THE RATIO!

THE RATIO!

Insya Allah on the 16th 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.

8 thoughts on “THE RATIO!

  1. seen ur profile and u graduated from aussie and a MARA scholar. just an advice. tone down a bit in ur writing. be humble but stern. i do agree on some of ur points and definitely agree that msian system can be further improved.

    i think u might be my brother’s batch or junior kot. now he works in mebl, grad from melb and gone thru IB in KMB.

    my 2sen
    ~a MARA scholer who had gone thru education in UK and Msia, has worked as Dr in UK and Msia, and quite well verse in UK and Msian system/curricula~

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    1. Thank you for all your helpful comments. For helpful they are.

      It’s very hard to tone down a much repressed dissatisfaction all these months. Darah muda and all.
      You were once youung(er) yourself, I believe. It’s hard to take when your reality does not meet your ideals. Not even a bit.

      Maybe as the years go by, I’ll be mellow.

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  2. Tired Specialist

    wow! as a HO you sure have lots of time in your hands to rant so much. I am sure if you put the same amount of energy in your work, you can remember your patients more. I personally sometimes cover one or two wards at one time, have clinic duties and visit district hospital once a week. My HOs on the other hand, stay in the same ward. Despite the flexi hours (something I personally oppose), they spend more time with the same patients than me. Yet, oddly I find myself reminding them some details of patients they are supposedly in charge of. They tell me they are tired, not enough rest lah etc and YET they are posting stuffs in FB half the time. I think its time you guys stand back, look in the mirror and well, try and see what we are seeing.

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  3. Thanks for dropping by, boss.

    Hopefully, being able to remember details of any patients would be something that we acquire over time as we mature into the profession.

    What I do and what I rant during my free time is hopefully not being begrudged as long as I am not negligent in what I do during my working time.

    All that aside, isn’t there even a glimmer of truth in what I am saying about The Ratio? About our lack of skills in the management of human resource?
    Or is it something not worth thinking about? At all?

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  4. An old MO

    Not a glimmer of truth at all in what you’re saying about The Ratio. As one of the “older generation of MO”, we did all the procedures you mentioned, did all the referrals, took all the scan appointments, took all the bloods, remember all the cases, send and trace blood results manually, went to blood bank to collect blood, beg the lab technicians to get result fast in the middle of the night, prepare instruments by ourselves, bullied by staff nurses and PPK, etc. If ever a staff nurse helps us, it’s a God sent angels, which happened once in a thousand years. We also have about 2 HOs per ward only. So what is so great about you? You think you’re the only one suffering? You think you’re the only HO that can work? (It sure sounds like it from the way your write). We have all been through that stage, we have all suffered, and I can proudly said I survived it.

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  5. In whatever you do and whatever you say, there will be people who agree with you or disagree with you. It’s Sunnatullah. There will be people who love you, really like you or really hate your guts. It’s sunnatullah. It’s also sunnatullah that people become defensive when they are criticize….by you.

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