Tagging & Expectations [1]

Salam...
Continuing from the previous post...

Tagging
Once you enter a department, you will be doing ‘tagging’ which usually last for 2 weeks for most departments, especially for a first poster. Working hours for a houseman generally starts at 7 a.m.. During tagging it’s usually from 7 a.m. to 10 or 11 p.m. everyday until you’ve been given off-tag.
So what do you have to do during tagging?

1. On the first day or the day before your first day into the department, go and introduce yourself to the Head of Department, and then to the ward’s Sister so that they know you’re coming.

2. Clerk as many patients as you can. Clerking means to get full history from the patients, do full examinations, come to a diagnosis and different diagnoses, plan and take related investigations and do your own plan of management for that particular patient. The more cases you see, the more familiar and comfortable you are with taking history & doing examinations. The more variety of cases you see, the easier it is to remember the management. Usually every cases will be seen by an MO after you finish clerking- learn to present properly, fluently and with confidence.

3. Learn and practice how to do procedures- basic procedures such as venupuncture, inserting branula, taking blood C&S using aseptic technique, inserting urinary catheter, inserting Ryle’s tube are all things that you are expected to be able to do by the end of your tagging. Paediatrics may be a little different; and some department also require you to be able to insert central venous long line, do peritoneal dialysis, wound debridement, inserting tibial/calcaneal pin etc.

4. Learn what form to fill for which investigation and which bottle to fill in. Learn how to trace the results. Learn to to refer cases and write referrals.

5. If you are in O&G, surgical or orthopaedic, learn to book/post cases for operation, how to fill in the form etc. Find out from your senior colleagues if there are special/extra requirements that you need to complete to be off-tag. This depends of the department and hospital you’re working in. For example, if you’re in O&G, you may need to conduct 10 deliveries and assist 5 C-sec to off-tag.

Expectations (Part 1)

Not in order of priority/importance, I’m writing this part as a fellow senior houseman who has passed her housemanship:

• Niat: Please correct your intention of working in medical field. We are doing service-based job so we deal a lot with people with different attitude, expectations and behaviour. This can be very stressful but in the end there are only two things: we’re trying to help patients and we seek to find barakah in our job. My previous Dean of Medicine gave us this du’a and most of my colleagues and I recite this in our prayers: "O' Allah, please let us be the tool of Your Mercy in serving the humanity regardless of race, creeds and religions"

• Able to clerk cases and present: You have 3-4 years of clinical years to practice this. By the time you graduated, you ARE expected to be able to get the chief complaint(s) and rule out differential diagnoses and summarise the case.

• Able to recognize signs and findings in examination: Of course, this will help you in your diagnosis. So the more patients you see, the more signs you’ll find, the better you are at recognizing things. Do know basic stuff like normal vital signs values, heart sounds and murmur, different sounds during lung auscultations, neurological abnormalities etc. We need you to be able to elicit signs from patients.

• Attitude: Which is sometimes a major headache to senior colleagues, MOs and specialists. Do have the right attitude: be polite and humble. Don’t be arrogant. Basic rules as a houseman is "jangan berlagak terlalu pandai, jangan jadi bodoh sombong" or so to say. 'Menjawab balik', giving excuses and justifying yourself are all different- know who you are dealing with. If you don’t know, ask, ask and ask. Do NOT assume. Be polite to ALL patients and relatives even if you are tired and hungry- they don’t know that. Respect everyone including the cleaners, staff nurse, MAs, your colleagues, MOs, specialists, consultants. Sometimes it’s not easy when you meet colleagues who are not cooperative and not of exemplary behaviour- just recognizes who they are and avoid having that kind of attitude. Be friendly.

• Be a team-player: Know who your houseman leader, follow rules set by the department and be a team-player. If you have finished with your task, help your friends in need. If everyone help each other, you can finish ward work faster and everyone can go and eat lunch or rest earlier. Also, when you see your MOs doing round and are still around, even if your shift finishes at 5, wait till they say you can go home or something along that line, in case there are still works to be done. How can you go home earlier than your MOs/Specialist? -.-; The same goes if there are still a lot of ward work to be done and it’s already 5 p.m.... Finish your work first then you can go home with eased heart. Pass over if you need to know learn what kind of cases that need to be passed over

To be continued...
Next (final entry): Expectations [2]

Taking that first step...

Salam...
I wrote this a while ago for my younger brother who's reading Medicine in Egypt, just as a sneak peak into housemanship- just some tips and tricks working as a junior officer in medical field. This will be posted in 2 or 3 entries since the actual draft is quite long. I hope it'll give a rough overview of what's to come for those who will be joining the medical fraternity soon.

Before that, let me wish you Happy New Year! Let's pray 2014 will be more meaningful & beneficial :)

Before I give the overview, just to let you know that to each houseman his or her own experience; everyone faces different things and there are a lot of factors that need to be considered so what I’m writing is solely based on what I have experienced in my 2-years of housemanship. Be informed that I’m jotting this as someone who initially was doing medicine in Australia for a bit then came home to a local private university to graduate- so I am fortunate enough to be given sneak-peak of how a HO life would be during my clinical years and I do understand the anxiety that overseas grads are facing.

Second of all, I’m also jotting this down from a medical officer point of view; just to give a feedback what are some of the expectation of a ‘functional house officer’. I have no intention of scaring any of you but I’d like to prime you on the current situation of a houseman life so that mentally you are prepared of what to expect when you come home.

After you have graduated, you will have roughly 2 to 3 months before you’ll be called to work. Choose wisely of what you want to do during this time because the coming 2 years (if you’re not being extended in any department) will be... kind of gruelling.

Choosing a hospital

First of all, where you choose your housemanship is important. Factors that you need to consider is distant from home, support system & how well you can adapt to new environment, what you expect to achieve by the end of 2 years and what you expect to experience. For the last 2 points, it basically means that, do you want to go to a district or a tertiary/referral centres? Or do you want to go to hospital with computer-based or using BHT/patient’s file. Generally speaking district hospitals have less patients, limited investigations and no sub-specialty- so basically you will have to learn to do investigations within limited resources and need to refer to hospital with facilities or with subspecialties if you encountered patients that needed to be referred.

For example I was doing my housemanship in Batu Pahat Hospital, a district hospital- quite a busy hospital with common cases. Our radiology department have up to CT-scan machine so studies like MRI, barium studies, MCUG all needed to be referred out. If we receive cases like ICB, intussusceptions, coronary artery diseases, oncology cases, these need to be referred to tertiary centers such as HSAJB, HKL, Selayang, IJN and so forth.

If you choose a tertiary centre, sometimes you probably find yourself managing high-profile or rare cases. Your ward may be very busy but you may learn a lot of things. Some hospitals used computer so you have to familiarize yourself on how to clerk with laptops, how to find results via the computer and so forth; the good thing is you don’t have to run to the lab to fetch the results and you can trace patient’s past record easier.

If you choose to go to Sabah and Sarawak, be prepared to learn new dialects. The advantages of going to West Malaysia, you’ll probably be more skilled in terms of procedures i.e. vacuum delivery, Caesarean-section, appendicectomy etc. Once you are allocated a hospital, you will need to report to the hospital right after the induction week finished, and then to Jabatan Kesihatan Negeri. Usually they will be a few days of hospital orientation after you report duty.

Next: Tagging

Emergency & Trauma = ETD

When I first started this posting, I was terrified- first responder, first person to clerk the patients and manage them before referring them to respective department or discharge. What if we missed clues? What if we managed wrongly?

However by the time we came to the end of this posting, I can only say that I had a blast in ETD- most of my colleagues were final posters, those whom we’ve worked with before in previous postings which of course made things easier as we knew our capabilities and limits; the MOs were superb, not only were they our superiors, but they acted more like friends so it was easy to consult and communicate. The specialist was awesome, someone admirable and well-respected. The staffs were team-players- from SNs, to MAs to PPKs... well, I can’t say everything or everyone’s perfect but you get the overall picture.

Lately I’ve been reading comments, reviews and articles perhaps about how patients were treated in ETD and how ETD was being over-abused by patients.

Please note that this is just my two-cents, I may be right but I may be wrong as well. 

4 months isn’t a long time in ETD but at least we know what is considered ‘emergencies’. Initially I thought that this only happen in the district where I was working but upon discussion with friends from different places, I know that this happens elsewhere as well.



My night shifts in Green Zone after Eid were pretty much no-sleep shift; colleagues who were with me could pretty much testify how J I was. Saying that, I still couldn’t understand why people would go over the troubles to come at 3 or 4 a.m. in the morning when they noticed their child has a fever starting at 2 a.m. It would perhaps be more beneficial to give paracetamol to your child and let them sleep the fever off and go to clinic the next morning if fever still persists rather than waking them up and make them feel groggy freezing under the aircond at the waiting area.

I also still couldn’t fathom the idea of patients insisted on imaging even after assessment, they don’t need one; perhaps were more willing to be radiated by the x-ray radiation? If so, then be it. And if you think 166/92 is so high of a BP, then tell me how does 202/120 sounds to you?

Seeing varieties of cases, I can sometimes understand parents/grandparent’s worries if there’s no stock of medicine for their children/grandchildren at home. Sometimes being woken up at night due to intense pain, continuous retching, difficulties in breathing etc; or complaint that has been for weeks or years like whole body itchiness for one year, right knee pain for 6 months, back pain for 2 weeks etc- these are all the things that public considered as ‘emergencies’- they don’t read medicine so it’s fair enough.

But while public think it’s emergency enough to come to hospital at that particular time, we have procedure called ‘triage’. If clinically you look well enough and your vital signs are stable, then you’ll be triage as ‘green’- non-critical cases and even in green, there are priority cases to be seen first.

If you are sick enough to be triage as yellow (semi-critical) or red (critical), we would really appreciate it if you or family members could provide us with information enough for us to pinpoint the main issues and manage accordingly. It’s a little frustrating when people come and expect medical personnel to know exactly what’s wrong just by one look and on examination only. No, we need history too.

The point is, while you think your condition is serious enough to come to ETD, we will assess and re-assess your condition according to priority. What you may assume as emergency may not be emergency enough for us to attend there and then, and we will make way to those cases that are real emergencies.

So while we can understand your concern for your ‘medical emergencies’, please, PLEASE do understand that we are doing our best based on what we’ve learned to attend to critical, semi-critical and non-critical cases according to priorities.

If fast lane is what you’re looking for or VIP treatment, it’s perhaps the best to go to private sector where you don’t have to wait for hours and every basic investigation are done.
If MCs is what you’re looking for, know that if you’re well enough to wait for hours and then be discharged with stable vital signs and no fever, then know that you are well enough to work... we’ve had colleagues who’s temperature 39 or keep on purging and couldn’t afford the luxury of MCs because of pending works....

Similar topics- Jump to:
- What Public Doesn't Know
- In The News: 6-Hours Waiting Time

Hope this will at least give some overview of what's going on 'behind the scene'.
I guess the bottom line in the end lies on public education.

Universal Studio Singapore & Legoland Malaysia

Along. Ira. Zahir. Zeze. Sham. These 5 people had been in a study group since Year 4. Occasionally Amal joined in. We all decided to go to different places for housemanship; never really planned to meet up every year although occasionally during end of posting break, we tried to meet up.

Last year we had Mini-Reunion Kota Kinabalu, Sabah. Unanimously everyone agreed we just have to go to USS before we finish our housemanship, add JPO and Legoland while we're at that.

12th to 15th September, 2013
Almost semi-impromptu trip after short discussion via Whatsapp.
It was the time where people who knew each other so well gathered- where Along again was being bullied despite her age, Ira’s ‘tempurung’ came to light again, Sham’s non-stop chatter as always, Zeze’s childlike persona lashed out, Zahir being teased mercilessly and Amal’s diva-self appeared. And of course, Emmet joined in the party ;)

To make things easier, we stayed at Tune Hotel, Danga Bay where we also bought our shuttle tickets to Sentosa Singapore and Legoland from; convenience was more like it, places to eat are also nearby with walking distance away.

Met up on the 12th at Johor Premium Outlet, Kulaijaya while the lot waited for Emmet, Zeze & I to finish our shift at 4 p.m. Had dinner at George & Dragon. Nothing beats good food with good company. More so when you have things in common and many stories to exchange; where I don’t feel weird talking about work and people actually understand. Precious moment.

13th September- Universal Studio, Singapore!
To summarize it all, we took our own pace because of the Express Pass. But we did miss a lot of rides. Skipped Madagascar and Battleship Galactica totally, the later due to closed for technical purpose. And yet we still ran short of time for picturesque photos at the back of the NY alley and shopping. Later I realized it was because of the rain, the fact that we watched the B-Boyz’ performance twice and because we were wet most of the time, it was more tiring to move.... Energy drained too fast.

But it wasn't really what we did that mattered most, but who was there ;)

//Upon arrival

//Dry pod that's not working

//Purposely went on this first to get wet. Even with ponchos we were quite drenched!

//Disappointed that these roller coaster not working

//And got soaked again in Waterworld xD Our theme for the day was really "Wet"

                                     

//After it stopped raining

//I call them the dramatic lot

//Yup.... Tall enough to get in XP

//Went on this TWICE ;)

//Chocolate Monsters in NY, contemplating our future~

//Because they were awesome!

//Went on this TWICE too ;)

14th September- Legoland, Malaysia!
Emmet went back to KL so that left 8 of us. I read mix reviews about Legoland but the conclusion that the place is more for kids rather than adult holds true. Kids will definitely enjoy their time here with 'classes' and 'lessons' and shows, it was fun mixes with education.
I was also expecting hot sunny day but half of the time it was rather cloudy (we thought it was going to rain at any time). It's worthwhile to bring umbrellas and lots of water. I was expecting to find water coolers around but couldn't spot any.

But put the nice weather with a bunch of Chocolate Monsters who made fun out of the littlest things, yes, it was a fun day! We made up for the lack of photos in USS here. Scenery was awesome, except for lack of shades and trees. And music too. They also had 4-D movie show and one Rapid Adventure ride really soaked you well, just beware of it.
Some of the attendants/hosts could be more enthusiastic though, considering it was mostly kids who went on the rides. Exception, and many kudos for the staff in The Dragon and the staff who took our group photos for their energy!

We also heard that they will open the water theme-park in October and a hotel nearby by next year. Perhaps that will attract more grown-ups to come :)

//The ever-so-enthusiastic staff who took our pictures

//Yup, tall enough again to go in! ;)

//Dramatic lot on action...

//...As prisoners

//Had fun seeing Jester being bullied!

//The scenery from rotating tower. The site where water-themed park will be opened soon

//Looking at this, we knew we had to go on it. Totally didn't expect a wet ride but it was worth it! 

//Went on TWICE just to get wet evenly xD

//But at least the drying pods are working here

//Told you we are a bunch of dramatic lots...

//Who made fun out of nothing and littlest things!

//Magnificent Magic Show- where the boy stole the limelight and made the show his instead. Precious!

//We should go to the real KLCC and took the same shot and put this side by side

//Mini-Port Klang

//Was having tough-yet-fun-time to capture Amal 'touching' the tip of Taj Mahal

//So impressed with the detail of the structures reconstructed in MiniLand

//The Brainstormers

That night session was even more precious- Girls’ Gossip Session! Updated everyone on everyone else’ stories and planned for our next trip!

It was a short break- very tiring but worth every cent & moment. A short gate-away from work just to hang around people who mattered in your life. Really thankful that everyone could spend a little time and create some memories ♥

Note to Self

This is for myself, a reminder, so I won't astray:

“Say, ‘Indeed, my prayer, my service of sacrifice, my living and my dying are for Allah, Lord of the worlds.’” (6:162)

Redirect to: Fall in Love with the Real Thing

There are bigger goals to achieve, sweeter end to attain, insyaAllah,
Ameen.

Mengejar Lailatul Qadar

Night.
22 Ramadhan 1413.

Where are we now?
What have we achieve?
Are we chasing 'the night better than 1000 months'?
Or are we still at the same spot when we enter madrasah Ramadhan?
Or are we still the same person prior to this holy month?
Have we changed?

This is a reminder,
especially for yours truly.
Wallahu'alam bissawab.

Monochrome

ˈmänəˌkrōm (n.) A photograph or picture developed or executed in black and white or in varying tones of only one color

People have weakness. I have them too. Everyday I'm learning. Everyone does, consciously or unconsciously. Given, sometimes mistakes are made. We are not perfect. I mean, to err is human, no?

Personally, I don't like talking bad about other people; mainly because of the negative emotions attached to it. If I happen to listen to it, I'd rather keep my mouth shut than joining to 'pour oil to the flame'. Of course, hoping that in return people won't talk bad things about you behind your back is a little too hopeful, I guess. People talk and you can't stop them *shrugs*

Somehow, I find that in each posting I go through, there's always a 'theme', depending on my own feelings towards the specialty and my surrounding. Somehow, for me A&E is a place where 'fear and anxiety meets excitement'. I have mixed feelings with this specialty- most of the time because of the unknown, 'raw from scratch' or fresh cases that we receive everyday and wondering what kind of people will we meet today- patient-wise as well as colleague-wise.

I find this time around, the longer I am here, the more I find myself not knowing things.
How little my knowledge is.... that's how I feel almost everyday.

Despite that, of course, you will try your best to do what you can at that point, and as fast as you can. So give and take, I know I'd make mistakes somewhere.

However, I'd appreciate it very much if mistakes were done, I'd be told straight to my face- correction, constructive criticism, or even if you want to scold me, if it is my mistake, I'd accept it.
What I do not appreciate is talking about it behind my back and never correct me, thank you.

I think everyone feels the same. What do you gain from doing that anyway? Isn't it more negativism in your heart?

Allahu'alam.

On the other note, it's nearing Ramadhan. I think it's not too early to wish everyone Ramadhan Kareem!

--------------------------------------------------------
言葉少なに重なる足跡が　モノクロの世界で踊る
めんどくさい駆け引きは　もうここらへんでヤメてそばに来たらいいさ
Our few words overlap with the sounds of footsteps　They dance in a monochrome world
How about you give those bothersome tactics a rest and come by my side?
[Monokuro (モノクロ)- from Single Endless Game by Arashi]

Endless Game

The Not-so-Crazy Escapism 2013 #4: Home

(and good food plus good COFFEE)

Another 4 months and it will be exactly 2 years I'm in Batu Pahat, as a houseman. We've entered the final posting: Emergency and Trauma Department; a posting that I initially had palpitation (and perhaps still do from time to time) when I first received my logbook.

Time flies- when you enjoy what you are doing, has colleagues and friends who walk alongside you and encouraging and friendly environment to be in.

That said, of course there are ups and downs.

One of the ways I deal with pressure/stress is- no surprise- to go home.

Just to be in the familiar comfort of your surrounding and family, even for a day is good enough. And surprisingly, a walk-through crowded shopping mall somehow makes you feel like you have no other worries in your life.

Although stress isn't really the reason to come home this week- more of the intention of having lunch with old friend, some-kind of a half-cooked plan on my behalf. 

Deactivating my fb was perhaps one of the best thing I've done in my opinion for now but the downside is I kind of lost touch of what's happening with some friends. So the other option is to meet up =)

And I'm just glad that some things and some people just never change. Maybe we have, in many ways, but the old 'us' are still there. I long to meet the rest though... Although to be honest, I perhaps have not much update from my side... Haha...

Crazy Escapism perhaps will end up becoming "Short Trip Home" *sweats*

Third

Demam dah kebah, alhamdulillah.
Starting tomorrow I'm in the shift in A&E,
semoga dipermudahkan, Ameen.

Letter To Myself

Dear Me,
This is just a little reminder for us...

I am still taking baby-steps in the working field; even more baby-steps in the medical fraternity. Sometimes when you are going through minor bumps while working, some hurdles to get through and during tough times, you would forget why you chose this line in the first place.

What started as an interest in medical turned into something much more meaningful as I went through student life. Choosing to work in this field is no longer just because I’m interested in medical line, but rather to find His blessings and to work as His tool on Earth. And because as time we learned new things and go through different things, every day I remind myself for what am I working today?

If the answer is because of God Almighty, no matter how tough the day goes, insyaAllah, things somehow are easier. There will be small joy somewhere and you go home with satisfaction and you work with lighter heart. Online, sometimes I come across links that I thought would be interesting read or videos to watch. Today I re-open the links and was brought to this page: "Accepting Fate"

 It somehow left me deep impression and without realizing it, tears flowed.

Whatever challenges that I thought I had gone through, the tests that Allah gave this chap was heavier. Whatever hurdles and bumps that I stumbled upon seemed nothing compared to his. I can’t describe how fortunate we are to be able to work in our chosen field; and I’m ashamed to admit that even with that sometimes I have a lot of complaints.

Reading an overview of this young lad’s journey made me humble, really really humble. I am living some of my dreams, it would shameful if me as healthy as I am not putting my all towards my work and my life, not using every second towards something beneficial for myself and others and for my share in the hereafter. How fortunate are we to be given good health and time?

It is true that you appreciate life more when you remember death.

How can I spread the little message towards those in similar journey as mine to treasure what we have, work as best as we can to find God’s blessing and stop complaining and finding excuses?
How can I send the little message for us to be thankful everyday and to be positive and optimist in whatever situation that befalls us?
How can we remind each other of this everyday?

Sincerely,
Me.