No male(s) during delivery, please?

I was being asked multiple times to comment on the issue stated above for some obvious reasons.



Being in this country with Islam as our national religion is kind of an unique experience because in this Bolehland, the religion is practised slightly differently from the original teaching for reasons beyond the understanding of even the brightest Muslim scholars.
Read: Islam in Malaysia: Perceptions & Facts. 


Neither am I an expert in Islamic studies nor a woman.

But I am a husband and also a medical person.

Personally, in life, everything is about prioritization.

You can't live without prioritization.
If you don't prioritize, you'll end up doing things that's not urgent,
and leaving things that is important unattended.

Let's put religion aside.


What's the priority?

As for me, the priority is simple.

Health and safety trumps privacy.

If possible, even as non-Muslims, it is the hope of every men that their wife's privacy will be protected from other men (except for swingers and naturalists), unless there is an issue of safety or possibility of better/more superior treatment that can be only managed by the more experienced male medical person.

The writer of the letter clearly understand this but he has a slightly different threshold as he only consider treatment by the male expert after complication arises.

As a medical person, medical practice is moving away from paternalistic medicine and constantly, if not always, is taking into account of the patient's wishes.

Taking into account of patient's wishes do not mean it is for the doctor to tleave the patient to blindly follow a suicidal path.

The medical person should try his/her best to give the best counselling based on latest evidence and possible worse case scenario to the patient together with the patient's family members/closest next of kin.

And if certain examination or treatment are being rejected, the second best or follow up should be considered for the patient.

In the West, namely, UK, focus is on the respecting the women's wish(es) and consent, including doing intimate examination.

It is done only if it is completely necessary and with formal consent in a comfortable room.

Here, sometimes, intimate examination is being done, for completion sake or not following protocol. It is something that we must look into.

But, most of the time, the women are extremely compliant because they value health and safety more than privacy. (the subservient value of Asian women, maybe)

In medicine, we must try our best to cater to women's wishes and needs.


For instance, for women with Jehovah's witness as their religion, they are never keen for blood transfusion, and in UK, as a solution or as the second best, they are being referred to medical centres with Cell-Saver if they are of high risk of bleeding.

Another instances would be for elderly ladies planned for removal of womb for benign condition.
If she is ardent on conserving the ovaries - why not?
Recently, a Prof asked us guys, how would you feel if I want to do a bilateral orchidectomy for you.

Thus, if in the hospital, if the woman's wish is to follow her religion strongly,
and the hospital can provide the appropriate female medical person, why not?



But the woman and her partner should be fully counselled (warned) regarding the downside of having such preference - mainly delay and in rare instances, deadly complications associated with delay.

As MOfrust puts it succinctly:

I personally feel, the letter should be rewritten in a different manner. Instead of MELARANG, it should be "meminta supaya kakitangang wanita yang mengendalikan kes isteri saya". Either that or add a clause at the end of the letter: 

I will take full responsibility of any morbidity that will happen in the event of any delay in treatment of my wife as a result of me not allowing any male staff to attend to my wife despite being informed on the inadequate female staff....signed and dated by husband.

For most people in the medical line, we always classify those patients as fussy patients who are better off going to private because they can get whatever they want at a higher price.

Often, I felt it is a wrong mindset.
It is just like some idiots who tell off some Malaysians,
if you don't like our education, or our government, or our healthcare, or our food, you can migrate to other country, or balik to the original country of our ancestors.

In the public healthcare, the cost of healthcare is almost the same.
The public paid taxes - some pay more, some pay less.
And allocations are being made for healthcare.
Meaning, the people paid for the services at the public healthcare facilities through their taxes, not just their RM1 only.



Thus, the women and their respective husbands can make their wishes crystal clear, but they must accept the shortcomings and difficulties faced by the medical staffs of public hospital.

Prioritization of healthcare should be done to cater to all the women in the wards, and not just fully allocating a female doctor for the patient who requested female doctors only.

And at that some juncture, they must decide - RELIGION or HEALTH/SAFETY takes precedent...

Don't be surprise that for some, religion may comes first. Read: Qurban

In our neighbouring country - Brunei, only female obstetricians and gynaecologists are accepted into service.

Did you know that?

Below are commentary for intimate health examination by the opposite gender, from the Islamic perspective.

Pada diri wanita ada ciri-ciri atau kriteria yang spesifik dan itu tidak dimiliki oleh lelaki, begitu pula sebaliknya. Apabila salah satu pihak meninggalkan kriteria yang telah ditetapkan Allah bererti ia telah meninggalkan fitrah dan merosak kudrat insaniah. Ada beberapa ketentuan dalam syariat Allah sehubungan kriteria yang dimiliki oleh wanita, oleh sebab itu berpegang teguhlah dengan syariat tersebut dan jangan perkenankan lelaki campur tangan dalam urusan dalaman jika tidak ingin dirugikan ataupun kehidupan fizikal dan kejiwaan wanita akan rosak.
Secara syariat, wanita muslimah hendaklah menjaga dirinya dan auratnya dari dilihat orang lain, kerana jika perkara ini terjadi pasti akan menimbulkan fitnah. Secara fitrah baik lelaki ataupun wanita yang bukan muhrim bersentuhan pasti akan menimbulkan berahi dan getaran jiwa yang akan mendatangkan tekanan syahwat baik banyak mahupun sedikit. Inilah namanya nafsu yang pasti ada pada diri seorang lelaki ataupun wanita yang normal.
Wanita mengandung ketika mengadakan pemeriksaan bulanan dengan doktor lelaki bukanlah tergolong dalam keadaan darurat, kerana ketika itu wanita tersebut bukan dalam keadaan sakit. Jika ia bukan dalam keadaan darurat sudah tentu hukumnya berdosa ketika seorang doktor lelaki menyentuh bahagian-bahagian tertentu tubuh wanita tersebut. Kedudukan darurat dalam Islam adalah jika sesuatu keadaan itu tidak ada pilihan lain, maka secara terpaksa atau harus kita melaksanakan sesuatu yang pada dasarnya bertentangan dengan ketetapan Allah. Umpamanya, memakan daging khinzir hukumnya haram, namun ketika dalam keadaan tidak ada sedikitpun makanan melainkan daging itu sahaja, sedangkan kita dalam keadaan kelaparan yang boleh membawa maut, maka hukumnya menjadi harus memakan daging tersebut sekadar mengelakkan dari mati.
Begitu juga halnya dalam masalah pemeriksaan bulanan, ia bukanlah dalam keadaan darurat, sebab masih ada cara lain atau alternatif lain untuk mencari doktor wanita ataupun bidan yang beragama Islam. Apatah lagi di negara kita sekarang ini mudah didapati doktor wanita, bahkan di hospital dan klinik kerajaan pun kebanyakan yang memeriksa wanita hamil terdiri dari doktor atau bidan wanita. Mengapa kita mesti mencari doktor lelaki jika hanya sekadar menginginkan kepakaran mereka disaat mengadakan pemeriksaan bulanan. Bahkan doktor wanita yang pakar sakit puan pun telah ramai di negara ini. Maka tidak timbullah istilah ‘darurat’ ketika mengadakan pemeriksaan bulanan dengan doktor lelaki bagi wanita hamil. Kecualilah ketika akan melahirkan, di mana wanita yang akan melahirkan tersebut memerlukan pembedahan dan perhatian yang serius dari ramai pihak. Maka ketika ini barulah boleh dipakai istilah darurat tersebut, kerana wanita yang ingin melahirkan itu tidak terfikir masalah lain, melainkan ingin selamat melahirkan anaknya.
Ditinjau dari aspek psikologi pun proses pemeriksaan bulanan yang dilakukan wanita hamil dengan doktor lelaki ini akan menimbulkan kesan yang jauh dan negatif dalam hubungan kekeluargaan. Bayangkan saja bagi seorang wanita yang selama ini hanya disentuh oleh suaminya, tentu akan merasa suatu getaran ketika lelaki lain menyentuhi tubuhnya. rasa kelainan dan getaran inilah yang membenihkan suatu keinginan tertentu kepada yang lain selain suaminya, lebih-lebih lagi ketika mereka menghadapi masalah atau krisis rumahtangga. Perkara ini sepintas lalu nampaknya macam perkara biasa dan sederhana, namun dalam jangka masa panjang, kesannya sangat membahayakan minda dan jiwa isteri tadi serta suaminya juga. Dalam hal ini bagi doktor lelaki mungkin tidak merasakan apa-apa perasaan terhadap pesakitnya, disebabkan terlalu ramai pesakit yang dirawatnya setiap hari dan ini menjadikannya lali dengan keadaan tersebut. Namun bagi seorang wanita yang normal dan sihat, getaran di jantungnya pasti akan terasa dan getaran inilah yang dinamakan syahwat.
Jika perkara ini terjadi bukanlah bererti setiap wanita yang hamil itu tidak baik atau wanita yang rendah moralnya, malah perkara ini membuktikan kenormalan wanita tersebut. Dalam hal ini kebijaksanaan suami sangat dituntut untuk melaksanakan tuntutan Islam agar isterinya mengadakan pemeriksaan bulanan dengan doktor wanita Islam sahaja.
Saya ingin membawa contoh yang sama dalam diri seorang lelaki. Bagaimanakah rasanya perasaan seorang lelaki jika bahagian tertentu tubuhnya disentuh oleh doktor wanita dengan nada bahasa yang lemah-lembut dan baik. Sebagai seorang lelaki yang normal, pasti dia akan merasakan getaran di jantungnya, kecualilah jika ketika itu ia betul-betul sakit (dalam keadaan darurat), sehingga tidak ada yang lain difikirkannya melainkan kesembuhan dari sakitnya itu. Begitu juga halnya dengan doktor wanita yang menyentuh pesakit lelaki mungkin merasa lali dengan situasi tersebut disebabkan profesi dan tanggungjawabnya sebagai seorang doktor.
Fahamilah tentang kaedah batas-batas aurat bagi seorang wanita atau lelaki yang bukan muhrim. Jika perkara ini tidak diberi perhatian secara serius, lama kelamaan akan runtuhlah sendi institusi rumahtangga keluarga muslim. Seandainya seluruh umat Islam tidak mengambil berat tentang perkara ini, bukan saja institusi rumahtangga malah negara pun akan runtuh kerana kejatuhan nilai moral dan agama dalam kehidupan bangsa. Peliharalah diri dan keluarga kita agar kehidupan bahagia di dunia dan di akhirat serta terhindar dari seksa api neraka. Wallahu A’lam…
Wassalam.
http://www.ukhwah.com/

The falling star

Morning round started with the specialist who came in early.

The lady in front of us was pale and obviously in slight distress, mildly gasping.

As the medical officers and specialists quickly did a run-through examination on the unfortunate lady in almost plain white, I ran and took a branula trying to secure a running line into the vein.

And the house officer, oblivious to all the emergency steps we're doing still in her own world, standing on the foot of the bed.

She wrote "S/B (seen by) Dr XXX (the name of the specialist)" and below written "Case and progress noted".

She didn't budge a single inch from her place of writing. Possibly was doing some kind of exorcism or external healing from writing on the medical case notes while her superiors all busy fluid resuscitating the lady.

Such is the quality of future doctors the whole innocent world are up against. Sadly.

A brief review of the case note revealed that she was being operated the night before for bilateral large endometrioma and currently suffering from hypovolemic shock possibly due to the underestimation of blood loss from the operation the night before.

Unfortunately, she was seen by the gynae medical officer on call but was not being fully assessed or scanned.
She was referred on table by the Surgical team after the glaring perineal findings came into the light (the laparoscope light).

Something that is very dishonorable about this whole incident is the lack of professionalism in the initial assessment.

The unfortunate lady would have been diagnosed correctly if she was being assessed with massive apathy because the bilateral endometrioma was as big as two ostriches' eggs.

She would have undergone an elective operation after good pain control and exclusion of the minute risk of malignancy.

Under a better controlled elective setting, it would possibly end up with reduced blood loss and dismiss the need for transfusion.

It would be less taxing on the on call team and the on call team can focus on other more dire emergency during the on call.

The gynae medical officer, Mr B was reprimanded only with a few words - I know you have brain, but you're purely lazy.

If this was the first time, then maybe it could have happened by chance, but it isn't unfortunately.

Mr B is a foreign student under training with our Master training programme.
They do not have salary as they paid for this programme.
Thus, his concept is that since the local students from Ministry of Health are being paid, therefore we should work harder than him.
And fair enough, our superiors (not all) conformed to the similar thinking, which I beg to differ.

We are paid salary but we're also being tied up for 5 years working for the government after we graduated.
Technically, we are also paying for the programme, similar to them.

Secondly, in an esteemed centre of training, I do not comprehend how can we let certain standards slide away just like that.

He is always missing from the wards and clinics.
What happens to the maximum 2 weeks of leave of absence for every 6 months of training?
If it was more than 2 weeks, isn't it a person need to be extended in his/her training?
Why lady trainees has to be on their toes and return within 2 weeks post delivery to assure non-extension of the Master training, yet some people just go missing more than 2 weeks without substantiated evidence of their absence?

There was just no team work in him.
He even can tell his teammate that he is not coming for ward round because he was invited the other day.
Do you actually need to be invited to ward rounds?
What kind of specialist are we breeding in this centre of excellence?

When there was shared and scheduled operation theatre hours, he refused to enter operation theatre.
And he boasted on how he could do a certain surgery by himself with supervision of lecturer, but end up his intraabdominal drain got stuck and required a relaparotomy.
Maybe it's just a rare unfortunate occurence, or perhaps it is due to lack of experience in assisting.

My eyes welled up with tears during ward round that day, knowing the clinical circumstances leading to the emergency endometrioma removal.
How could such a appalling and disgusting performance be accepted in the institution?
Even if he is a smart student, he is an excellent protege, he is possibly the exam top scorer, is that how we should accept the birth of a specialist who lacks professionalism and proper attitude for life and patient?

The saddest of all, his infamous role model for delinquency is well known by all the lecturers and Consultants but yet there are no formal response to such a shameful attitude, only table talk about him over meal time.

This inaction will only breed more to follow in his footsteps.

It is really unforgiving for this institution to allow such a candidate to be honored with the recognition of a specialist at the end of program without any correction of his current appalling attitude.

Is our institution still ardent to be stars of the sky or are we letting ourselves reduced to a falling star?

The fitting things for fits

Calm Sunday morning.

Thought of waking up  - naturally.

Naturally basically means sleep till late late, but kids are already jumpy and going all over the bed like baboons in the zoo.

My wife and I craved for the beef noodle near the old town.

We forced ourselves up and got dressed up for that awesome morning meal.

By the time we were there with my 2 little angels, the whole place was packed with people from all walks of life.

That shop was hidden away into small alley and without any signboard of the shop's name.

Frankly-speaking, it doesn't need a name.
Everyone seems to know this place.

As we sat down and began to order, the dried a.k.a. gravy version, mee and koay teow had already finished... at 845am.

Only left were the noodles with soup version.

Still a good enjoyable dish.

The next table was filled with a group of youngster, possibly in their early 20's.
A few of them started to light up a ciggie each.

It annoyed me a lot as my kids were there exposed to those toxic fumes.

Intermittently, I stared at them, the few who lighted up, giving them my infamous crazy eyes stare.

Luckily the nicotinic aroma did not travel to my table as the fan was directing the wind away from my table.

Out of sudden, a sudden crash was heard.

The soup of a youngster who sat just behind me were splashed all over the place.

My initial thought was they were playfully fighting or playing, but as I turned over, I could see above my shoulder, a young man was basically fitting on his chair.

All of his friends, in their stylish half-blonde and semi-redhead hairstyle, were stunned and tried to hold him down and tight as if their strength will stop him from shaking.

I quickly ordered my wife to bring my children to the other side of the table.


With the help of his friend, a plump guy with less clothing or hairstyle sense but more senses in everything else, we brought him down to the floor slowly and put him in left lateral position.

All his other friends just stood there, indulging in their own anxiety, puffing away more ciggies and basically blowing those smokes to their fitting friend and to my face.



I asked them to go away and provide more air for his friend and the plump friend (let just call him fatso) was suddenly on the phone.

While holding the phone, Fatso pinched on the fitting friend's nose and obliterating it, as I was holding his cheek turning him left lateral.

I was shocked, surprised and practically speechless.

Fatso revealed he was talking to the fitting friend's mother and that was fitting boy's mom's order.

I quickly slapped that hand off the nose as I saw the lips slowly turning cyanosed.

At that point, I had to declare my identity as doctor and I know what to do.

The fit aborted spontaneously but he was still drowsy and breathing in deeply.
The blueish discoloration of the lips went into a crimson shade of relief.

I asked for help to fan the fitting guy and someone volunteered to do it with the newspapers folded into two.

On and off, there will be people, mostly looks like those who survived Japanese occupation, coming over my ears and trying to convince me to shove a spoon into his mouth or do something to prevent him from biting his own tongue.



One actually suggested putting in a finger.
I smiled at them, although, I could not tell you how much I wish to laugh out frantically and suggest to them to volunteer their fingers.

I explained that it is important not to put as if foreign body broken off it may cause choking.
I also explained turning to side will prevent the tongue from falling back and block the airway.

Fatso continued to talk to the mom, telling the mom, I was pressing on the fitting man's neck.

"Helloooo.... This is cheek and not neck lah."

Anxiety-induced visual illusion.

"Please call for ambulance." I ordered.

Fatso asked me "Mister, do you have the phone number of ambulance?"



My mind was yelling "WTF!" but my words was exactly "Call 999 and ask for hospital".

I was not sure if it was education failure or community failure or just purely another anxiety-induced morbid panic, even as a young chap when my legs were short and my shorts were small, I always knew 999 was for police, firemen and ambulance.

The ambulance couldn't come because they don't know where were we.
Really couldn't blame them, this place was pretty hidden away from the main streets.

That person slowly regained consciousness and I asked him if he knew who he was.

I asked Fatso what was the fitting boy's name. "Yxx Hxx"

As if in a deep slumber, he answered "I am Suai Ker Xing (Handsome Xing)." and fell back to sleep.

All his friends quickly brought him into their "sport car", modified version of our local car and they sped off to the nearest hospital.

It's been quite long time since I last seen any fits.

The last fit that I encountered was the 5 seconds eclampsia that spontaneously relieved, too fast for my eyes. This was like 5 years ago.


Wifey was impressed and sort of figure out I am not just another lame fanny doctor.

It was an eye-opener to my kids and they are still trying to digest what exactly was happening.

All my cute daughter told me was "That uncle is sick."

As a whole, I think my medical and public health colleagues still have a lot of grounds to cover as even the epileptic's mother do not know how to administer the correct first aid (WTF, pinch nose and obstruct nasal airway) and the general public as a whole in the misperceptions in attending to person with seizure.

Here's a good read about seizure treatment.

Babysitting

Fond memories during secondary school came back to me.

It was a time when studying supposed to be the primary thing to do, yet lots of other activities took precedent.

Frankly-speaking, I was over-obsessed with extra-cocurricular activities.
For the few clubs which I had passion to serve and lead, there are one or two clubs which the teacher-in-charge forced it down the throat for me.

From managing the administrative and public relation of the people in the clubs and organisations, I grew more knowledge and experience in handling certain situations. But, most of the time, it is just sorting out who are the babies who needed much babysitting and who are the adult who mature and rise up to the occasion.

Together with my other awesome schoolmates, we organized and led the members by setting up good systematic schedule of activities and their respective responsibilities. As secondary school students, it is pretty obvious, having responsibilities and managing those responsibilities well is part and parcel of growing up.

In the Board of Librarians, we are divided into different teams where we would go on duty on each day and if there are shortage, initiative will be taken to ask for coverage from other teams where there are abundance.

It worked pretty well because the stringent admission interview to the Board, looking for only a simple sense of responsibility and insight.
At that point, we had a strong team of around 40-50 librarians.

Leaders are neither babysitters nor dictators.

Babies belong at home, not at workplace - it is pretty clear.
All the crying and urine bowel
incontinence.

Dictators belong to the gas chamber, not at workplace - because it will kill off the essence of teamwork.

Teamwork is a simple thing that most adults should know and cultivate, especially if those are the same cohorts who are supposed to be trained to be specialists.

Unfortunately, this simple beautiful value failed to be cultivated by some people, possibly due to (let me quote my professor) misspent youth.

There was a not-very-recent spat between colleagues where one refused to be equally rostered into operation theatre duties. The colleague quoted "If you do not wish to operate, don't be an effing gynaecologist."
Pardon the vulgarity, but it does sound logical.

Then, there was this recent spat (unknown to many) where another refused to be equally rostered for weekend ward rounds. It is a pain or nuisance, sometimes to work in weekends, yet it is part and parcel of the duty.

It really baffles me.
If one is interested and have passion in that field, why would you trying your best to escape from the thing that you love?

It is like you found the girl that you love and then trying your best to avoid her.

Maybe you don't really love her.
You can't rise up to the occasion.
You can't really love her as a whole.
Maybe you just want her as trophy wife/gf or her money.
Maybe, just maybe.

Point to ponder, really.

I guess sometimes, aging can have deleterious effect on people.
As some people ages, they returned to their infancy.

It came sooner, rather than later for some people.

Who let the dogs out? Who! Who! Who!

Rotation continued. Now in a new environment.
Nice view from the window.

Almost a penthouse.

Here's the thing - the new hospy is different from my previous hospy. (Kinda obvious, duh!)

No, what I meant to say is that - the new hospy is not under Ministry of Health and I am still considered a staff of the Ministry of Health.

So, my status in this hospital is not a staff of the hospital but rather a student of the hospital, although all the 'students' worked their asses off (doesn't mean we lose weight on our hind end), every 'students' from Ministry of Health don't have a carpark or other benefits because we're not deserve to have it.

Kind of make sense, though.

Like how Balisan has always make sense in prospering us for 50years, while continue secretly superprospering their own cronies and deprive rakyat of our own well-deserved wealth of the country.

Beside the 'students' privileges, they are charging the patients at a price range between a full private and a full public hospital's rate.

Anyway, here's the thing.
A patient made a huge fuss at the nursing counter.

She was standing there, hawkeyed on everyone working and writing behind the nursing counter.

She commented on how early the Professor already declared her safe to be discharge and the delay we had caused.

We were all halfway doing ward rounds.

She refused to follow the correct protocol to go down and collect the number for her medication to sort out the total fee.

She patronized the meagrely-paid clerk to call up the pharmacy to ask for cost and declare a number for her personally.

The clerk fumbled and could not get a proper response from the pharmacy because the pharmacy required the medication slips to check various costing.

She barked at the clerk and barked for the ward Sister.

The ward Sister helped to sort out the medication part including going down to pharmacy for her to get the number and costing.

Then, when everything added up, the Sister passed her the bill with a checklist of all medical services she acquired during her one night stay, without costing.

Costing usually will be calculated when paying at the payment counter at the lobby.

Again, she barked at the Sister insisting on wanting the full amount in dollars and cents because last time when she was admitted, she was told 1K but when the charges sent to her house, it was 2K.

The Sister kind of felt lost and turned to me.

I was busy sorting out logistics to post a patient up for diagnostic laparoscopy for suspected ectopic pregnancy.

For those who don't understand what is ectopic pregnancy, it is pregnancy outside of womb, usually in the tube and if ruptured, the patient may die. Yes, die

Apparently, the hospital was in semi-chaos since last Friday
(I can't reveal why because if I did, the private wing of this hospy may just hire a gunman (or more) to snipe me down. Yes, I am serious)

Sister: Dr.Pilo, macam mana? (how?)
Pilo: Just follow protocol.

Then the barking started again. She stood firmly at the counter edge.

What follow protocol? Can't you just sort out this simple things for me.
What is your name?
Hi, I'm Dr Pilo. I can write my full name and give my phone number to you if you want to. But now, I am busy. But, you must follow hospital's protocol.

She was shocked to see that I did not sport the sad-puppy look together with the clerk and the ward Sister.
She walked away.

I continued to call this and that and this and that and this and that (repeat like forever).
Still, the solution to the logistics problem remained elusive.

She quietly settled the bill with the billing counter and came up.

She composed herself and came back for 2nd round of battle, barking again in human words.

Sigh. I hate to be involved in pathetic debate.

Most of time, I will win, but I will feel extremely sad because the other party will be greatly depressed by then. (bad kamma for me)

Thus, I chose to be as 'nice' and 'relevant' as possible.

Italics The Patient

Bold Pilo

Underline Pilo's thought

Since you're so happy in giving me your name and phone number. Give me then.
Okay, here's is it (I wrote down my full name and phone number). I am busy right now because there's an emergency I need to sort out. If there is anything that I can help with, within hospital protocol, I will help you, but not now.

Let me tell you you are an arrogant doctor. Very arrogant.
Dear Madam, out of 10 of my patients, 10 of them would disagree with you. 
This IS arrogance, fyi

Hey, is it really so hard and difficult to do extra to help one sick ill patient out of your 10 patients?
Dear Madam, I am helping all as much as I can.
You should just tag with me and see how for yourself how much MORE extra I had done for my patients. Sick, ill and barking, what a paradox

Is this what you called service? Is this what you called service?
Dear Madam, I am doing job, to prioritize my duties and responsibilities and work within protocol.
Thank God she did not repeat the 'Service' word for 9 times like the 'Listen' fiasco.
Service? Service? You think I'm a 'duck' mer? (insert vulgarities here)

I want to see Matron.
Dear Madam, here's the Sister, she will sort out for you.

She continued to talk to the Sister rudely and wrote up a complaint letter.

I intended to inform my Head of Department because in my old hospy this kind of stuff is kinda big, because God-knows-why even if we're not wrong or involve in any illegal activities.

But the Sister told me: Nah, it's pretty common here. Just wait for the complaint letter and explain.

Common.

I wonder who or what have been constantly providing the fertile ground for the breeding of this ungrateful, demanding and unreasonable patient's culture.

Sad, but annoyingly true.

Winning every arguments...

Real life surgical theatre's friction (shared from an awesome friend):

In OT...

Anaes: What op was done previously for this patient?
Surg: xxx
Anaes: What kind of anaesthesia was given?
Surg: ?? (That's your territory, I tot you should know it or find out before op)
Anaes: I don't care, u go find out. That's your patient.

-------------------------------------------------------------------------------------------------------

Personally, I would go ask for the anaest and get back to him/her because
1 I did it for the patient, not for the anaest
2 allow myself to learn more about anaest
3 life's too short to be pissed by something small like this

If the anaest's tone wasn't polite, remember Winston Churchill's quote:

You won't reach your destination if you keep stopping to throw stones or sticks at every dogs that bark along the way.

Sometimes, makes me wonder, when patients thank the surgeons, how many surgeons actually tell the patients to thank the anaest who plays a large role, too.

Nevertheless, it makes people wonder how the 'your patient' mentality can be cultivated even in such an esteemed medical centre.

I am neither pro-anaest nor pro-surgeon, I am just pro-rakyat.. oops.. I mean, pro-patient.

I still remember vividly a conversation between me and Anaest Consultant.

Pilo: Dr L, do you need blood for this case? I think its rather straightforward, GSH should be sufficient
Dr.L: EXCUSSSEEE ME, Dr. Pilo, I don't need the blood. The patient needs it. Not me. (smirk)
Pilo: Oops.. sorry, boss. (Smile)
Winning every arguments do NOT makes you a winner.

Agree to disagree and you'll see a whole world of difference.

P.S. no wonder, about a decade ago, a simple bickering between anaest and surgeon turned easily into a boxing match with the surgeon giving the anaest a slap with a bloody glove...

Medico-burn-out-ography

Obgy at number 4. Seriously?

Agree. Bureaucracy is very cardiotoxic, neurotoxic, nephrotoxic and genitotoxic.

No complaint here.

Burn out outside of work? 

Raised my hand

Those with answers, please raise your hand

I AM a houseman in one of the main training hospitals in Ipoh.

The Government has already issued a directive earlier about the implementation of the shift training system, whereby a houseman’s working hours is fixed at 60 hours per week in every hospital.

Why is it that some departments comply with the Government’s directive while others don’t?

The same reason why your university who passed you in final exam did not comply to the Ministry's standard in producing a good doctor, but instead lean on their political or royal connection and produced more calculative doctors who are more interested to count the hours they had poured into service rather than the quality of care that they had provided. 

I am working 86 hours in week one, 84 hours in week two, 82 hours in week three and 60 hours in week four of a month.

Why is it that some administrators at the hospital are not able to understand what the Government has already made clear?

Fyi, our government expired on 9 March 2013. If you care to read while you calculating your hours of service. We're probably waiting for a new government who will eff us less or continue to get more effing from the return of the current regime.

Is it because there is no penalty for those hospitals who refuse to comply with the Government’s directive?

Nope. There is no penalty for being righteously right about preparing the correct method/regime of training for our future doctors and not blindly follow baseless directive. It is called evidence-based medicine.

Are they so sure that housemen are very terrified young professionals who are too scared to voice their opinions?

You can voice your opinions all you want. Your opinion does not heal patients. Your opinion does not shame the 'older' professionals. If you're truly terrified, go see a psychiatrist. If you're not, you're a shame to yourself and your family - but I am willing to help you. I understand your fear and lack of confidence. 

Are the superior officers so affected by their old way of training that they refuse to see that the younger generation of housemen are capable of being good doctors in the near future, even with shift systems?

Nope, most had embraced it quite well. In fact, it is you and your fellow 'young professionals' who refused even to attempt to try even the slightest taste of how medicine was years ago where there's no limit in providing care. You take holiday or break, the disease/germ/bacteria/virus does not take holiday. Simple as that.

How can the current housemen be undermined before we even have a chance to prove ourselves?

How can we undermine you if you don't allow us to? You're confabulating. Read: Psychiatrist.
Maybe we'll come up with House Officer Olympics end of this year, just so you can prove yourself and earn a medal. I suggest Branula insertion relay, Blood bank sprint and Complaint letter to newspaper marathon. 

Do you think a houseman would not want to be an excellent doctor after taking the effort to earn his degree after five or more gruelling years at medical school, with such a high cost and with financial loans to pay?

Talk is cheap. Now, write is cheap, too. You want to, but you're too busy counting the hours of your service. I repeat, shame on you. Yes, you. 

I have so many questions in my mind but my last question will be: If anyone is able to answer my questions, will you please raise your hand?

I raised mine.

A MERE HOUSEMAN

Batu Caves, Selangor

P.S. My answer in Pink.

P.S.S. Please click on the ad on the upper right corner to support my movement on Anti-Calculative HOs.

Ministry of Health's Statement of the Year!

This letter from the Ministry is currently being circulated in the cyberspace.

Most of doctors who read it was in shock, anger and mainly vulgarities played a huge role mainly.

My best friend in the similar current apprenticeship as I am doubted this letter and thought it is a photoshopped letter.

Who could blame him for the content of the letter is totally absurd and goes way of the tangent of logic.

For the people outside medical field, let me put it into a simple language of the message being sent in this letter.

1. The Ministry have totally filled up the posts of Medical Officers up to 95% with some States fully occupied and some overfilled (possibly it's KL or Selangor).
Commentary: If this is so, it simply means the government has run out of doctor's post and house officer's post should be converted to temporary post.
2. The Medical Officers should play more active role in clerking and examining the patients.
Commentary: This is an overstatement because in our current state of house officers, most medical officers re-clerk and countercheck most of the clerking and examination.

3. House Officers should be fully undergo the shift system and they are to be trained, and NOT to provide service ( Not extra pair of hands, as well)
Commentary: House officers are being downgraded to Final Year Medical Students or less. Heck, I started clerking even when I was in med school and assisted as first assistant in few Surgical Ops. The most intrigueing part is why the FUCK is the Ministry paying every house officers around RM 5K each PER MONTH from the rakyat's money if they are not providing service or extra pair of hands, but to be trained. I thought it should be the other way round where one pays for the training.

Considering an UNDER-estimation of around 1000 house officers now, RM 5 millions every month are being drained out of Rakyat's money just so House Officers (luckily not majority of them) can lepak and called it 'training'.

Luckily at this moment, at ground level, such absurdity is not being implemented, but I am sooooooo ashamed to be part of such an important establishment which came up with such a shallow juvenile formal statement.

When I told my barber about it, my barber laughed her ass off.

"I don't think I can be trained to be a barber without holding up a scissor or a razor."

Simple logic which even the Ministry failed to grasp.

If this is implemented at the ground level, my Plan B would be to go apply for house officer's post in my current department, get extended indefinitely and spend 'my training hours' to study for external papers or do some research.

Sounds like a good plan?

Hands tapped by Prof - TWICE!!

All alone guarding the fort - the whole full board recognizing the full labor ward.

My wardmates left to attend teaching and presenting for our monthly Census. 

Out of the flash, Prof appeared.
I presented the whole ward of patients by referring to the maternity board.

Alerted by a staff nurse after noted a suspicious fetal tracing, we made our way to that patient. 

The fetal tracing was indeed suspicious, bordering on pathological. 

A quick review revealed the mother had indeed entered 2nd stage of labor. 

I scrubbed up and attempted to guard the perineal with my right hand as the baby's head is crowning.

Prof tapped my hand. 
PAAAKKK!!

"Hands poised!" he said. 

I removed my hand. 

The lady kept bearing down and the baby's head kept coming down. 

I moved my hand back to the similar place, stuck tightly with the perineal body.

My Prof tapped me again - TWICE!!

PAAAAKKK!!!

"Hands poised, young man" he exalted, again.

Therefore, first time in my working history (was not that long to begin with), I stood at the end of the bed, overlooking the delivery of a baby without any perineal guarding.

And her perineal only have a short second degree tear.

Tiu. It was sublime. For that moment in time.

Was it luck? Was it a coincidence?
Is 'hands poised' another fancy English term by Prof T?

I decided to look it up academically (basically just googled it - lah).

I don't even know wtf is the meaning of poised.

Here's what I got from Reducing Genital Tract Trauma at Birth 

 The first was a study from Great Britain that assessed the role of hand maneuvers for the actual birth in a large, randomized controlled trial.^[4] In this study (called the HOOP trial, for "hands on or poised"), some 5,471 women were randomized to either "hands on" (one hand flexing the baby's head and the other hand guarding the perineum) or "hands poised" (both hands off, but ready to apply light pressure to the advancing head in the case of rapid expulsion) at delivery of the baby. Both approaches are taught in British midwifery education programs for management of birth, and both are practiced in the United Kingdom. 

Midwife compliance with the experimental allocation was 84% overall, 95% in the "hands on" group and 70% with "hands poised." After each birth, trauma to all sites in the genital tract was systematically assessed and recorded by the attending midwife. This was the first large clinical study to provide a detailed and complete picture of the total array of genital tract trauma sustained by women having normal, spontaneous vaginal births. 

Results of the HOOP trial showed that trauma is indeed a very common experience of low-risk childbearing women: 68% had major or minor trauma to the perineum, 61% had vaginal lacerations, and 11% had episiotomies. The trauma profiles of women in the "hands on" versus "hands poised" groups were virtually identical (recall that the techniques were used at expulsion of the baby, and not earlier in the labor). However, marginally fewer women in the "hands on" group reported perineal pain at the 10th postpartum day (31% versus 34% for the "hands poised" group). 

This represents a 3% absolute difference (95% confidence interval, 0.5% to 5.0%; statistically significant because the confidence interval for the risk difference does not overlap 0). While this difference is small, it is of interest to U.S. midwives because "hands on" for management of the actual delivery is the practice norm in this country.

And all this time, for the people, mostly HOs or nurses who conducted the delivery, ending with obstetric anal sphincter injury, the superiors would just screw them up nicely for not guarding the perineal properly and send them to some classes.

When all they need is to stand up (after reading this post) and reply "Hands poised".

P.S. it appear like I am rather stupid, not knowing all this all this time. 

Save a life. Get your shit together!

Just when you think your poop is just another disgusting waste material and nuisance, please be reminded that it can also save lives of patients suffering from Clostridium difficile colitis.

Wondering whether our local medical fraternity is prepare to make this brave contemporary move in the foreseeable future...

Shit just got real!


http://surgerywatch.blogspot.com/2013/01/cdc-fecal-transplant-donors-needed.html#!/2013/01/cdc-fecal-transplant-donors-needed.html

The Centers for Disease Control has issued an urgent plea for fecal transplant donors. After the recent publication in the New England Journal of Medicine of a randomized prospective trial documenting the efficacy of fecal transplants for the treatment of C. difficile colitis, a critical shortage of suitable feces has occurred.

Potential candidates must be in good health and not have taken antibiotics within the 30 days before donation. Fecal typing is not necessary as adverse reactions to donated feces have not been reported. For most people, donation is painless.

After much deliberation, CDC Vice-Director Dr. Steven Gerrard has announced that the drive for fecal donors is being launched with the slogan “Save a life. Get your shit together.”

The smoking children

 

Can we have this in Malaysia, please?

Sad, angry, unmotivated doctor

A must read about the 'beauty' of our healthcare system...



http://thestar.com.my/news/story.asp?file=%2F2012%2F12%2F31%2Ffocus%2F12519704&sec=focus

I AM one of the thousands of JPA sponsored doctors who came home to serve after spending five years learning the trade overseas.

The change is sizeable I must admit, from the patients’ disease spectrum, expectations, understanding and social background to my colleagues and seniors’ working attitudes, clinical competence, career progression, team support and ethics.

I see little benefit in discussing the quality of housemanship, insufficient training resources for post-graduates doctors, or even the national healthcare system when we are not doing much to address the core component of the problem – politicking policy-making.

The major difficulty in delivering good healthcare is the lack of the will to address the flaws rather than not having a good system.

Our policymakers are mostly not feedback-friendly and take negative comments on the system and policies in place as mischievous and uncalled for.

Nothing saddens me more than to hear a senior personnel brushing off a complaint of our inadequacy with: “That is how the system works”, or “Please work within the system”, and then paradoxically advising us to “Express our discontentment via the channels in place”.

In Malaysia, five out of 10 decisions are “flip-floppy” mainly due to the over politicking policy making.

I am being very nice to give that figure of five in 10.

Inconsistency is the most consistent feature in our system.

Two years ago, the Health Ministry came out with the system that all peninsula doctors who agreed to serve in East Malaysia, where doctors are most needed, would be granted priority in transfers back to their peninsula hometown after their two- year stint and new doctors from the peninsula would take their place and the cycle continues.

A very well-intended system to address the issue of getting healthcare to places that needed it most. Well done.

But what happens in reality?

The transfers happen to a certain extent, but it is not all according to plan.

The sadness of our Malaysia system, like in all other sectors, is that those who refuse the transfer and have powerful connections or know how and who to complain to will be able to defy the system.

When there is no replacement, there is little choice for the local administration but to make sweet promises to the current batch to work a little longer.

There is a saying among the rural doctors: “Don’t make your life more difficult in exchange of making those who sit in office’s life easier.”

We doctors pledged to give equal treatment to all, not to the selected few who are educated or who have money and it is only fair that we be treated the same by the system.

We must strive to have a system in place where everyone will have to follow and happily respect the system, and there is no cutting of corners, jumping queues or different queues for different people. That should be our aim.

For my esteemed policymakers: Your job does not end with the issuance of a “pekeliling” (circular) of your carefully crafted well-intended system: You must make sure it is adhered to: fully and not only to those who are willing to follow.

Will the patient be anymore happy having a sad, angry and unmotivated doctor compared to having no doctor at all?

Of course in the politics of policy making, numbers are more important.

There are a lot of us who are willing to serve wherever we are needed.

But it saddens me when some are here and stuck due to a Janji tidak Ditepati.

ACS

Kuching

Heatlh Ministry replies.

In response to HOUSEMAN from Kuala Lumpur, the Heatlh Ministry have a few statements in reply to the letter.

"IT has been almost a year since the sad passing of Dr Danny Lee. And from that incident until now, promises were made to ensure the well-being of houseman.

May Dr Danny Lee rest in peace and not be a scapegoat for the blame of long working hours. If it was the Heatlh Ministry overworking him to death, it should surmount to manslaughter and his family members should chose to pursue this in the court of Law.

Seniors before you had been working long hours with less incidence of depression and zero suicide. When our Ministry's Director-General was a house officer, he worked long hours and never heard of any suicides in the same rank. Anyway, we have suicide cases in various occupations, including the competitive secondary school students and mothers who can't cope with many children. Maybe in the same context, the students should learn less and have more holidays, and perhaps the mothers should give away their children, just because she requires less work.

Further more, some of us have been working for 28 days straight with no break/off days (oncall nights, we work minimum 14 hours a night).

Please be reminded there are no such thing as on call nights. It is an oxymoron. It is called night shift. Anything related to on call is out of the context for house officers. Kindly refrain from using the word on call with any of your shifts.

We are working in a hyper-stressed environment, overworked to our physical and mental limits and worse.

Kindly submit a full time table how you are being overworked to your physical and mental limits.
We are living in an evidence-based world, you know.

We would also appreciate an evidence that your baseline limits is not way way below the average people who supposedly had graduated from a medical school.

So my question to the MOH, was the promise made about us working 60 hours a week true and will it be truly and strictly implemented or was it a publicity stunt?

We compliments you for asking such a good question.

Now, having been working for a year, can you answer this question - what is the normal level of total white cell count, platelets, hemoglobin, urea, creatinine, AST, ALT and blood glucose? (without looking at the reference value).

The Heatlh Ministry can assure you that this is not a publicity stunt and we welcome your resignation for a better job offer in neighbouring countries which will NOT make you work more than 60 hours a week and probably in your context, maybe you can have more than 2 days off a week.

No one is pointing a gun or strap a C4 to your head to work in our Ministry.

If you have problem in typing the resignation letter, don't bother to. Many your peers had just disappear without any words, verbal or written. We will accept it as your precious resignation as long as your parents do not file any police report by 24hours of your disappearance.

Read also For Future Doctors: Shift work for Housemen?

Original letter.

http://thestar.com.my/news/story.asp?file=%2F2013%2F1%2F8%2Ffocus%2F12545354&sec=focus#.UOwBfVsCiAA.facebook

IT has been almost a year since the sad passing of Dr Danny Lee. And from that incident until now, promises were made to ensure the well-being of houseman.

I refer to the report “Housemen still being overworked and bullied, sending some into depression” (The Star, April 14, 2012).

The Health Ministry (MOH) stated that housemen are supposed to work 60 hours a week with two off days.

But the sad reality is, that is not happening.

Let me shed some light on a typical houseman’s work day is. Depending on the posting, most of us have to be at the hospital as early as 6.30am (not taking into account where some of us live) and work up to 6.30pm. That is an average of 12 hours of work per day, seven days a week.

Further more, some of us have been working for 28 days straight with no break/off days (oncall nights, we work minimum 14 hours a night).

What is worse, in some postings, housemen are forced to work from 7am to 7pm.

And that is the reality of life as a houseman.

We are working in a hyper-stressed environment, overworked to our physical and mental limits and worse.

Not many houseman dare to complain as threats of extensions by their superiors constantly remind them that they have no say in anything as long as they carry the title “houseman”.

Please don’t get us wrong, some of us enjoy working but we do not enjoy working every single day with no proper break/off days.

My context of “off days” means a break from work between 24 hours and 48 hours.

So my question to the MOH, was the promise made about us working 60 hours a week true and will it be truly and strictly implemented or was it a publicity stunt?

I can assure you most housemen in other hospitals, still work an average of 12 hours a day, seven days a week.

We do not mind working long hours, but we mind not having two proper days off so that we can have a break from the stressed environment of the hospital.

HOUSEMAN
Kuala Lumpur

Crimson tide

The 'best' thing about the new hospy that I am working right now is all deliveries to be conducted by doctors.

All deliveries to be conducted by medical officers or house officers under medical officers supervision.

It does bring back good memories of the time when I first conducted my first delivery, which is in the same hospy but different labor room.

Now, the labor room is new and so-called advanced.

Computerized partogram. Data through computer. CTG centralized view.

Maybe it's inertia.
Maybe it's adjustment disorder.

The installed system has less pros and more cons.

Browsing through the computerized data takes a lifetime and the previous records still need to be traced manually on paper technology.

Although one may argue the invincibility and economics in intrapartum care records as its prime and sole raison d'etre, I beg to differ.

Files can be corrupted, hacked, stolen, altered and destroyed with good computer programming skills.

Plus, the poor record-keeping using the not-so-user-friendly system will work against the medical institution.

Feedbacks from Prof J on the review of the documentation can be summarized in one word - Rubbish.

When I had complicated third stage and documented in length in the 'remarks' column, the senior nurse partly 'censored' my entry because when printed out, it doesn't look 'nice'.

Lack of triaging also renders serious conditions do not get immediate attention.

When a preggie lady came with per vaginal bleeding, as I am busy, I instantly ask a loitering house officer to attend to the lady for brief history.

The house officer just ignored me and walked away.
When I confronted him, the nurse in charge backed him up, telling me about how the whole system works. Patients to be registered by the clerk. Then, reviewed and vital signs be taken by the nurse, before the lady can be clerked.

Probably there is a reason why a lady came with massive abruptio but was seen only after 15mins later.

All victims of technology, or rather victims of common sense deficiency.