Thursday, October 13, 2011

Young doctors mollycoddled

Read this, can't agree more!

Young doctors mollycoddled

I REFER to “Overworked housemen” (Letters, Oct 5) and other grouses that increasingly make their way into our media by Generation Y housemen. As a specialist in a government hospital in Selangor, I feel that instead of silence that may be misconstrued as guilt, there is a need to reply.

We are now at a crossroads in our health system. The high standards that were maintained through the years have fallen by the wayside. This is especially evident from the constant complaints of the younger generation, although the system and the government are bending over backwards to accommodate them. The reasons:

-- An overload of new housemen/doctors – 500 a year in 1998 and 7,500 in 2011, with the number estimated to rise to 10,000 in coming years.

-- Too many medical schools in the country – 42 at the last count, with some having very low standards. Indonesia with a population of about 300 million has half the number. How did these colleges come to be recognised?

-- Too many medical schools recognised overseas, with the standards, especially of Russian ones, being extremely low.

-- So we are now inundated with housemen to train, wherein 60% are of very low standard – meaning not even fit to pass the finals in a medical school exam, let alone to treat patients.

-- We, the specialists, are forced to retrain and even reteach these incompetents.

-- There are only so many times you can give advice to a person who doesn’t listen – sometimes when a patient’s life is at stake, voices have to be raised! Don’t you agree?

-- Increasingly, our politicians get involved when some VIP’s son or daughter who can’t cope, just wants to float through. Many specialists have been given letters of warning, when all they were doing was enforcing appropriate disciplinary action in respect of housemen who had gone AWOL.

-- The number of litigation cases against the Health Ministry due to housemen is at an all-time high.

-- The shift system was opposed by all senior faculty in the ministry, vis a vis all senior specialists, but it was forced on us. Who is going to monitor all these housemen under the shift system – the specialists?

-- When these housemen become medical officers and specialists, are they also going to go on shift?

-- We have better things to do than mollycoddle a tsunami of sub-standard doctors. If we are not careful, there will be a great exodus of specialists from the public health system in the next few years.

All you see in government hospital nowadays are the poor and the illegals – everyone else has an insurance card! So to the powers that be, wake up and smell the coffee.

via email

Tuesday, December 14, 2010

Hospital Scenario #3

An orthopaedic HO referred a case to Internal Medicine MO.
HO: This 75 chinese male was admitted for multiple infected bed sores, need Wound Debridement under General Anesthesia, we want to refer medical for pre-op optimization.
MO: So, what's the underlying medical condition that u want me to optimize?
HO: The patient does not have any co-morbid or no known medical illness.
MO: (already got irritated and started to raise his voice) So, why the patient got bed sore?
HO: Err... not sure, according to family member he has been bed ridden for few years.
MO: Did the patient has any him fracture, stroke, spinal injury?
HO: Err... I m not sure.
MO: So, can u ask further history from the patient or call the family to find out further?
HO: Ok.

1 hour later, HO called the MO back: The family member is here for u take further history, Dcotor.
MO: £$%@&*

Monday, December 13, 2010

Hospital Scenario #2

An old Lady was admitted for epigastric pain yesterday, provisional diagnosis was treat as gastritis and to rule out acute coronary syndrome. This morning an "innocent" HO did round, happily copy down the investigation results, stated Troponin I 15U and CKMB 22U, and impression was still " Treat as gastritis and to rule out ACS."
The MO: OMG!

Thursday, December 9, 2010

Scenario in Hospital *1

Mecical officer : Off this patient Central venous line.
House officer : Yes, sir.
The house officer took out his scissors, immediately cut the exposed part of the central venous line, leaving the internal line remain in patient's vein and said : I'm done, sir.
Medical officer was shocked and terrified.

Wednesday, December 1, 2010

睡眠者效應(Sleeper Effect):當下被拒絕,但其實已經成功了

A Taiwan article, nice. Remind me that journey of life is very long, no need to rush.

昨天看到一則文章,非常有趣,它是提到心理學的一個現象「Sleeper Effect」,中文可翻作「睡眠者效應」。這篇文章在探討,「睡眠者效應」在心理學上已久,但是,它在「行銷」方面教了我們什麼呢




























Doctor too many, Part 5

Can't agree more, would like to share this article

A doctor too many — 5

The problem of too many medical schools being set up in too short a period, which I have raised repeatedly many months ago, is finally being acknowledged by the authority.

On Saturday, Star carried a story on its first page prominently about too many housemen in our hospitals.

Then yesterday, Minister of Health was quoted in the Star, while acknowledging there are too many doctors, as saying that the two ministries (ministry of Health and Ministry of higher education) were working together to ensure a “satisfactory quality” of medical students graduating from abroad”.

I have written in MalaysianInsider about the problem of having too many medical schools, and in May this year, I have written a press statement as well as called a press conference on this issue. It was carried by Sun, as well as Nanyang.

The problem of too many medical schools being set up in too short a time–over the last 10 years, 21 medical schools were set up – inevitably resulted in a shortage of good and experienced medical teachers. It has also resulted in the training facilities unable to grow fast enough to cater for all the medical graduates, resulting in one housemen to 3 or 4 patients ratio, instead of the ideal of 1 to 15 patients.

When there is not enough patients to learn from, the houseman would have very limited hand-on experience to deal with illnesses later on, because after all, medicine is apprenticeship. We learn from looking after patients. The more patients under our care, the more variety of cases we will see, the more experience we gain and the more competent we become.

There are now 3500 housemen being churned out a year. The figure is to hit 4500 soon when all the local medical schools become fully functional. The problem is not with the foreign graduates. The crux of the problem is that we are simply producing too many local doctors without facilities and manpower to adequately train them.

As regards to the standard of foreign graduates, what we have to do is much simpler. Do not simply give recognition to any overseas Medical colleges, especially those from under developed countries. We need to vet them thoroughly before recognition can be considered. There is really nothing wrong with those graduating from UK, US, Canada, AUstralia or NZ. Their medical schools are of world class. Not so with some of the universities of our Big Neighbour down South. Some of the universities have not even been heard of, but they are either producing doctors for us directly or are in partnership with some of our medical schools to provide twinning courses and indirectly producing doctors for us.

Nowadays, it is easy to set up medical schools. You dont even need to have hospitals to back you up. Just pull your string to get a license, and the rest is easy. Set up a pre-clinical school where medical sciences like biochemistry anatomy and physiology are taught and this part is easy and will be like setting up any science colleges. . Once you have a pre-clinical school, the clinical training part can be arranged with some of the unknown universities down south, and there you go, you have a full university churning out doctors. Parents are paying through their nose to put their children in these so-called twinning program. Nevermind the university is unheard of, as long as our Health Ministry recognises it, and as long as the title Dr can be awarded to the graduate.. This is unhealthy.

There cannot be double standard in the vetting of medical colleges overseas, just as we cannot allow any Tom Dick and Harry to set up medical schools locally to make money.

Otherwise, we are going to face with the problem of doctors unable to diagnose simple cases. There is really no point pouring billions into our health system when our doctors in future cannot even treat simple cases correctly or undertake simple procedures competently.

There are already anecdotes of doctors unable to take blood from patients, or of doctors watching movies in cinema during office hours, or doctors loitering in canteens simply because there are too many of them in a ward. These doctors are going to be the very ones that will tend to our healthcare, you and me included. Our lives will be literally be in the hands of these people.

If the situation does not improve, all I can say to you is that ” May God Bless you” the next time you need to see a doctor.

Related readings:

A doctor too many

A doctor too many 2

A doctor too many 3

A doctor too many 4

Sunday, November 28, 2010

Life of a Houseman in GH in 2010

Can't believe it but it's true, there are just too many houseman around who got nothing to do. How are they going to be trained and function as a capable doctor later?

Saturday November 27, 2010

Time even for a movie during work

PETALING JAYA: Some housemen in a Klang Valley hospital have so little work that they can even catch a movie during their shift, claimed a medical officer, who declined to be named.

“It was because they knew that the medical officers (senior doctors) would just do the work instead,” she said yesterday.

She added that some specialists and heads of department were reluctant to give more work to housemen.

However, the doctor said she received adequate experience when she did her housemanship at the Sultanah Aminah Hospital in Johor.

Another doctor, who had recently completed his housemanship at the same hospital, said his peers in the Klang Valley also said they were not given enough responsibilities.

“Since the beginning of my housemanship and until the time I left two months ago, the housemen in the hospital where I was trained, had sufficient training on the job,” he said.

Related Story:
Too many new doctors and too few hospitals to train them