Khamis, 27 Mei 2010


I am a doctor in the government hospital. I work in various hospitals for more than 23 years. The working condition defer from one hospital to another hospital. For the last 12 years, I have been working in 2 new hospital with IT facilities. Working condition definitely more comfortable in the new hospital. However, all of us doctors in the government hospitals, our aim is the same. We are trying to give the best medical services to our clients at par of the world standard. We are trying very hard to satisfy our public. Some patients complained direct to the health minister just because they have to wait more than 1 hour in the government clinic where they only have to pay RM5. Some of them refused to pay the registration fee of RM5 and insisted to be seen early and accused the staff in-charge so slow. Mind you, the complain went straight to the Minister or DG. There are many no basis complains from our public that we received everyday. Our administrator busy typing explanation letters where they can spend more time to handle other important matters. I also noticed that some of our public just kept silent if they have to wait for 2-3 hours in private hospitals or clinics where they are paying much more than they do in the public hospitals. It seems that they don't mind because the specialist will see them. In the government hospital, only the MO see them. Sometimes, small numbers of them, waiting for 5 minutes in OPD seems to be so long. The public has a perception that government hospitals give a second class treatment. No matter how hard you try, you won't be able to satisfy all of them. What we need to do is, continue to improve our services in all areas. I can confidently say that services in the public hospitals have improve tremendously and as good as private hospital or even better. As doctors who are trying so hard to give the best treatment to our patients, the complains do make us feel bad and demoralizing. I don't deny that there are genuine complains that require drastic action. There were complains that completely nuts. I will tell you the story.

My specialists work so hard with 2-3X ward rounds a day. I can assure you that non of the patients will go home without being seen by a specialist. I don't have many specialists but the doctors that I have are very dedicated doctors. One morning, she did her ward round as usual. The medical officers and HOs followed her. She talked to every patients that she saw and explained to the mothers or the carer on the progress of the child or patients. She saw one of the mother who stayed with her baby. She is a teacher. My specialist explained to her the condition of her child and the treatment that was given. The mother voiced out that she has something going on at home and even she was gonna missed the celebration of the teacher's day in her school. She requested for her child to be discharged on that day. My specialist explained to her that her child was still not well and needed to be in the ward for a few more days to complete the antibiotics. However she insisted to go home and accusing my specialist so inconsiderate. not caring enough and refused to understand her problem. My specialist told her that her child needed the treatment. As the mother she should gave more priority to the child health. Teacher's day celebration was not so important compared to her child's health. The mother got angry and wanted to see a specialist and not knowing that the doctor that spoke to her was a specialist. My specialist told her who she was and said she is the consultant in-charge. The mother accused my specialist of being so arrogant. She wanted to lodge a complain to the hospital director. Actually my specialist could have just let her go but her concern was the child's safety. The mother didn't understand that. She just wanted to go home. She even said that my specialist was not caring enough because my specialist forgotten to wish her happy teachers day. I want to ask all of you . Is it wrong not to wish her happy teachers day. We can't even remember our own birthday. Funny woman....too much... Anyway, in the eyes of the administrator, we are still wrong. Customers are always right.

Rabu, 26 Mei 2010

Bringing up children - the way I see it.

I love to share a lot of things with my children. Whenever I have time, I love to be with them, talked and shared stories. We got into the car and I drove them around our village or we went to the recreational area in town or a waterfall near my home. They are in their teen now. It was fund to listen to them. I learned to love the songs that they like. The movies that they watched and told me all about it. Basically, the songs in my phone is full of songs that they dedicated them to me. Any new songs, they will down loaded it to my phone. At times, we spent the whole day eating, talking and enjoying our time together. When they were small, I was just a medical officer then. I was in the master programme. The amount of work that I have to do, so many patients taht need to be reviewed, cases to be clerked, books to read and 10-12 calls per month, I didn't have much times to spend with them. However, my children seems to understand my situation and the nature of my work. They waited for me everyday in the evening. I will make sure the time I spent with them full of activities that both of them enjoyed. I fed them myself. Sang them a special song every night when putting them to sleep. I was very lucky to have mother and sisters who were willing to look after my babies during the day and at night if I was on-call. When I had free time or time off, I would used it to the fullest to be with them. Attended to their every need. On weekends, my husband and I took them for a picnic or holiday. If not, I took them around town in the car. We went to the shopping mall as well as to the amusement park. If you want to know, the popular place that I normally take them every year until today is "The Zoo". We either go to the Zoo Negara or Zoo Melaka. I love to go to the zoo and I will tell you why.
My children always enjoy their time in the zoo even though we go there almost every year. There are always new animals and new experience. Sometimes, my other family members went along, up to 5 cars full of children and adults. We brought foods with us, had picnic in the zoo and had a great time together. Basically, I have made standard regulation for the family. The regulation sounded funny where every newly born babies in the family will have to go to the zoo when they turn one year of age by all means. All of my nieces and nephews know about it. Surprisingly, all of them follow the policy without any hesitancy. I guess they have no choice or they do feel that going to the zoo is one of the way to be together and get closer with each other as one happy family. I want them to love each other the way I love all of them and my brothers and sisters. No doubt we do have argument and differences in opinion of certain matters but when it comes to the family matters, we are together. We will discuss about it in a very professional manner. We put our differences aside. Respect the eldest is what I was taught from young by my Mum and Dad. I have 4 adorable brothers that I love most, 2 elder sisters and 2 youngest one that we shared our jokes and secret. I am very lucky indeed.

Back to the zoo trip, I still remember the first outing my children had was a trip to the Zoo Negara. My sisters and brothers always wonder why zoo be my choice and not else where. I just smile at them. They warned me not to get too close to the animals, scared that you will become just like them. I said to them " all the animals are my friends". In all of us, there are animal sense and if you don't control it, it will manifest. I told them that by watching the behavior of the animals, it gave me a lot of insight about life and love. I saw how the mother of the monkeys took care of their small ones. How caring they are. She taught them how to cope with the changes around them. The birds teach their babies to fly. The monkeys teach their babies to climb the trees and jump from one tree to another. She will continue her duty till the babies successfully walk or jump. She teach them again and again.

I want to share with you how I look at life based on the observation that I have while in the zoo. How we bring up our children to this world and prepare them to face any circumstances that may arise along the way just like the animal does. When we have baby, I imagine that this baby is a caterpillar. The motherof the caterpillar will build a shell or cacoon around the caterpillar to protect them from harm and danger. The mother of this caterpillar will carry out her duty everyday in providing him with food, water and of course not to forget love. She taught him how to protect and defend himself from birds or other animals which will eat him when they get the chance. He has to be alert all the time. The mother of the caterpillar will continue doing this without feeling tired until the caterpillar grow into a butterfly and is ready to be on his own. As I mentioned before, genetic does play an important role in determining what sort of butterfly this caterpillar will turn into, but the environmental factors and influences from the mother also play a role in the transformation of this caterpillar. Based on these factors, the caterpillar will have to decide whether he want to become a beautiful colourful butterfly, or becoming an ugly moth or becoming an elephant butterfly. Of course, as the mother of the caterpillar, she wants the caterpillar to turn into a beautiful butterfly. This beautiful butterfly will fly away and make the mother proud of him.

Similarly like us human. Good mothers will protect their children with their life. I feed my children, give them good food so that they will be healthy, be there for them when I am needed, clean them up, brush their teeth, comb the hair, and put them to sleep. I will teach them the value of life and gave them education. I showed to them good examples so that they can follow. When they make mistake, I will correct them and teach them to think critically. Not to forget, teach them about our religion and believing in own self. There are many other things that I do and give to my children so that they will become an adult that I can be proud of. Of course, as I said before that external influences have a major role in the development of a child. However I believe that if we give them a very strong foundation and education, they will be able to make a choice whether they want to be a beautiful butterfly, or an ugly moth or an elephant butterfly. It is all up to them. What we mothers can do is to pray for their happiness and give them your blessing. In any way, if they have problem or a broken wing during their journey, they will come back to you because they know that you are always there for them. As a mother, you should be ready at all times to treat their broken wing so that they can fly again. This is life the way I see it.

Selasa, 25 Mei 2010

Junior doctors

My hospital started to receive HO for training about 2 years ago in 2008. For the last 2 years prior to that year, I was working with medical officers and 3 of my specialists. Well, even though we didn't have enough staffs but we managed any how to finish our work on time. We were able to go for lunch fairly consistently. Job was done perfectly well at the end of the day. I still feel that I have full of energy in the evening. However, the scenario has changed since the HO came to the hospital. We know that these junior doctors are supposed to learn and to be trained in order for them to survive out there as a safe doctor. As a senior doctors, our job is to teach and guide them. We also know that they are not extra pair of hand in the department. We understand that clearly. Nowadays, I feel that the job and responsibility in training the HO really drained my energy toward the end of the day. More than 50% of them have poor medical knowledge and skill. You really need to teach them from zero. You have to teach them again and again but nothing happened. You can't even raise your voice because they won't turn up for work the next day. Some of them required one to one coaching. On top of poor medical knowledge and skill, their attitude toward patients is also bad. My specialists are doing ward round at least twice a day. They continue to give them teaching and tutoring until one of them lost her voice. She was found to have four nodules on her vocal cord. The ENT surgeon said that she has over used her vocal cord and advice her stop talking or reduce it temporarily. You can imagine how much talking that she has to do everyday. I pity her and wonder how is she going to stop talking when you need your voice to teach the HO. Unless she decided to ignore them or don't teach at all. She told me one day that she just can't do it and kept quite. So, the solution was for me to do the talking and let her rest her vocal cord. I advice her to take it easy. You can only do that much but most of it up to the doctors themselves whether they want to learn or remain the same. If their knowledge and skills are not up to the requirement, they just get extended. No doubt, I have to do a lot of paper work but I don't want to get stress up unnecessarily. The amount of teachings and guidance given by my senior doctors are beyond description. Repeatedly telling the same facts again and again. Looking after 4-6 patients, already being considered as hard work and very busy. Some of them also commented that we are not suppose to compare the past and current. The ward round completed very late everyday. Because of these they end up having kuih or bread for lunch.
I am not saying all of them are bad but having bad HO today is not a rare species anymore. You are bound to have them in your department. Extension of posting sometimes doesn't make them better. Worst come to worst, the parents will come after you for extending their children. On top of having poor knowledge and skill, they have bad attitude. Many of them have to be referred to the psychiatrist for assessment. The common diagnosis is reactive depression or poor coping mechanism. As the head of department, now our duty is being channel to handle problems of poor coping mechanism in them and writing report for their poor progress. No PA to type letters make things worse. We have less time to do our clinical work. Hours and hours are spend to counsel them and give them encouragement. Sometimes we won and sometimes we failed. How long it will go on, only God knows unless certain measures need to be taken by the higher authority. Initially, the duration of housemanship training was one year but since 3 years ago it was increased to 2 years because one year is insufficient to train them. Are we going to increase further the training period to 3 or 4 years if these doctors are still have poor clinical skill at the end of their posting or akuna metata, no worries attitude. I guess, it is a serious problem that need urgent solution.

Isnin, 24 Mei 2010

To be successful in life

If you ask me whether I am happy now to be a doctor, my answer is yes I do. I learned a lot from my teachers and friend doctors. We always share our experiences and thought. I consider myself lucky because my teachers are good teachers and my friends are excellent friends. They motivate me a lot. My lecturers in the medical school were wonderful group of people. They were fierce but very dedicated to teaching profession. I am not saying that new generation of lecturers are not good. But some of them have no teaching experience. They themselves have bad personalities and lack of knowledge. My teachers, my specialists when I was their HO or MO now listen to the lectures I gave in the seminar or conferences. I want them to see the product of their effort in teaching and scolding me long time ago in making me a successful doctor. I am very grateful and thankful to all my friends and teachers who have a great role in making who I am today. I can't repay all of you back. Even now, my teachers are referring cases to me for further management of patients. Dear teachers, I want you to be proud of me and thank you very much for all the things that you have taught me.

My dad used to tell me that good teacher will produce good student. Good children come from good parents. When thinking about it, there is truth in it. My close friend said to me one day that genetic play an important role in making who and what you are. I do agree but not 100%. I still feel that external forces and environmental factors play more important role in determining who you are. That the reason I guess why my Dad told me to choose a good students to be my friends when I was 7 years of age. I asked him why?. He said " if you want to be clever, make friend with clever people and if you want to be successful in your life, mix around with successful people, because you will become 50% of the total of all of your friends". We don't want to be a mediocre people do we. My Dad taught me a lot. How to be patience, forgiving and always think positive. Never look back. Learn from mistakes that we make a long the way. Believing in yourself when no one does. Because he said that's what make you a winner. When I was young, I spent a lot of my time with my Dad. He is such a resourceful person. I admired his courage and passion. He looks very highly on education. He works very hard to provide all of us with education. I listened to his story. My Dad was the one told me that I will grow up to be a successful doctor. Since then I told him and myself that I will turn his dream into reality and I will. I remember all the things that my Dad taught me. He reminded me not to forget to say thank you to God, always for HIS blessing. Obviously, genetic is not the only factor in determining who you are. There are multiple factors and external forces play bigger role in your life.

I always reminded my doctors to do their work sincerely and honestly. They have to improve their skill and knowledge all the time. They should progress and not to regress. What we have learned today won't be relevant in near future because technology improve and changed. You must have right attitude because the right attitude will determine your altitude. Everything in life has a purpose. Becoming a doctor too has a purpose and certain principles have to be followed.

I am back after so long break

The last time I opened this blog was last year. My niece asked me several time why I didn't write anything in it. Well, it is not an easy task because I have to do it in between my busy schedule. Time fly so fast without you knowing it. It was almost a year. I do know that if you want to do something and wanted to wait for the perfect time, there will be no perfect time. There will be no tomorrow. Just do it. Otherwise, nothing is done. Many successful people in their carrier follow the principle of "READY, FIRE AND AIM" rather than the usual phrase " READY, AIM AND FIRE". What it means is that if you want to do something or anything and you already have all the things you need, just fire. If you failed to hit your target, what you need to do is try to make necessary changes so that when you fire for the second time, hopefully you will hit the target. However, if you decided to aim first rather than fire, probably you will end up aiming to the target for a long long time trying to get the perfect time and direction to shoot. We know, there will be no perfect time or perfect situation. All the time, we need to make adjustment and changes because world around us keep on changing. Of course, the changes that we make should bring us benefit. Based on these principles, all of us should make the best use of time and we need to live each moment as if it is vitally important.

Flash back to the time when I first reported as a HO in the second largest government hospital down south. My father and I took a train to Johore. To cut short the story, I reported duty as a HO to the Hospital Director. At the administration office, I met a few of my university's friends reported on the same day. Initially I was so worried but with my friends around with the same motives, I felt a little bit relief. The Hospital Director was a nice lady. Give us a lengthy lecture on the regulations, the role of the HO, our responsibilities and tasks that we had to do. I was posted to the O&G department with 4 other HOs from various universities. Out of 5, only one man. Together we went to the department to report to the HOD. He looked at us. Never smile. Told us our duty and responsibilities. Advised us to work together as a team. Not to forget to welcome us to the department. At that point of time, my carrier as a junior doctor began.

My God, it was hard and tough. I started my day in the hospital at 7.00 am. First thing in the morning was blood taking. I felt that I was the vampire. The different was I didn't drink the blood. There were 2 of us to take care of 40-45 patients. Thank God, I have a wonderful partner. We work together. He was the senior HO in the Gynae ward. I am very grateful to him because he taught me a lot. He taught me how to do my work fast and how to remember the names of all the ladies in the ward. That was not enough. We had to remember their age, how many pads they used, how many of the pads soaked with blood and so on. The consultant will get angry if we didn't know our patients well. We were not supposed to look into the BHT for information. Every morning rounds, when I heard the foot step of my consultant, I felt my heart stopped beating. My hand shaking. The eyes of the specialists and consultant like a sharp knife to my heart. I knew they meant well to teach me and encouraged me to know my patients well because patient - doctor relationship have to develop so that the patient trusted me to treat them. We have to show that we care. We also needed to show to patients that we are safe doctors. But it was hell.

I did 10 to 12 calls per month. When I was on-call, I only managed to sleep 2-3 hours at night. That was good enough. Sometimes no sleep at all. I had my dinner very late at night when the food already iced cold. I lost a few kilos that I gained during holiday. in a way. good for me. At that time, there was no proper place or room to rest if we had no patients to see. I still remember that I had to sleep in the store with all the equipments around me. In the store, there were 3 beds for the doctor on-call to sleep if we have time. If you were lucky, all three doctors were girls. You didn't have to sleep with male doctors. I was always unlucky. Several times, I had to sleep with male HOs in the "store". I felt scared but I had no choice. I used to remind them not to do anything funny. I knew, my friends HO were nice people. Furthermore more, we were so tired to think of anything else except to sleep as soon as we could. Time was so precious. We didn't want to waste time. After 3 months in Gynae ward, I was sent to work in labour room. I did a shift duty with another HO, 12 hours shif duty, 7.30 am to 7.30 pm and 7.30 pm to 7.30 am. The shif changed after 2 weeks.

Another priceless experience that I went through went I wast in the labour room. I can tell you, the teacher who taught me how to conduct normal delivery was the nurses. They were excellent. They taught me how to do episiotomy and stitch correctly. That year was a dragon year. Many Chinese wanted to deliver in that year. The labour room was very busy but I enjoyed working with the dedicated nurses there. They helped me a lot in my work. I learned so much from them. The specialists just taught me to perform instrumental delivery. Assisted them in the OT. I remembered clearly that one of the specialist, I don't know whether intentionally or unintentionally cut my hand with a scappel blade while assisting her when she did LSCS just because I was so slow to do the traction. That was my first LSCS. She didn't say sorry or said anything at all. God only knows how I felt that time. I didn't make any remarks or comments. I took it as learning experience. My friends asked me to report to the HOD but I decided not to do it because I was scared that she will make my life miserable in the department. What I enjoyed most during my O&G posting was the closeness that I have with the medical officers and nurses. The beautiful moments that we shared and the great moment together I will never forget. Working together, do it sincerely and love what you are doing are the main factors that make me what I am today. Frankly speaking, despite having to work so under stress situation, I did enjoy my O&G posting. You have to be proactive and willing to take up the challenge. My consultant used to say that all the doctors have license to kill but don't ever use it. Life is so precious and please value it the way you value your own.

My second posting was Surgery. Again, I enjoyed the posting very much. I worked so hard and learned as much as possible. The HOD and the specialists were very nice and helpful. In the third month, I had a chance to do my very first appendicectomy. It was a successful one. I was so proud of myself. With the encouragement that I had from the specialists, I managed to do herniotomy and laparatomy with assistant. I did wound dressing on my own. Learned it from the nurses. I performed minor surgeries such as removing the lumps and bumps. Did I&D. It was fun.

Overall, my housemanship period was a memorable one. Even though I didn't get paid or call allowance like HO now, we still work with dignity and committed to the work and responsibility that was given to us without questions. I took my job as a doctor seriously. Most of all I love my work and want to do more to serve the people. For the young ones who are willing to take the challenge, you are welcome to be a doctor. You have to know that we are dealing with human being and not machine. If you harm them, you won't be able to replace them or reverse back. Spoiled engine can be replaced with a new machine but human life, no substitute.