Thursday, May 17, 2007


Never a good way to start a blog entry. Especially after such a long hiatus.

Apologies in advance to those awaiting my comments on articles and such. Will get around to them in time.

For now, I just need to vent before I perforate a gastric ulcer. ( I'm sure it's already there, just that it's asymptomatic at the moment. )

I do, however, have bouts of chest pain nowadays. Like Cameron Diaz and her reflux symptoms in The Holiday ( which I just rented and really enjoyed -- short review to follow ). Or of a more pleuritic nature like the sharp pang I got during a resus early this morning.

Ode To Dante

The last fortnight has been pure torture. Here's a list of reasons ( not 100% comprehensive though ):

Circle #9: MOPEX changeover

Yes, we go through this painful process every 6 months, but the combination of a relatively weaker batch with multiple other factors has proven to be a major headache. I'm sure many colleagues agree that the last group made the transition to the A&E Department much more smoothly. The difference is most marked during night shifts, when manpower is skeletal and a single slow MO can hold up the entire queue.

Of course, we've had difficulties before, and understand the stress involved. Rest assured that we allow a reasonable period of adjustment and always try to believe the best of our junior doctors. Many who started out shaky later earned top appraisal grades and ran resus for us ( yes, even the 1st year rookies ), so we never write anyone off unless they're completely beyond redemption.

Circle #8: Blur MOs

Again, we try to be sympathetic, but certain lapses can still irritate. Running 5 different blood tests ( including the costly NT pro-BNP ) for a simple URTI or ordering 10 x-rays for every painful spot is just unacceptable. Not being able to read the x-rays you personally ordered kind of defeats the purpose. And scurrying out of resus to look for me to read an ECG for you ( while the patient sits there in pain and diaphoretic, with no IV line, SL GTN or oxygen ) -- well, this just makes me wonder what the heck you learned during housemanship ( which includes a rotation through internal medicine, which orders a lot of ECGs, no? )

Anyway, I'm hoping these MOs will learn fast, i.e. by the end of this month. Beyond that, my sharp tongue will take over.

Circle #7: Everybody lurves us

Including the other cluster's polyclinics and the private sector AND loads of GPs. We have patients who live on the other end of the island being shipped over, often at the doctor's discretion, sometimes at the patient's request. Nobody bothers to check which hospitals these people are on follow-up with ( or maybe they know and just don't care ), and the patients themselves don't say anything either. So we end up managing cases with long histories at other institutions, which is damn frustrating.

Oh yeah, and there's a strange trend where patients opt to be admitted at our hospital instead of being transferred back to their original parent institutions. May be a self-referral, AOR discharge to come over to us, or more commonly, they end up at our A&E during one of many ambulance diversions.

Circle #6: Questionable referrals

One short shift in the consultation area was more than enough for me earlier this month. Maybe the new OPS MOs are just being paranoid, but hey, we do get weird memos from doctors with very small MCR numbers, for "undisplaced fracture of the distal phalanx of the little toe, sustained 1 week ago", or "cough for 1 year", or "headache for 10 years".

I kid you not.

The day I spent in P3 was marred by an unpleasant experience with a DM foot patient's angry children ( both in their 20s ). Chronic leg ulcer on regular dressing at OPS, referred for "abscess and gangrene".

Turns out the teeny-tiny area of black pigmentation has been there for weeks, with no progression, and she only had mild cellulitis ( for which the OPS didn't even treat before referring ). Relatives were pissed, and so was I. Only problem was that I was PO-ed with the polyclinic doctor, and they were PO-ed with me. Spent 20 minutes explaining why she could be managed as an outpatient, that the referral was unwarranted, that they could always return to us if the infection got worse, and they thought I was brushing them off. Sensing a potential complaint, I gave them the last-resort option of admission -- which they declined.

Could've seen 3 other cases during that episode. Thanks a lot, Dr. ***** from **** OPS. >:-(

On the flip side, I've encountered cases who first consulted the OPS or GP clinic and were given appointments dated 3 months later, for complaints which actually require immediate admission. E.g. Classical anginal symptoms with recent escalation, and obvious ischemia on ECG; definite melena on PR ( given a gastro appointment in June, haha ), just to name a few.

Blame the doctor, or the educational system? You tell me.

Circle #5: Ambulance diversions

I KNOW it's sanctioned. I KNOW there's a set of criteria to follow. I KNOW it can get busy over there.

But we're seeing more than 400 cases daily ( 100 more than our usual off-peak day average ), and now hit almost 500 on Mondays and weekends. Our resus room is ALWAYS full ( as was the case for my extremely busy night shift yesterday -- my 1st solo call, woohoo! ), and considering the current bed crunch in the wards ( ICU and HD / ICA included ), we can't even clear resus fast enough to receive new patients.

We also have fewer MOs ( total, per shift and especially during nights ).

I'm just saying: maybe we should be allowed some respite as well. It's only fair, right?

Circle #4: Manja mama's and papa's

Have been getting a lot of those lately.

Usually teenagers or young adults. Female. Typical Ah Lian. Or fitting the low-pain-threshold profile ( ask any doctor if you're not clear ).

Often drunk. Hyperventilating and bawling their eyes out. Surrounded by 10 different guys vying for their attention -- also drunk, tattooed and verbally abusive to A&E staff ( but oh-so-sweet to the annoying attention seeker at the centre of it all ).

They always get seen first ( i.e. get to jump queue ) because they kick up the biggest fuss. I practically ordered a nurse to stick one of them in P3 the other day ( young woman sobbing because of an infected sebaceous cyst -- huh?? ) but alas, even the AC kena trumped because the nurse didn't want the big crowd in the waiting area to see the patient looking so "distressed".

So much for "emergency".

Circle #3: Lack of sympathy

Nobody cares how busy the department is. They just complain about the waiting time for consultation, investigations and beds. We keep explaining that we've got an overflowing resus room, that there're multiple ambulance diversions occurring, that there's a bed shortage, but they just... don't... care.

And just to side-track a bit: since when did patients start assuming we know everything about their medical / surgical conditions, absolving them of all personal responsibility? "Just check your records lah, it's in there what", even though their last admission was >10 years ago, hence the records are on microfilm in a warehouse and won't be retrieved for another week. Almost no-one knows the names of their medications, and everyone has a "heart problem" ( even if a recent treadmill / echo / Holter / stress MIBI +/- coronary angiogram were ALL NORMAL ).


Circle #2: The BMU mystery

Okay, I'm not allocating blame here, but can someone tell me why beds mysteriously become available at 3am in the night?

Circle #1: There are no beds!

Someone please build 3 more hospitals, 'cos Northern General isn't going to save us.

Read this quickly, because I expect a phone call from admin very soon, after which I will probably be "advised" to delete my rant -- warranted as it may be.

[ p.s. Would make things a lot easier if there wasn't a firewall for Blogger at work. How else can I comply if I'm stuck on shift and can't access the Internet till I get home? ]

Ahh, that felt good. :)

Good Luck, Blake!

I must admit I'm very surprised by the turn of events on American Idol 6. Melinda has always been tipped to win, but Blake has clawed his way through the all-female line-up to battle for the Idol crown with an equally talented Jordin Sparks.

Think Blake is quite the dark horse of the competition. Was pretty much under the radar most of the competition before emerging from his shell more recently -- most notably this week, with an absolutely perfect rendition of Maroon 5's This Love.

I enjoy Jordin's spirit and gorgeous voice ( much nicer than Melinda's rough tone ), but she's still too young, and faces the risk of sinking into oblivion ( remember Diana DeGarmo? ) if she doesn't play her post-Idol cards right.

Elliott Yamin sang his guts out during a guest performance today. Hate his hair, but gotta love that voice.

People magazine predicted early on that Blake would win -- just based on the number of Internet posts he's generating on Idol b-boards. Looks like they're going to be proven right. Go Blake! :)


The Closer -- an Erin Brockovich-styled cop TV series starring a very spunky Kyra Sedgwick. Pilot was hilarious and well-written. Airs Fridays on Starworld Channel 18.

The Greatest Game Ever Played -- will repeat on HBO later this month. Shia LeBeouf shines as a poor boy with a truly God-given talent for golf. Good script, tight direction and excellent acting make the film both compelling and inspiring.

The Holiday -- just rented the VCD and really enjoyed it. Admit the last third is pretty cheesy, but it teaches a lot of good lessons, one of my favourites of which is "In the world of love, cheating is unacceptable." I tell you this from personal experience, so perhaps that's why I love the show so much ( same way I can't get enough of Someone Like You ).

Jude Law is yummy. :)

Memoirs of a Geisha -- kinda liked this one too, but the ending was deeply unsatisfying and ( if I remember correctly ) different from the novel. Try to ignore the laughable accents ( most of which are non-Japanese ) and concentrate on the amazing cinematography and beautiful depiction of the nation's rich culture.

Japanese men are a very good-looking bunch, FYI. Asking for directions around Tokyo was fun. :)


The Queen -- my mother, who's practically a walking encyclopedia on British royalty, was unimpressed, as was I. Seemed very run-of-the-mill, almost like a made-for-TV movie. Should've given the Best Actress Oscar to Meryl Streep for The Devil Wears Prada, which was sooooo much better.


Now that I've missed my chance to catch Spider-man 3, I've got my sights on Zodiac. David Fincher is a genius, and his latest effort received rave reviews in the US. Can only imagine how good it is. Will be on leave the week after it's released -- yes!

Thanks for reading. Wish me luck with the admin people. :)

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