Saturday, April 05, 2014

A Houseman Guide : How to Survive Your First Posting

It's been a whole month since my last entry here and I'm truly sorry for the lack of updates. I promise there are so many things I can't wait to share but right now, I'm inspired to share my two cents worth of opinion on the short film, Budak Baru above. (*Beware, lengthy but worthy post ahead*) If you all have not watch it, this short film is about the experience of a newbie aka first poster starting her inaugural journey as a houseman in one of the Malaysia hospital. Interestingly enough, as life as a housemen in Malaysia has always been the talk of the town, with so much focus center on the welfare of housemen so much so it seems the medical officers and specialists welfare are simply neglected, it is not surprising as to how fast this video had gone viral all over facebook and youtube.

To begin with, this short film while depicting the harsh reality of what some new housemen had to endure, it doesn't happen to every housemen in Malaysia. I, for one, had met very good senior housemen, MOs and specialists during my first posting. The above situation only occurred because the senior houseman (Dr Azmy) is one of the typical example of a bad senior houseman, one who does not want to spend time teaching his juniors, probably got so fed up and stress from the long tiring hours of working that he is losing his passion in this profession and one who is not exactly the most helpful person around. The female MO/ specialist in the video is also not one of the nicest boss around; discriminating and impatient. The good news is, there are plenty of really nicer senior housemen, MOs and specialists around that are not like them.

So to all future housemen, if you are like Azlin, the budak baru, the new kid in the hospital, some of you might get culture shock especially if you graduated from overseas and are not familiar with our local hospital setting. On your first day, you'll probably felt all pumped up with mix feelings, starting at a remotely unfamiliar place with unfamiliar faces, feeling optimistic yet kind of scare, wanting to help yet do not know where to start. You might meet good seniors and bosses and your picture of what housemanship is like will be brighter and happier but if you happen to come across senior housemen and MOs/specialists like them, I can see how you will easily get dejected and discouraged. Hence, I hope these tips that I had gathered from my time as a housemen working under the shift system (yes, go ahead and breath a sign of relief. You don't have to work 36 hours on call straight anymore) will be able to help you survive your first posting and subsequently, your housemanship. I wasn't a perfect houseman, I made mistakes and I got my fair share of ups and downs too, but at least I think I survived my housemanship pretty well with these tips.

Stick with the triple H- humble, hardworking and helpful. Nobody likes an arrogant, lazy and calculative kid or colleague. Period. We (I) don't care if you are the top grad from your uni or if you are Mr/Ms-Know-it-All but at times, knowledge alone is insufficient. You need experience as well. Always stay humble, do not assume yourself to be above anyone. Do not pick up the lazy traits from your colleagues around and do not be calculative either. Some people are just so plain lazy they are always skiving or coming up with the most amazing excuses to not finish their jobs before passing over. And I realized with the shift system especially, many housemen are getting more and more calculative. They divide their patients so fiercely that even though in some situations where their colleagues have to run up, down, left, right everywhere in the hospital because the patients that they are in charged of that day all need extensive plans, the rest of them who are already 'free' are not willing to help out this poor colleague. In the end, this poor HO will have no lunch and probably have to go back late because no one is willing to help him/her out just because they are "not in charge of that patient". Many specialists used to and still do always said that in their times, there's no such thing as division of patients. If one ward had 30 patients, all patients are under your care and you have to know each of them inside out. But now that the number of housemen are increase, you don't have to cover 30 patients anymore most of the time and if you are lucky, you only cover 4-5 patients a day. So, if you have attitude problems, then you'll probably gonna have a hard time adjusting and coping with your housemanship because your bosses don't like you and if your colleagues don't like you too, no one is going to guide you and trust me, you will need a lot of guidance to survive your housemanship.

Every posting that you start with, you'll start with a period known as the 'tagging' period. This 'tagging' period is the time for you to learn the most essential stuff you need to know about the posting. Since it is your first posting and if you have zero idea about a houseman job, start learning everything from the scratch. From how to clerk a patient (which will differ from what you learn during your medical school days) to how to do referrals to how to get xray appointments to how to talk to relatives to your daily bread and butter of blood taking and branulas setting, pick up these things from your seniors. Follow them around and get them to teach you how to do these things. And then put what you had learn into practice. And since it's likely a 'monkey see monkey do' situation, pick the right people to learn from. A senior who is willing to teach you and not one like Azmy preferably. If you work in a computer based hospital, you will need to learn about how their IT system works as well. In the medical world, it is important to act fast so try to pick things up fast too because the faster you are able to work, the less stressful and less scoldings you will get eventually.

We understand, you want to be polite and nice but really, sometimes wards can get really busy and crazy and everyone has to be running around trying to complete their job as soon as possible before the MOs/ specialists come for rounds so asking 'what you can do to help' when you are probably clueless to everything that they are doing at that moment is probably not going anywhere. Unless you already know how to take blood and set lines from your medical student days, you are really of not much help at that moment, so don't offer something that you can't do. Instead, you can ask if you can run along with them, observe what they do and learn from there. The only way you can make yourself feel useful is probably by doing all the 'odd' jobs that they have no time doing. Some might bully you by asking you to do their jobs as well even though they are not busy but just take it as opportunities to learn. After all, there is no loss from doing more, remember rule no.1.

It's normal and common for first posters to be blur. There's plenty you still do not know of. After all, theories and practicals can be so different at times. So don't be shy or egoistic to ask  for help when you do not know what to do. Even MOs and specialists seek help from each other from time to time when we met situations we could not handle, so there's no shy in asking for help. Life and death is but a normal human cycle, so you'll definitely encounter a lot of patients collapsing and death in this line of work. Hence when you encounter a patient who collapsed right in front of your eyes for the very first time, you might be like Azlin, totally stunned and do not know what to do. And if you so happen to unfortunately be the only houseman in the ward with no other colleagues to help you, your only choice will be to call your boss aka MO. PLEASE DO CALL FOR HELP FROM YOUR MO IF YOU REALLY HAVE NO OTHER COLLEAGUES TO HELP YOU. Yes, you might get scolding later from your MO for not knowing how to resuscitate a patient but if it's a fact that you really do not know how to resuscitate, then acknowledge it. At least, do not put your patient's life at stake because of your own fear, incompetency or shyness.

Revise your knowledge and practice on your skills. There's no other shortcuts in picking up skills even simple ones such as line setting and blood taking other than through plenty of practice. During your tagging period, volunteer to help set lines and take blood.  Learn, learn and learn and then put them into practice.

It's also common to be scolded by MOs and specialists because even senior posters make mistakes, what's more if you are new. Take those scoldings or sarcasms as lessons to improve and motivate yourself further. It can sometimes make you feel very depressed or not appreciated but don't give up easily. After all, even though there exist a 5% of MOs and specialists who like to scream, use unkind words or bombard housemen at all times, most of us do not like scolding housemen for nothing. If there's no reason, we do not like to yak at you either. So, if you are getting a lot of scoldings, re-evaluate yourself too.

So, after rounds you might be thrown 1001 management plans to carry out and while it is true you need to learn how to prioritize your duty, never lose your compassion towards your patients. If not you'll only end up working like a robot every single day. Treat your patients and their family with dignity and all due respect. Most family members will like to know about their family condition as well and sometimes their understanding of the patient's condition can help you in the management of the patient. You don't have to do it in the midst of being very busy but you should always find time to get back to them. Take time to speak to them politely even though some family members can be very demanding, difficult or arrogant. But put yourself in their shoes and I'm sure you'll feel equally anxious if your family member(s) is admitted.

Yes, it's your responsibility to review and examine all the patients (or the ones you are in charged) every time before rounds, regardless of whether it's the morning, noon or night round. When reviewing patients, you not only review their progress, but their latest and up to date investigations, output, intake or any other issues related to that patient especially for the morning rounds. Do not simply try to 'kelentong' your MOs and specialists the progress of patients, examination findings or investigations results just because you didn't had enough time to review them. It's actually a very dishonest, disgraceful and irresponsible act that has the potential to harm your patients so don't feel too good or too proud of yourself after doing such an act. If you know you will get scolded for not reviewing your patients well and know that you need more time to review them, then come early to work. I know it can be tiring but at times, you just got to do what you need to do. If you want to feel appreciated and gain respect, then earn it. Don't lose the trust your bosses put upon you. And most importantly, by lying about a patient's condition, you are just jeopardizing your patient's health. So, you totally defeated your purpose of wanting to help people.

I'm not saying you should start pretending to like everybody or try to be Miss or Mr Popular but it does help a lot if you have more good friends to work with. That way, you all can always look out and guide each other. I can never be more thankful to have friends who are willing to stay back even after their shift hours just to teach me a new procedure during my initial months as a houseman. From what I observe, friends and colleagues like that are getting more and more rare these days.

Nobody ever promise it's going to be easy being a doctor. All those movies or dramas you watch on tv makes a doctor's life appear pretty cool and good but in actual fact, there's a lot of sacrifices you have to make to appear cool and good at the end of the day. If you are already having cold feet after watching the video, it's still not too late to change your mind about being a doctor. Otherwise, even after knowing that it is going to be a stressful, tiring and sometimes not as rewarding as you had thought it to be profession and you still want to stick to it, then you gotta have a lot of determination and passion. Always remind yourself the reason you chose to stick to this profession whatever it might be when you feel like giving up. (maybe you can find one of the reasons why you had wanted to do medicine here)

While not all hopes are loss, for there are still good housemen around, there are certainly the black sheep of the family too. So please do not pass on the vicious cycle of bullying or looking down on junior housemen. If you had been through the bullying or having to struggle without guidance, you know how it feels like so put a stop to the vicious cycle and guide and help them instead. It's also time we stop judging the capability of people just because of where they grad from. Some of these overseas grad may be slow at the beginning because of culture shock, but they are actually good and some even better than some of those grads that are supposedly from more reputable varsities but have poor attitudes such as being plain selfish and conceited. Judging someone by where they grad from is as discriminating as judging someone by the state they come from.

Housemanship may be tough, but it can also be a very enjoyable period. Truly, there's no one profession that is really easy no matter how breezy they seems. The grass just always seems greener on the other side. Thus, since you have sign up to be a doctor, going through housemanship is just part and parcel of it. Don't give up or get discouraged easily and don't do unto others what you do not want unto yourself. Housemanship is a time for you to learn and face the reality of a doctor's life. If you think that you can't take housemanship, then maybe this profession is really not cut out for you. Otherwise, good luck with your housemanship and hope the guide above helps in some way or another at some point in your houseman life. :)

PS The above are based on my personal experience going through housemanship and in no way is affliated to anyone else. It might not work for everyone too as every individual is unique in their own way. Most importantly, just try to enjoy the process of housemanship no matter how difficult it might be. If you need someoneto talk to on this matter, my email is always available. :)

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I know that when the time comes, you will make an excellent house"woman". :-)

Hi. I'm currently in my final year in one of local Uni. I had read this entry and it's really good writing! thank you so much for giving your tips and advices. Please pray for us since i'll be finishing medical school and later will be a fresh HO.. Really thankful with this entry.

Can I have your email address. Need some advice. Would like to drop u an email