her Doppler, and then take things from there, depending on the scan results.
Not really if you're a patient of our hospital.
Mrs H and her niece were informed by the DVT Nurse that since she's now an in-patient, she can't have her Doppler scan. Never mind the fact that she already has a scan appointment for today. The appointment is only valid if you are an outpatient! The nurse went one step further by explaining it would be wrong for her to do the scan! Doppler scan for in-patient can only be done by a radiologist!
The niece asked me to explain the situation. She said she couldn't understand why such ridiculous decisions were made. I duly replied, "Neither can I"
Red tapes! Bureaucracy! That's the reason, if you ask me.
DVT Specialist Nurses are higly trained to perform Doppler. Yet they are only allowed to do a scan on out-patients. Is it technically different to scan an in-patient? Why does an in-patient need to be scanned by a doctor?
The consequences of these decisions are:
1. Mrs H has to be kept in for a few days, while awaiting her In-patient Doppler scan.
2. It costs approx £300 per day per medical bed. Say 3 days she has to stay in, that would be a cool £900.
3. A precious medical bed taken up by a non-essential case, one which can easily be managed outwith hospital. This will potentially preclude more urgent case to be admitted.
4. It's well known that hospitals are not the cleanest place of all. The longer one stays in, the higher chance of him/her picking up a nasty airborne infection. Mrs H clearly did not need to be admitted.
Poor policy-making? I bet.
Wednesday, March 02, 2005
No fear
Junior doctors are afraid of speaking to consultants. Everybody knows it, but no one wants to admit it.
I was phoned by the Surgical SHO yesterday. He explained to me that there's a surgical patient in his ward who suffered a heart attack post-operatively. This patient was then seen by one of my three bosses, Dr J, a couple of days ago. Dr J said he would come back to review, but had yet to return.
So I asked him, "I see..but what exactly you want me to do?"
He said, "Can you ask Dr J to review?"
I replied, "Yes I can. But why can't you do it yourself?"
Long pause. Then he said, "You are his SHO, aren't you? So I'm asking you to ask him"
Immediately I sensed another case of Consultants-are-gods-so-don't-bother-them syndrome. So I told him, "It's your patient. You want him to review, so you should call him. He's very nice and doesn't bite. I'm not your secretary either"
"FINE!!" And the phone went dead.
I must admit I used to feel intimidated speaking to consultants during the very initial period of my career. But then one day I realised they don't actually bite. They can be very nice (most of the time!). They are nasty only when you haven't got your facts right. For instance, if you want to discuss a difficult case with them, you better do some decent preparation before knocking on their doors. Make sure you have all the latest blood test and X-ray results. Believe me, they can become impatient very quickly if you keep on answering 'Sorry sir, I don't know'. I know this because I have been there before!
At the end of the day we are all here to do a specific job - to treat patients. Consultants are paid to give advices; hospital slaves are paid to carry out the task set by consultants. The latter, due to their seniority and level of experience, are bound to know less than the former. There will be times when they can't manage a case, and need senior help.
So my advice to my fellow slave is: Go ask the consultants. Don't let them sit in their lavish offices doing nothing. Make them work (like a true hospital slave)!
I was phoned by the Surgical SHO yesterday. He explained to me that there's a surgical patient in his ward who suffered a heart attack post-operatively. This patient was then seen by one of my three bosses, Dr J, a couple of days ago. Dr J said he would come back to review, but had yet to return.
So I asked him, "I see..but what exactly you want me to do?"
He said, "Can you ask Dr J to review?"
I replied, "Yes I can. But why can't you do it yourself?"
Long pause. Then he said, "You are his SHO, aren't you? So I'm asking you to ask him"
Immediately I sensed another case of Consultants-are-gods-so-don't-bother-them syndrome. So I told him, "It's your patient. You want him to review, so you should call him. He's very nice and doesn't bite. I'm not your secretary either"
"FINE!!" And the phone went dead.
I must admit I used to feel intimidated speaking to consultants during the very initial period of my career. But then one day I realised they don't actually bite. They can be very nice (most of the time!). They are nasty only when you haven't got your facts right. For instance, if you want to discuss a difficult case with them, you better do some decent preparation before knocking on their doors. Make sure you have all the latest blood test and X-ray results. Believe me, they can become impatient very quickly if you keep on answering 'Sorry sir, I don't know'. I know this because I have been there before!
At the end of the day we are all here to do a specific job - to treat patients. Consultants are paid to give advices; hospital slaves are paid to carry out the task set by consultants. The latter, due to their seniority and level of experience, are bound to know less than the former. There will be times when they can't manage a case, and need senior help.
So my advice to my fellow slave is: Go ask the consultants. Don't let them sit in their lavish offices doing nothing. Make them work (like a true hospital slave)!
Tuesday, March 01, 2005
Dr E and I
Few months ago, I reported an incident involving me and Dr E. He accused me of mismanaging a patient. I still maintain my innocence. I have since spoken to several other senior colleagues. And every single one of them was appalled by the way Dr E treated me. They all agreed that it wasn't my fault.
I should feel vindicated. I should feel relieved and consoled.
But I am not!!
One good thing about all the medical consultants in my hospital is that they are all very friendly and approachable. Until this incident, that is. Ever since the incident, whenever I see Dr E and wish him a good morning/afternoon, he will just walk pass without acknowledging my greeting. I am being ignored!
I can live with it. But I can't stand being belittled by him. Two days ago I made a diagnostic mistake. I'm not trying to justify my mistake, but these two conditions do mimic each other, and it is often very difficult to differentiate them confidently. Anyway, Dr E wasn't impressed with my misdiagnosis. He sneered at me, and said, "It's obvious isn't it that this is condition X, and not condition Y?"
I felt humiliated. Worse still I feel dejected and demoralised.
It may sound overemotional (and maybe a bit sissy-like too). But how am I supposed to stay loyal to such a boss? How am I supposed to give him my 120% when I don't feel appreciated?
Perhaps I'm right afterall to call myself a hospital slave.
I should feel vindicated. I should feel relieved and consoled.
But I am not!!
One good thing about all the medical consultants in my hospital is that they are all very friendly and approachable. Until this incident, that is. Ever since the incident, whenever I see Dr E and wish him a good morning/afternoon, he will just walk pass without acknowledging my greeting. I am being ignored!
I can live with it. But I can't stand being belittled by him. Two days ago I made a diagnostic mistake. I'm not trying to justify my mistake, but these two conditions do mimic each other, and it is often very difficult to differentiate them confidently. Anyway, Dr E wasn't impressed with my misdiagnosis. He sneered at me, and said, "It's obvious isn't it that this is condition X, and not condition Y?"
I felt humiliated. Worse still I feel dejected and demoralised.
It may sound overemotional (and maybe a bit sissy-like too). But how am I supposed to stay loyal to such a boss? How am I supposed to give him my 120% when I don't feel appreciated?
Perhaps I'm right afterall to call myself a hospital slave.
Thursday, February 24, 2005
Totally wrecked, utterly disgusted!!
Disgusting! Disgusting! Disgusting!
That's the exact word that echoed throughout the hospital last night.
I admitted a 76 year old lady from a nursing home. Not the ordinary nursing home, but a supposedly HIGH DEPENDENCY nursing home. One which was meant to be providing high level of nursing care 24/7. Very much like spending one's life in an Intensive Care Unit in the community. Mrs S is known to have Progressive Suprenuclear Palsy (PSP), a condition which mimics Parkinson's disease.
A quick glance at her, I knew she had been neglected by her NH. In a very bad way. She was unkempt. She was wearing a dirty food-stained nighties. A few abrasions were evident in her face, some of which were infected and oozing pus. On further examination she had a huge pressure sore in her sacral area. She was also struggling for her breaths. She was severely dehydrated.
Worse still, when one of my nursing staffs catheterised her, pus...I repeat..PUS was drained directly out from her bladder!! Another nurse described it as bad mustard-coloured. More yucky discharge was found dripping out from her genitalia.
As she was non-communicative as a result of the PSP, I decided to phone the NH to obtain more background stories.
1. Mrs S had several falls in the last few days. On one occasion she became drowsy after a fall. (For those who are not familiar with medicine, drowsiness/confusion/coma after a fall often suggests severe head trauma, which includes an intracranial haemorrhage. A medical opinion is mandatory under these circumstances) The staff at the NH however thought the doctor should not be called out to examine the patient.
2. Due to the nature of her PSP, Mrs S had difficulty swallowing. This makes her highly at risk of developing an aspiration pneumonia (ie chest infection due to vomitus getting into the lungs). Those idiots in the NH failed to acknowledge this, and kept on feeding her in the usual manner. And now she came in because of just that.
3. One of the most basic nursing skills is to turn bed-bound patients regularly in order to prevent pressure sore. No half-decent nurse would ignore this simple but important task. But guess what? Those idiots again failed to carry out their duties. Mrs S's sacral sore was like a volcano crater. If that's not bad enough, the staff whom I spoke to over the phone claimed she wasn't aware of her sore!! I decided I won't even bother asking her about Mrs S's bladder and vaginal discharges.
My wife and I come from a third world country. Whenever we discuss about United Kingdom we never fail to admire British civilisation. "How advanced these people are!" "How did they manage to build such a sophiscated castle in the 12th century?" Bla bla bla....In short, we have very high regards for the Brits and their civilisation.
This unfortunate encounter with Mrs S made me rethink my opinion about this supposedly developed, industrialised superpower of the world. A country which at one time colonised 1/3 of the world. How could these people from the NH do such things to a vulnerable old lady?? I'm starting to lose faith.
That's the exact word that echoed throughout the hospital last night.
I admitted a 76 year old lady from a nursing home. Not the ordinary nursing home, but a supposedly HIGH DEPENDENCY nursing home. One which was meant to be providing high level of nursing care 24/7. Very much like spending one's life in an Intensive Care Unit in the community. Mrs S is known to have Progressive Suprenuclear Palsy (PSP), a condition which mimics Parkinson's disease.
A quick glance at her, I knew she had been neglected by her NH. In a very bad way. She was unkempt. She was wearing a dirty food-stained nighties. A few abrasions were evident in her face, some of which were infected and oozing pus. On further examination she had a huge pressure sore in her sacral area. She was also struggling for her breaths. She was severely dehydrated.
Worse still, when one of my nursing staffs catheterised her, pus...I repeat..PUS was drained directly out from her bladder!! Another nurse described it as bad mustard-coloured. More yucky discharge was found dripping out from her genitalia.
As she was non-communicative as a result of the PSP, I decided to phone the NH to obtain more background stories.
1. Mrs S had several falls in the last few days. On one occasion she became drowsy after a fall. (For those who are not familiar with medicine, drowsiness/confusion/coma after a fall often suggests severe head trauma, which includes an intracranial haemorrhage. A medical opinion is mandatory under these circumstances) The staff at the NH however thought the doctor should not be called out to examine the patient.
2. Due to the nature of her PSP, Mrs S had difficulty swallowing. This makes her highly at risk of developing an aspiration pneumonia (ie chest infection due to vomitus getting into the lungs). Those idiots in the NH failed to acknowledge this, and kept on feeding her in the usual manner. And now she came in because of just that.
3. One of the most basic nursing skills is to turn bed-bound patients regularly in order to prevent pressure sore. No half-decent nurse would ignore this simple but important task. But guess what? Those idiots again failed to carry out their duties. Mrs S's sacral sore was like a volcano crater. If that's not bad enough, the staff whom I spoke to over the phone claimed she wasn't aware of her sore!! I decided I won't even bother asking her about Mrs S's bladder and vaginal discharges.
My wife and I come from a third world country. Whenever we discuss about United Kingdom we never fail to admire British civilisation. "How advanced these people are!" "How did they manage to build such a sophiscated castle in the 12th century?" Bla bla bla....In short, we have very high regards for the Brits and their civilisation.
This unfortunate encounter with Mrs S made me rethink my opinion about this supposedly developed, industrialised superpower of the world. A country which at one time colonised 1/3 of the world. How could these people from the NH do such things to a vulnerable old lady?? I'm starting to lose faith.
Friday, February 18, 2005
Our Echo Technician...
Regretably, I ran into argument with someone in the hospital again yesterday.
One of my patients became very unwell suddenly yesterday morning. Despite discussions with two senior consultants, we failed to establish the diagnosis. Dr G suggested an urgent echocardiogram, which I dutifully ordered.
Two hours later, one of the CCU nurse phoned me, saying that the Echo Department refused to perform the test. Realising the gravity of the situation, I placed a quick call to the department. The Echo technician explained to me that she asked the patient to be sent down to the department 1/2 hour ago, but patient didn't come. She won't do it now as the patient had missed her allocated slot.
I asked her, 'Do you take into consideration that the patient might have been too unwell at that time to attend her echo appointment?' To which she replied, 'Don't you dare speak to me like that!!'
I further added, 'Surely it's more important to do perform a test based on clinical priorities'
She very unhelpfully said, 'Well! If it's so urgent, then you should find someone else to do it'
I would if only I could. The problem was the only people who can perform an Echo in the entire hospital were herself and her other colleagues. They ARE the Echo Technicians, for God's sake!
My boss called me at 0830hrs today. Was told by her that the Echo Department have registered their displeasure with the way I handled the situation. Why am I not surprised??
One of my patients became very unwell suddenly yesterday morning. Despite discussions with two senior consultants, we failed to establish the diagnosis. Dr G suggested an urgent echocardiogram, which I dutifully ordered.
Two hours later, one of the CCU nurse phoned me, saying that the Echo Department refused to perform the test. Realising the gravity of the situation, I placed a quick call to the department. The Echo technician explained to me that she asked the patient to be sent down to the department 1/2 hour ago, but patient didn't come. She won't do it now as the patient had missed her allocated slot.
I asked her, 'Do you take into consideration that the patient might have been too unwell at that time to attend her echo appointment?' To which she replied, 'Don't you dare speak to me like that!!'
I further added, 'Surely it's more important to do perform a test based on clinical priorities'
She very unhelpfully said, 'Well! If it's so urgent, then you should find someone else to do it'
I would if only I could. The problem was the only people who can perform an Echo in the entire hospital were herself and her other colleagues. They ARE the Echo Technicians, for God's sake!
My boss called me at 0830hrs today. Was told by her that the Echo Department have registered their displeasure with the way I handled the situation. Why am I not surprised??
Monday, February 14, 2005
Boring life
Life in the hospital is getting more boring by the day. I'm seeing the same sort of patients day in and day out. I'm starting to lose interest. I need more challenges!!
I'm actually quite looking forward to my week of nights, starting from this Friday. As much as I hate night shifts (I love my sleeps, obviously) I think it's about time for me to go on night duty again. At least I'll be practising real medicine, and not seeing the same bunch of old ladies and gentleman who have nowhere to go because of lack of residential beds.
I want to be overworked! I want to clerk lots of new patients! I want to be a true hospital slave!!!
I'm actually quite looking forward to my week of nights, starting from this Friday. As much as I hate night shifts (I love my sleeps, obviously) I think it's about time for me to go on night duty again. At least I'll be practising real medicine, and not seeing the same bunch of old ladies and gentleman who have nowhere to go because of lack of residential beds.
I want to be overworked! I want to clerk lots of new patients! I want to be a true hospital slave!!!
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