Sunday, July 01, 2007

Baa Baa Black Sheep

Right, I'm going to stick my neck out once again and write something risque.

So as promised, here's a watered down version of my experiences thus far.

Bear in mind, of course, that the definition of Black Sheep In Medicine doesn't just pertain to practical errors. On the contrary, it alludes more to the doctor's attitude and moral character. After all, I doubt any of us can claim to be 100% mishap-free ( myself included ).

I encourage readers to add to the following list via the comments box.

Gender terms are used at random so don't jump to any conclusions.

How To Spot Black Sheep In Medicine - Part I

1. It usually starts during housemanship.

If this person had a bad rep as a HO, chances are she'll continue to have one later in her career.

Whether it's a case of performing disappearing acts ( especially during night calls ), slacking off on changes, or backstabbing her colleagues ( even those who outrank her ), if the stories are widespread and disturbingly similar, they're most likely true.

If the seniors who appraise her are sharp enough to notice and give her the grade she deserves, then that's a fortunate thing, because I've worked in departments where the hardest workers get screwed with B's and C's, while the lazy buggers who know how to sweet-talk the consultants and supervisors get away with A's.

As such, I usually prefer to talk to my juniors whenever I encounter problematic HOs / MOs. It's the most accurate and objective feedback you'll get, and I trust it wholeheartedly.

2. They almost never admit guilt.

Because those who do are the ones who will change for the better.

Black Sheep, on the other hand, will argue till their faces turn purple, or just stand there and keep quiet, without showing any contrition or humility.

Or at most, they'll modify their behaviour temporarily to avoid incurring your wrath any further, before reverting to their old ways once they're out of your line of sight.

A willingness to change reflects some degree of insight, a quality I search hard for in everyone I work with. Even now, I sometimes overlook things which are then picked up by fellow colleagues. But it's important to show appreciation rather than stubborn pride, and I never consider it beneath anyone to apologize.

2 cases in point:

In my current batch of MOs, there're 2 who stand out -- one for positive reasons, the other for negative ones.

Some time ago, you may remember an angry rant on my blog about a junior doctor with really bad work ethics who got blasted by me. The MO accused me of having some personal vendetta behind my complaint, but thank goodness it was taken seriously by both the MO's supervisor as well as the HOD, and my fellow seniors backed me up, so this person ended up with the worst appraisal grade in the entire cohort.

Granted, we've noticed a few changes since that episode, but earlier this month, the bad habits returned yet again, when the MO went missing at midnight, as nurses and patients' relatives hunted high and low throughout the department. Even the handphone was switched off. Who knows when the MO finally returned, since I'd just finished my shift at the time and was too tired to hang around to find out. But the MO's supervisor was on call that night and made fully aware of what happened.

In contrast, the other MO has shown immense improvement in just 2 short months. He initially irked me with his bo chap attitude -- running to me for everything, even resus cases who were just wheeled in and needed oxygen and an IV line, or expecting me to read x-rays and make diagnoses for him because he just couldn't be bothered to think for himself.

I tried to point these out to him on a number of occasions -- sometimes snapping at him in the process when I was already busy attending to my own resus while he loitered beside me -- but the turning point came when he glaringly missed a DKA and didn't even bother to start antibiotics for a raging infection, which was then picked up by a ward MO who happens to be my friend.

I spoke to him very sternly following that incident, stating clearly that what he did ( or rather, didn't do ) was indefensible. He looked absolutely horrified and immediately apologized for the error. Since then, he's shown much more diligence in his work, and actually appears to be thinking before approaching any of the seniors for their advice.

No more complaints from upstairs -- always a good sign. :)

3. Beware of those who curry favour.

A surgical trainee I worked with during my MO days -- let's call him A -- related a story of a classmate of his -- let's call him B -- during their HO posting in Internal Medicine.

A and B belonged to different wards and thus worked under different consultants.

A's consultant ordered a knee aspiration for a patient, but specified that she wanted it done a certain way. However, A didn't think the method she described was correct, and informed her accordingly. She, on the other hand, insisted she was right, after which A refused to perform the procedure, fearing that it would cause massive bleeding.

B came to hear about the conflict, and went behind his friend's back to offer his services to A's consultant. After obtaining the latter's blessing, B carried out the aspiration according to her ( incorrect ) specifications, only to cause ( as A predicted ) significant bleeding.

A went on to become an orthopaedic registrar, while B is now in a medical specialty.

Am I the only one who sees the irony in this?

As for patient feedback, err, I choose not to rely on it. I'm sure some of the praise is warranted, but there's a legendary chap in my department who was often overheard soliciting for compliments, saying things like, "Wah! See how skilful I am? I got the plug into your vein on the very first try! Make sure to put this in your feedback form ok?"

So the clueless patients did as they were told and got this MO lots of service quality stars. Never mind how obnoxious and lazy he was. His resume sure looked good.

Most seniors don't really care, of course, especially if the kissing ass works in their favour. But an SGH gastroenterology professor's words about one such MO resonate to this day: "Spacefan, you're very quiet, but I know you work extremely hard. Unlike 'someone' who talks a lot and tries to impress us but doesn't back it up with his actions. Rest assured that I know who's the better doctor."

Wise words to live by, my friends. I will always consider this professor one of the nicest, most upstanding people I know.

4. An unwillingness to help is a red flag.

This is an excellent indicator of any doctor's work ethics ( and overall character ), and I can tell you straight off that a doctor who actively helps her colleagues is someone you should admire and respect.

Having gone through the entire spectrum of rotations from general / orthopaedic surgery, to eye and ENT, to cardiology, internal medicine and A&E ( including hell-on-earth KKH children's emergency ), I know that the most hardworking and helpful HOs/MOs are the ones with the best team spirit and greatest integrity.

I read somewhere that Integrity = doing the right thing... when nobody's watching.

These doctors go way beyond their designated duties to assist others in finishing changes, clerking cases and clearing clogged queues, often without the knowledge of the seniors ( and therefore without earning any brownie points for appraisal time ).

CGH General Surgery used to have a peer appraisal system, during which lazy MOs who tried to cover up their bad habits were exposed and hung out to dry by their disgruntled colleagues. Do they still have that now? If not, then all departments should implement it.

This is just for starters. More will follow at a later date. It's time for my lunch now. :)

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