Young doctors mollycoddled

Read this, can't agree more!

http://www.thesundaily.my/node/67897

Young doctors mollycoddled

Posted on 12 October 2011 - 08:53pm
Last updated on 12 October 2011 - 10:00pm

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.

S.A.
via email

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: £$%@&*

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!

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.

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.

http://mr6.cc/?p=5451&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+mr6+(Mr.+6)

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？

所謂「睡眠者效應」，來自於二次世界大戰，當時美國對現役軍人播放一些戰爭教育電影，主要想提振美軍的士氣，讓他們很想「參戰」！他們在這些軍人看完電影之後，對他們立刻測驗，結果令電影拍攝者「大失所望」，因為這些美軍竟然完全不被電影所影響，「並沒有」因為看了電影，而產生任何感動或參戰的衝動。檢討原因，應該是因為美軍在看電影之前，就已經先知道這是一部「戰爭教育片」，那是拿來影響他們、教育他們用的，因此美軍在觀賞電影之前，就已經先在心裡建築了一道無形的「心牆」，讓這部電影的訊息「進不來」！

縱使那部電影拍得多麼血腥，多麼震撼，又多麼的令人氣憤，任何正常人一看完都會產生「戰爭」的愚蠢衝動，但是這些美軍因為「心牆」，所以讓這部電影的訊息，竟然進不了他們的內心深處。

有趣的來了。他們對同一批美軍，在幾個月後再做第二批的調查，結果發現，歐不，大家搞錯了，電影並不是沒有進入美軍的內心深處！

它，早就進來了。

第二批的調查顯示，許多美軍開始莫名其妙的產生了強烈的戰鬥的慾望！他們不知道為什麼，但是心理學家認為，應該是幾個月前的電影的效果，他們開始研究，為何這些戰鬥電影的效益，要到幾個月後才會出現？而且，這些美軍還不知道，他們的戰鬥慾望，是因為這些電影所造成的？

他們以為已經「拒絕」了美國政府的「強迫推銷」，但其實，美國政府早就已經成功的鑽入竄入他們的心裡了？

心理學家發現，原來，當下這些美軍對電影製作者（或許是他們的祖國「美國」），有著太深的既定印象「美國就是要催眠我、叫我打仗」，所以不相信電影的震撼畫面，但是，過了幾個月後，電影的震撼畫面的記憶，比對電影製片者的記憶，撐得還要久，以致於最後美軍只記得那些震撼畫面故事，忘了到底是誰給他們那些震撼畫面與故事的，這些電影，終於在幾個月後，達成了他們當初設定的目標！

啊，到底怎麼回事？

為何會產生這麼奇特的「睡眠者效應」呢？

我這邊就引用智庫百科的資料，可以整理成二大原因：

原因一，是因為大家對「人」或「品牌」，比較「記不牢」：「名字」畢竟還是一個比較「抽象」的概念，人的記憶本來就對人或品牌比較不容易記得長長久久。或許這個人很差勁，或者對此公司的印象不佳，但沒關係，只要這個人或這間公司當下給了的那個「畫面」或「故事」有夠震撼，那麼，最後大家終究會先忘了這個人或這個品牌，只記得那個畫面，讓這個畫面的效果，到很久很久以後好好的展現出來。

原因二，當下的「人」或「品牌」效果太大，大到當場不正常扭曲或擴大來掩蓋掉主要的訊息：雖然「人」與「品牌」是記不牢的，但是它們在當下的影響力可能太大，大到在當下「蓋過」了主要的訊息，讓主要的訊息在當下沒辦法發揮出來。這種現象有時候是因為「意義障礙」：所謂的意義障礙，主要是因為人們在接受訊息時，因為那個「人」或「品牌」的短期效果太強烈，讓他心理上產生了巨大的情緒，因而妨礙了他去正常理解前面的這一段訊息而產生的。時間過去後，這些「意義障礙」慢慢不見，這個人終於可以正常的理解、分析一段訊息。

所以，它對於「行銷」的意義為何呢？

我舉個兩個真實的廣告例子的自己的體驗，我看到某廠牌牙膏的廣告，告訴我目前市面上的牙膏，有70%（或類似這個數字）不是在台灣製造的。當時我並沒有因為這個廣告，而買了這個產品，但久久之後到今天，我甚至忘了是哪一家廠商對我作這個廣告的，但今天我在挑選牙膏的時候，那個畫面、那個訊息依然太震撼！以致於我會直接挑選明顯的是「海外原裝進口」的牙膏，寧可付貴一點！換句話說，如果你是一間明顯的是「海外原裝進口」的廠商，那麼你可以透過這一個強烈的訊息，就算在當下沒有太大反應，在幾個月後、甚至幾年後，甚至往後的幾十年，會收到我這個消費者「永遠的不斷回來買單」。

但另一個例子，就是某綠茶廣告的「女友瘦身、男的噴鼻血」的畫面，這個廣告讓近百萬人在YouTube看過，印象非常深刻，也對這位女生手上的那一個牌子的綠茶，產生深刻的印象。但，也由於「睡眠者效應」，在一兩年後，人們一定還記得這位瘦身過後的女性和那個噴鼻血的男生的畫面，但是會忘了她手上握著什麼品牌？加上超商架上一大堆的綠茶品牌，混亂了我們心中的印象，最後大家只會記得這廣告所要產生的訊息「喝綠茶可能能瘦身」，卻忘了是誰要傳達此訊息。這家廠商有可能不小心幫「同業」「一起」打了一場廣告。

另外，該文章在他處有一則留言，內容是某間公司說：「啊哈，難怪有時候去客戶那邊提創意，當下客戶覺得不怎麼樣，結果，過了五個月以後，他們做出來的東西，和我當初講的一模一樣！」這種事情，我們也曾經碰到過，由於我們是網路行銷團隊，當我們去「建議」這個點子時，客戶一定會在心中築起「心牆」，產生排斥，不接受我們的「強迫推銷」，也因此不認為我們精心提出的這個點子有多麼偉大、多麼大創舉？但過了幾個月後，當他們再次有網路行銷需求，回來想想應該做什麼事，這時候他們對當時的「點子」仍有印象，卻忘了是誰提的。在我們看到客戶在幾個月後做出一模一樣的東西之後，現在我們都會每幾個月就回到原客戶那邊問問看，甚再追加一些點子，他們的反應和當初會很不一樣。

所以，大家要記得，有時候我們向他人推銷什麼東西，當下是被「拒絕」的，但其實，我們努力的推銷、努力的將畫面與故事塞到他的耳朵裡，就算當下沒有得到回饋，其實，已經進入了他/她的心裡了。

有趣的是，「睡眠者效應」還不止於「行銷」上面的意義，它還告訴我們人生的道理──

簡而言之，睡眠者效應就是在說兩件事，這兩件事可以在人生中參考：

第一：通常讓決定我們「短期」要做什麼事的，是某個「人」，或某件重大的、充滿情緒化的事件。

第二：但是，決定我們一生長久的幸福、快樂、美滿的，卻是超越人、品牌、情緒等等所有表面物品的「下面」的那些事！

舉個例子來說，今天你的工作可能在一間公司，老闆兇巴巴的，主管天天盯你，當下很火大，真的很想馬上抬起屁股一走了之。你會很不解，為何其他人都還是工作得好端端的？

「睡眠者效應」說，有可能你還沒看到這個工作場合的好處，只看到當下的激動、不爽，只被當下那個「人」給氣得沖昏了頭！其他人或許也曾經激動，但沒有行動，反而慢慢的慢慢的看到「下面的好處」，酒愈陳愈香。我們甚至可以說，「睡眠者效應」為這些待得久的員工構築了保護門檻，幫助他們擋掉新進的、躁進的同事。

另個例子來說，有些人對一些朋友、親戚、甚至自己的長輩無法諒解，有的人對自己父母懷著恨意，電視上見到某藝人或素人說：「永遠無法原諒他/她！」那表示事情才剛剛發生。但，你會發現，許多比較老一點點的藝人/素人卻在電視上侃侃而談，「當年」是多麼恨誰，現在卻已經釋懷，再大的仇恨都可以化為烏有，為什麼？WHY？有可能也是因為「睡眠者效應」。我們以為是時間的關係讓我們「淡忘」，但其實，我們只是忘掉了那個「人」，還記得「事」，由於對「人」不再這麼排斥，我們終於看到了「事」的全貌，可以冷靜的判斷。

其實，「睡眠者效應」在教我們的是，人生是一段很長的過程，如果是平常的決定，那麼明快的訣擇是行動力的展現，愈俐落愈好，但如果是雍關一生的決定，那麼，不一定要在當下產生「激烈」的決定，不然，五年之後、十年之後，當「睡眠者效應」發酵之後，以前重要的變成不重要，以前不重要的慢慢浮現，將後悔莫及！

我們的人生，乃由雜陳的五味所組成的，我們每天的心情乃由好幾種心情交叉混合、輪流搭配出來的，所以，今天的不快樂並不是因為你不快樂，而是因為「快樂不比不快樂多，不快樂比快樂多一點」，到最後，這些讓我們每天痛苦與快樂的「人」，或「品牌」，或「情緒」，總有一天會被遺忘的。

這也告訴我們，就算在辛苦的時刻，仍然努力的把握那一點點的玩樂、一點點的放鬆時刻，儘管只是到樓下抽根煙，也是放鬆；儘管是周末短暫十五分鐘走在無人的街上，也是放鬆。「睡眠者效應」告訴我們，應該用各種方式來盡量延長，人生別毀在當下的感受，真正的氣味要釀久一點才會慢慢出來的。

Doctor too many, Part 5

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

http://hsudarren.wordpress.com/2010/12/01/a-doctor-too-many-5/

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

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?

http://thestar.com.my/news/story.asp?file=/2010/11/27/nation/7514254&sec=nation

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