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Sunday, April 15, 2012

a very good article

 i came upon this article in the malaysian insider... written by dr kamal amzan.. a very good writing indeed !


So, you want to be a doctor

April 13, 2012
APRIL 13 — “A trainee doctor was found dead after an overdose. He was found dead with a used syringe beside him, with a drug used to fight off fatigue.” The Star, April 12, 2012.
For me, this is an issue close to my heart.
A few years ago, a friend of mine committed suicide by jumping from his apartment on the fourth floor of an apartment complex. He was a jolly good fellow, but faced a few bumps in his years as a medical student.
And throughout the years I worked as a houseman, two of my colleagues broke down and are under psychiatric follow-up, another four quit the profession while two others left for Australia.
My consultant used to call those who break down “collateral damage.”
I had my ups and downs those days. Some days I worked 36 hours straight, no rest, a Snickers bar in between, and was expected to be sharp, smart, alert, and to make the right calls at the same time. At one time, I remembered going home at 7pm, after 36 hours of working, only to be called back to the ward at 10pm because of someone else’s mistake.
No human should be treated this way. Expecting us to make the right decisions, and to treat patients well while depriving us of sleep and rest is ridiculous.
As if that was not bad enough, we were often subjected to verbal abuse in the wards, at times in front of patients and their family members. Some of us were even employed as security guards to chase away family members during non-visiting hours, and as a dispatcher running around searching for old notes.
I’m not sure what it is like now but those were the “good” old days.
Though the system produced good, resilient, disciplined, military-like doctors, there were a few who fell along the way from fatigue and mental breakdown.
Ten years back, we were short of doctors. Now, we have an oversupply of them in the hospitals. I used to take care of 16 patients in the ward and, now, from what I gather each houseman takes care of five to six patients only. And since some of the hospitals are computerised, they are no longer running around dispatching notes and results.
If this applies to most of the government hospitals, it must mean that their workload is markedly reduced.
I suppose the Ministry of Heath has begun to realise that housemen learn, think, respond better when they are well rested. I would rather have a few energetic, well-rested doctors treating me rather than more of those tired, sleep-deprived doctors at my bedside. On that note kudos to the Ministry of Health.
But then, as the working hours become shorter, and workload lighter, the quality of doctors we produce may now be an issue.
The Ministry of Health should conduct stringent tests before these doctors complete their housemanship. If they don’t perform or have an attitude problem, don’t pass them and keep them in the system for as long as it takes.
Revoke their title, bar them from practising if necessary, because what is worse than a tired doctor is one with a bad attitude and knowledge.
As much as housemen deserve better treatment, it should not be at the expense of our patients.
It is a good idea to make compulsory SPM/STPM leavers do community and volunteer work in hospitals, nursing homes, orphanages before applying to take up medicine. Aptitude and attitude tests are also a good way to judge someone’s character, but it is by no means a conclusive test to vet a person.
I mention all this because I do not want houseman to suffer from professional disillusionment. It needs to be addressed before they even step into medical schools or we may end up spending hundreds of thousands of ringgit training doctors, who at the end of the day realise ,”Hey, I do not want to do this for a living.”
Which is what we are beginning to see in our young doctors.
You may have a string of As in your exam but the passion you have in helping a fellow human being is the one that determines how good of a doctor you are.
Patch Adams said, “Our job is improving the quality of life, not just delaying death.”
A good working environment, and attitude is important in any profession especially medicine. And when the government is taking steps to improving their working condition, housemen should learn to count their blessings that they have been given an opportunity to serve humanity.
It is a privilege that not many have.
If all fails, then perhaps our SPM leavers should ponder on this quote by German born American physician Martin Henry Fischer before taking up medicine, “A doctor must work 18 hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.”
Because when the going gets tough, it is the tough who get going

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