Thursday, 15 December 2011

Survival Tips for House Officers (HO)

Sumber : Blog Dr.Harlina

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 1 - Set your intention right. It's neither about the money, the highly respected position and the power. It is about PUBLIC SERVITUDE, serving those who are in need of healthcare. Only after you have served well, then only you could deserve the rewards, privileges and rights allocated for medical practitioners! Welcome on board!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 2 - Have the right attitudes. Being the most junior officer in the team, you really have a lot to catch up and learn. Never pretend that you know all. Never hesitate to admit that you do not know, to ask questions and assistance. Respect those who are more experienced than you. People with the right attitudes are welcome wherever they go, always...all the time!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 3 - Put on your best smile and outstanding manners. Greet everyone with a cheerful salam. No matter how busy you are, don't forget to move your temporo-mandibular joints and carve out a big smile. It will stimulate a fountain of endorphins in your neuron synapses, and aha...the feel-good feeling will set in. Don't believe this? Just try....just do it.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 4 - Work extra hard to convince people that you are reliable, responsible, accountable and able to complete tasks and meet expectations - within the first two weeks! Once people know you're committed, you'll gain their trust, respect & cooperation. Just mark my words!

SURVIVAL TIPS FOR HOUSE OFFICER : Tip no.5 - Refresh your inner self with daily, constant and effective spiritual input. For Muslim, don't ever neglect your 5 times daily prayers, no matter how busy you are. You really need that 5 -10 minutes regular breaks. It acts as a cooling oasis for you to rejuvenate.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no.6 : Mend your bruised heart and dented self-esteem, quickly and effectively - each time you received unpleasant reminders of your incompetency & shortcoming from your seniors. It's a part and parcel of the job. Admit your mistakes, but PLEASE, try hard not to repeat them. To err is human, but to keep doing the same error is a major blunder!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no.7 : Keep in touch with your loved ones - parents, spouses, close friends, teachers etc. Don't shut out your life, which mainly linger around your wards, call roster and private room now. There is more to life out there than just work or crashing into bed to recover from sleep deprivation.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no.8 : Make friend with the nurses. Never ever be their enemy. Life would be much easier if you know how to win their hearts. Dr Meena (Paeds MO) gave me this very precious advice : Harlina, be nice to these people (nurses). They will decide whether you will have your meals or not during your calls. Yesss, I later realized how true that advice was!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no.9 : Forgive those who raised their voices at you. They might be angry patients, stressed-up MOs, overwhelmed colleagues, frustrated consultants, irritated nurses etc. Nobody had ever shouted at you before,eh? Being a HO, anticipate your first experience here. Forgive them, forget them and live on. After all, we're all just humans living in the same pressure cooker!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no.10 - Thank God for the honour of being His instrument/tool of Mercy to mankind. A great opportunity is at your doorstep to catapult your good self to be bigger than life. Grab that opportunity and seize the golden moments. Nothing compares with the feeling of satisfaction whenever your patients & relatives say : Thank you, Doc !

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 11 - Handle yourself well when dealing with difficult people. Feeling victimized, bullied and discriminated? After reflecting on yourself, I suggest you pluck some courage to meet face-to-face. Clarify, admit your mistakes and make peace. InsyaAllah, things will be fine.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 12 - Treat your patients as if they are your own parents/relatives. Just as how you would like any doctor to treat your parents, that's exactly how you should treat your patients now. Remember, what comes around, goes around! Motivate your patients always, you'll feel the positive energy seeping into you too.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 13 - Express your love to your spouse everyday, using his/her love language. Let him/her know how much his/her support & understanding means to you. Share your ups and downs, laughter & tears. Thank Allah everyday for sending you this special person. Those who are still unmarried, what's keeping you, guys?

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 14 - Be sincere in treating your patients, be gentle and caring. Control your anger and frustration, avoid explosive emotional outburst in front of your patients. If you really need to release the steam, do it in the washroom with the tap running (peace, Mother Earth)- I consider that as an effective form of anger management!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 15 - Keep abreast with what's happening around you - medical & non-medical, locally and globally. Read the papers, journals & magazines, listen to the news bulletin, engage in general discussions. Have your own opinions. You're a doctor now! People wanna know what's going on in your brain.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 16 - Always extend a helping hand to your peers/colleague HOs.That's the only way to ensure help comes your way the next time you desperately need one. Less of `Me, Myself & I', please! More of `We & Us' now. Be a sporting team member, will ya!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 17 - Make effort to remember names esp. your patients'. Address them appropriately. If you're greeting them for the first time, use `Encik, Cik & Puan' instead of `PakCik, Makcik, Pak Aji, Apek, Aci, Akak, Abang, Adik'. Make quick glances at the patient's file and pronounce his/her full name clearly. Just see how impressed they will be!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 18 - Endure the disappointment when you discover the realities of the system. Witnessing unprofessional, unethical conducts - far from what you learnt in med schools? Feeling upset, angry, demoralized? Good, at least I can count on you to be a future committed agent of change!

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip no. 19 - Learn to read your consultants'/specialists' minds. What do they want from a HO? Dedication, commitment, eagerness to learn, willingness to be corrected & guided. Give them those, and they won't make your life miserable.

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip no. 20 - Keep your room in the HO quarter clean, tidy & cheerful! Hire a keeper if you could afford one.Throw away all the rotten left-overs. Buy an air-freshener & some flowers. Pull up the curtains, let the sunlight in. It's supposed to be a bedroom, not a cave!

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip no. 21 - Spend your salary wisely. Share your first paycheck with your loved ones. Pay up your debts / credit card bills. Recall your financial planning lessons. Avoid weekly shopping mall rounds. Window shop with your stomach full, you'll be able to control the cravings

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip no. 22 - Push the `pause' button, get out for some fresh air, watch the sunrise/sunset. Reflect & contemplate. Remember, you just a small part of a very complex design. Put your perspectives back on track. Inhale & exhale - be grateful to Allah for everything you have.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 23 - Volunteer to help arranging the call roster.Experience the pain in accomodating all requests and dealing with unhappy colleagues who could not get their wishes. Best time to learn how to give & take here!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 24 - Be friendly & mix around with everyone. Do not reserve your greetings only for the bosses & VIPs. Greet the staff nurses, PKs, cleaners, security guards, gardeners etc. Drink your coffee at the pantry. Stop being choosy & selective. Snobs are lonely people.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 25 - Pray for your patients' well-being. Support their emotional & spiritual needs. Listen to their stories. Don't be afraid to be close to your patients. You will learn how to detach your emotions & rational thinking while looking after patients - so you'll remain objective and professional.Learn the balance to keep the ideal distance between you and the patients.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 26 - Surprise those who look down upon you by exceeding their expectations. Impress those who think highly of you by exceeding their expectation too. Whatever it is, do your level best. Be brave to take up challenges, be humble enough to ask for assistance and be ready to receive feedback - Recipe for a satisfying career!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 27 - Do not allow self pity to consume you now. Never curse yourself. Regretting your life choice of becoming a medical doctor, feeling envious with those friends who are enjoying life, free to do whatever they like? Well, I bet they're envious of YOU too! Just hang on there, persevere & be strong.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 28 - Admit your mistakes and try to redeem yourself. It takes a lot of courage, self-esteem and confidence to own up for your shortcomings. At the same time, do not boast around and inflate yourself. If you've really done good, let others acknowledge. You do not have to keep reminding others.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 29 - Enhance your medical knowledge thru' revising textbooks/notes ( I hope you haven't sold all textbooks to the juniors in med school!). Get answers to questions ASAP. Experience medicine with accurate knowledge/information, not simply following orders like zombies -without critical thinking.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 30 - Let the deaths of your patients serve as gentle reminders/ tazkeerah - that you will also face yours, sooner or later. Treat the dead with respect, whoever they were. Look at those cold, still bodies - now separated from their souls. Pray for them. Convey your condolences to the mourning relatives... they'll appreciate that.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 31 - Keep in touch with your emotions, but avoid being overwhelmed. Acknowledge the anger, sadness, frustration, confusion etc. Don't simply brush them off, what more trying to stiffle them! Manage those emotions - you're a human being, not a robot! Ventilate, it helps clearing up your lungs & mind.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 32 - Promise yourself that you're gonna make one person smile today! He/she might be your patient, colleague, MO, consultant, staff or spouse & parents at home. Simple rule of life - if you wanna smile, make another person smile, if you wanna be happy, make another person happy, if you want people to appreciate you, appreciate others first!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 33 - Commit yourself to life long learning from your surroundings. Your patients are your best teachers. Learn how they handle bad news, manage their emotions, ask for help and accept their fate. Despite all the pain & sorrow, they still tell you how much they appreciate what you've done for them.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 34 - Master the negotiation skills, otherwise life can be so inflexible and stressful. No matter how busy, there is definitely time for short prayers, quick meals, brief naps & shower time. The secret? You just have to know how to negotiate with people around you.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 35 - Start scribbling your life journal / log book. You're facing new challenges everyday, it's too precious to simply let them pass by without any acknowledgment. Write down the lessons learnt. You will have to share those with others one day.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 36 - Agree to disagree - the best way to handle difference of opinions. Speak your mind out, share your concerns & input. Don't be a YES-man all the time, people won't notice that you exist! Learn to say ` I beg to differ' as a subtle way to say `No, I don't agree with you!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 37 - Observe your consultant's leadership style closely - emulate what is exemplary, avoid what is not impressive. Do not get involved in power play. Be principle-centred. At times you have to disagree with your friend if he/she is wrong and compliment your enemy if he/she is doing the right thing

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 38 - Be professional - what does that mean in simple term? Doing the right thing when nobody is watching! Three elements of professionalism - self reflection, self regulation, self correction. You're expected to give your best and place patient's interest above self! How's that?

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 39 - Put aside some money for charity. For Muslims, start saving for your Hajj pilgrimage. Make time to open Tabung Haji account, if you haven't done that yet. Share and be generous. Enjoy the feel-good feeling of sharing your wealth with others.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 40 - Try to perform one task extra than what is expected of you each day. This is to avoid boredom out of routinized activities. How about volunteering to push the patient's trolley to the OT, buying lunch at the warong for the ward staff or helping a patient to the washroom? Yes, it is not YOUR job, I know. I'm just suggesting. Don't be angry with me!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 41 - Ask yourself these questions time and again: `Is this world a better place because I am around?' Do I make a difference?' Human beings need to have answers to those questions. It's our spiritual need : self-actualization in Maslow's Pyramid on Hierarchy of Human Needs.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 42 - Always end your conversation with your patients with this magical question : ` Is there anything else that you would like to know from me?' So many questions can spring out from the patient's mouth - worries, concerns and misunderstanding which need immediate attention & clarification. Now you know why so many patients did not turn up for their follow-up visits, eh?

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 43 - Visualize who you would be in 10 years time. It's not too early to apply creative visualization techniques now. That's the first step towards your success. Come on guys, you shouldn't just barely survive this housemanship, you have to succeed!

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 44 - Keep holding to your principles, even when nobody seems to bother. Be the only one doing the right thing, tho' everyone else seem to favour & do the opposite. Truth will always prevail, sooner or later. You have to be strong to be a person of substance & integrity.

SURVIVAL TIPS FOR HOUSE OFFICERS : Tip no. 45 - Be an outstanding team member. Always be helpful, considerate and committed. Be ready to take up leadership role whenever necessary. At the same time, don't be bullied around. Defend your rights, stand strong on your ground. You'll be liked and respected, just mark my words!

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip. no 46 -Convince yourself that you play a very important role in the healthcare system of the country. You might feel like a slave sometimes, being pushed around, instructed to do this & that. Just bear with those a little while more. You will soon transform to be a matured, experienced medical officer,in-charge of junior HOs who come after you.

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip. no 47 - Think seriously about starting a family soon. Family commitment pushes you to another level of life and forces you to consider others in making decisions. If you're still looking for the right suitor, keep on praying. If you already have the potential suitor, just proceed making arrangement for a simple wedding. Let's continue with not get stuck forever with your career!

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip. no 48 - Clear up your mind, clean up your heart regularly and constantly. Spend your holiday in a quiet, peaceful outdoor environment. Keep in touch with nature. Feel the magnificent power of God, the Creator around you. Remind yourself, how small, weak and dependent you are to God's help every second of your life. Pray - O Allah, just don't leave me alone!

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip. no 49 - Have the courtesy to meet and thank all your consultants, clinical specialists, registrars and MOs whom you have worked with, before finishing your posting in that particular department. Do not just disappear into thin air. Greet them at the corridors, acknowledge their presence.

SURVIVAL TIPS FOR HOUSE OFFICERS: Tip. no 50 - Get use to the fact that `Once a doctor, always a doctor!'. Internalize life-long learning commitment. You are allowed to add the title `Dr.' to your name, but be aware of the responsibilities that come with it. Prove that you deserve such a noble title to be put in front of your own name!

Sunday, 4 December 2011

Housemanship shift system - it's not all bad as potrayed

This article was taken from :

There is a lot of talk about the houseman shift system lately, and I heard a lot of feedbacks be it from the mouths of the doctors, the newspapers, social media like facebook, twitter, and blogs. I am one of the lucky few houseman who has got chance to experience housemanship in two ways; first half of my housemanship doing oncalls and second half doing shifts, equally divided three postings each. And I have the privilege to make a comparison between the two.

Since the beginning of an era, the main complains of doctors anywhere in the world are that they are being overworked and underpaid. Now that houseman are not overworked and underpaid anymore, why do we still complain? We should have been grateful that the whines of the past 50 years have finally realized in 2011! I really really bet you that all those who have been thru housemanship would really wish that their work hours were less back then. Heck even I wished for lesser work hours when I was in 1st till 3rd postings, when the oncall system was in place.

I was quite opposed to the idea of the shift initially. But as I go through it, I don’t think it’s all bad. As I mentioned in my previous post, the number of houseman is increasing. The government cannot possibly increase the number of patients to cater for the increasing number of houseman. To force us do more frequent calls will not increase the frequency of the patients we see as we are forced to do calls with few other houseman, about 3-4 houseman in one ward. Shift system makes us see more patients more frequently albeit in a shorter period of time.

The result of lessening the work hours are inevitable; we shall see much less patients and thus allegedly lacking clinical exposure. The good old consultants may claim that in their olden days they saw much more patients, they did more oncalls, they had more horror experience with their bosses, they managed the ward, the clinic, the operation theater alone as houseman while their bosses came in to work late, some even play golf.

With due respect, in the olden days the mortality rate is much higher, in the olden days you could not possibly be taking care of 40 patients and finish your work perfectly, in the olden days the diagnostic investigations were not as available and lavish as the current days, in the olden days there were not so many treatment options and patient care guidelines, in the olden days the nurses were damn good and efficient not having to call houseman for a simple IV line, in the olden days time is not wasted on petty documentations, in the olden days there is much less medicolegal cases, in the olden days you don’t even know what HIV is, some subspecialties were not known to mankind, some recently classified diseases were not even disease yet. Really, I do not think of anything to be proud of back then. And we do not appreciate horror tyrannic bosses as we do not appreciate a hostile working environment.

I do not mind listening to the tales of the specialists on how it was during their good old days. It actually gives me more inspiration to strive harder. But you can not, really can not, expect things to be as same as the olden days. Things change. So should the working attitude.

This lessening of work hours have implications on houseman clinical exposure as well. Some specialists have been proposing for entrance and exit exam of housemanship, with continuous department level assessments. I do not mind that at all, given that it is somehow true that clinical exposure has been much less and some HOs bring quite the worrying attitude, even to the other HOs. If the higher ups are really keen towards producing safer medical officers at the same time lessening the work hours, they must find a mechanism to assure the public that we are safe doctors.

So yes, we work lesser hours. That gives us more quality rest time and social time, like any other normally functioning human being. Apart from physical health, mental health is also very important. We do not want any doctors to be fatigued or psychotic or depressed. If you think that the current medical officers and specialists are really great with their mental health, try to be more observant. Few of them are really just making other people’s lives more miserable! No, they are not teaching or scolding houseman at a clinical error. They simply swear, they yell, they degrade and humiliate their juniors, they make people feel awful all the time. Do you think a normal human being would do that? I understand that as a houseman in the good old days you were also being constantly harassed and insulted, and claims that made you a better doctor. But does it make you a better human being? Does Allah almighty give you the rights to insult your juniors? I don’t remember He gave those privileges to His prophets.

Previously housemen are just being scorned within the walls of the hospitals, but now they humiliate housemen in newspapers and social media. The reason is they want the public to know how lousy we are, and watch out for the graduates of this and that countries. I do not know what good that can do. They mentioned that housemen are being spoiled and mollycoddled, but in fact the public should be more worried about the mental health of some medical officers and specialists as they are the clinical decision makers who are fatigued and psychotic. Lucky I only met few people like this in my hospital. These people ask respect from us and yet they treat houseman like idiots. And we have to respect them, how??

Some of medical officers are not without irresponsible attitudes. I remembered there was one patient who was seen by neuromed in Emergency Department the day before, but I mistakenly referred to another neuromedical MO as a new case. After she did her 3 page review, she yelled at me “Why are you refering this case to me? This case was refered yesterday to another MO! Why didn’t you call him? Why do you waste my time doing all this useless shit?!”… Excuse me, a patient is a useless shit?? I admit my mistake for the wrong referral, but to say that a patient is a useless shit??? Some other MOs did not even come when called for help or opinion. Some even said “ask your houseman friend lah how to manage.” Some MOs become over-apprehensive when a case is refered to them. They specialists mentioned about a lot of houseman with lackadaisical attitude, but what about your MOs? Irresponsible MOs with attitudes are far more dangerous, don’t you know that? Some of them are just psychotic beyond borders because they are allegedly stressed out.

I have worked with some MOs and specialists who really teach houseman. It is long and tiring rounds but the rounds are brain stimulating. The problem is some of them prefer resting time or doing administrative works over bedside teaching, and scorn us for being low in quality. Ironically they work in a teaching hospital. Yes it’s annoying if a houseman doesn’t know the basics, but if you do not even teach, you can’t put blame on them. I am not proposing breastfeeding, I am proposing tighter supervision. Some houseman even get the basics wrong that you must really correct. If you are concerned that housemen are of low clinical quality, then you should do something about it. If not concerned, please take your rest time, and make peace about our quality.

I do feel shame that my bosses (the medical officers and specialists) are working harder than me. There should be a mechanism to limit their working hours as well. A fatigued medical officer and specialists are more dangerous than a fatigued houseman. A fatigued houseman after an overnight call can still function like a robot, following orders from the superior. But a fatigued medical officer and specialists will endanger patients as they are the ones giving orders and supervising the juniors, and they are bound medicolegally.

I am two postings away from becoming a medical officer. I do not mind doing oncalls all over again as I had done it before and I enjoyed doing oncalls. But as more of my batch of houseman are becoming medical officers, I hope that the government revises the working hours for medical officers as they are currently the most hardworking group of doctors, covering the houseman’s works especially when the housemen go home after their shifts. As I mentioned, I do feel embarassed that my medical officers are working harder than me.

Why am I writing this? Because I find it true, to myself at least. When I started my first posting as a houseman in surgical department, I always dreaded coming to work everyday. There was once I had a sleepless call due to multiple emergency operations. I couldn’t help my colleague at 4am to take morning bloods in the ward as I was still in Operation theater till 7am. The next morning rounds, I was so screwed by the specialist for not taking LFT of a patient post op. He pulled my tie to him and threatened me with extension, in front of patients, nurses and my colleague. I explained to him I was in operation that time, but he just said you houseman are making lame excuses, so stayback till 11pm tonight. Mind you I was postcall and it was a weekend! And that kind of things did not happen just once.

My temper back then was very unimaginable. I honked on the roads all the time, I was really a reckless and fast driver, I yelled at waiters and customer services, and I was swearing curses like I don’t care, even to my parents. I slept dreaming of my dreadful bosses. I look tired even when I am not oncall or postcall. After starting shift system at my fourth posting, I found out that I have been much less stressful, even I forgave a driver who accidentally hit my honda city quite easily. And frankly, I feel happier coming to work each morning, and I do not feel like quitting medicine as much as I have posted in this blog before.

I now love my job as a doctor. I want to brush up on my clinical skills, though I know it takes some time. And I do care about my own health, physically and mentally. Change in the working attitude really needs a paradigm shift. Few specialists already on board for lessening work hours. We hope the other majority follow suit. Please take note that a physician burnout is no small issue. I am sure those who are medical officers and specialists now wished their housemanship in the past to be less tedious and less dreadful.

For further reading

Saturday, 3 December 2011


Allah, the Most High, commands:

Read! In the name of your Rabb (Only God and Sustainer) Cherisher, Who created — created man, out of a leech-like clot: Read! And your Rabb is Most Bountiful. He Who taught (the use of) the Pen, taught man that which he knew not.

(Al Qur’├ón 96:1-4)