Mar 28, 2009

russian resistance

leningrad: the great russian resistance

I met this hardworking medical student when I was a relatively young house officer back in the old general hospital where everything is plain lousy but by standard, providing minimum sufficient medical service to the public.

She would follow the ward rounds. After rounds, follow us to do scut job. Ask about almost everything under the sun in the charts. Tap a few clinical practical experiences under my colleague’s supervision.

I was amazed at how much she spent in the hospital and her initiative to learn.

I later found out that she was in her first clinical year, and she is studying in Russia and she is doing attachment during her holiday.

I don’t see much of my colleagues doing attachment when we are in holiday, and I guess by far, at that point, I really think highly of Russian medical students. It was later that I found out she is probably the small minority.

My fellow friend POTS wrote a very interesting sarcastic entry on the house officers from Russia. Ever since then, he was entertaining a huge mob of Russian-educated Malaysian students and I did notice there is a bit of spillover to my new domain due to my small comment on his entry.

I guess by POTS’s excellent and perhaps precise sarcasm on the quality of Russian grads, it is only sensible for the students there, the agents who brought them there, the parents who chose the Uni there for their kids and also perhaps relevant government-related units to feel threatened or perhaps annoyed.

Of course, the most reasonable rebut would be there are bad apples everywhere, please do not generalize or make early assumption.

But here’s the thing, POTS opinion is purely observational. It is exactly like observing the nature. If the majority of soil of the land is loose, it will cause a landslide sooner or later. POTS is not putting a few pebbles thrown down the cliff by some baboons into the equation of the forecast of a landslide.

It is nature, just like, it is also observational that even graduates from the top local Unis are performing poorly and some are even pure menace even to themselves. No doubt.

Every department has a fair share of Russian grads.

The most memorable one that my department had did improve after lots and lots and lots of hardwork and perseverance. Initially, her knowledge (or grave lack of it) can be equal to a third year medical student. By simple assessment, one will find she is no difference from a fresh year 1 medical student. My humble specialists (even the most benign one) got totally shock. One even wrote a complaint letter to the Pengarah, 5 pages long. She gradually improved after more than one month of tagging and with kindness of the head, based on her working performance, attitude and her knowledge of recognizing the intra abdominal fat as omentum, she left the department without extension.

Needless to say, I also heard news about other house officers tagging till months in other department and was not given extension. Basically can’t wait to chase them away to other department. This is a conversation that my colleague overhead.

HOD 1: Hey, how do you actually let this Dr. X leave the department? (smirked)

HOD 2: Hahaha, now Dr. X is all yours (long smile)

Basically I do not have knowledge of how much red tape or paper work in other countries, but the Consultants in the hospital are loaded with clinical duties as well as receiving loads and loads and loads of paperwork plus multiple unnecessary meetings that somehow totally unnecessary and mostly were held simply for accreditation and not to improve the healthcare in any big way.

Therefore, critizing the Malaysia’s Consultant for not taking their time to teach the new house officers to take blood pressure for patients is perhaps masquerading as a joke. But in reality, is truly a comment out of lack of judgement, experience, common sense and lack of respect for you and the Consultants.

IMHO, like the old age word of wisdom, prevention is always truly better than cure. I propose MMC to let the Russian grads to have their final year training in our local university just to filter out the bad apples, plus to prove that the Russian Uni are the simply better than Malaysians’. By then, with the standard exams, one will see whether the general observation is truly statistically significant.

It will be harmful to the public once they donned the white coats and roamed the streets. Houseman training is not meant to develop perfect house officers, but rather to train one to be a sensible and functional medical officer. Therefore, house officers should not be judge by their efficient in doing ground work as house officers but also to have good clinical judgement and management of medical officer.

Back to memorable house officer, I guess if given more time to really build up her foundation she would have graduated well to function safely as a doctor, but sadly, she’s stuck in the system. Can’t go forward, can’t go back.

I think the major message that me (and perhaps POTS) trying to raise is an awareness for Malaysian to avoid going to Russian Uni to study medicine, but if you’re already there, do make extra, double, triple and quadruple effort to learn things in medicine, NOT just to pass.

One might pass the exam, but one may fail as a doctor.

One must realize the benchmark of providing a safe health care is pretty different from the benchmark of the exam.

If you really screwed up and brought up to the court,

that’s the end of your career and the total waste of your parents (or government’s) money.

By that time, you can’t go forward, can’t go back.

Likewise, everything is observational.

It is not who you are, or where you come from that matters, it is what you do.

There are 4 classes of people in this world.

Those who don’t know, but knows they don’t know.

Those who doesn’t know, but think they know.

Those who know, but think they don’t know

And those who know, and know they know.

Do not fall into the danger of becoming the 2nd class of people.

If you’re the 1st class of people, your perspiration will see you through.

No point getting depressed on the fact that you’re studying in Russian.

Probably, in the future; observation will see that the Russian grads will perform better than the local grads.

After all, we’re all products of the ‘good’ system.

P.S. if I'm still stalking that medical student.


cw said...

i'm a 5th yr russian student.
i wished every m.o would be able to have the objective mindset tht you have.
we do try our best to level up with the local grads but it's hard to push yourself through when it all seems countercurrent.
i have been doing my elective attachment since 3rd year in two different hospitals, and while i have met the very few drs who would take us seriously, the majority actually comprises of those who just thinks we're pests. the typical initial introductory question-which uni you're studying at? would be followed by :
1. a complete cross-examination-and outcome would be number 2 anyway.
2. he/she blatantly ignores you

we have been even rejected from the surgical department by the head after he found out we were all russian med students. we didn't even have the chance to prove ourselves; he just didn't want more russian students tagging along.

and so, what we did was stick around,followed rounds, examining patients, looking at xrays, from 7.30 until 7pm, waiting and asking around for drs who would be kind enough to let us tag along.
we would be ecstatic for even the most minor procedures- blood withdrawal, injections etc.

there is only so much you can do in 2 months when the odds are against you.

we seek for mentors, and i'm sure as hell tht im willing to work my a** off, given the suitable environment.
i will continue in my quest come this july.

Anonymous said...

I always believe attitude play important role in life.One might be inadequate knowledge as long as he/she willing to put down his/her pride to learn..everything will be fine in the end..thanks!^^

pilocarpine said...

cw: ur senior and lousy batchmates spoilt the market. it's really tough being countercurrent, but the fiercest fire make the best sword.

i believed if you're hardworking and dedicated, not just another exhibitionist, sooner or later, people will tell you...

"hey, you're an atypical Russian grads..."

Sarah said...

tapi kan...when i was doing my elective posting in m'sia (melaka hosp), the doctors didn't let me do anything and when i asked questions they looked at me like i'm crazy then proceeded to talk in chinese (i don't speak it) among each other...when i asked them something i didn't understand in the charts (the abbreviations, for example) they scolded me and said that i was dumb for not knowing this. i wasn't allowed to try any procedures on the patients (ok, this one i understand why lah but still...venapuncture bkn susah sgt kn).

i so want to be a good doctor when i graduate but from the past treatment i had at the hosp, i felt like i was a lower level than germ!~ :p

pilocarpine said...

dear sarah,
your enthusiasm will be well rewarded. do not be discouraged by people who are not willing to teach. pls understand, some of our job burden are heavier enough without teaching others. you may ask other people like nurses or ask doctors when they are free, not freaking busy with their own work and emergencies. good rapport goes a long way.

procedures-wise it is up to the doctor to bear responsibility allowing you to do under his/her supervision. do not underestimate small procedures ie venepunctures or branula insertion. From what i gather, 1HO (not from russia) inserted wrongly into artery and resulted in amputation due to acute limb ischaemia, discovered a bit too late.

being lower level than germ, means you're a virus? a nucleus? a proton? an electron?
being lower means you have more spaces for improvement, if you strive to fill out those spaces.