I'd worked as an houseman in Kuantan Hospital Tengku Ampuan Afzan for exactly a month now. I started working in ward on 5th July, till today. However i have officially been a government servant since 21st of June, on the first day of Induction (and my salary had basically started counting from 12 am on the same day). Then the first week since i reported to this hospital on 27th June has been for some infectious control programs, and practice of blood taking at the Ambulatory Care Center, which is super super chilled. So basically, i had started the real HO life on the 5th of July.
The first one month of 'life' was like the 'sohai' period (stupid and useless period). It was for me just about familiarizing with the whole new system, new places, new people, new languages. One of the thing that surprised me was the extensive use of medical abbreviations (many of which are not even internationally standard ones, eg BUSE, COROS, CBD, BO, Branulla, Lytic Cocktail, BHT etc etc). Even by checking the name on the internet, it doesn't show any results. All used in this primitive Malaysia only ma. Why Malaysia medical system is staying under its own roof using stupid terms like that and make life harder for people from oversea?
Second is the language. Yes, my own Malaysian national language. My Malay sucks. In the beginning, the way i clerk case is almost similar to the way i clerk in Kanada language when i was in Mangalore. The funny thing is some doctors here actually present a case in malay mixed with english. and almost all nurses speak in malay only. It took me quite sometime to actually able to speak in sentences. Imagine that!
Next is the drug names. It should be a standard of using only generic names! However, those names in the med chart was all in brands, which are totally aliens to me. I have to spend time to open the Medscape, or search online through my phone, or check the MIMS to have the slightest ideas what is what. Funny thing is, some of the brand names are no longer available in pharmacy. Why no more branded drugs? Because government is going to bankrupt soon!! They now give only generic drugs (cheap ma). Medscape on my ipod has especially been super useful for me in searching for generic drug names, the dosage, the indications and contraindications etc etc. Of course, the pharmacist has called me numerous times in the to rectify on the dosage of my prescriptions etc.
Then it's the paper work!! Lab forms! Reporting of certain diseases! Reviews! Entries! Radiology appointment! Lab report tracing forms! Discharge summaries! Way too many kinds of forms to be filled! Most of them need a carbon copy, IC number, diagnosis, and stamp. I find filling forms a big nuisance, had tried to cut down on some details to cut short the time spent but got screwed so many times by the lab. In private hospital in India i worked, u just need to put stickers (containing all the pt's details) on the forms, and tick whatever investigation you need on the form. Life was so easy back then.
The next thing is the blood taking. I don't know is it because of my skills has dropped, or the difference between Malaysian and Indian patients' blood vessels. Taking blood in India is to me a super easy job, and if u cant do it, there are nurses or colleagues to help u. But here, taking blood seems like a big job to me. You need to push the whole trolley and carry more stuffs to the pt's bed. Very often, i failed in collecting blood -it's either no veins are visible, or even though i am confident that i poked the right place, only bubbles of blood enters! Sometimes taking a pt's blood or inserting the cannula can take more than 30 mins for me. There were times when i failed and tried to ask for nurse's help, only to find out non of the staff nurses know how to take blood! Gonna ask the other HOs? Everyone is way too busy doing their work. Gonna ask MO? no way, it's a shame! So in the end? You are stuck with the pt and start trying from wrist area to elbow area to femoral to arterial blood. The whole thing of blood taking is just damn frustrating for me.
Next is the my knowledge. I had basically started out with zero knowledge here. That's because the 1 year of internship in India is way too relaxing, and do not require any studying. As an intern in India, you need not to be responsible for the pt management. You do not even need to know anything about the pt and still able to survive. Internship for Indians is just the 'break' after the hectic final year MBBS as well as the time to study for entrance PG exams (which do not apply for us foreigners). One thing i especially do not know is ECG! In KMC, we only need to know MI and count the rate to pass our spotters exam. I somehow realized almost everyone here can read ECG as easily as ABC. Just a few glimpse they can know what the ECG shows. For me, i even forgot how to count the heart rate!! That's what scare me the most, and i do not even have a book to read bout ECG except my iOS app - ECG Guide. There are so many cardiac pt who need daily ECGs, and when i asked to describe about the changes, i would be stunned.
Then is the whole big issue about the work load. We work up to 90+ hours a week easily. It's a big contrast from the easy go lucky internship life in India. In India, you are only expected to do 3 things: collect and send blood, collect reports, and write discharge. (plus some procedures and history taking). Interns in India are still considered 'spoon-fed' by PGs. "Do what you are told, and leave the rest to the PGs, cause you are totally irresponsible for the patients' management". However, doctors here are expected to be pro-active, to walk the extra miles, and at the same time there's absolutely no one to ask you what to do and what not to. You are expected to learn from colleagues or by yourselves through the hard way. Here we have to do every single thing!! Starting from when the pt got admitted, clerk the case; take the blood; take the blood samples all the way to the lab (if needed STAT); come up do the rounds with MO; then do the rounds with Specialists; then take blood again (if newly ordered by specialist), get the radio appointments by going all the way to Radiology dept and present the case to radiologist and get his/her signature after some screwing and come up again with the appointment letter; then refer the case to another dept by calling up the MOs and present the case via phone and get some screwing; then fill up tracer forms and go all the way down to lab to trace the lab reports wanted by the supervisors STAT; then asked by nurse to change the cannula of another pt who just got blocked; then write the discharge of some other pt; then go and do some procedures (you are expected to perform Paracentesis,Thoracocentesis, Peritoneal Dialysis, CVP perfectly, plus maybe BMAT and LP) for the pt who need it; then follow the MO to see the case i just referred earlier; then carry out again whatever is ordered by him/her; then go and clerk another new admissions..... the list goes on until you forgot your lunch and suddenly realized it was already 6pm. Until the next morning, during the specialist round then only you found out you forgot to carry out something for that pt and then get screwed again.
Another thing i would like to stress on is the job scope of nurses. As of today, there is already overloading of nurses in Malaysia, and they have started with shift systems early on. Imagine around 7 -8 staff nurses for each ward of around 40 patients, plus few students nurses. The shocking thing to me is that, the nurses here do so little! All they do is monitoring of V/S, cleaning up the mess of the pt, changing their bed sheets, giving them med, and doing paperwork, plenty of paperwork! Sometimes, the nurse do not even need to be on pt's bed and get all her job done at the counter with the file. It's not hard to see all the nurses just handing around the counter chatting while doing some 'serious' paperwork. The staff nurses do not even know how to take blood. It is only those senior 'sisters' that had did all the blood taking and pt care years ago before the whole system changed. Even the 'sisters' themselves admit that they no longer enjoy working in govt hospitals cz all they do is paper paper paper bullshits.
Currently, i am glad i'd passed the 'dumb' period of being a houseman as a first poster from a foreign system. I am now more in sync with the way things works, able to find time for my lunch, able to read up a bit, and able to walk a bit slower. But, there are still too much for me to learn and know. I'd already had 4 times on call, thank god no pt has died under me, and for each call i was able to sleep (which is rare for other people). I now have some juniors already, and i am expected to start teaching them, which i did. Started having more friends, able to have more confidence in prescribing without asking, or suggest new diagnosis and drugs. But of course, i still get some screwing sometimes, mainly for forgetting to do something (who doesn't?)
Generally i am super thankful to have Medical as my first posting. It is the busiest posting among all, the hardest to get adjusted to, with the most work to carry out, and most brain power needed. However, the MOs and specialists are all very nice. They are willing to teach, to correct, and the way they screw is considered 'nice' as compared to other dept. People say, if you survived Medical, nothing else would be a problem. And i rightly hope so.
1st of September onwards, all HO in Malaysia will start the "shift system". There will be no more On-Calls. No more 90 hours per week. No more On-Call allowances (which can easily go up to RM1000 per month). Maybe the Critical allowance (RM750) will be waived off as well from our salary. Everyone work 8-10 hrs a day. More 'life', more sleep. What claimed by our Health Minister is that, the shift system is for our own good!! He wants the specialist to have more rounds in a day, can teach more personally, and reduce our work load due to all the complaints he received every second from HOs complaining about being bullied, treated unfairly, stressed, mental break down, gone psycho etc. But i do not think it's the main reason. The main main reason is that - our government has no money! No money to pay for our On-Calls, which is RM100 per calls. Like this, the government can save up to RM50 millions per year! This government is going to be thrown out soon, so they must suck as much as possible while they still can.
However, according to the condition in Kuantan, there are not enough HO to shift thrice a day. We now have 4 HO per ward containing 40 pt. Each HO will be in charge of around 10 pt max. If you divide the 4 person into 3 shifts, which means a single HO for the whole ward? How will the quality of work be? It will lead to more pass-overs, reduce of responsibility, and less closely monitored by specialists. So in the end, who will suffer? The patients. Treatment plan will be delayed. The pt will be like a ball passed around the HOs. This is because it is impossible for 1-2 HO to cover the whole ward and at the same time complete all the works i aforementioned within that few hours time. Yes, we will have more time for ourselves and family and friends, continue with our social life and whatever hobby we used to had. But how about the quality of healthcare? Already the healthcare in Malaysia is down the drain as we can read about it every single day. How much worse will everything become? Day by day, more and more HOs are being produced both from local private unis as well as foreign ones. How will the future doctors be? Will we be able to be up to par and be "safe doctors"? Everything is going to be more and more gloomy, especially for us young HOs' future in Malaysia. Last week, there was a bad news for us HO in medical ward of HTAA. As of now, we have 7 HOs on call per day, and the 7 person is so so just enough to cover the all 4 wards, the periphery, and the dengue ward. But, there was an order from i don't know how high above, to cut down on the number of HOs on call per day to 4. Yes, reduced by half to 4!! @#$^%&*. The reason being? The hospital, or i don't know where, is out of budget! They cannot afford to pay RM300 more per day even for this one last month before the shift system starts! What kind of fucking bullshit is this! Where does all the money goes? Buying nice rings and big houses for the politicians themselves right??
How i wish life would be just like internship in India. Go to work at 9, come back at 5. Plenty of time to have a cup of coffee and lunch in between. Just doing the job of a 'clerk' instead of doctors. Come home play sports, play games, watch movies, go out for dinner, come back late night and sleep. But of course that's the difference between the US system of India and the old UK system of Malaysia. At least in India, we can become a specialist in no time, but in Malaysia, you might easily get stuck of being a what they call 'chronic MO', going no where and doing all the hard work. That's the frustrating and gloomy part of being a Houseman in Malaysia. Less pay, more work, no pride, little future, and your hireachy in the hospital is in fact lower than the nurses.
p/s: all these experiences are applicable to Kuantan HTAA Medical unit only. I do not know how are the other Mangaloreans doing, as i seldom hear from them. (maybe d/t superbly busyness?)
