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!!!
Wednesday, February 09, 2005
CNY's eve dinner
As predicted the wifey had done an excellent job yet again. I helped myself to a 5- course feast last night.
CNY treat from the wifey
Wifey and her masterpiece
The highlight was obviously the Yee Sang. Mom said she sent it all the way from Malaysia two Mondays ago, but unfortunately it failed to reach us in time. Flapped we didn't: we made our own Yee Sang. 30min prior to the dinner!!
Having not tasted Yee Sang for the last 9 years, I thought I had already forgotten how it taste. But as soon as the first spoonful gone in and hit my tastebuds, it instantaneously brought back sweet past memories!
Yee Sang - before being 'attacked'
Yee Sang - after being attacked
Later I learned that this sumptuous dinner could easily feed 5 hungry stomachs. Do I care? NO!! I think no one would, if they have the priviledge of tasting such delicious home-made meal.
If I were to be very honest, I couldn't care less about the food or the Yee Sang. I was just glad to have a companion, sitting down with me at the dining table, on a CNY's eve. That's what I would call HAPPINESS.
May the Year of Rooster bring luck and prosperity to everyone!!
CNY treat from the wifey
Wifey and her masterpiece
The highlight was obviously the Yee Sang. Mom said she sent it all the way from Malaysia two Mondays ago, but unfortunately it failed to reach us in time. Flapped we didn't: we made our own Yee Sang. 30min prior to the dinner!!
Having not tasted Yee Sang for the last 9 years, I thought I had already forgotten how it taste. But as soon as the first spoonful gone in and hit my tastebuds, it instantaneously brought back sweet past memories!
Yee Sang - before being 'attacked'
Yee Sang - after being attacked
Later I learned that this sumptuous dinner could easily feed 5 hungry stomachs. Do I care? NO!! I think no one would, if they have the priviledge of tasting such delicious home-made meal.
If I were to be very honest, I couldn't care less about the food or the Yee Sang. I was just glad to have a companion, sitting down with me at the dining table, on a CNY's eve. That's what I would call HAPPINESS.
May the Year of Rooster bring luck and prosperity to everyone!!
Tuesday, February 08, 2005
9 long years
Tonight is the night.
After leaving my family to pursue studies and career in UK 9 years ago, I have been celebrating Chinese New year all by myself year in year out. But not any more! Now that I have a companion-for-life I'm very much looking forward to the CNY's eve dinner tonight. The wifey has been planning the dinner for quite a while now. The menu has changed countless of times. She has been researching through the WWW and cookery books, with the aim of making me the most memorable CNY dinner.
Tonight is indeed The Night.
After leaving my family to pursue studies and career in UK 9 years ago, I have been celebrating Chinese New year all by myself year in year out. But not any more! Now that I have a companion-for-life I'm very much looking forward to the CNY's eve dinner tonight. The wifey has been planning the dinner for quite a while now. The menu has changed countless of times. She has been researching through the WWW and cookery books, with the aim of making me the most memorable CNY dinner.
Tonight is indeed The Night.
Saturday, February 05, 2005
Don't come here in Feb or Aug..or ever!
It's a common belief that early Feb and Aug each year are the worst time to be admitted to hospital. Why? Because new batches of hospital slaves come on duty. They include newly qualified docs who probably still can't tell a fibula from a tibia, and some more experienced docs who are good at treating patients but don't have the slightest clue about their new hospitals.
Mortality rate for in-patients soar during these months. More medical mishaps happen too. Needless to say more risk management forms are being put against the slaves.
I'm not condoning anyone. But personally I think these problems can be resolved if there are more doctors serving in the hospital. Simple mathematical equation:
More doctors = Lower Patient:Doctor ratio = Better care = Less morbidity/Mortality
Instead unnecessary monies are being poured into hiring fatcat managers, who look after statistics rather than the patients. We are here because of patients, we build hospital also because of patients. Yet the Management are more interested in 'keep the stats right to look good'. Unfortunately reductions in mortality/morbidity rates are not targets that have been set by the Government, hence no action from the Management. Until then patients will be seen in A&E within 4 hours (as dictated by the Gov), but then die off quickly after that!!!
Mortality rate for in-patients soar during these months. More medical mishaps happen too. Needless to say more risk management forms are being put against the slaves.
I'm not condoning anyone. But personally I think these problems can be resolved if there are more doctors serving in the hospital. Simple mathematical equation:
More doctors = Lower Patient:Doctor ratio = Better care = Less morbidity/Mortality
Instead unnecessary monies are being poured into hiring fatcat managers, who look after statistics rather than the patients. We are here because of patients, we build hospital also because of patients. Yet the Management are more interested in 'keep the stats right to look good'. Unfortunately reductions in mortality/morbidity rates are not targets that have been set by the Government, hence no action from the Management. Until then patients will be seen in A&E within 4 hours (as dictated by the Gov), but then die off quickly after that!!!
Wednesday, February 02, 2005
Home Hospital
The wifey has not been very well in the last few days. Troubled by severe neck and shoulder pain after coming out from 'Meet The Fockers'. Her being a romantic and loving wife, loves to lean on my shoulder during a movie. I think she must have strained her neck muscles by doing just that.
Paracetamol after paracetamol. Massage after massage. We even tried some traditonal massage oil. But the pain just won't go away. Soon walking up and down the stairs became a big struggle for her. I teased her by calling her a robot, as she scrambled down the stairs in a hilarious robotic manner.
The wife was in bed all day on Monday, hardly able to move. Very reluctantly I volunteered to cook dinner. The last time I cooked for her, she was very enthusiastic before I served the food, but lost her appetite the mo she saw the food that I'd prepared. I kept things simple this time. Surely I could manage making some pasta without causing her becoming nauseated. Luckily it turned out reasonably ok. Well..at least the wifey cleared her plate!
She is now more or less back to her normal self. I'd love to think it's all because of my TLC, and to claim credit for that. I just hope she won't be asking me to cook for her again!!!
Paracetamol after paracetamol. Massage after massage. We even tried some traditonal massage oil. But the pain just won't go away. Soon walking up and down the stairs became a big struggle for her. I teased her by calling her a robot, as she scrambled down the stairs in a hilarious robotic manner.
The wife was in bed all day on Monday, hardly able to move. Very reluctantly I volunteered to cook dinner. The last time I cooked for her, she was very enthusiastic before I served the food, but lost her appetite the mo she saw the food that I'd prepared. I kept things simple this time. Surely I could manage making some pasta without causing her becoming nauseated. Luckily it turned out reasonably ok. Well..at least the wifey cleared her plate!
She is now more or less back to her normal self. I'd love to think it's all because of my TLC, and to claim credit for that. I just hope she won't be asking me to cook for her again!!!
Friday, January 28, 2005
Ash Cash
Hospital slaves' wages are only peanuts compared to other professionals. I earn in a year what a certain galatico Señor Beckham earns in 2 days.
Every bit helps. And one source of extra income is from the ash cash.
For those deceased who will be cremated, a cremation form will need to be filled in prior to the trip down the crematorium chamber.
There are 2 parts to this form. Part A is filled in by the doc who has looked after the deceased prior to death, usually a junior hospital slave like me; Part B by a senior doc with at least 5 years of clinical experience who has never seen the deceased. Both docs will be paid a handsome £55.50 each for their less-than-5 min effort.
Different people feel differently about what to do with the ash cash. Some say the money is sacred, and will willingly donate the monies to charity. Some see the monies as extra pocket money, and will happily spend it.
I fall somewhere between the two groups. Received my dues yesterday, quite a bit of them I must say. And I've decided to donate part of the cash to the Tsunami Appeal Fund. The rest goes to the wifey. Me, still leave with nothing!
Every bit helps. And one source of extra income is from the ash cash.
For those deceased who will be cremated, a cremation form will need to be filled in prior to the trip down the crematorium chamber.
There are 2 parts to this form. Part A is filled in by the doc who has looked after the deceased prior to death, usually a junior hospital slave like me; Part B by a senior doc with at least 5 years of clinical experience who has never seen the deceased. Both docs will be paid a handsome £55.50 each for their less-than-5 min effort.
Different people feel differently about what to do with the ash cash. Some say the money is sacred, and will willingly donate the monies to charity. Some see the monies as extra pocket money, and will happily spend it.
I fall somewhere between the two groups. Received my dues yesterday, quite a bit of them I must say. And I've decided to donate part of the cash to the Tsunami Appeal Fund. The rest goes to the wifey. Me, still leave with nothing!
Wednesday, January 26, 2005
Brief Unprofessionalism
I was doing my routine morning ward round this morning in a 6 bedded room, when I saw this very familiar scene on the ward TV. I didn't believe it at first, but 5 sec later, I'd no doubt about the place. It's my home country: MALAYSIA!!
I failed to control my emotion, and shouted to my patients (3 of which were demented!!): 'It's where I come from! It's where I come from!'
It was only then that I realised it was a bit unprofessional to have shouted like that in the middle of a ward round.
Anyway, I was thrilled to see a British travel documentary TV programme about Malaysia. Just like the title of the programme: "Wished You Were Here!"
I failed to control my emotion, and shouted to my patients (3 of which were demented!!): 'It's where I come from! It's where I come from!'
It was only then that I realised it was a bit unprofessional to have shouted like that in the middle of a ward round.
Anyway, I was thrilled to see a British travel documentary TV programme about Malaysia. Just like the title of the programme: "Wished You Were Here!"
Monday, January 24, 2005
Real Life Medicine
Some many months ago, I was doing an on-call with my senior, Dr B. I was then called to the Casualty urgently to see a middle-aged man with acute chest pain. Myocardial infarction (medical jargon for heart attack) was one of my several differential diagnoses. His ECG was borderline for MI. After discussion with Dr B, we decided not to thrombolyse the patient.
A bit lost now?
Just to give you a crash course on MI. When someone has a coronary, one or more arteries in his/her heart get blocked by a blood clot. As a result, the heart muscle supplied by this artery becomes starved of nutrients and oxygen, and dies. If an ECG is performed during the attack, it will show a certain change called ST elevation. The treatment for MI is a powerful clot-busting drug to dissolve the clot. This procedure is termed thrombolysis. Basically the sooner the drug is being administered, the more healthy heart muscles can be salvaged.
Back to my story. As it transpired, the man did have a heart attack. One of the cardiac nurses (rather unhelpfully) put in a risk management form against the both of us. I was requested to submit a formal report regarding my (lack of) action. Fortunately I was vindicated.
Unfortunately history repeated itself last Friday. I was once again doing on-call with Dr B. A middle-aged lady with yet another borderline ECG. The only difference this time was she strongly and repeatedly denied ever having any chest pain. She was brought in after fainted on a bus. We didn't thrombolyse her because the evidence for MI was rather weak. Subsequent investigations however showed she has had a MI.
I'm sure someone somewhere will very soon put in a risk managment form against me and Dr B.
The problem is: Medicine is never as straightforward as it seems to be! Not every patient, every case would comply with textbook medicine. In fact we hardly ever see such a patient. Working on the shopfloor, seeing real patients with their ever unique presentation of disease, is different from learning a particular medical condition in the textbook. At the end of the day, I am the one who has to make an assessment of the situation, and then initiate a treatment plan which I think is most appropriate. Not the nurses, not the consultant, and DEFINITELY not the fatcat managers.
Hindsight is always a more superior tool. But when I'm seeing a patient there and then, I can only do what I believe is best for my patients.
A bit lost now?
Just to give you a crash course on MI. When someone has a coronary, one or more arteries in his/her heart get blocked by a blood clot. As a result, the heart muscle supplied by this artery becomes starved of nutrients and oxygen, and dies. If an ECG is performed during the attack, it will show a certain change called ST elevation. The treatment for MI is a powerful clot-busting drug to dissolve the clot. This procedure is termed thrombolysis. Basically the sooner the drug is being administered, the more healthy heart muscles can be salvaged.
Back to my story. As it transpired, the man did have a heart attack. One of the cardiac nurses (rather unhelpfully) put in a risk management form against the both of us. I was requested to submit a formal report regarding my (lack of) action. Fortunately I was vindicated.
Unfortunately history repeated itself last Friday. I was once again doing on-call with Dr B. A middle-aged lady with yet another borderline ECG. The only difference this time was she strongly and repeatedly denied ever having any chest pain. She was brought in after fainted on a bus. We didn't thrombolyse her because the evidence for MI was rather weak. Subsequent investigations however showed she has had a MI.
I'm sure someone somewhere will very soon put in a risk managment form against me and Dr B.
The problem is: Medicine is never as straightforward as it seems to be! Not every patient, every case would comply with textbook medicine. In fact we hardly ever see such a patient. Working on the shopfloor, seeing real patients with their ever unique presentation of disease, is different from learning a particular medical condition in the textbook. At the end of the day, I am the one who has to make an assessment of the situation, and then initiate a treatment plan which I think is most appropriate. Not the nurses, not the consultant, and DEFINITELY not the fatcat managers.
Hindsight is always a more superior tool. But when I'm seeing a patient there and then, I can only do what I believe is best for my patients.
Weekend On-call Report
As it turned out, the weekend on-call had not been too bad. 19 new admissions on Friday, of which I saw 10; then 9 on each of Saturday and Sunday (me 5 each).
As usual, the caseloads were predominantly chest pains and SOBs (shortness of breath, that is). It also appeared that there's an outbreak of D+V within the hospital cathcment area. Too much dodgy Chinese or Indian takeaways perhaps??
Apart from a brief argument with one of the A&E Sisters, which in retrospective was totally unnecessary and indeed childish, it was uneventful from the diplomatic front.
Things are starting to look bright again.
As usual, the caseloads were predominantly chest pains and SOBs (shortness of breath, that is). It also appeared that there's an outbreak of D+V within the hospital cathcment area. Too much dodgy Chinese or Indian takeaways perhaps??
Apart from a brief argument with one of the A&E Sisters, which in retrospective was totally unnecessary and indeed childish, it was uneventful from the diplomatic front.
Things are starting to look bright again.
Thursday, January 20, 2005
All calm before storm
Today has been reasonably quiet and easy. But things will be very different tommorow as I'll be on-call for the weekend, starting from tommorrow. This means I'll be the clerking machine, seeing the vast majority of the new acute medical patients. I'll be working non-stop (most probably) from 0830 till 2130. I would not have time to rest or to eat. In fact base don my previous experience, taking a 2 min toilet break would be equally impossible.
Friday is always a mayhem in the hospital, with GPs referring every single patient they see to us, and then go on a weekend break. We,on the other hand, will have to sort out their mess from the community. If the GPs detect any hint that the patients might give them problems over the w/end, he or she will have absolutely no hesitation to chuck them to us. They hate to have their w/end interrupted by patients. They don't want to be called out to see patients at home. Weekdays fine, weekend NO!!
So we will most likely end up having 30-40 patients being sent to us in a 12 hours shift. That's an awful lot for a district general hospital. Worse still, there will only be 3 doctors on-call tommorrow. Even worse still, is that because I'm the SHO, I will be seeing 60% of them. The JHO, being a newly qualified doc, is understandably slower then me; the Registrar, being more senior than me, will only troubleshoot here and there. It would be lucky if he can help me to clerk a few patients.
Nonetheless I think the experience would be most rewarding and gratifying. Only if I don't end up arguing with the Management (again!!) tommorrow regarding the A&E 4 hour waiting time target.
Friday is always a mayhem in the hospital, with GPs referring every single patient they see to us, and then go on a weekend break. We,on the other hand, will have to sort out their mess from the community. If the GPs detect any hint that the patients might give them problems over the w/end, he or she will have absolutely no hesitation to chuck them to us. They hate to have their w/end interrupted by patients. They don't want to be called out to see patients at home. Weekdays fine, weekend NO!!
So we will most likely end up having 30-40 patients being sent to us in a 12 hours shift. That's an awful lot for a district general hospital. Worse still, there will only be 3 doctors on-call tommorrow. Even worse still, is that because I'm the SHO, I will be seeing 60% of them. The JHO, being a newly qualified doc, is understandably slower then me; the Registrar, being more senior than me, will only troubleshoot here and there. It would be lucky if he can help me to clerk a few patients.
Nonetheless I think the experience would be most rewarding and gratifying. Only if I don't end up arguing with the Management (again!!) tommorrow regarding the A&E 4 hour waiting time target.
Wednesday, January 19, 2005
X-Ray Update
At last we have the knee X-ray for Mrs B. NO fractures, NO evidence of osteoarthritis, NO calcification. Good for her. Let start mobilising her a bit more with physio.
Tuesday, January 18, 2005
Patient knows best
One of my patients was admitted with knee pain last Thursday via the Casualty Dept. According to the hospital computer system, she had a knee x-ray in the department. When I fisrt saw her on Friday, she was adamant that all she had in Casualty was a chest X-ray. No knee.
She suffers from Parkinson's, and looked a bit confused then. I promised her I would find her knee film, thinking that she might be forgetful. Meanwhile we should treat her pain symptomatically.
Days came and gone. Still no knee x-ray found today, and more crucially patient is still in much pain. I finally decided to place an urgent call to the X-ray Dept.
"Sorry doc. The knee was requested, but the form wasn't signed by the Casualty Officer. So it wasn't done", said the radiographer.
DUHHH!!! No wonder no one could find the knee film.
Mrs B has Parkinson's, but obviously she isn't demented. I wonder, I wonder why didn't I believe her last Friday? Surely the patient knows best??!! I just hope there isn't any thing serious (eg a big fracture) on her knee X-ray (to be done in the next 1/2 hr). Will keep you update!
She suffers from Parkinson's, and looked a bit confused then. I promised her I would find her knee film, thinking that she might be forgetful. Meanwhile we should treat her pain symptomatically.
Days came and gone. Still no knee x-ray found today, and more crucially patient is still in much pain. I finally decided to place an urgent call to the X-ray Dept.
"Sorry doc. The knee was requested, but the form wasn't signed by the Casualty Officer. So it wasn't done", said the radiographer.
DUHHH!!! No wonder no one could find the knee film.
Mrs B has Parkinson's, but obviously she isn't demented. I wonder, I wonder why didn't I believe her last Friday? Surely the patient knows best??!! I just hope there isn't any thing serious (eg a big fracture) on her knee X-ray (to be done in the next 1/2 hr). Will keep you update!
Friday, January 14, 2005
One step closer..
Received my MRCP Part 2 written paper result yesterday. Believe it or not: I PASSED!!
Didn't think I would pass this time. In fact I felt awful coming out of the exam hall 1 month ago.
Have been receiving words of congratulations from bosses and colleagues all day. Needless to say, both the wifey and myself are thrilled with the result.
2 down, 1 more to go. Shall sit for the next part of the exam in July. Hopefully it will turn out alright too. With a bit of luck, I would be able to add the magical 4 letters M-R-C-P behind my name come this August. Can't wait!
Didn't think I would pass this time. In fact I felt awful coming out of the exam hall 1 month ago.
Have been receiving words of congratulations from bosses and colleagues all day. Needless to say, both the wifey and myself are thrilled with the result.
2 down, 1 more to go. Shall sit for the next part of the exam in July. Hopefully it will turn out alright too. With a bit of luck, I would be able to add the magical 4 letters M-R-C-P behind my name come this August. Can't wait!
Tuesday, January 11, 2005
A dying patient
Mr KB was a very pleasant man. Diagnosed of advanced lung cancer few months back, but never gave up on hope nor himself.
I was asked to see him 2 days before his demise. He was breathless, but in my opinion no worse than usual. His daughter asked if Mr B could be placed in a single room, instead in his current 6-bedded room. They would like a bit more privacy, she pleaded.
I told her this was not possible, because the room was occupied by a patient troubled by D+V. In actual fact, this patient had not have any more D+V for at least 48hrs (ie not contagious anymore). This would mean, in theory, their beds could be easily swapped. I turned down their request for a single room, partly because I didn't think Mr B was terminally ill, but mainly because I thought it would be too much of a trouble for the nursing staff to swap patients all over the ward.
Mr B then went downhill rather rapidly and unexpectedly. Later that night (after I went off duty), he was moved into the sideroom. I saw him again 2 days later, at this point, he appeared moribund and was really struggling for his breaths.
I asked him if he would like to have a small dose of morphine to keep him calm and comfy. He duly accepted my offer. 2 hours later, he passed away peacefully in the presence of his entire family.
I'm glad I managed to provide him some comfort shortly before his death. But I can't forgive myself for turning down their request for some privacy during Mr B's final days, on the basis of 'not wanting to trouble the nurses'.
Afterall, that's what we, as the healthcare providers, are paid to do.
R.I.P, Mr B.
I was asked to see him 2 days before his demise. He was breathless, but in my opinion no worse than usual. His daughter asked if Mr B could be placed in a single room, instead in his current 6-bedded room. They would like a bit more privacy, she pleaded.
I told her this was not possible, because the room was occupied by a patient troubled by D+V. In actual fact, this patient had not have any more D+V for at least 48hrs (ie not contagious anymore). This would mean, in theory, their beds could be easily swapped. I turned down their request for a single room, partly because I didn't think Mr B was terminally ill, but mainly because I thought it would be too much of a trouble for the nursing staff to swap patients all over the ward.
Mr B then went downhill rather rapidly and unexpectedly. Later that night (after I went off duty), he was moved into the sideroom. I saw him again 2 days later, at this point, he appeared moribund and was really struggling for his breaths.
I asked him if he would like to have a small dose of morphine to keep him calm and comfy. He duly accepted my offer. 2 hours later, he passed away peacefully in the presence of his entire family.
I'm glad I managed to provide him some comfort shortly before his death. But I can't forgive myself for turning down their request for some privacy during Mr B's final days, on the basis of 'not wanting to trouble the nurses'.
Afterall, that's what we, as the healthcare providers, are paid to do.
R.I.P, Mr B.
Monday, January 10, 2005
RISK MANAGEMENT
Attended a talk on 'Risk Management' late last week. The speaker was the Head of Risk Management Dept of the hospital I'm currently serving with. To me, he's just another $50000-a-year fatcat who is draining the resource-depleted NHS. In another word, someone who is employed to do nothing so that no more monies are made available to better staff the medical and nursing departments.
He said most adverse incindents could be avoided if the risk-takers(ie doctors) could be a wee bit more careful. He went on to show us graphs after graphs of meaningless statistics. This was followed by an explanation of the incident reporting system and the way his department (staffed by more fatcats) deal with problems.
I must have dozed off half way through his talk, becoz I didn't seem to recall him mentioning anything about his ridiculous wages and the lack of doctors on the shopfloor.
I woke up just in time to hear a member of the audience asking him if the shortage of doctors in the hospital constitutes a risk, and what is his department going to do about it.
To this end, he answered: 'Well, my department only collates data. We then submit them to the Board. They are the one who make decisions about the hospital.'
I left the talk no wiser than when I first arrived. One can only wonder why the department wasn't called Risk Data Collation Department. In what exact way does it actually MANAGE risk??
He said most adverse incindents could be avoided if the risk-takers(ie doctors) could be a wee bit more careful. He went on to show us graphs after graphs of meaningless statistics. This was followed by an explanation of the incident reporting system and the way his department (staffed by more fatcats) deal with problems.
I must have dozed off half way through his talk, becoz I didn't seem to recall him mentioning anything about his ridiculous wages and the lack of doctors on the shopfloor.
I woke up just in time to hear a member of the audience asking him if the shortage of doctors in the hospital constitutes a risk, and what is his department going to do about it.
To this end, he answered: 'Well, my department only collates data. We then submit them to the Board. They are the one who make decisions about the hospital.'
I left the talk no wiser than when I first arrived. One can only wonder why the department wasn't called Risk Data Collation Department. In what exact way does it actually MANAGE risk??
Friday, January 07, 2005
Prawn attack!!!
The wifey cooked me some very delicious prawns in tomato sauce last night. Thoroughly enjoyed it.
Then bammmm!! My head started to itch suddenly. Then my ear canals. Better get a quick hairwash I thought. It was after the wash that my wife asked, 'Hey! What happened to your skin?'
I was covered in weals, spots and rashes, all over my body. My face started to burn. My non-medic wife cleverly suggested that it could be an allergic reaction to the prawns.(Hey smartie! Wanna be my medical assistant?)
The itch became a bit too much to bear. Double-quick stepped to the local A&E, and was told I needed to register first. Worse still, there were loads of people already there waiting to be seen. God knows the waiting time. By this time my face was like a furnace. I cheekily slipped into the treatment area, and found a colleague of mine on duty. She immediately gave me some strong antihistamines.
I'm not sure if it was a placebo effect or not, but I certainly felt a lot better itch-wise after ingesting the antihistamine.
Wifey then asked if we should sue the supermarket where we bought the prawns. Nah! Itch or no itch, I have had a nice meal. Let them off this time, I say.
Then bammmm!! My head started to itch suddenly. Then my ear canals. Better get a quick hairwash I thought. It was after the wash that my wife asked, 'Hey! What happened to your skin?'
I was covered in weals, spots and rashes, all over my body. My face started to burn. My non-medic wife cleverly suggested that it could be an allergic reaction to the prawns.(Hey smartie! Wanna be my medical assistant?)
The itch became a bit too much to bear. Double-quick stepped to the local A&E, and was told I needed to register first. Worse still, there were loads of people already there waiting to be seen. God knows the waiting time. By this time my face was like a furnace. I cheekily slipped into the treatment area, and found a colleague of mine on duty. She immediately gave me some strong antihistamines.
I'm not sure if it was a placebo effect or not, but I certainly felt a lot better itch-wise after ingesting the antihistamine.
Wifey then asked if we should sue the supermarket where we bought the prawns. Nah! Itch or no itch, I have had a nice meal. Let them off this time, I say.
Wednesday, January 05, 2005
EASY LIFE
Best day of my medical career life so far! As a hospital slave (who is underpaid and definitely overworked), I usually have 35-40 patients directly under my care. I see them every morning during my ward round, and depending on the caseload and the severity of their medical problems, each round last between 3.5 to 6 hours.
Today, for the 1st time ever, I had only 8. Never have I ever finished my ward round in 1.5 hours. Which means after 1030hrs, I just hung around doing nothing. And still got paid for that.
Starting to sound like a typical Malaysian civil servant, huh??!
Today, for the 1st time ever, I had only 8. Never have I ever finished my ward round in 1.5 hours. Which means after 1030hrs, I just hung around doing nothing. And still got paid for that.
Starting to sound like a typical Malaysian civil servant, huh??!
Tuesday, January 04, 2005
Good to be back
Thank God! The festive period is finally over. Believe it or not! I dread Xmas and New Year every year. Shops don't open when you need them most, public transport not providing frequent enough services, and damn!! hospital came to a standstill with only few (unlucky)doctors working. Yours truly was one of the unlucky ones.
We had a full strength of doctors today. Great! It means things get done, patients are seen and treated. Everybody is happy. I think the biggest winners are undoubtedly the patients.
Put it boldly: I would not wish to be admitted to a hospital during the Xmas/New Year period. How on earth am I going to get the best treatment when there are so few doctors around?? What's the point of spending millions of pounds investing in high-tech medical gadgets, when you can't even finance more doctors to work??
I suspect if the media (tabloids especially) get the wind about the way hospitals were run during this period, they will absolutely have a big field day.
At the end of the day, we are here to serve. Patients' interest should always be the top priority in the operation of any hospital.
Have we all failed our solemn duty to the patients??
We had a full strength of doctors today. Great! It means things get done, patients are seen and treated. Everybody is happy. I think the biggest winners are undoubtedly the patients.
Put it boldly: I would not wish to be admitted to a hospital during the Xmas/New Year period. How on earth am I going to get the best treatment when there are so few doctors around?? What's the point of spending millions of pounds investing in high-tech medical gadgets, when you can't even finance more doctors to work??
I suspect if the media (tabloids especially) get the wind about the way hospitals were run during this period, they will absolutely have a big field day.
At the end of the day, we are here to serve. Patients' interest should always be the top priority in the operation of any hospital.
Have we all failed our solemn duty to the patients??
Saturday, January 01, 2005
HAPPY NEW YEAR
Not a very good start to the new year, with the rapidly rising number of deads in the Indian Ocean region. I'm contended with what I have: a wonderful wife and a seemingly good career. I should consider myself very lucky indeed.
Nonetheless, a new year would be less meaningful without naming a few new year's resolutions. I wish:
1. to pass my MRCP exams
2. to attend more outpatient clinics (time & workload allow)
3. to perform my first cardiac pacing procedure
4. to have less run-ins with the hospital management,
and most importantly,
5. to spend more time with my family
Have a good one everybody!!
Nonetheless, a new year would be less meaningful without naming a few new year's resolutions. I wish:
1. to pass my MRCP exams
2. to attend more outpatient clinics (time & workload allow)
3. to perform my first cardiac pacing procedure
4. to have less run-ins with the hospital management,
and most importantly,
5. to spend more time with my family
Have a good one everybody!!
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