Saturday, June 13, 2009

Back To Normal Transmission

For the time being, at least.

Some of you must be tired of my recent blog entries - a friend commented that my blog's become "sterile". Thanks, man. :)

Where's all the bitching and whining gone? A little bit of it migrated to Singapore MD. But I'm still holding most of my pent-up frustration in check.

Right now, it's 4am Saturday morning, and I'm ploughing through yet another mountain of admin work, though taking a short break to write this.

Am currently following State Of Play - the original BBC version - which has reruns on cable's BBC Entertainment Channel 76 every Thursday night.

I haven't seen the Hollywood remake starring Ben Affleck and an increasingly tubby Russell Crowe ( please go to the gym ). I've never been a big BBC fan ( other than long-ago productions of Jane Eyre, Pride And Prejudice and The Black Adder ), but State Of Play is proving addictive, especially after its 2nd episode.

Well-written and perfectly cast, the main reason I even know about this series ( didn't even make the connection between this and the film version ) is my deep interest in James McAvoy's career. This was one of his earliest roles, and he looks like a mischievous schoolboy here, playing a rookie reporter with a keen nose for hot leads.
Although how someone like him can be cast as the offspring of someone who looks like Bill Nighy is really beyond me.

The pace can be a tad slow at times, but the characters are compelling, and overall production is terrific.

Have been bugging Books Kinokuniya about the Adam Lambert issue of Rolling Stone magazine. Can't place an order until the magazine actually arrives, which I find kind of ridiculous. The harrassed staff fielding phone calls says she's received numerous queries about this particular issue. Same thing happened with the Clay Aiken edition back in 2003 ( which I also reserved and purchased at Kinokuniya ). I just find it cool that RS picked the right person to feature. Kris Allen may have won the title, but that doesn't make him the Idol. Not by a long shot.

A month into the new MO batch, we have yet again identified the weak and the strong. An alarming number of them are doing their very 1st MO posting in the ER. This was previously not allowed - in my time, you had to be at least a 2nd year MO before you could work at the frontlines - but who knows why the ban was lifted, and with dire consequences.

While it's true that a few of these very young MOs turn out to be star performers who go on to specialize in emergency medicine, the majority end up merely passing through, with quite a few being rotated through the ER against their will. The result: inexperienced junior doctors who may mismanage their clueless patients, fly below the senior doctors' radars ( we only review selected cases and ward admissions ), demonstrate zero team spirit, and incur the wrath of patients / relatives, who then complain and demand to speak to a senior doctor, who has to mop up the mess.

This round, we have another record number of MOs deemed unsuitable for night shifts, so those who can do calls may have as many as 7 on their monthly rosters. On many occasions, the night team is weak, necessitating the help of the evening shift MOs, who stay back for hours to help clear cases.

I'm not the sort to ask for help, but this year, I've had to keep people back simply because if I didn't, we'd all DIE.

It isn't always easy to pick out the slackers from the truly slow ones, but peer feedback ( in particular, input from veteran MOs who've been with us for a year or two ) is definitely useful. What I call "evasive tactics" can range from hiding out in the observation ward pretending to look busy, or walking from one end of the ER to the other pretending to look busy, or refusing to see cases 1-2 hours before one's shift ends.

I just find it sad that such behaviour is becoming the norm rather than the exception. Especially in the ER, which is no longer popular since most traineeships don't list it as a compulsory rotation, unlike 8 years ago when I worked side by side with surgical and medical trainees. Perhaps this is the reason we're getting more frivolous referrals from the specialist outpatient clinics, where even simple conditions not requiring urgent investigation or treatment are bumped off to the ER for "further management" - also called "tai-chi-ing".

Same thing goes on in the wards, with multiple blue letter referrals for even a mild cough ( this is a true story ). Turf wars continue to rage, though the ER does a pretty good job staying out of the fray - let the specialists fight it out with each other directly, don't be the messenger, I always say.

And do you know that certain UK med schools don't teach their students how to do proctoscopy exams? I think one of these so-called "top universities" is collaborating with NTU on the 3rd medical school. So does this mean our future local grads won't know what a proctoscope looks like either?

While complaining to a surgeon friend whom I've known for 8 years, she mentioned the "grandmother syndrome", where the older generation uses the typical line, "In my time..." I suppose some of this holds true. Medical practice has evolved through the years, and it's only natural that this impacts our juniors' behaviour to some degree. But is it so wrong to hold them to a high ethical standard? Lying, laziness and disrespect towards seniors have no place in medicine.

Ahh, nothing beats a good ranting. :)

Tips for the weekend:

- Saturday: Nobel Prize concert 7-9pm on Okto Channel 8.
- Sunday: Dancing With The Stars 7pm on BBC Entertainment Channel 76, Hugh Laurie on Inside The Actors Studio 8pm Okto, Bride & Prejudice 10pm Okto, and No Country For Old Men 9pm on HBO.
- State Of Play has multiple reruns during the weekend, Channel 76
- Late Night with Conan O'Brien airs both Sat & Sun on CNBC Channel 15

Take your pick. :)

Time to get back to work. Sigh.


Anonymous said...

ER was a compulsory rotation for all interns where I did my internship (somewhere in Australia). It was scary indeed being at the frontline. However, I suppose we had enough seniors around to consult and the nurses there were of great help too. So, I don;t see the problem of 1st year MO working in ER as long as there's sufficient support.

I've been working in Spore for a few years now. I still feel that patient load is crazy and I can't be thorough in my job as a result. I think that's the main issue.

mumbler said...

sounds scary. but yeah, lots of seniors are keen for a&e or anaesthesia rotations as baby MOs. maybe it's because many of us would be thoroughly sick of the wards by the end of HO year?

Anonymous said...

Situation will get worse as MINDEF wants their doctors to do A and E before re-enlistment.
To mumbler, choose polyclinic, admin posting lah.