They say change is good.
The hospital will be implementing the shift system for the housemen soon. They started a trial run in one of the hospitals and since it has been getting such 'good' feedback, they are now starting it here.
I'm not too clear on how it is going to be, but apparently there will be three shifts with periods of overlap between the two for about two hours. The housemen at the other hospital allegedly loved this new system, because it meant abolishment of the oncall system and it is heard that the MOs, on the other hand aren't too happy as it meant that the housemen were handing over their work to the next shift and nothing ever gets done.
Things are bad as it is; I didn't have housemen till about a year and a half ago and even then we only had two or three at a time. Fortunately most of them have been really good and never brought us much problems so I was totally unprepared for the lousy quality of young doctors that I am seeing here.
I try to take a step back and wonder if I was ever this bad when I was a houseman and I think I was even worse so I try to cut them a little slack, but it irks me when their lack of responsibility for their patients and sense of pride in their work affects how the ward is run.
Note that I didn't say lack of knowledge - a boss I had once said it doesn't really matter if you don't have the knowledge, because you can always go back and read but if you have an attitude problem, well, good luck I guess.
I don't want to sound like an old fart and start reminiscing about the 'good old days' because I hated hearing it when I was being told off by my specialists - but I do honestly think the housemen nowadays have it easy. I have about 8-10 housemen in my ward which has about 45-50 patients. They distribute the patients according to cubicles and most of the times, 1 housemen will be in charge of only about 5-6 patients.
and they still muck things up; one told us confidently during morning rounds that the patient is still being kept fasting awaiting op whereas the said patient had already undergone his procedure the night before.
Eh, did you review the patient or just the case notes?
I try to be nice because I know it can be hard but seriously?
I remember coming to work at half six to bucketfuls of blood requests, going for rounds and then more blood taking - not to mention chasing after radiologists for appointments then accompanying patients for procedures and interspersed between all that, clerking anywhere between 4-8 cases per day.
Some housemen go through the day not clerking any cases at all.
Things are different nowadays indeed.
What will the shift system mean? No oncalls. That would be weird. Being oncall has been so synonymous with being a doctor, that I can't imagine not doing oncalls. I guess one can look at it and say, a well rested doctor is a safe doctor. But, an under exposed doctor can be a dangerous one too.
One doesn't learn during ward rounds; I learnt most of it while being oncall. Being oncall means you get to see the cases and come up with a preliminary plan before presenting it to your superior and see whether you have got it right. Being oncall also means that you get your MO to yourself so, depending on how approachable he/she is, you get to ask questions that you dare not ask during the rounds.
Some say the shift system is being introduced in response to the many parents who have complained about how tired their little princes and princesses after working for more than 36 hours. Some say, it it because too much money is being spent paying for oncall claims, now that there are so many of them but I think, the bottom line is whether it will be the best thing for the patients?
Furthermore, when the housemen have been trained in a shift system, how will they cope with the oncall system once they become MOs? Will that mean that subsequently the shift system will involve the MO as well?
I wait the future with bated breath.
7 comments:
agreed. doesn't matter how many doctors there is or what kind of system the hospital runs, it's practically useless if none or very few of them are responsible. i think, they never bother to take up any responsibility because everyone keeps stressing that "they can't be held responsible".
i don't bother stressing up about it. if they get through housemanship, they'll become medical officers. once they sits on the other side of the fence, where everything could be held against them, they'll wake up.
back in anest, if i get myself a terrible houseman, i told myself that i've been expecting it. if i get a good houseman, i consider it a blessing. i just tell them not to expect me to sign their log book unless i see that they deserve it.
Tell me all about it, it's getting all the hoo-ha at HTM too, how to do a shift system with two HOs? Haha! So we're waiting with baited breath too.
Hafizah-
I guess you are right. Stressing about the dismal state is like stressing about illegal logging and how the politicians are pilfering our money away.....you only get yourself more stressed.
But still.....
WKY-
I thought you had stopped reading my blog! Hehe.
Shift system in Tanah Merah???!!! Crazy or whattttt?????
yeah. that "but still..."
i feel that way too sometimes. i try my best to ignore it. but sometimes, i just explode. i just do. ehehehe...
I'm guessing it's proportionate to the number of posts you have. Haha! No worries, we're getting them freshies already at HTM. At the last count, 9 of them. All doe-eyed, innocent, resuscitation-virgins, what-chama-call-em and with bouts of staring into space, spread out in the various disciplines. Haha!
'one does't learn during ward rounds' then tell me why are doctors in malaysia doing rounds 3 times a day? i was a sr med student in Canada where we only do walkaround rounds with the specialist once a week and the rest of the week we round on patient ourselves and report back to our senior resident (equivalent to MO here) with proposed plans..patients are still safe n more efficient way to manage time rather than hearing specialist yell at HO in the name of teaching..
You are generalising. Not everyone does rounds TDS or QID (though with the shift system we might resort to that). Rounds are done compulsorily in the mornings. Afternoon rounds are done with SELECTIVE patients - those who are gravely ill or has had procedures done and needed updating be it with results or those having new complaints.
Some specialists may take it upon themselves to teach as they do rounds but I found that with a majority of the HOs, the mentality is that 'with rounds I now have a list of jobs that I have to take care of before I go off for lunch' and all they are preoccupied with is finishing that job list. With oncalls, when you are no longer so preoccupied with ward work and all you have is this patient in front of you and you now have to reach a diagnosis and then discuss the plan with your MO. Being oncall means you get to propose a plan of management and still have someone to tell you if you are on the right track because when you are thrown to a district hospital and you are the only MO oncall in the whole hospital and it is 2 am and your patient is deteriorating, you will kick yourself for not paying more attention when you were a houseman.
Well, at least that was how I felt when I did my first oncall in my district posting.
Are you now working in Malaysia?
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