Jul 31, 2012

True/False: HOs Have No Responsibility

There's a famous Malay phrase "Sediakan payung sebelum hujan" (Prepare the umbrella before it rains).

The matching Chinese phrase goes in line of something along, only when you feel like going to defecate, only starts to dig a hole.

Chinese phrase as usual is more mean and give you a much better perspective.

The consequences from the Malay phrase would suggest along being wet and soaked, while from the Chinese saying, one would either have a whole lot of shit to hold in the rectum or let them out to their pants and sliding down the legs while one is busy digging the much needed hole.

That's a graphic thought. a graphic shit thought.

A department going through tough times will only get tougher, mainly because of the department's unpreparedness to face such shit and the tension rises will break the positive spirit, or whatever left of them.

A frequent reminder to everyone is "House Officers have no responsibility".

And when someone at higher rank re-phrased that reminder as "House Officers are not Doctors."

Dome Apple
One of the fellow house officers who is close to me shared with me his total disappointment and how this phrase really break his heart. Not only his. There are a few more who share the same sentiment.

Nevertheless, there are also a few of them who are happier to hear this tune.

I can still remember vividly when I was in Operation Theatre last month.

They came unprepared and late.
I had to do their job. I diluted the antibiotics.
I put in the details of the patients.
I put up the CT films.
I prepared the post op notes.
I did my work and also did the work of house officers.

The surgeon was being exceptionally joyful that day and was outstandingly forgiving.

Yet, although the house officer was given a whole half an hour to cut and paste the preliminary post op notes, she did almost nothing.

Sitting there idle, simply taking any other surgeons' post operative notes.

It was as if she was pushing the limit, trying to get herself being excused from the OT.

The surgeon operates almost every week and although the op findings may differ, the op procedures and post op orders are much or less the same.

Templates are there.

Every week, house officers enter the OT will prepare the necessary, but that week, the house officers are exceptionally appalling.

And this is not their first posting, mind you.

Then, on another day, during ward rounds, another polite specialist reminded the house officers to familiarize with postnatal reviews and stressed the importance of counselling for contraception in the most gentle word.

I even briefed them everything and gave them simple reference materials to read on. 

Yet, the week after, nothing changed.

Last Friday, as the Gynae ward was filled up to the brim.

As I went through my rounds at night, I could see 2 of my Night Shift House Officers struggling to complete all the passover work from before 5pm.
Tracing results.
Reviewing Ultrasound result before 5pm and informing me.

All this unnecessary passover was creating major inertia in finishing their night rounds.
Plus there were patients coming in as well - to be clerked, seen and treated.

No CME that Friday, both Gynae team and Periphery team, plus few tagging house officers of around 8 house officers should be in the ward.

Yet, they decided to finish up whatever in the 'To-do-list' rather than knowing the patients in the ward and recognizing what is left to do.

When I enquired about reason behind such incompetency with 4 times as much people in ward, the verbal answer given was simple.
First of all they do not know about the routine discharges for the patient on Chemo.
Secondly, the Periphery team does not about what is happening in the ward.  (No one in the ward is stopping anyone to find out about the patient and learn)

I still await their written explanation letter.

I think whatever evil flooding the public hospitals with house officers is rather out of my control, but I think at certain level, I had the responsible to tell the House Officers that they have responsible and they are real doctors. (Or else why would they deserve to be paid)

The house officers have responsibility to learn.
The house officers have responsibility to be prepare to learn.

They should find out what are they doing.
If they know they are going to this OT, or this ward, they should have the decency to find out what that is necessary in full details.

Not 'let's go in and experience how it feels like'.

Personally, it is an extreme turn off whenever taggers comes in to see a procedure which they had never read about.

They came in just to flaunt their presence and get me to sign their pathetic tagging logbook sheets.

Take ERPOC (evacuation of retained product of conception), for instance.

They do not know about the patient.

They do not know about the procedure and its other indication.

So, my conclusion, is they come is just to attend a circus show... oh, wait.. a free circus show where I am the clown.

- medical officers - 

The best is when some of them actually requires us the Medical Officers to invite them to the blardy FREE CIRCUS SHOW and one of colleague was being reprimanded by someone of higher rank about this - over and over again.

Hence, a simple notice was being put up in Labor Room by my colleague, which essentially has what I am trying to tell them.

One can imagine how shock I am when one told me 'Threatened miscarriage' as one of the indication of ERPOC.

Essentially, "house officers have no responsibility" does not hold water.

They have a duty to learn and the department have a duty to keep them learning and not strip them off their responsibility.

They had to learn to do their job and strive to do the job of Medical Officer, because after their housemanship, they will be one, right?

Isn't this simple logic?

And it is the sole responsibility of the department to instill such responsible in them.

It would be a crime, a sin and a grave mistake to do otherwise.

Sadly, now, it is the Medical Officers doing the jobs of House Officers.

I would like to quote what my respected ex-Boss, DrK once mentioned to me.

"If the HO have the capacity or chose to learn thing slower than the rest, then, we'll keep him/her longer in the department to learn what he/she should know in the department."

Without instilling a proper culture and habit among the youngest and largest member of the department, the whole repertoire of a functional unit is indeed internally a joke.

Fingers crossed.

I would be devastated if the house officers from the department, one day, turn out to be medical officers who essentially receive referral on symptomatic pregnant lady at term with high blood pressure, albuminuria with gross pedal oedema and decide that lady requires an ultrasound KUB (kidney,ureter,bladder) and antenatal clinic follow up a week later. 

P.S. To see a 'retrospective added correction' by a house officer into a 'high profile' patient's medical record today really had me wondering...

P.S.S. Whenever there is any doubt why number of MOs in the department is declining...


fibrate said...

And when you become a specialist you realize you have to do a medical officer's job. It never ends. Bad HOs become bad MOs, and some of them will end up as specialists, usually bad ones also, in keeping with character. Be afraid, be very afraid

pilocarpine said...

I think at some point of the career, it is not easy to climb d specialization ladder. But I'm sure pretty lot of them will be in the primary care setting and ruining it, which is a lot worse than wat u think I can be.

ZactAxe said...

Take what you give: this scenario is thanks to some 'sensible' superiors at helm, tat reprimand ppl who teaches the young, instead of questioning why the incapable junior doctors is so incompetent..

Wait till one day there's no more senior competent doctors, when we r the desperate patients lying there waiting their mercy..

pilocarpine said...

I think there will always be someone senior competent around... Because I believe the world will never face the extinCtion of good men and women.. Call me an optimist, if u must..

There's still a lot of great house officers and it will be a pleasure to work with and under them in the future...

Anonymous said...

Let us not be too biased about all that was narrated above. You people miss the crux of the discussion. To be an example, you have to be the example. Medical officers/specialists/consultants are not angels either. I agree that the quality of house officers these days could be deplorable. But why has this happened? People should stop pointing fingers and get to the bottom of the problem. Here's a clue : Whether you are a HO/MO/Specialist/Consultant, you are firstly a human and treat everyone with dignity and utmost respect. Keep your egomaniac tendencies in the carpark when you turn off the ignition. Enter the hospital not as a impulsive personality but an enlightened one. You people just lack intrinsic motivation.

pilocarpine said...

Dignity and respect is not what people give u. It's how u earn them and whether you deserve them.

Those who works hard and honest deserve my respect, irrespective of their hierarchy.

egomaniacs, irrespective of their status,too, do not deserve my respect.

You don't earn respect just because you're higher in status, ie I don't respect DrChuaCD, MCA superstar.