I wish my dear friend, Balqis is here so that she could organize another talk that she had given us two years ago.  She used to give a presentation entitled “Generasi Pemuda dan Perubahan” inspired from the book written by Fathi Yakan.

Our Youths have too much energy.  Far too much. And they use this energy to ‘merempit ‘ or go clubbing or getting themselves embroiled in gangsterism. They could have used those energy to do something meaningful in their lives.

But they did not.

Probably because when they try to bring about some change, there will be the older generation chastising them. The older generation will probably say something like these:

“Shut up. You don’t know anything! Just do as I say.”

“Selama ni tak pernah siapa cakap yang kita buat salah. Kita dah buat benda ni lama! Awat bila hang mai, macam-macam tak kena. It’s all in your head.”

“Iys, tak padan dengan HO!  Baru saja jadi houseman, dah kompelin itu ini. Kena ajar sikit budak ni!”

“Hang nak cakap apa pun, hang tunggu hang jadi MO dulu. Banyak pula masa hang nak tulis blog!”

“Kita baca Yassin malam Jumaat ni dah lama sejak zaman nenek moyang kita lagi. Tahlil pun dah lama jadi adat dalam budaya kita. Tiba-tiba hang pi cakap bidaah pulak! Hang belajar mana ni??”

It’s a classic Kaum Muda versus Kaum Tua yang kita belajar dalam subjek Sejarah dulu.

It’s just like the song Father and Son by Yusuf Islam (aka Cat Setvens) too.

Most of the time Kaum Tua did not bother to answer the issues raised. They just randomly say something that does not address the points made. They would say exactly like the examples I have given above.

At last Kaum Muda becomes too exhausted and tired of fighting this pent-up energy that they have repressed to please Kaum Tua.  Kaum Muda then grows older and becomes just like Kaum Tua. And the cycle repeats itself.

Agama Islam memandang  tinggi Kaum Pemuda.

Waktu kamu muda lah kamu mampu untuk buat apa saja! Waktu kamu mudalah kamu mempunyai potensi yang sangat tinggi!

Waktu kamu muda, kamu boleh lawan bos kalau kamu rasa kamu di pihak yang benar. Kalau kena pecat pun, pecatlah! Sebab kamu tak kahwin lagi, kamu tak ada anak. Kamu tak ada komitmen. Gaji kamu hanya untuk diri kamu. Kalau kena pecat, pecatlah! Kamu cuma menanggung diri kamu sendiri. Kamu tidak perlu risau anak isteri tak makan, tak perlu risau perbelanjaan persekolahan. Kalau kena pecat,  pecatlah!  You know you can find something else to do. I don’t need a boss like this, you will say with conviction.

Waktu kamu muda, kamu mampu buat banyak perkara tanpa berasa letih. Kamu mampu tidur 2-3 jam sahaja sehari untuk belajar, untuk siapkan presentation, untuk melakukan aktiviti  luar, untuk berusrah.

Waktu kamu muda lah kamu mempunyai masa yang paling senggang. You have more time to contribute to the society because you don’t yet have family. Your time is not divided by so many organizations /individuals that are dependent on you.

Waktu kamu muda juga lah kamu mempunyai duit yang banyak. Your money is yours alone without having to allocate some of it to your wife/ children/ loans/ investments/savings. Waktu kamu muda, kamu boleh hidup 2-3 orang dalam satu bilik tanpa berasa rimas pun! Kamu boleh jimat on accommodation. The money can be used to travel and see the world, and perhaps to preach the religion of Islam.

Orang muda mempunyai potensi yang sangat tinggi untuk menyumbang dalam masyarakat.  Orang mudalah golongan yang  paling bertenaga, gagah, berani, bersemangat, tidak mudah menyerah. Kalau kamu seorang yang berani  MEMPERTARUH NYAWA merempit di jalan raya, maka kamu juga lah orang yang sama yang tidak akan takut mempertaruh nyawa untuk sebab yang lebih utama…menegakkan kebenaran.

It explains why so many of our warriors in the past are YOUTHS!  (takkan kita nak harap pakcik-pakcik tua pergi berperang menegakkan kebenaran?? At the same time, takkan kita nak mengharap kanak-kanak tidak cukup umur untuk bercakap lantang. The duty falls on US, the YOUTHS!)

Sultan Muhammad Al Fatih conquered Constantinople when he was 23 years old! (At 23 years old, I was only a 3^rd year med student whose worries and concerns are very trivial, indeed.)

How old was Tariq Bin Ziyad when he conquered Spain? He was only 20 years old when he was sent by Musa Ibn Nusayr in the year 711 AD as a chief commander to conquer Al Andalus. 20 years old, folks! When we were 20, we were probably more concerned about the latest Korean dramas more than anything else!

One anonymous specialist commented on one of my posting saying: WOW! As a HO you sure have lots of time in your hands to rant so much bla bla bla.

I don’t get it! Would you rather I don’t even have the time to eat or sleep, and only then I will be considered as a good HO? How is that so?

It doesn’t take a lot of time at all for me to write. It’s not like I have to ponder what to say for hours before I write about it! If I can finish a 5-pages essay in one hour as a student in SPM, then I have NO TROUBLE whatsoever to finish one blog post without sacrificing that much time. Why do you have to begrudge what I write during my free time? Would you rather I talk about the latest Korean drama, or who is dating who in Hollywood, or what I eat and where I travel to? If I don’t write a blog, someone else will! So, what kind of posts do you like to read? Gossips?? Or the kind that sweep issues under the carpet, perhaps?

So that people can complain about HOs in newspapers, in media, among specialists and MOs…but HOs cannot say a single thing even though they feel betrayed by the bad rep that they got which, oh by the way, stem from your own government policy? We send students to Russia, then we say (unjustly) that Russian students are incompetent. We send students to overseas, and then we say the oversea students do not get enough hands on experience.  We build a lot of medical schools all over the country, and then we say there are FAR TOO MANY housemen and they will not have enough training! Your policy, and WE got the bad rep! And when people talk about us, we are supposed to be mute. I guess that’s what most people want…a mute HO. A mute Hamba Orang.

I was told that some MOs are of the opinion that as a HO, I really should not say anything much. Tunggu jadi MO dululah, baru hang buat apa hang nak buat. To that, I wrote in my FB status one of the things I wish I could have said to such statement.

“Kau nak buat apa pun, tunggu laa sampai kau jadi MO. Bila kita dah jadi MO, someone will come and said, kau tunggu sampai kau jadi specialist kalau kau nak buat apa pun. Bila dah jadi specialist, we then found out that we still have to answer to the HOD. And then bila dah jadi HOD, kita kena answer to Pengarah. Bila dah jadi pengarah, kena answer kat DG. Bila dah jadi DG, kena answer to Menteri. Bila dah jadi menteri, kena answer to PM. I bet you, when you finally become a PM, you will find out that your hands are still tied because there’ always someone higher than you that you have to answer to. And then you will end up not doing anything at all because you are used to just passively wait.

I say, just cut the hierarchy of authority short by saying, “I answer only to Allah. Period.”

Adakah bila kita dah jadi MO, kita masih akan peduli tentang HO? Betul ke?

I don’t think so. Bila kita jadi MO, kita ada isu kita sendiri. We have other MO issues that we would like to fight for, kan? When we become a specialist, we also have our own issues as specialists, of course!! Maybe by the time we become MOs or specialists, we will not understand AT ALL what our subordinates are so unhappy about, right? Just like what is going on at the moment! I might turn out to be like the specialist who would say “ Wow! Banyak masa kamu nak kompelin dalam blog ni! Zaman saya dulu….”

Kan?

So the right person to talk about HO issues is the HO. The right person to talk about MO issues is the MO!! The right person to talk about the specialists issues is the specialist!!!

So, what is it that you are so angry about? Because HOs are supposed to be mute?

We can agree….or we can disagree, COURTEOUSLY!! With reasons!  That’s all it takes to build an intellectual medical society who respect each other’s opinion regardless of their rank in the government service. We should ban public humiliation and shouting! We should stigmatize hostile behavior regardless of from whom the hostility comes from.

I cannot imagine what will happen if Islam forbids courteous freedom of speech! Will Islam have spread, do you think? Will we still have stories of how a woman challenged Khalifah Umar Al-Khattab regarding his ruling of the mahar? Will we have heart-warming stories of how our ulama fight against an unjust ruler?

What legacies would we have to pass on to our next generation?

Why should we speak up?

As I have mentioned in my previous post (H.E.R.E) , I had spoken against the examination system in my uni when they failed my friend TWICE. The examination system was very ‘kuku besi’.

Why did I do that?

1)      Because most of the time, the victim will be so paralyzed with grief that they would not be able to speak for themselves.

-you have to understand the plight of government-sponsored student. If we cannot finish our studies within 5 years time, we have to finance the remainder of it with our own money. Not all of us are filthy rich! Some of us had to return to Malaysia for having failed one too many.

2)      Because the victim usually does not have the credibility to complain against the system that has failed her. They would only say, ‘Sebab kau fail lah, maka kau kompelin. “ She needed someone who would complain against the system even though that person had passed!

3)      At that time, I had three more years to go as a medical student.  What would happen if I fail later? If I had the attitude of “ni bukan masalah aku. Aku tak fail.” , what would happen if I fail later? If I waited until I failed before lodging a complaint, I would be as helpless as my friend. They would say the EXACT same thing…you complain because you failed. Why didn’t I see you complaining against the system when you passed last year?

Imagine what kind of spineless coward I will sound if I say, “Well last year, it wasn’t my problem. That’s why I didn’t say anything even though the system was cruel.”

Alhamdulillah, I am able to obtain my degree within 5 years. I would have no idea how to finance my own way through med school if I had failed!

But I spoke up as an insurance! Just in case. So that if I fail, I can say “I have talked about this even before I failed.” So you cannot use the same argument you used against my friend towards me!

You see, if you don’t speak up against injustice when it happens to others, it will back fire on you later! When it happens to you, you will be just as paralyzed as anyone else…you wouldn’t know what to do because you really can’t do anything at that time. Well, not CREDIBLY.

If we sanction bullying when it does not happen to us, what can we say when it happens to us later?

How WEAK and SELFISH we will sound when we say, “When it happened to others, it was not my problem. I was happy with the system, then. Now, it happens to me, so….well, I am not fine with the system anymore.”

What a great attitude to have, then?

Katakanlah suatu hari seorang kawan kamu dituduh melakukan sesuatu yang dia tak buat. And you know. Will you stand up for her?

Or will you say, “Aku nak perabih housemanship aku dulu. Aku tak nak masuk campur. Aku nak buat apa pun, aku nak tunggu aku jadi DG dulu. Bila aku dah berkuasa, baru aku boleh buat apa-apa. Sekarang ni, aku sokong dia dari belakang saja.”

Huh, sia-sia saja Fathi Yakan menulis Generasi Pemuda dan Perubahan.

Sia-sia.

At the end of the post I would like readers to have a few take-home messages:

1)      The YOUTHS have such incredible potential and they have a lot to offer. But they CAN’T if all you want to do is repress their enthusiasm and curb their potential with unhelpful snide remarks.

2)Kaum Muda and Kaum Tua do not reflect age alone. Whether or not you belong in the group of Kaum Muda or Kaum Tua is a matter of philosophy. I have seen a 40 years old specialist who has a Kaum Muda attitude…and I have seen many-many younger generation with Kaum Tua attitude.

2)      The right person to talk about HO issues is the HO. The right person to talk about MO issues is the MO. And the right person to talk about specialists issues is the specialist. Don’t take away that rights.

3)      When you don’t speak up against injustice done towards others, it will backfire on you sooner or later. When that happens, you will wish to go back in time and do the right thing. But you can’t and it will kill you inside.

“Sesiapa yang melihat sesuatu kemungkaran, maka hendaklah mencegahkannya dengan tangan, sekiranya tidak mampu maka dengan lidahnya. Sekiranya tidak mampu, dengan hatinya. Yang sedemikian itu adalah selemah-lemah iman, “ (riwayat Muslim)

Here comes my first declaration.

I hereby, declare myself to be quite the happiest person alive today.

You see, I am on an eight days straight holiday, Alhamdulillah. Eight straight days will pass in a rush, but while it last, I will enjoy the free time to the max.

A lot of people were surprised when I told them that I still have eight days of my end of posting leave.

“Afiza, hang tak pernah ambil cuti ka sepanjang empat bulan ni?”

I nodded, proudly.

PROUDLY.

But wait a minute. What have I got to be proud of? My not taking any leave has nothing to do with me.

When you think about it, my not taking any leave in medical is actually a testimonial to how good medical posting has been treating me. Medical Department should be proud.

I didn’t have to take any leave with medical; I like their shifts. I am more than content with my post night off as well as the free time that I have during my pre-night shift.

I didn’t have to take any leave in medical; I like the MOs and the specialists.

I didn’t have to take any leave in medical; my colleagues were awesome to work with. No one has yet to go EL on me. Thank God.

I’m gonna miss medical. I am gonna miss their lady-like and gentlemanly ways. It will be hard (if not impossible) for other postings to compete with the beautiful manners of the MOs and specialists in medical. Medical posting proves to me that we can learn just as much (if not more) without being screamed at or humiliated upon. Thank you, medical,for proving me right all along.

That brings me to my second declaration of the day.

I feel like I was treated as adult in medical. Our point of views are listened and heard.

I was in medical during the time when we were suffering from a severe shortage of housemen. There were no new first-posters coming in and at the same time, the old housemen who were due to change postings had already done medical previously.  There was one time when we were left with only 25 housemen. And remember too, that medical is quite the busiest department simply because most patients in the hospital will be medical patients.

Because of the severe lack of housemen, there was one time when we need to go back to being on-call (but with a more humane change compared to the previous on-call style. We could go back at 8 am the next day). Meetings were organized to talk about how to manage our housemanship resources and allocations. Our views and opinions as to how we wanted to work were being heard. We got to vote on the suggestions too! And I couldn’t help but thought that this was charmingly democratic.

Yes, we felt like we were treated as adults.

I didn’t feel like I have to shut my mouth from giving opinions. I didn’t feel like they were going to keep on bringing up whatever mistakes I had done weeeeeeeeeeeeks ago and keep harping on it.

They were no personal attack.

Whatever little scolding I receiveed were JUST and WARRANTED.

And they were no swear words. I mean, I didn’t hear the F word being freely uttered shamelessly whenever they talked.

For example, I didn’t hear “Where the F*** is the patient’s f**king drug chart? Where the F*** is everything when I F**king need it?”

I HATE the F word. No one should be allowed to use it in public and feel proud while saying it. No one should get away from being able to say it without having incurred the license to be looked upon like dirt. No one should feel like they can say that word and still deserve respect. Not even surgeons.  Not even consultants. Not even specialists.  Let alone MOs and HOs.

Not even ANYONE, period.

I have this rule in life that says, “What you won’t say in the presence of your parents, your daughter, your wives or in respected companies, you shouldn’t say those to anyone at all.”

Just imagine your parents listening to you using such coarse words in every sentence after every other word!  I imagine my parents would pinch my ear and then scrub my mouth with povidone and 70% alcohol solution…and that is if they could not find sterilizing equipments, FIRST. Not only it constitutes bad behavior, indeed, but it also speaks volumes of the (SEVERELY!!) limited nature of your vocabulary.

Really!

Is your English THAT mediocre? Do you not have any other adjectives in your brain? The word F*** is the best you can come up with?  Really??

Will you allow me to donate you a dictionary? No, I won’t even ask you to thank me. It will be MY pleasure.

I abhorred hearing the F word in my presence. I hate the lack-of-respect that person has shown towards me. I hate even more the fact that the person does not respect himself/herself. If you respect yourself you will NOT deign to blemish your soul with dirty words.

The medical world consists of people who are supposed to be altruistic and brilliant. Frequent swearing should not be included as acceptable conduct in this refined cycle.

When I was in Australia, the Australians do swear.  A LOT!

But when I was around and heard those words, the guys actually turned towards me, blushed and apologized.

“Sorry, Afiza. Slip of the tongue. Shouldn’t have said those words when a lady is around,” They would say and wink.

Ah…palpitations and fast AF.

Such gentlemen! And they treated us Malaysians like ladies. They didn’t swear in our presence. They took one look at our hijab, and they thought we were all that was angelic and good. Hahhah.

When they apologized to me, I thought it was most weird. At that time, I did not even mind, you see.  It was THEM who were more sensitive than I. I didn’t know why I didn’t mind. Probably because I’d already accepted that as part of their culture. Probably because I expected that sort of behaviour from them. What I didn’t expect was for them apologize to me afterwards. It positively warmed my heart, my dear readers.

But when I am back in Malaysia, I hear the Malaysian guys (and some girls) swearing like the Oxford dictionary has no other adjectives, comprising of only 10 pages thin…..and NO APOLOGY? I was aghast!! I was so used to hearing people apologize after swearing, that I was appalled and astounded that I didn’t receive any in Malaysia. And then, I was ashamed. I didn’t expect this in my own culture, you see.

How could it be that the western gentlemen  AUTOMATICALLY feel ashamed and apologize to Muslim ladies when they accidentally speak coarsely in our presence…YET the Malaysian ?gentleman (the question mark is there for a purpose) did not even bat an eyelash when they swear so eloquently, they can make even PROSTITUTES blush!

WE! Who are supposed to have ‘ciri-ciri ketimuran’, did not even bat an eyelash and passively accept obnoxious behavior in our presence!

Shame on us!

“Bukanlah Nabi s.a.w itu seorang pemaki orang, tidak juga seorang pengucap kekejian dan bukan seorang pelaknat orang lain“. (hadis al-Imam al-Bukhari daripada Anas bin Malik r.a)

So, let’s be like our hero, the Prophet S.A.W and stop swearing. Challenge yourself to speak beautifully, wittily, intelligently…. or just decently.

I guess what I meant to say is, at least, speak like the people that make up the medical department. That alone, is a source of immense gratification, at its maximum.

Ah, have I mentioned I am going to miss medical?

Despite the fact that I was going to go on-call the next day, I could not stop myself from watching the movie Three Idiots on TV3 that Wednesday night.

Oh, I have watched that movie a year ago. I remember how that movie left me INSPIRED at that time. And I RARELY re-watch movies. I re-read books all the time. But I don’t re-watch movies. I was not that big a fan of movies. To me, watching movies is one of the great activities you do when you chill out with friends every now and then. But when I have the time for myself, I don’t re-watch movies I have seen. I much rather re-read, every single time.

But the Three Idiots is one of the exceptions. You see, I have a list of inspirational movies that I vow to have in my collection, insya Allah. These are movies that are uplifting and feed the soul. Another good movie is The Pursuit of Happyness (no, I don’t misspell the title). And if you haven’t watched  The Children of Heaven (a gift from Iran), you need to be doused in cold water and wake up! These are the movies that I would watch to remind me that life is nothing without living it inspiringly. It’s better to burn brightly and briefly rather than to flicker on for a long tedious time, I would say.

You have to live a life that will bestow a sort of legacy to your children and grandchildren. You cannot live a life COWARD. You cannot live a life SILENT. You cannot live a life OPPRESSED. You cannot live a life DEPRESSED. You have to live a life that makes a difference. Life is short. If you got unfairly treated just because you refuse to compromise on what you believe, then know that it would only be for a stint.

That is why I love to watch movies that have the triumph-against-all-odds theme. The small cat triumphs against the big bad wolf who is a lot more powerful; or the small-time detective wins against the evil force in the CIA; or the struggle for justice against a cruel ruler (THE A-ME-RI-KAH) One day, hopefully, there will a theme of Palestine winning back their stolen lands from the hands of the Zionist, God willing.

That is why I love movies that have happy endings (after a long, torturous struggle, of course). Because those are the kind that inspire. Happy ending rewards doing good. If you make the heroes suffer till the end, then the take-home message will be: doing good is a useless deed because you will have nothing to gain from it. So in movies that feature struggles of any kind (or in Islam, we call struggle as jhad) you MUST make the good wins; it’s the ONLY acceptable ending, as far as I am concerned. That’s why whenever people ask me to join in their movie agenda, I will always ask about the ending first. The ending is your ‘matlamat’, your purpose. If you tell me it’s a sad ending, that would tell me I have lost the purpose of watching it. So why should I embark on a journey of a lost cause or a failed quest?

I don’t care if people think those movies are not realistic. If I want reality, I wouldn’t be watching movies. Happy ending to me, is when the good wins and justice prevails. I don’t care how fantastically unrealistic the methods of winning might be, but in movies, the heroes MUST win against the antagonist.

No matter what.

********************************************************************

No one likes to be compared.

No one, but NO ONE likes to be compared unless the comparison is made with them being the more superior. Of course.

Perhaps, it’s a middle child syndrome. Perhaps it’s just me. Growing up, I absolutely loathed being compared to my more brainy elder sister. My parents, I was certain, did not love me enough. Or loved me less, I thought.

But later, MUCH later, I came to realize that comparison can be viewed in a positive light if one could actually sit and reflect on the basis of the comparison being made.

Just forget the hurt. Forget the emotional defense we erect against the (imagined) feeling that we are not appreciated. Do not even speculate of the feeling that the comparator may have about you when he/she makes that comparison.

Do not torture yourself in that manner, I beg you.

****
“Look this is terrible. When I was in Australia….” I could not stop myself had my life depended on it. I gave myself a mental shake to just quit the tirade before I start.

But I COULD NOT.

I told myself, people will get tired of hearing you comparing Malaysia to Australia. Or they will hear what you say thinking you are a snob; someone who after 5 years of being abroad, has totally gone berserk making this and that comments about Malaysian Health Care system. Or they will think that you are trying to broadcast the fact that you are overseas grad. Macam bagus, chet!

But look, I wouldn’t compare if I didn’t care.

I couldn’t help it. I care. Too much. I am not an outsider, working overseas, looking at us critically. I am an insider, working in Malaysia, looking at us critically.

My parents can criticize me and compare me to my sisters all they like. With them, the intention is clear; they want me to be better. Not the best, but better. But would I tolerate the same treatment from strangers? Of course not (well, not meekly and not without serving them one or two of my branded sarcasm). Because the intention is questionable. Why would you criticize me when you don’t have any stakes in my success nor my failures? Unless you, as a total stranger can SOMEHOW convince me that you love me like my parents do and want all that is good for me, you must be either a busybody with nothing better to do, or you are a chronic impulsive backbiter, or you are just the sort of person who likes to criticize just for the sake of criticizing; criticize in order to hurt or brag.

But I have stakes in the success or failures of the health care system in Malaysia. I chose to work here.

Whatever I say that may hurt the feelings of anyone in the system, hurts me just as much. Let’s not our disagreement in what is only my opinion, spring forth from my limited knowledge as a mere mortal, cause friction against us who works in the system. Let’s disagree, COURTEOUSLY. Ladies act like ladies; and gentlemen behave like gentlemen. Have we so quickly forgotten the restrained elegance of our ancestors when they deign to have a conversation?

“Tuan hamba yang bijaksana, hamba khuatir kelancangan kata-kata tuan hamba akan menyebabkan kita terjerumus ke dalam daerah binasa. Hamba fikir tuan hamba terlepas pandang akan beberapa perkara penting sewaktu melontarkan buah fikiran tuan hamba sebentar tadi.”

Masha Allah, it’s hard to be offended if everybody can converse in that way, don’t you think? Everyone competing to top one another with regards to not only who can say the best of things, but who can say them in the best of manners!

To quote Imam Syafi’e “Never do I argue with a man with a desire to hear him say what is wrong, or to expose him and win victory over him. Whenever I face an opponent in debate I silently pray – “O Allah, help him so that truth may flow from his heart and on his tongue, and so that if truth is on my side, he may follow me; and if truth be on his side,I may follow him.”

With that framework firmly in mind, let us begin this discussion.

***
So, how do Malaysian Health Care System compare to that of Australian?
Comparing two complicated health care system is quite impossible without the right direction of looking at things.

It’s not as easy as saying “They have this, they don’t have that. But we have this, and we don’t have that.” It would be too simplistic and not fair to either system.

For example, the internship program in Australia is characterized by careful supervision by your boss (registrar, advanced trainee or specialist). They don’t get to do procedures so much. They are more or less, a clerk. But then, they are not expected to be independent once they have finished their internship. Even if they are posted to other non-tertiary hospitals (our equivalent of district hospitals), they would still be supervised by their seniors. There is not much GREAT need for them to just go ahead and do procedures while they are an intern because those skills can still be learned under supervision when they are no longer an intern. Supervision is expected throughout your training. Besides, how MUCH attempts do you need to be supervised for before you are competent enough to do it on your own? Remember episiotomy? I have never done one as a student! But when I became a houseman, I witnessed two episiotomies, I attempted one under supervision, and then I did the rest on my own. The same can be said for peritoneal tapping, plureal tapping, peritoneal dialysis and so on and so forth. The dictum of “See one, do one and teach one” is true. So for the interns in Australia, there is no great need for them to do procedures because their health system is designed for them to be closely supervised until they themselves become a specialist.

But for us in Malaysia, the housemen must be able to do procedures after housemanship is completed because we will be posted in the district hospitals where there won’t be any specialist to guide us all the time.

So, for everything that they do or don’t do, and for everything that we do and don’t do, there are reasons behind it and it wouldn’t be fair to simply compare at face value. The reason lies on how the health system is designed.

That’s why you cannot simply mix and match one system with another.

You cannot aim to work like the interns in Australia with the aim of being an independent MO in the district. That would be dangerous. And, we cannot expect them to work like us with so many procedures to be done because they are taking care of a lot more patients than we do. While we only take care of a few patients in our cubicles, they are taking care of 30 patients scattered all over the hospital.

So it would be really difficult to compare without going into details regarding the reason that lies behind it.

Why don’t I simply tell you how they work over there, and you can make the comparison on your own?

The interns over there work in a team. The team consists of a specialist, a registrar (our equivalent of an MO), an intern and sometimes a medical student. So if you are doing medical posting, you will be with the same specialist and the same registrar for a few months. That’s your team! If the chemistry is right, you will enjoy getting to know each other and work together as a team. If anything happens to any of your patients, you know exactly who to call who would know about the patient in details.

Your patients are not in any particular ward. You cannot just say “Oh, now I am working in ward A”. Instead, your patients are scattered all over the hospital.And you will be taking care of them from the day they are admitted until the day they are discharged.

We have this term called ‘on-take’. So let’s say on Sunday, specialist A is on-take; that means any medical patients admitted on Sunday will be assigned to be under the care of specialist A…regardless of which medical wards the patients end up to be. So some of the patients may be at ward A, and some others might be at ward B, C, D and so on.

During office hours, the casualty doctors will call the registrar in team A to see the medical patients. But the registrar in team A do not have to be on-call at night. We have one medical registrar working at night in casualty who would see the cases and later pass them over to team A in the morning.

Team A will know about these patients because at 8.00 am every morning, there is a morning meeting (breakfast provided, too *wink wink*) where all specialist and registrars and interns would gather. They would discuss a few ‘bizarre’ case that was admitted that night, and passover the patients to the specialist who was on-take that day.

So on Monday, it would be specialist B who is on-take and each day it would be different specialist until you get back to Sunday.

So can you imagine how the work load is like? On Sunday, team A would have lots of new cases (their patients can be as much as 20-30)…but as the week progress they will be discharging a few patients already without taking anymore patients for the rest of the week. By the time they get to Thursday, team A may only have 10 patients. And then on Sunday, they will have another influx of new cases.

You will be given a list (printed by a clerk) of who your patients are and in which wards are they in. The list will have one empty columns where the interns can write what need to be done at the end of the rounds. If team A is also an infectious disease team, then team A will also round the infectious disease patients.

Clinics will be on the day when you are not on-take. So for Team A, clinic would probably be on Tuesday and Thursday. Not on Sunday.

All specialists will do the full rounds on the day of their on-take to know all the new cases and discharge a few patients to allow for some empty beds. Some specialists do rounds everyday of the week. But most would only do the full round 3-4 times per week. When they have clinics, they will do partial round, seeing only critical cases.

So your real best friend is the registrar who you will be with day in and day out. Sometimes, the registrars will help you with discharges when they are too many. You will do procedures with the registrars too. The registrar will help you out because you are a team….the smooth running of the team depends on both of you. If the interns couldn’t cope, the registrars will pitch in. Besides, during the day when your team does not have any clinics, what else would the registrar do after rounds, right?

Well, if the interns can cope, the registrar can go to the library and study, of course. Usually you are quite free during the days when you are not on-take and no clinics. It’s quite common to see registrars and interns studying in the library.

The interns start working at 8.30. The registrars sometimes comes at 8.30 too. The specialist comes at nine. The interns would update the investigation done on the previous day. At nine, they would go and see their patients together. Interns are not expected to know the cases well when patients are first admitted. But they will know the case well as the week progress, since they are seeing the same patients daily.

In one particular week, (usually Wednesday), there would be compulsory intern teaching from morning until noon. All interns would attend, and the registrar will take over the interns role for that day (except for the discharge summary, of course, but some even do that! Such registrars are angels in disguise!) so that the team will continue running. There is no need for the interns to sacrifice their teaching day just because they are worried that no one will carry out the orders of that day. The academic part of being a doctor is very much supported and they make the week as such that you will have one busy ‘on-take’ day, and then as the week progresses and a lot of patients under your team are discharged, you will become less and less hectic and will be able to go to the library and study.

As you can see, that kind of schedule is beneficial for everyone. We all have exams, right? The registrars can study as the week progress and become less hectic, the interns also have their own academic program without them having to worry about who will carry out the urgent orders for the patients, and the specialist can also have a few days of free times for their journal articles.

And they are able to do all these without feeling like they have not attended the patient properly; they are able to be ‘academic’ yet their mortality rate is better than ours who saw patients everyday (sometimes TDS!!) and work 36 hours straight some more!

They also have weekends off, except if it is their turn to do weekends call. They will be working the same amount of hours as the office hours.

After a few months of being in a team, working during office hours, it would be your turn to work afternoon or nights. If you work in the afternoon, you will start from 3.00pm to 11pm for a week. If you work at night, you will start from 11 pm to 8am and then attend the morning meeting for one hour. You will do this for a week (so that you don’t have to adjust your circadian rhythm quite so rapidly) and then go back into your team after 2-3 days of holiday. During pm and nights, you cover half of the medical wards (and the other intern will cover the other half) mostly attending unstable patients and do the brannulas. You don’t have to cover ICU, CCU, CRW….that’s the anaest’s kingdom and you are not needed. The anaest manage their patients by themselves.

Clerking new cases are already properly done from casualty. You don’t need to re-clerk the patient in the ward, as what needs to be done would have already been done before patient came into the ward. In the morning would be soon enough for the patient to be seen again.

For unstable patients, they have the term MET Call (Medical Emergency Team call). This is basically a 24 hour service system that rapidly responds to calls from medical staff about patients that meet the MET calling criteria. The MET consists of a medical registrar, intensive care registrar, and an appropriately accredited nurse from the ICU. There’s no need for you to call the medical MO who is busy clerking case in casualty. The RRT will come with resuscitation bag (like a luggage bag) where all the equipments are kept. They can come quite fast, less than 3 minutes.

But how do you know when to sound the alarm? Do you wait until the patient collapse first and only then sound the alarm?

Well, they don’t wait until the patient collapse before sounding the alarm, of course. They have rapid response criteria or MET criteria, which when I was a student I could remember quite well. But basically it consists of the vital signs that exceeds certain limits. The nurses will let you know about any patients that fulfill the MET calling criteria, you have to decide whether or not you need to sound the alarm. The decision bit is the hardest part as we try to encourage interns to treat the patients and not the numbers. However, you won’t get scolded for any false alarm as long as the patient meets the criteria because the aim of the MET call is to PREVENT adverse outcomes (namely cardiac arrest, severe respiratory depression, ICU admission) rather than to react to the outcomes. But you have to at least evaluate the patient’s baseline vital signs before calling the MET, and after having done that, you will be able to justify why you call them.

So I’ll feel safe working nights over there. I know if I am worried about any patients who may or may not collapse, I can always sound the alarm and the MET call people will come. They will first come and then ask what’s going on while assessing the patient. There’s no need for you to call the Anaest and present the case first, and then wait for the decision of whether or not they think you have justified yourself enough to call them. They will come first, and then later if they think the patient is fine, they will teach and discuss with you like academicians and professionals do.

When they discharge patients, they will discharge the patient back to the patient’s GP (In Australia, a GP is a specialist; like FMS). So you will give the discharge summary to the GP as well. All patients will have one GP. If they don’t have a GP, they won’t be able to access Medicare (their subsidized medical care). Usually, they’ll be seeing the same GP for the rest of their lives unless they move elsewhere and need to change GP. In that case, the GP will transfer the patient’s files and mailed it to the new GP. This is good in terms of we don’t need to worry about the follow up of the patients if it is a general medical patients. There’s no need to follow up hundreds of patients in the hospital clinics. Unless you think the patient needs special attention, only then you schedule the patient to see a cardiologist/chest/infectious disease/rheumatologist/ gastroenterologist etc etc. Otherwise, the GP is more than adequate when it comes to managing the patient’s primary health care. If the GP feels she couldn’t handle the patient within her expertise, she could refer the patients to the specialist clinic as well.

Actually it will take a whole lot longer than one post to talk about any health system. But I will just summarized what do I find different between our system and their system.

1) They don’t get to do procedures like we do. They have less clinical experience than us. There are pros and cons to this. It depends on which shoes you are on. If you are a patient, you will say I would like someone other than interns to do my episiotomy, right?  But as an intern, I would like to do as much procedures as possible, and I will do my utmost to convince the patient that I am confident to do those procedures (even while I am shaking in my shoes).

2) They have a lot of supervision until they become specialist themselves. While we are expected to be independent in the district hospitals.

3) They respect the academic culture. They don’t just tell you to go to teaching while at the same time leave you to worry about the radiological investigation that need to be done that they had ordered STAT!

4) They don’t have to work hard, missing the sunrise nor sunset, in order to be efficient.

5)You will be caring for the same patients from the day they are admitted until the day they are discharged. There is no such a thing where you have to suddenly be in charge of a patient whose file is already as thick a a novel and you have to study through them.

5) They would disagree with you, they are annoyed with you and you will know it too. But you don’t know it just because they scream at you. No, they can find other subtle ways of letting you know that you need to improve. Very creative, them!

I hope that this will give a clear picture of the working culture in Australia compared to in Malaysia. But everywhere you are, you get the good and the bad. Let’s make it a point to make sure that the good outweighs the bad.

Assalamuaaikum, and until the next posting, insya Allah, take care.

This is gonna be a very short post.  (i know short posts are VERY RARE in my blog, eh?)

I just would like to promote the existence of a particular blog called Blogger Ubat Muda. This is the site where (not very) young doctors can share their experience, exchange words of encouragement and motivation as well as write about their views regarding our health care.

You can read all about the mission and vision of Blogger Ubat Muda in the blog itself. The link is H.E.R.E

The idea was first proposed by my ex-classmate in MRSM Langkawi, Dr. Azzad who is a well known blogger of the blog SAYADOKTOR (uh huh, I am sure I need not say anything further about him), and he went on to find a few more regular writers for the blog.

If anyone is interested to join us, just let us know. Don’t worry if you don’t write regularly because we are also interested in publishing articles from ‘penulis jemputan.’

This is the site where we can discuss issues courteously and reasonably without trying to cause friction and heated arguments among each other.

Let’s all compete with one another with regards to not only who can say the best of things, but who can say them in the best of manners, insya Allah.

The reason was because of the way they failed my friend. Twice. My friend was not allowed to check her papers to learn from her mistakes.

Well, I was scared at that time, of course. But it was my nazar, I had no choice but to complete it. My nazar was, “If I passed all my papers, I will help her fight.” Of course if I didn’t pass my papers, I would lose the credibility to fight the system, because then they would say I was complaining simply because I myself fail.

I tried to complete my nazar in the best way I knew how.

I appealed to the International Office.

I wrote my letter in points:

1)      Your examination system is oppressive. We have only one exam per semester. We don’t have quizzes or small tests leading to the big semester exam. So we could not gauge our level of understanding before the real exam and we don’t have the opportunity to know what we don’t know or what we know.

2)      And when we fail the one exam that you deign to organize for us, you did not allow us to check our papers. How are we going to learn from our mistakes?

3)      Furthermore, not only there’s only one exam per semester, not only you don’t allow us to check our papers or even discuss the answers with us…you also do not give us any repeat papers. Basically if we fail that one exam (one exam in the whole semester), we will have to repeat the whole semester because you refuse to allow for repeat papers.

4)      Other universities have repeat papers or at least supplementary papers. In fact, other faculties in this uni itself, at least allow for supplementary papers. The medical faculty doesn’t allow for supplementary papers at all.

5)      In short, you only organize only one exam for us. You do not give us the opportunities to prepare ourselves for the one exam by organizing quizzes of tests. And then, you do not allow us to check our papers to learn from our mistakes. And you do not give us supplementay papers or repeat papers when we fail.  In what way is this system not oppressive?

The mat sallehs over there did not respond to my complaints by saying “You are a negative-thinking medical student.” They have enough pride to respond intellectually by going over points by points that I had taken pains to number up. They didn’t sweep the issues under the carpet and simply said she is a negative thinker. Because that is a DEFINITE sign of someone who is too lazy to come up with a better argument.

“Why don’t we just paint the picture of her as someone who has negative thinking. There is no need to answer her point by point. Just throw one accusation at her, then, maybe what she said would not sound so true.”

Nope. They did not do that.

They answered one by one of my points, numbering them in the same way I numbered my points. And then they said, how can we help?

My friend still failed. She still ended up going back to Malaysia. I still didn’t get what I want right away.

But two years later, they have revamped the system.  Now, pre-clinical years consists of a few quizzes and tasks that would make up for a percentage of the final score. Of course, by that time I was already a 4^th year medical student and no longer benefit by the change. But it doesn’t matter. The point I am trying to make is, they don’t simply look at the complaints in a defensive manner by saying that the person who makes the complaints are negative, without bothering to address the issues raised.

They also did not try to make my remaining 3 years in the uni as difficult as possible as a payback for my so-called churlish ways. They did not, for example, go to my PBL (problem based learning) tutor and get her to embarrass me in the tutorial. They recognized, that would be the cheapest trick on earth.

What is it that I have done to deserve being called negative-thinking? Because I talked about how we could improve our medical culture of being rude and discourteous to our subordinates? Because I talked about how nurses are more focused on doing the reports online in the e-HIS, sometimes even when patients are collapsing? Because I talked about how doing daily reviews online in E-His will not be beneficial a few years down the track as the only important thing to be done online is the investigation result and the discharge summary? Because I talked about how we could improve the shift system, making it a balance between the old on-call system and the current flexi hours system?

Those who label me negative thinking did not bother to answer any of the above issues. They did not say, I agree with this or disagree with that because so and so. They did not do that because it is much easier to simply ignore the points and make an argument consisting of I am negative.

How… positively… ehem, intelligent!

This is the case of different mentality. Of course.

And so we then wonder “Kenapa orang-orang yang kerja oversea ni tak nak balik?” So we then come up with a program of bringing back our professionals to Malaysia. We called the program “Returning Expert Programme” executed by the Prime Minister’s Department. It is a programme introduced in 2001 which provides interesting incentives for Malaysia talent living overseas who wish to return to Malaysia.

We practically bribed them to leave the status they have in overseas so that they can come back and work in Malaysia.

How about using that money (otherwise called interesting incentives) to study the working culture in overseas and reform our system so that they will come back for the right reason? Truly! We won’t have to bribe people to return to us and the solution would be permanent, too.

I chose to work in Malaysia after performing my istikharah prayer. Otherwise would I have returned? I don’t know. The only great thing about Malaysia is the location of my parents and family as well as the oh, so delicious Malaysian food. In terms of religion, Islam in the West is thriving too, so I do not miss the Islamic environment here!

I have just clearly related the story of how the non-Muslims in the Western country have better Islamic values in how they deal with issues. They are professional! Even though I was only a medical student and have no status whatsoever….and a foreigner to boot! So, Why would they care about me or my complaints?

You see, they didn’t care about me. I never deluded myself into thinking that they did. What they cared about is how to improve their system, which is something that we don’t. So here lies the difference in attitude.

When I was in my psychiatry rotation, all students were given a survey of how satisfied the students were about the teaching that were provided. Next year, they improved again and again. By rights, why would they care about us, mere students?

But again, they cared about improving!

But the system in Malaysia punishes those who speak up. It was funny when we go around wondering about how our government is dictatorial and would not give us the rights to march on the street and speak up. Look into the mirror and you will see why! You see, we are just like the government we criticize.

Just sweep the issues under the carpet and give people labels.

Much easier, isn’t it?

****

Since I have been labeled negative by a more positive thinking person, I have no choice but to defend my honor.

How does a negative thinking HO behave? I am sure she would be so stressed out that she would take EL multiple times (even though in this system, who can blame her?)  I am sure she would also leave a lot of unfinished tasks to be carried out by others. She might cry in public once or twice. She might also have had instances of going to the specialist in charge of HO and said she would like to resign. Some might even go to Pengarah and said, “saya nak tukar posting lain dulu.”

If anyone can come up with just ONE instance in which I have deliberately done any of the above, then and only then I will agree that I am a negative thinking person and not tough enough to be trained under the system. Otherwise, please consult the conscience of your heart before calling me negative again. Even if you had called me stupid, I would have agreed. If  I am not stupid I would already be a specialist and there’s no need for me to be under training.

But to call me a negative thinking person when I have never behaved like one, now that is something I am not willing to accept unchallenged.

For 10 months of working, I have never had any EL. NONE! Zip, zero, nada!

I finally had one EL on the 6^th of October because Tabung Haji SUDDENLY said my parents flight to Mekah will be on the 6^th.  It was very sudden and I had no choice but to take 1 day of  EL to send them to the airport. It was important to me because anything could happen to my parents in Mekah. Some did not make it back safely. And for THAT reason, I requested for EL. Even then, I had called the captain one day earlier to inform her about that. She then said, there is no one who could replace me. She suggested for me to call my ward colleagues to ask their permission and warn them to come earlier the next day to cover my cubicles.

2 days later, I treated them to Pizza Hut, my way of saying thanks for allowing me the EL that I needed in order to do what was very important to me, at that time.  I am fully aware of how troublesome EL is and I absolutely hate it when people do that and I end up covering their jobs. And for that reason I was very thankful to them for having allowed me the leave that I required.

When I was night call covering ward 5c and 4D, I had gastroenteritis. Multiple times of diarrhea as well as bouts of vomiting food particles. Rather than take EL ( because I have always hated it when someone go EL citing the reason as ‘diarrhea’. Awat hangpa ni kalau EL ja, mesti sebab diarrhea?) , I asked the staff nurse in 5 c to insert Brannula and give me 10 mg IV maxolon when tab maxolon did not work.

I did not take EL lightly. I took my responsibility very heavily. And for that reason, I have to defend my honor when anyone dares to call me negative thinking.

I have never gone to any of my superiors in order to resign even when I was in my first posting. I have seen people who resign when they were only a few days in the medical department; the most benign department consisting of the most kind-hearted and soft-spoken specialist and  MOs I have ever come across! I have seen people who resigned when they were doing surgical, which is a quite enjoyable department apart from the early hours. Of course I got scolded in surgical too, but it was devoid of feeling like it was personal.

So, in what way do I behave like a negative person again?

***

This post is written so that when someone come up with that kind of comments which do not have any basis in reasons, I can just reply by copy-pasting the link to this post. Save my energy and my time from having to reply to such unhelpful and ANONYMOUS comments. Don’t you believe in what you say ENOUGH to own up to it?

With that, Assalamualaikum and until the next posting, insya Allah. Take care.

SALAM HIJRAH.

“Never do I argue with a man with a desire to hear him say what is wrong, or to expose him and win victory over him. Whenever I face an opponent in debate I silently pray – “O Allah, help him so that truth may flow from his heart and on his tongue, and so that if truth is on my side, he may follow me; and if truth be on his side,I may follow him.” Imam Al-Shafi’i.

I name this post as Afiza’s Principles of Good Health Care Management

1)Principle Number 1:The concept of Favor.

You do someone a favour when your action benefits her.

And whether or not something is beneficial is not defined by YOU; it is defined by HER.

In the first place, we housemen don’t care whatever it is you want to call the system that we are working in; be it the shift system or the flexi hours or WHATEVER.

In the first place, all we want is not to have to do on-calls because it means working for 36 hours straight without rest!!

It doesn’t mean we want to work in shifts! It only means that we don’t want to work for 36 hours straight because it is inhumane; it doesn’t benefit the houseman and it doesn’t benefit the patient.

And I have always believed that the best plan is the simplest plan. If I have the authority to put a decree on this, I would simply say, “Berkuatkuasa pada hari ini, semua jenis ON-CALL adalah haram sama sekali. Kamu bekerja seperti biasa sewaktu office hours. Manakala  sesiapa yang diperlukan untuk berada di hospital pada waktu malam, tidak perlu bekerja pada waktu office hours. Mereka hanya perlu datang dari pukul 5.00 hingga 6.30 pagi keesokannya dan dibenarkan pulang setelah orang pagi tiba bekerja seperti biasa. This goes to the MO as well.”

Simple kan! Apa yang susah sangat?? I know I don’t like on-calls…but the shift/flexi-hours that we are implementing is not so great either even though I am willing to give it a try.

I admit, the system that I suggest above would still reduce the number of housemen working during office hours (whereas the on-call system means you have more housemen; who cares if 6 of them are sleepy and exhausted, right?). However, MY system would have a lot more housemen around during office hours compared to if we are implementing the shift system.

If with the on-call system, you get 40 housemen working during office hours; then with MY system, there’ll be 34 housemen working during office hrs (minus the 6 that will come post-office hours). Whereas with the shift system, a lot more of them will be working out of office hours…which is NOT WHAT WE WANT!!  We want more housemen during office hours because that’s when all the referrals, and all the requests for radiological investigations need to be done.

MY system is a balance between two extremes! So, get it done!

Remember the concept! If you want to do housemen a favour; you give them what they want. Essentially, all they want is to NOT have to work 36 hours straight while at the same time maintaining the harmony of enough housemen during office hours.. Not wanting to work 36 hours straight  is not equivalent to wanting the shift system. Because even though the shift system means there’s no more on-calls, it is also disruptive to the normal office hours where the majority of the work need to be done.

Is someone up there listening??? Please.

2)Principle Number 2: The Concept of doing it ‘All or Nothing at all’ / ‘Not doing things in halves.’

“O those who believe, enter Islam COMPLETELY,… -“

Once upon a time, I was given a perfect lecture by my ustaz. My ustaz told me about the wisdom of a particular mufti.

“The mufti was asked by the media, what is Islam’s solution to AIDS. The mufti then answered, had you implemented the Islamic system from the very beginning, AIDS won’t even exist in the first place and you won’t be asking this question from Islam.”

If there had been no rampant sexual promiscuity, no homosexuality, no IV drug abuse, no alcoholism (and hence, no all the previous evils mentioned) AIDS won’t spread. You subscribe to a hedonistic system of life, but when something bad happens, you sought solution from another system altogether. How is that not plain stupid, you tell me!

If something is wrong with your iPhone, do you ask SAMSUNG what is THEIR solution to the problem your facing with your iPhone? Of course not!

Apple won’t claim that there won’t be any problems with their product. No companies can make that claim. But any self-respecting companies would claim that they will have the solution to whatever problems that may arise in the system that they create! It’s only fair to expect THAT of any system!

See the western system of economy. They legalize riba (usury), and now their economic system is collapsing around their ears with a loud crash. And now they are spending more money to find out why they had lost money in the first place. The system does not have the answer…will not have it…EVER. They engage in riba, they engage in currency speculation….and they have gotten away with making money out of nothing for years and now the terrible consequences of such endeavors are catching up with them fast and furious. I dare them to ask what is the Islamic solution to this!

Now, I hope I have made it clear that you cannot mix and match different parts of different systems and not expect things to become plain insane.

Now you have to choose. What kind of system do you really want us to work in? Do you want us to work in shifts or do you want us to work as we used to?

You have to understand that if you want us to work in shift, you have to design a proper system for it. Not simply mix and match.

For example, in HSB medical department, the system works like this: The morning shift is from 7.00 am to 5.00 pm;  afternoon shift is from 11am to 11 pm; and the night shift is from 10 pm to 10 am.

The amount of housemen who work during office hours are reducing…so we are covering more patients than we are used to. But our superiors still expect us to know all the cases well; the bloods are still expected to be ready especially if the night people were unable to complete them, we still have to do the housemen round first, before the MO/specialist round.

We end up starting our morning shifts at 5.00 am!  To make matters worse, in certain wards, we rotate like the hurricane. On Sunday I was covering ICU, on Monday I was covering CCU/CRW (because the person who covered this ward on Sunday was rostered to do night shift on Monday) and then on Tuesday I was rostered to cover 1^st class ward (because the previous houseman who covered the 1^st class ward on Sunday and Monday is now rostered to do night shift on Tuesday). I don’t know any of my patients because I am changing wards everyday! How can you REASONABLY expect me to know all the cases well when YOU can’t do it too if you were in my shoes unless you come at 4.00 am to study all the cases you have never seen before in your entire life until that day itself? You tell me!

You see, you can’t implement system in halves. You said the objective of implementing the shift system is so  that we will have less working hours and a better lifestyle. So, you said that the morning shift starts at 7.00….but then you also expect me to be able to do all the things that I am expected to do during the old system. (you want one thing from one system, but you also want another thing from another system….so you end up not reaching the objective you set out to achieve in the first place which you CLAIMED as for us to work less)

You want us to cover more patients per shift. But you still expect us to be the phlebotomist, the attendants, the ones who do the procedures, the ones who arrange patient’s future appointments, the ones to fill up all the STROKE Registry forms and Cardio Registry forms, the ones who refer inter-departmental cases. We used to do all these while caring for 6 patients only and we still went home later than 5.00 everyday.

See? I am not averse to the shift system. But I am averse to the discrepancy in how it is implemented and your expectation of us when the system is implemented.

3)Primciple Number 3: The concept of technology as a means of solving/easing daily problems.

By rights, when we use technology, it is with the aim of making our lives a lot easier.

So we have to recognize…what is our problem….and solve it with technology.

But in HSB, with the e-HIS system, it is the other way around. We end up using the technology because it’s there; regardless of whether or not it is helping our work.

Hospital Sultanah Bahiyah is number ONE when it comes to creating daily nuisance in the disguise of the e-HIS system and all sorts of computerized technology. Take the OBS CENTRAL in the ObsNGyn Dept for example…using continuous CTG monitoring in healthy pregnant women is one perfect example of how we have no idea how to use technology PROPERLY.

I will list the problem in order!

1)      The nursing reports are done in the computers… for the online ‘ghost’ to read, perhaps?

2)      In certain wards like ICU, CCU and 3C, it is so-called paperless….meaning even our daily reviews are made in the computer.

3)      We need to order blood investigations and radiological investigations through the computer first before it can be made available online. (I will tell you why it’s bad, later).

When I was a student in Australia, I actually enjoyed reading the nursing reports that were handwritten in the patients’ files. I thought it was important to read the small paragraph of what the nurses had written…I really did think it was vital for me to know if the patient was sleeping well, was the patient taking orally well, and had the patient pass motion etc etc. I actually read their reports because it was there, written in the same place that I was going to write MY reviews on.

In HSB, all the nursing reports are done in the computers! While my reviews are done in the patient’s files! As the consequence, none of us housemen actually read the nursing reports. We end up asking the patient the very same thing that the nursing reports would have told us in a glance.

It’s not efficient!

We should be using the E-HIS system in things that are absolutely vital for us to be able to trace it back a few years down the track when the patient  represent himself in the future. For example, the discharge summary SHOULD be done in the system…because when the patient gets admitted in the future, we would want to know the patient’s previous history and admissions. Also the blood and radiological Ix SHOULD be made permanent by having them online; we need to be able to trace them back for the patients’ future admissions.

But what is the use of the nursing reports being made ‘permanent’ online? Is it going to matter a few years down the track, that during the patient’s last admission he has passed motion well for one day, and then vomit the next day and then got constipated the day after that…and then got diarrhea the next day.

No, right?

A few years down the track, those things are online rubbish. What’s not rubbish is knowing (from the discharge summary) that during last admission, the patient had suffered from irritable bowel syndrome or gastroenteritis or rectal carcinoma etc etc (not the details of what happened everyday).

Do you get me or not when I say we don’t use technology properly…but we use it just because it happens to be there, so we better make the nurses use it to their heart content! Heh!

And you know what the funny thing is?! The funny thing is, even the nurses hate it! It complicates their works. Their roles as nurses are not to spend time doing reports online. Their role is to look at their patients. Not to glue their eyes on the computer screen and let the student nurses do all the observations/ sponging/ suctioning/ procedural-assisting.

It is for the same reason that I am VERY MAD when it comes to doing my reviews in ICU/CCU/ and 3C. Because I do not get WHY, oh WHY, do I have to do it online? Doing reviews online takes time because you have to open a few windows (to check the Ix results as well as the reviews in other previous entries). Doing my reviews online takes a lot of time because I have to compete the use of the computer with the nurses! Now, I am not lacking in competitive spirit…but not for something that will become an online rubbish. Like I said, a few years down the track, my DAILY reviews online is not important anymore. The patient will only have a few diagnoses that I have to recognize in the discharge summary for the benefit of the patient’s next admission. So only the discharge summary should be online.

You know, in Australia they know when to use the computer; and when not to use it.  Daily reviews are done in the patient’s files. Only the discharge summary is done in the system.

Furthermore they are also smart in the sense that they get all the blood results to appear online. But they can order the investigation through paper, which takes less time than having to order it in the computer.

The size of the paper that they use to order the blood IX is about 1/3 of the A4 size paper. All they have to do is get the patient’s sticker (which is already pre-printed in bulk with the patients names, age, MRN; in other words, they don’t need to go online to get the stickers printed) and stick it on the form; then write down FBC/RP/LFT….and then put the patient’s blood sample together with the forms in the specimen bag.

Like I said, they know how to make technology works for them. They know they need the result online, but ordering it online will take time (especially, if you have to compete the use of the computer with the nurses who are busy passing reports to one another). So they design a system that enables them to order investigations in the easiest way possible while also making it appear online.

Look at us! It’s true in one sense; our work is easier because we can get to see the investigation results in the computer stat when it’s ready. But we make the ordering of it to be so hard and time consuming. What a fool we are.

Do you see what I meant in my previous post when I said that we are HORRIBLY inefficient in using our resources; human resource as well as our technologies.

I spent time writing very long post on this because I think it’s important that we recognize our mistakes in our healthcare. It’s not that we don’t have enough doctors….we just use them for doing non-doctor things….and thus they will always be busy NOT BEING DOCTORS. We have the nurses doing reports online for Allah only knows which ghost to read! As a result, the nurses are not doing nursing stuff….so we then come up with the inspired idea that we don’t have enough staff.

We have good technologies….even at par with other developed countries. But it’s time we recognize that non-proper use of ANYTHING will not get us ANYWHERE. It’s like what the Malay means when they say bagaikan kera mendapat bunga!

4)Principle Number 4: The Concept of Useless PaperWorks (useless to the ones who actually do the patient nursing care in the wards)

We set up stroke team, infectious disease team ….and the jobs of the team consists of sending us FORMS for us in the ward to fill up. The jobs of those teams are not to fill up their own forms…but to distribute the forms to other wards with the related cases.  It’s US who have to fill it all up, like we don’t have enough to do.

Oh yes….if the patient happens to have all AIDS, Hep B/Hep C ….then the forms should have two copies, too…because they will go to separate divisions.

So what the heck is the job of those teams??  If we have to fill up one form to notify that the patient has all AIDS, Hep B and Hep C….shouldn’t it be THEIR job to double up the forms since it has to go to separate divisions…THEIR divisions! We do our nursing/doctoring jobs in the ward…..and then we also have to do your team’s administrative job. You guys memang pandai unburden yourselves…..and put the paperworks on us who do the actual care that actually benefits the patient.

You and your paper work can do nothing to a simple thing like a patient’s spiking temperature.

I know it’s important to notify these things. But since we have already done our part in caring for patients in the ward, which is something that YOU didn’t do….why can’t YOU do your paper-works job, for a change, and leave us alone!!

Thank you!

**That ends the online-lecture of Afiza’s Principles of Good Health Care Management.**

Insya Allah on the 16^th of October, the medical department in HSB will be starting the renowned shift system.

I am glad.

I expect things will go haywire, topsy-turvy for awhile as we adjust to the increased number of patient that we need to take care of. We are so used  to having 4 housemen in the ward, and that means the ratio of housemen to patients is roughly 1:6 . With the implementation of the shift system, AT MOST, we will have only 3 housemen in the ward (so the ratio will be 1 houseman to 8-9 patients). Sometimes, there may be only two housemen. In that case, it would mean that 1 houseman will be taking care of 14 patients.

Now, if you ask the interns who are working overseas, they will probably scoff and said…so what?? I am taking care of 30 patients per day.

Yeah, sure, super-genius! But you don’t have to be the phlebotomist, and the one doing all the procedures. We do pleural tapping…do YOU? We do peritoneal tapping….do YOU? We do bone marrow aspiration….do YOU? We do central venous line….do YOU? We do Lumbar Puncture too….do YOU? We do all the procedures! We also do all the blood taking before the morning rounds….do YOU? Our rounds start at 8…that means we have to come at 6.30 (at the latest) EVERYDAY to make sure all our 6 patients blood result will be ready before the rounds. We also have to do our own reviews before the round with specialist.

So, don’t scoff and expect us to take care of 30 patients when we are the ones who have to take all the bloods and do all the brannulas during office hours, and we are also the ones who have to do all the ordered procedures.

We are also the ones who have to do the inter-deprtmental referrals. If my patient needs an urgent CT scan, it is I who have to speak to the radiologist. If my patient suddenly develops hematemesis, it is I who have to speak to the surgeon to refer the patient for scope.

I do the attendants work as well, would you believe it? When I want the result of ABG stat, I am the one who run to the ICU. Not the attendant/PPK.

And when they are discharged, I do all the clerical work as well, on top of the clerical work that is already expected of me on a day-to-day basis.

While in overseas, you are the clerk daily….and you are the phlebotomist ONLY when you are working out of office hours. In Malaysia….I am the doctor, the clerk, the phlebotomist, the attendants, the registrar (because I do procedures that you don’t and I make referrals!), and sometimes I am even the nurse (when the nurses are slow in getting what I want to be done stat!)

So, you can’t expect me to be ALL THAT while caring for 30 patients!  Even I can be a clerk for 30 patients. But I can’t be ALL THAT I have listed above for all 30, just as you can’t. Caring for 6 patients may sound like very little….but the jobs are non-stop!

It always irritates me to NO END when the older MO boasted “During MY time as housemen, I took care of the whole ward. BY MYSELF”.

G…God!

Sure. But YOU didn’t do the bloods…..the nurses did. YOU didn’t have to set the brannula….the nurses did. YOU are not expected to know all the cases in the ward. YOU didn’t have to prepare your own stuff for procedures. YOU didn’t have to beg the nurse to PLEASE hurry up and prepare the instruments for long line/pleural tapping/peritoneal tapping/BMA/ LP….and when bored of waiting because you knew you had so many more referrals to do, YOU didn’t end up going all over the ward finding the instruments yourself.

In a way, you were luckier. The nurses of the old-generation  actually acted like nurses and they did their work properly and thus helped along your work….they even arranged for the patient’s next TCA upon discharge. Nowadays, it is I who have to arrange it.

But if you really believe that your caring for the whole ward is MUCH harder than our caring of 6 patients, by rights, you should see us go back at 5.00 sharp everyday…and we would even be at the counter gossiping the time away by noon. After all… caring for six patients to caring for the whole ward is such a SHARP contrast, isn’t it?

So what’s wrong with the system? WHY is it that even when the ratio of housemen to patients are dramatically reduced,  do we still go back late everyday? Why are we not so out-of-work that we don’t spend our supposedly free time in the pantry or in the library? If the time occupied caring for the whole ward compared to the time occupied caring for 6 patients are roughly the same….then something MUST be wrong somewhere, isn’t it?

And all my dear readers by now should already know me too well to expect that I shall MOST CERTAINLY spit it all out.

I have even made a list of the muddles that we housemen are in but to keep a long post short, I will just reveal the ONE MAIN THING that we are horrible at…..

….I hereby declare that WE ARE SADLY, HORRIBLY, EXCRUCIATINGLY, TERRIBLY INEFFICIENT IN MANAGING OUR RESOURCES.

Do you know that in John Hunter Hospital in Australia where I did my medical study, they don’t have 30 interns per department?  They don’t! In the WHOLE hospital, it will only be around 50! How come their workload is so much lighter than us?

In HSB….at the very least, there will be 30 housemen for EVERY DEPARTMENT (and tu pun, captain akan merungut susah nak buat roster; we need more!!) Most of the time, we try to maintain 40 housemen per department. That makes 240 housemen AT LEAST in the whole hospital! That is a huge number and if we give that amount of interns to Australian hospitals, they will end up only having to work half day with plenty of holidays in between AND their morbidity/mortality rate won’t be any worse than ours!

WHAT!!!!  is WRONG with our health system that we cannot utilize that much human resource efficiently without making the cliché of ‘HO stands for Hamba Orang’ still sounds relevant to this day?

Yeah, yeah yeah….give me all the usual idiom of “Dimana bumi dipijak di situ langit dijunjung, so tak payah nak compare-compare oversea dengan sini. Kalau banyak merungut, pi balik kerja kat oversea.”

To that, I will just say “Your jealousy is showing! I am at the special position of being able to objectively compare our horrible system and their superior system. I have done both system!You… HAVEN’T! So your opinion doesn’t count. Sorry. I will be more prone to listen to someone who is ALSO oversea grad but find that Malaysian health system is superior…if you can find that person, then we’ll talk. Okay?”

Nak kata I berlagak? I don’t bloody care. Those who know me, they know I am nice. But I am speaking facts….the fact of which, if you haven’t been in any other system other than in Malaysia, you have to at least, consider that what I am saying have merits and not act like you are so very patriotic (and I am not?) and would champion Malaysian health system to your dying breath.

I am patriotic!

I could have worked overseas, you know? It’s not like I got rejected from working in Australia, and therefore I have no choice but to come home. I CHOSE to come home despite the fact that I was MARA scholar. Those who have never been offered the scenario of being able to choose where they could work, cannot say they are more patriotic than I am. I was in the position to choose….and I chose Malaysia.

And it works both ways, you know.

Whenever someone from overseas look down their noses at me and say that their system is superior, I swear I could feel my spine stiffen in indignation. I will be the first to object to such statement.

When my friend who worked in Ireland said “Well, I care for 30 patients.” I will then say, “Yes, but you don’t do procedures, right? You are just a clerk!”

When my friend then said, “How can you stand working for 36 hours straight when you are on-call. How about patient’s safety, being cared by an over-worked and overtired doctor?”

I then said, “Well, it’s not so bad. You get used to it. It makes you a tougher person.” All the while waiting for my Pinocchio nose to increase in length.

Then my friend said, “Why should we use lab-coats? Very unhygienic. You know, infection control and all.”

I was THE advocate of NO LAB COATS all these while but I had said, “Well, we changed lab coats everyday from Faber. So, it’s very hygienic.” (there still leaves those who only change their labcoat once per posting, however).

My point is; YOU don’t work in Malaysia. You are in NO position to say anything about the system that I work in. How dare you come up with disparaging remarks about OUR HEALTHCARE when you have never even entered our system!

So, do you get me? I don’t like the system that we are in. I am the first to declare that our system has such HUGE room for improvement. But I’ll be damned before I let anyone who has never worked in Malaysia get away from looking down their noses at us!

I am part of the system, so I can talk. It’s like, if I say my siblings are a torture to live with, the only thing you should do is listen but NEVER AGREE with me since YOU DON’T KNOW and your agreeing with me will only make me defend them.

The fact is NEITHER system is perfect. If you have worked in both system, you’ll know that. (And if you haven’t worked in BOTH, be very careful lest you annoy either parties).

NO system is perfect.

But in overseas, they make it perfect for the doctors after they make it perfect for the patients.

In Malaysia, it’s not perfect for patients; it’s not perfect for doctors. It’s just perfect for someone higher up who didn’t give squat about how those below are faring!

That’s the whole problem!

I am sorry to those higher up who may be reading this. But what I said is true. Call me sometime, and we’ll talk! See? I am not even anonymous. I talk and I own up to it. If you are annoyed, at least you know who you are annoyed with.

As long as we are bad at managing human resource, it doesn’t matter how good the ratio of housemen to patients will ever be, the life of doctors nor the quality of patient care will never be better. NEVER.

So since nowadays we are all for constructive criticism, do I have any suggestions on how to improve our management of resources (human, or otherwise)?

Of course I do! One of them is; start implementing MY kind of shift (read my previous post H.E.R.E.) And reconstruct the E-HIS system (insya Allah, I’ll go into details in the future).

But that will have to keep until next posting. It’s too long already and I am at heart, an instinctive performer who knows when to make a good exit.  My dictum of a good exit is to keep the audience wanting more. (heh!)

So stay tuned. Until next posting, you guys take care and know that I am sorry for sounding like an arrogant ass if I do, but know that I am actually very humble. I am bad at everything else other than writing (okay, that doesn’t sound so humble).

It’s just that I always find that some things are much easier to understand when the message is delivered with ‘attitude’. So, out of necessity, I have to act arrogant when I really don’t want to.

I have missed blogging. Allah knows how much I missed blogging.

But work, is work, is work, is work. I am no longer a free single lady. I am married to my job and there are responsibilities entailed. It basically means I don’t get to be called doctor and being looked upon with awe without working my backbone sore for it. If only they know how empty my brain really is, maybe they will call me “Dr. Afiza” with less reverence than they usually do.

I am not complaining. I am enjoying the fact that some patients and nurses actually think I know what I am doing, lol. But I am still getting used to the prefix being attached to my name. Whenever someone called out to me “Doctor” I still had trouble believing it was me they were calling. And it’s been eight not-so-glorious-months already!

I have good news to impart to my dear readers.

All praises belong to Allah, I passed my surgical rotation. That means, I have passed two of the worst rotations in housemanship, namely the OnG and the Surgical. Life is sweet….well, until I got into my next posting, that is. For now I am enjoying the glorious days of reading fiction and magazines and not thinking about the suffering of the patients that I have passed over to my colleague. I am sure my patients are in good hands. It’s not like I am that good with anything other than sucking their blood out by means of the syringe.

The exam itself was okay. I mean I wasn’t brilliant. But I think I was acceptable enough to move on to other postings. And to me, that was all that matters.

Have I mentioned that I now go to work with a considerably my happier mood? It’s all because now I knew what my future goal is. I would like to be a medical officer in Klinik Kesihatan. Which requires me to complete my housemanship….then I can relax in Klinik Kesihatan for the rest of my medical career. I guess, I am not very ambitious as a doctor.

I know how a lot of people would look down on those who would like to relax in Klinik Kesihatan….they think the MO in KK are taking the easy way out etc etc. Well, I never really care about what others thought of what I would like to do. If they think I am less passionate about medicine than I should be, well I have no apologies to offer.

They may even think of us who desire the lifestyle offered by KK as less bright and less intelligent than they are. Certainly, less hardworking and less diligent.

Well, to them I will simply say I have nothing to prove anymore.

I don’t have to prove anything to anyone.

Do you know that I hated school growing up? But I went through it and with the grace of Allah, manage to get straights As in all my exams. For someone who hated studying…having to complete primary and secondary school (that’s eleven years!!) was torture. But I completed it. I completed it having to study the loathsome Add Maths and Phyics and Chemistry (I can only barely tolerate Biology).

And then I hate matriks (of course I hate any forms of institutionalized education). So I accepted the offer by IB, having to study the burdensome Pure Maths. But I completed it, all the while pining away for the time to read fictions and then someday to write them, if I ever get lucky.

And then I went to Newcastle Uni, studying medicine; a field that I have very little interest in, if any. I completed it as well.

Now, I am in the process of completing my housemanship. I have become a pro of doing what I don’t really like doing….I have had that practice since at the age of seven; going to school when I didn’t really want to.

I have nothing else to prove. I have done all those things people expected me to do and I tried to do it well regardless of my sentiment towards it. Now, it’s time for me to do what I WANT to do. I think I have done plenty of proving.

I have proven all my life that I can do what I don’t like doing and I can do it well, Alhamdulillah.

Now imagine what I can achieve when I do what I REALLY like? THAT, my dear readers, is what I have to prove. Not to anyone else. But to myself.

So, yes, the whole point of this post is to declare to all and sundry that I am done with proving anything!

No one can fault me for negligence even when I hate what I am doing. Yes, I may hate housemanship but I never once took sudden Emergency Leave and caused troubles to the captain to arrange for replacements.. Never. I am in very good terms with all my captains because I never caused any trouble. I never once not attended any of my on-calls. Never. I never pulled the invisible stunt and decided to be MIA. Never­. I never went back home when I was on-call (not even when I was in ACC or ENT). Never. I never KNOWINGLY, not do what I was supposed to do. Whatever I neglected to do, it was out of ignorance or my limitations rather than sheer laziness.

When I was posted in ACC, one of the senior houseman had in an indirect way tried to implicate that I was trying to leave him more work during his on call and not completing the work during office hours. I got immediately angry. I told him, “Today aku yang on-call. Kalau aku tak sudahkan during office hours pun, aku yang akan sudahkan by the end of the day. Hang risau apa ni?” It was hard trying to make it sound like I wasn’t pissed off. I did not raise my voice but my dry tone was tight. I was, at the very least, annoyed.

It turned out that he thought it was his turn be to on-call on that day. So, he was worried that I haven’t finished one stupid bloody discharge. To be honest, I did forget about the discharge. But then, I was the one who was on-call. And the patient was a chemo patient and her chemo was still running and there was no rush to discharge the patient at all. And also, he needed not trying to make it sound as though I was not doing the discharge on purpose. That was what I got pissed off about. Because I took pride in not being lazy. I may hate my work but I am not lazy. I do what I MUST, despite of my feelings about it.

Besides, on-calling in ACC is nothing! ACC is the most relaxed place to be on-call. It’s like being paid to sleep. So, a lot of people would like to do as many on-calls as possible when they are in ACC because 1)it’s easy money, 2)you would have filled up all the quotas of your on-call that months easy-peasy.

So my senior houseman then said, “Tak apalah, biar aku on-call hari ni lah.” He likes the easy money, I am sure.

I would have let him have the on-calls. Because I don’t need the money even if it’s easy money…I like to be at home. I know a lot of housemen need money….they are paying for their car and their rent and their food. While I am paying for nothing….I had not bought a car yet at that time. I stay with my parents…I don’t need to pay the rent or the bills. I don’t even have to worry about food. If I could do it, I would offer my on-calls to anyone who wants it. I was THAT blasé about on-call money….I don’t want it, I don’t need it because I have no financial responsibilities and I like being at home more.

But because he was so annoying earlier I just said, “No it’s okay. Biar aku on-call hari ni. Ni memang giliran aku. Hang tak payah risau, hang pi balik laa.”

Senang!

He was the ONLY one who has ever indirectly trying to make it sound like I was deliberately not doing my job. I did not like that and I, in my own way, let him know.

I am very touchy about these sort of things. I like to earn my money. And any implication of people saying otherwise, would make me very unhappy. And I have no compunction about showing it.

Even in OnG, when I was in my first posting, I was generally well-liked by my HO colleagues because I did my job. I may be a stupid first-poster who knew NOTHING about how to get things done but they knew what I didn’t do, it was not due to laziness. Once they explained to me how it was supposed to be done, I got it done, no matter how painful it was to do.

Of course some of the MOs (one Indian MO lady in particular) thought I was stupid. But even SHE cannot accuse me of being lazy. She can call me stupid all she likes…I was a first-poster, what did you expect, moron? But if she ever accused me of being lazy, I would challenge her to court. I am THAT serious about not having the reputation of being lazy because it’s a very damaging reputation as an HO.

But that was a long time ago. Now I am a third poster. I have some free advice to first-posters.

When I was in surgical, I heard lots of complaints coming from senior posters who had had to work with first posters. I myself, remembered how hard it was being a first-poster and therefore I always try to be friendly with all first posters in surgical. I remembered how well I was treated in OnG by my HO friends. I remembered how thankful I was to everything they have taught me during the first few weeks of ignorance. And I remembered those people fondly….Siti Salwa, Maftuhim, Hidayah Tajuddin,Lini, and many-many more. They were patient of my stupidity.

Mereka bersangka baik terhadap kebodohan aku dan tak mengangap kerja-kerja bodoh yang aku buat adalah kerana aku malas.

And for that, I will forever be thankful that I had these bunch of people who were really patient in teaching me what I did not know.

In OnG, you cannot work alone. You have to team-up. Especially when there is a sudden plan for emergency caesar. One person needs to book the case in the computer, another person needs to get consent, another person needs to fill up the emergency pink slip, another person needs to refer the case to paediatrics. So you need all these people functioning…and it is in their best interest to educate the new HO as adequately as possible and as fast as possible. So that’s what they have done towards me. So I was lucky.

But some first posters in the surgical dept. were not that lucky. In surgical, there is less need to team-up. So, if someone makes mistake, they don’t feel duty-bound to teach….they much rather mengumpat kat belakang and assume these first-posters are lazy. I am so sorry for them.

I never had ill-feelings towards the first poster whenever I on-called with them. Most of the time, I just assumed that they did not know (the way I was in OnG) and I just explained to them how it should be done.

For example, there are so many steps to remember just to prepare patient for operation. One needs to fill up the pink slip, and then book the case in the system. And then you need to keep patient nil by mouth and order some antibiotics stat to OT. You need to make sure the patient signs the consent. And you need to take patient’s blood sample for group and cross match. If you missed any of this step, or if you have done something slightly wrong in any of the steps, the patient may not get to OT. So, people then say “Dia buat kerja salai-balai. Kerja tak habis etc etc.”

Maybe the HO did not even know what was wrong with his work. And therefore could not improve in the future. Because no-one told him! They simply assumed he was lazy and then talked behind his back.

When I was in OnG, there was one gentleman HO who took the time to go through all my morning reviews at the antenatal ward. He then kindly told me that I did the review wrong. He went from one patient to another and said, “This patient is post-caesar. You can off IVD, off the brannula and start her on haematinics. In post-op patients, make sure you asked whether she has passed flatus, has she passed motion, tolerating orally well or not, has her baby passed urine?”

He corrected one by one of my clerking and my management plan before the MO rounds so that I won’t get scolded and he won’t get scolded for not teaching me. Even though OnG was hell on earth for me, but I was shown that level of kindness by my fellow HO. Something I would never forget. (Also I think it’s because the MO would blame the senior HOs if they didn’t teach us properly, so they are more likely to take the initiative themselves).

I would always remember his kindness. And it was that kindness that would propel me into doing the same to all first-posters. I want to befriend them the way I was befriended. God knows housemanship is tough enough without adding the pressure of not being liked by your colleagues. So when I have time, I did all I can to make them feel welcomed, so that they won’t feel like they were a burden.

So when one of my fellow friend complained that a particular first poster was lazy, did a very stupid morning review, did not take bloods and liked to shift responsibilities….I did not know what to say. I have only recently left the anguish of being a first-poster…so I still felt sorry for them. However, my friend who complained about the first poster, is not the sort to make up stories.

My thought was, the first-posters just did not know what were expected of them. And even if they knew what were expected of them, they may not know how to go about doing it properly.

My advice to first-posters:

1. Vocalize your ignorance. If you are not good at taking blood tell them so. Say “Weh, aku cuba dah nak ambil blood, tapi selalu tak dapat. Boleh tak hang tolong?” So that we would know that you are not lazy. It’s just that you are not competent yet and you need help. And so we will help.Masalahnya, some male first-posters are egoistic. They didn’t admit their ignorance…so when they don’t do their works, we naturally assume they are lazy.

    

   Look, let me be frank. Having the reputation of being stupid is much better than having the reputation of being lazy! Trust me. If you don’t know, say it and admit it….even if you have to admit to a female HO.

-when I was a first poster in OnG, I made my worries and my ignorance known. Aku selalu mengadu yang aku tak tahu and they are so kind. They will say “Biasalah tu, first posting. Nanti hang akan terer punya.” They cannot be angry at me because I made it known I am not lazy, I am just stupid.

2. Ask for help and do what you are told to do.

   - when the MO got irritated with the whole ward and hence your fellow colleagues kena marah because of YOUR mistakes, please apologize. It’s easy, I will give you a script, “Weh, sorrylah.. Sebab aku, hangpa semua kena marah. Actually macam mana nak buat morning review sebenarnya?What did I do wrong? Sorry…aku tak tau langsung!” Hah, and then they will tell you what to do. Next morning, you do exactly what you are told. So if you still got scolded, THEY will come to you and say, “Weh, sorry hang kena marah. Semalam aku terlupa nak habaq…hang kena off brannula yang tak dipakai sebelum MO mai round.”

-That’s what I have been doing to all my juniors who asked me for help. Kalau depa kena marah sebab aku terlupa nak bagi proper instruction, aku yang rasa bersalah. So takkan aku nak marah diorang malas pula kan?

-It’s strategy man!You have to show people that you don’t know and you are willing to learn. And if you make mistakes, you are a first poster. It’s expected! If you show them that you don’t know, they will pity you. That’s the idea.

3. Always offer to help. Go back at the same time as your colleagues.

   Most of the time, even if I have finished my work in my cubicle and it’s already 5 pm, I will saunter to my other colleagues and asked, “Weh, hang ada apa-apa lagi tak yang tak siap? Jom kita siapkan cepat-cepat. Dah pukul lima. Nanti kita boleh balik skali.” I offered help because it’s bad manners to leave your ward colleagues and go back at 5.00 sharp. It’s a tacit and silent etiquette that in the ward, you do things together. Especially balik rumah! Jangan tinggal HO buat kerja ward tak habis-habis. If you absolutely MUST go back, phrase it nicely. “I have things coming up and need to go home. Aku dah siap semua bahagian aku punya. Boleh takaku tinggal hang awal hari ni? ” Most of the time your colleague will appreciate that you even bother telling her that you need to go and can’t help her.

    

4. Be friendly.

   It makes life as a HO a lot easier if you can be friendly and nice to everyone. I especially love the MOs in surgical. I am in a much friendlier term with them than when I was in OnG. It makes life a lot easier when I need my logbook signed. Hehehe. Just be careful that you are not nice to the point that you are easily bullied. Be very careful about that.

    

   I like to be nice and helpful. But they know my nice-ness have limits and they cannot get away with bullying me. In general, I play very fair. I am nice to those who are nice to me. No one can accuse me of being arrogant and snobbish. When they asked me to do things I don’t like to do, I would do it but I made sure they knew I didn’t like it. If they asked again in the future, they knew they would better have a very good reason.

So, I wish good luck to all who are starting out as housemen. Do make friends and during your first posting, be especially careful about being labeled lazy. Defend your honor and your reputation. Especially important in your first posting that people think you are NOT lazy. Always, always admit that you don’t know and always humbly ask for help. During my first posting, I cannot remember how many times I began my sentence with, “Weh, aku tak tau macam mana nak…..”

Most people are kind at heart. Especially those who are doctors. Most of them are helpful people. And even if they are not motivated by the urge to be altruistic, they would welcome the opportunity to feel wise and clever and show you what they know. You have nothing to lose by admitting that you don’t know and you need help.

Good luck first-posters. I am a third poster and I still need all the luck I could get. May my journey and yours be as smooth as a baby’s skin until we get to KK. Heh!

So there!

****

I have always wondered whether my superiors in HSB have ever stumbled into my blog and then find out that I have been dissing HSB (and previously the OnG department in specific) all these while. I have always wondered what would I do if they call me out for being TOO BRAZEN and TOO LOUD in my dislike of HSB and the previous department I worked in. I wondered whether when push comes to shove, will I be able to justify whatever it is I have written in my blog.

However, upon further critical pondering, I found out that I don’t really care if anyone finds out about my blog and report on me to my superiors. I have done even more daring things overseas….I complained against the medical faculty to the International Office… and I was a foreigner at that time! And now that I am back in my own country, among my own people where I have always belonged, there’s even less reason for me to hide my claws.

I know that ALMOST all my superiors in the surgical department hate the shift system and they would think less of HO who actually welcome the shift system. I know of one particular specialist who said he is DISGUSTED by anyone who actually likes the shift system.

Fine.

But being me, I did not believe in hiding my opinion simply because the echelon of the health system detest it. If they find out about my stand and find me disgusting, be it. But I have never hidden the fact that I welcome the shift system to anyone. I have spoken about this openly to HOs as well as to some MOs. If any specialist had asked me, I might even let them know what I really think. Sadly, none of the specialist ever asked.

Now, let me be more direct and clear about my stand regarding the House Officer roster.

I give my support to the shift system…not because I think it’s a MUCH MORE superior system than the current system. But because I believe that between the shift system and the current system, the shift system is the lesser of two evils.

Now what do I mean about that?

Read on!

****

I am sick!

I am tired!

I am utterly EXHAUSTED of hearing people saying the extreme of two things: They either REALLY love the current system and hate the shift system…. OR they REALLY love the shift system and abhorred the current system.

NO ONE has in their mind the idea of having a middle ground or a win-win/lose-lose situation.

They either want to stay in this sickeningly torturous system ad infiitum…or they would like to have as much holidays as possible as what the shift system seems to promise us.

As a Muslim, I have learned the concept of wasatiah! Sederhana! Equilibrium! You can never go wrong by being Wasatiah and avoid any forms of extremities.

Had HSB been more reasonable and had granted us the usual “HOs are allowed one day off per week and those who are post-call are allowed to go home at 12.00″ I would have been more than satisfied with my lot in life. These things are nothing extra than what other HOs are getting in other hospitals! I didn’t ask much! Just what other HOs are getting in other hospitals.

But no! They decided to go on the extreme….and be cruel.

So now, it’s been acknowledged during the meeting in KL that HSB is at the top of the list of hospitals with complaints coming from HOs and their parents. On top of the complaints coming from other regions in Malaysia too!

With all these complaints coming from all over the place (and some of them came from very influential people; anak Dato’, Tan Sri and even Kerabat) , there’s pressure to change the current system into a more relaxed system….aka the shift system.

I acknowledged that the shift system is bad in several ways….the most glaring of them is the fact that our training will be greatly compromised. We may have less chance of doing procedures. Some even said that we would end up becoming an incompetent MOs.

Right.

But I still chose the shift system…simply because no one has thought of suggesting another system, that is the ‘middle-ground, wasatiah’ system. The system I would like to suggest consists of very minor changes to the current system, yet will be able to satisfy both sides if they are willing to compromise.

Let’s do it my way:

1. we all stick to office hours (but we understand that we have to finish our work even if it means staying beyond working hours)

2.Abolish on-calls; Instead, have only a few people working outside office hours. In surgical department, we usually have six HOs on call per day.   These six HOs do not have to come during office hours. They start working from 5 pm until the next morning and passover to the HOs who come working during office hours the next day. We call this system as ‘working nights’.

3.  Let the same six people ‘work nights’ for a week. Next week, another set of six HOs can work nights for the rest of next week. And you keep on rotating the ‘working nights people’ each week while the majority of HOs work office hours; because that’s when MOST things need to be done.

4. All HOs get one day off clinical days per week as is our rights.

A simple but sweet system! Tak pening kepala! I don’t know why anyone did not think of such system! They either want us to work like a slave…or want us to be too relaxed until we are not learning anything.

Yes, extreme folks!

****

Since no one is suggesting my kind of roster, I am choosing the shift system.

You can say whatever you want….that I am not a dedicated doctor, not passionate, or I shouldn’t be a doctor in the first place yadda yadda yadda.

Say it! And it would not change my opinion one bit.

I still stand with my believe that you are not a good person if you are just a good doctor but a lousy child, a lousy mother, a lousy wife.

Furthermore, you are not a good person if you are a lousy slave of Allah. Part of being a good Muslim is investing the time to continuously learn about your religion…possibly learn arabic, understanding what is it you have been reading in the Quran effortlessly.

Even if you belong in other religions, the same concept applies. If you are a Christian, part of being a good Christian is going to church every Sunday and probably get involved in the Bible study or Bible circle or whatever it is you call them. Just like us Muslims, we have usrah/ Quranic circle.

These things are important too, aren’t they?

One particular specialist was saying “I don’t know where is your passion as a doctor!”

Right.

I happen to be passionate about being a good daughter too. Others happen to be passionate about being a good mother/father and a good wife/husband too. They are forgetting the fact that as a person, we have many roles in life and we have to juggle all these responsibilities. It’s not fair for you to expect a HO to be with patients all day (36 hours!!) while he/she couldn’t even care for his/her own sick parents! The most important person in our lives other than God and his messenger is our parents!

Why are you making us choose between being a good doctor and being a good person?

Is it because you are not exposed to the health system in other countries where they didn’t have to make a choice between being a good doctor and a good mother? They don’t have to choose. They can be both!

Just because you have always been trained that way, you think that is the only way to train! Your lack of imagination is astounding! You seem to think that the current system is the only way to train HOs into being an excellent doctors. As though other interns in other parts of the world with a different system don’t all end up being a good specialist in the end too.

Again, your limited imagination is incredible! If you are disgusted…then, I am nauseated!

It’s very easy to just brush our concerns off by saying, “You cannot complain about lack of family time or whatnots. You chose this life!” It’s a very selfish way of not solving the problem. The fact is, most of our doctors are married or will marry and will have kids…these problems that they face are very real and affect the majority of us. Don’t you care at all? Are the kids of doctors not as important as the kids in the paediatric wards? How do you utilize your mind and your reasonings? How dare you think you sound smart when you said, “You chose this life. Suck it up!” to your fellow colleagues.

You have just successfully demonstrated that you are indeed a good dedicated doctor…

…but nothing else.

***

For the record: I love my time in surgical. MUCH MUCH MORE than the time in O&G.

Most of the specialist are very nice. Some of them are witty and funny! The surgeons are cool ‘buggers’ (to borrow one of my specialist’s favourite word).

I love surgical in ways that I don’t in O&G.  In a lot of ways, I enjoy my surgical rotation very much and I know I would miss my time in surgical. The Head of department likes to teach and I learn a lot during his rounds…he is quite hilarious at times. The MOs are super nice and much, much more reasonable in their scoldings.

However, I cannot agree with my superiors stand regarding HO training, much as I respect them. They keep saying that during their time, they had it worse.

All I want to ask them is “During that time when you had it worse, did you hate it?”