36 posts tagged “rantings”
Tomorrow shall be the start of another long week...hopefully it's better than the last.
The 10 things which contributed to my irritability last week. Some people says I'm a very patient person but I don't think I am.
1) I freaking hate people who evade their responsibility and pushes it to other people - "tell it to xyz" syndrome. Sort it out yourself man! The term DIY is not only for the hobbyist.
2) I wish people would just do their freaking job. I hate calling up people to ask them to do their job.
3) I just cannot stand inefficiency. I've been doing the same procedure donkey years with the same staff, and still things cannot be prepared properly.
4) Please do not call me up for every damn thing. God gave us all the same brain matter, 2 hands and 2 legs...
5) If the problem lies with the system, revamp the system. I'm not there to bypass the system ALL the time. If the system cannot be revamped, then it's just too bad. Don't make it my problem.
6) Don't tell me if things aren't sufficient/unavailable. I'm not a magician. I don't have a wand in my hand.
7) There are many other people out there which are also working...I'm not the only worker around.
8) I'm not desperate for the on-call claim of RM4 per hour. Adding insult to injury is requiring us to writing every patient's name, time spent and diagnosis in our claim. I'll be supremely ecstatic not to do any on-calls.
9) Before referring any case, please activate some of your own neurons first...if you don't know please bloody learn or find out yourself first.
10) It's not my bloody problem if there isn't enough beds !!!
I hate complaining but there I've said it. I think I shall use the sentence "I'm sorry I can't help you" more liberally. And remember to shut off my handphone. I think I need a break real bad...Sigh, I wonder how long can I endure this before I start using some expletives...
I wish I were away from the hospital uncontactable, looking at beautiful things, listening to great music, taking some great photos, having a wonderful conversation and meeting new people.
The last few days weren't my best of days. Many small things which have been bothering me just adds up. The weather didn't help either, thunderstorms and rain almost daily. Not in any sort of merdeka mood.
So I went to the courts to loosen up. The courts were full, so I took my camera for a walk just outside the courts. The dramatic skies added some mood to the scene.
Later the rain came as expected and I had some grueling games. Felt better after that. Came home emptied my squash bag and found many busted balls which I just kept. Don't know what to do with them. Kinda wasteful to just throw them away.I used to make some decorations out of them when I was younger...and more creative hehe
I think I shall take things slower and relax...Work and patients will never end no matter how hard you try.
Day by day, I think my enthusiasm for this profession is fading away little by little. I think it's because of the way our health system has turned out. Not only in M'sia I guess but around the world too. Darn...I could have taken any course...I mean any course in university.
You can't blame some doctors for a little nonchalant about their patients, a little cold hearted at seeing death or a little non-committal to treatment decisions. Today there is a paradigm shift in patients' thinking. Today's patients do not put priority on "tender, loving, care". They want guarantees they get their diagnosis STAT, they want to be cured STAT and they expect state of the art treatment FOC if possible. As soon as something adverse happens, they are quick to point fingers. Somebody must be responsible for that. After all the government keeps on harping that we have "World class infrastructure, world class facilities and world class expertise" so nothing should go wrong. (Btw, I thought it is mainly medical personnel that is migrating south in droves but a recent article in the newspapers, lawyers, architects etc etc are also leaving M'sia in droves)
Well, so today's doctors also have a paradigm shift. Avoid being blamed at all costs. Despite knowing the futility of treating an extremely poor prognosis patient who will obviously die (some people may argue that a miracle can happen), doctors offer all kinds of "possible" investigations and treatments. Never mind that we do not have access to the treatment, never mind that we do not have enough beds for treatment, never mind that patient obviously cannot afford it and never mind that it is unlikely to be of any benefit (but still "possible", yeah anything is possible). But if the patient gets worse or dies, the doctor is absolved of any "negligence". "Hey, I told you so you need this and that but you couldn't get it/it's not available so it's not my fault"
I just wonder if it is ethical to offer a treatment which we obviously have no access to. Patients will feel shortchanged and distressed that he is not getting that "elusive state of the art treatment" and lose hope. But hey, that's not the doctors' problem. Doctors are just adapting to the demands of todays' healthcare and society's expectations. Defensive medicine. Avoid being blamed at all costs. Perhaps later must refer the patient to psychiatry for depression as well...how ironic!
Patients also are are quick to demand anything in the public sector, but if it is the private sector I guess you'll have to talk till your jaw ache to justify a RM100K medication which is no miracle cure either - but patients expect a miracle cure because they are paying so much !! On the other hand, once you mention the costs of treatment to the public patients, they shut up very quickly, just for a brief moment...before they open up again and say why can't they get it free from the government !!! Dang...can never win one.
Anyway defensive medicine is here to stay whether anyone likes it or not.
The turn-over rate for my sports shoes are legendary. Recently my rather new shoes gave way again, not because the sole gave way but because the stitching gave way a little and became loose. And the result...my toe nail became loose and bled inside. The importance of getting a well fitting sports shoe cannot be over-emphasized. Anyway I got a new pair asap and well, it is much more comfortable than the old one albeit at a higher price coz I really don't fancy getting another toe black in colour.
Anyway soon after that I decided to buy another squash racquet to replace my Titanium one which was broken (temporarily I was using my beloved 12 year old graphite racquet ) and got a new one, lighter and supposedly better racquet. German product wor...I had high expectations. Alas, after 2 sessions of the game, look at what happened...just after a few really mild accidental hits on the wall, the racquet cracked! Just 2 days of using my new racquet. My 12 year old graphite racquet has taken many many harder hits on the wall without any problems (designed in Austria, made in China). So much for German technology.
Anyway if not for the "imperfections" of the shoes and racquet I wouldn't have the pleasure of buying a new racquet hahahaha...although it is going to be painful for the wallet. I just hope it's not going to break too often!
I'm really fed up with the political situation in our country...coupled with the obsession with race and religious matters. I think it's about dominance really...
And the fact that 5,000 students in a university protested at the suggestion of allowing 10% of other races to be enrolled just exemplifies how bad polarization has creeped into our education system. Check out here and here. So will we be seeing more race based universities? So much for national integration. I'm a little worried at how things are turning out these days. Maybe I should start having a back-up plan...
Anyway I decided to take my mind away from all these depressing political stuffs. Came across this fantastic video of Michael Jackson's Beat It song by Fall Out Boy. When the mood is right I just love rock songs!!! Wish I could be at a rock concert singing my lungs out right now. Oh and I just bought these 2 new music CDs (can't remember the last time I actually bought music CDs). Ok...maybe I'm a little out of fashion hehe
Just a ranting after a long day.
Have you wondered how much you knew about a person? Friends, colleagues, subordinates, superiors etc...
I've seen instances where "meek" House Officers turn into "monsters" once they complete their housemanship. I've seen House Officers who are "careless" became extremely conscientious Medical Officers. I've seen "famous consultants" who graced the cover of newspapers acting like a jerk towards his subordinates. I've seen quiet patients whom I rushed through consultation, who are the most appreciative later on. I've seen VIPs who acted as though the world owes them something and VVIPs who are extremely gracious and even willing to stay in 3rd class wards. I've seen people who are friends during times of need only.
In short, we can never tell a person by his looks, upbringing, religion, education, status or profession.
I wonder why some people chose to remain friends with jerks who are obviously in for his/her own benefit only? Why some people just cannot see through a person? I just wonder...Is it because the "friend" can crack a joke or two? Is it because he/she is good looking? Is it because it is entertaining to be around him/her? Is it because he/she is famous? Is it because he/she is rich? Is it because he/she is clever? Is this reason enough to remain as friends? I don't know but certainly I would think twice.
"We make them cry who care for us, we cry for those who never care for us, And we care for those who never cry for us" I find these words ring so true.
Maybe nobody is perfect. Maybe I'm too critical. But perhaps tonight I've seen another facet of human behaviour.
Sometimes patients (and relatives ) do not like me very much as I'm frequently the harbinger of doom. Well, I have the unenviable task of breaking bad news to the patient (and frequently the relatives too). And of course as ridiculously as it sounds I do ask if they want to know the diagnosis.
I feel to give inappropriate hope or unreasonably high hopes to a patient is not right. Preparing a patient for death is just as important as giving hope to life. It's a tough balance. But when there is an 95% chance of a patient dying...would you prepare him for death or lift his hopes up for the 5% chance? Colleagues may disagree with me, but I'm being pragmatic and sometimes patient's relatives do not like to talk to me because of this.
I think preparing a person for death is extremely important. A person may have personal stuffs to settle, dark closets to open, people to forgive, ask for forgiveness etc etc. Giving inappropriate hope may deter the patient from doing things dear to him before he leaves this world. Patient or their relatives may start to look for futile treatments to improve the 5% chance. They may spend lots of money for dubious treatments (futile treatments are never a justification for desperation), numerous 2nd, 3rd and 4th opinions, makes excessive demands to their loved ones, ultimately leaving everything in a mess when they pass away. Not to mention the relatives later blaming the nurses and doctors and trying their best to find any minor fault which they think may have contributed to his (hastened) death.
The common reaction given by the patient (and more frequently their relatives ), especially Christians I must admit, is that perhaps a miracle will happen. Yes, a miracle can happen I agree. But we cannot make decisions based on the hope that a miracle will happen. Yes, you might survive a 10 storey fall by miracle, but would you bet on surviving the fall?
Preparing someone for death is difficult. It's unpopular, nobody likes to hear it, nobody likes to do it. And nobody will thank you for telling them chances are they are dying. Not in our Asian culture anyway. We avoid it, we give inappropriate hope, we pass the buck, we refuse to address it. But I think it's absolutely necessary at the risk of looking as if we are "taking the easy way out", for not trying hard enough.
I had a 90 year old rather frail patient with end stage kidney disease who needs dialysis. Everybody knows dialysis slots are extremely limited (we are not in USA or Europe) and nobody wants to "give a death sentence" to this patient. She may get a couple of "urgent" dialysis but long term slots are not available. So the decision was left hanging. And unfairly I feel, doctors pushed the decision to the patient's children! Hey dialysis is not risk free, the patient may well collapse during dialysis. What the patient's children said? They said " Doc, you do what you think is best. DO NOT ask us again for our decision (to dialyse or not). Several doctors have asked us the same thing many many times ". My colleague and I made the final decision - rightly or wrongly. I would have done the same for myself.
On the other extreme there are relatives of dying patients who wants "Everything to be done to ensure the patient lives for as long as possible", whatever living means to them, perhaps to avoid their own conscience of "killing" the patient. Prolonging death is unethical. Not to mention the extremely limited resources which perhaps could be used to save someone else.
I really don't know what to make up of the recent news that RM1.175 million is required to maintain 16 Proton Perdana cars over 4 years. And the Pahang MB said his Mercedes Benz needed RM42,000 to maintain a year while a Proton Perdana needed RM57,500. Check out here (I think I need to check my last year's income statement if my salary FOR A YEAR exceeded this amount or not)
Either way it sounds bad. Either we are making a lousy car which needs servicing every 2 weeks (to come out with that exorbitant amount) or someone is pocketing a lot of money.
A car mechanic and a doctor are similar in many ways. One is repairing cars, the other repairing the body. Both charges consultation fees. Both do house calls. Both can prescribe medicines (or spare parts). Both advocate regular health screening (or regular maintenance). The difference is that nobody sues a mechanic if he botched a job or charges exorbitantly. No one regulates the mechanic's charges.
Lebih baik baiki kereta daripada baiki orang
I found this list of "Quality activities" in the ward. Wow...this list exceeded my expectations. Never knew some of it existed. There are 25 "quality" activities in the hospital to ensure "quality service"!! But who are doing these activities? The same handful of doctors and nurses, in addition to their overloaded work and responsibilities with an overcrowded ward. Seriously which clinician is interested to do all these crap activities? All I can say is, please leave me out of it. Cannot "tahan" doing crap paperwork. Unfortunately I was "trapped" into doing one of them though :(
Please feel free to scrutinize the list!
Notable crap activities are : Corporate cuture, Development of administrative circulars, Total Quality Management, Innovation, MS ISO 9001:2000, Accreditation, 5S, Communication & Information Technology, Bench marking, Quality Control Circle and lastly Therapeutic garden!
I think we are trying to squeeze water out of stones.
Does common courtesy and manners still matter today? Or have they given way in this "dog eat dog" world. Yeah, using vulgar language and signs are entertaining. It captures the attention and perhaps achieve the objective more clearly and faster. Some people seemed to idolize vulgarity, rudeness and brash language as though it is something great, something most people won't dare to do. So the person who does it must be brave, great and deserve to be idolized. Very "keng" as they say.
From our Member of Parliment, to even doctors, perhaps specialist and consultants too, we have seen such behaviour and language. An example of this is here. More often than not, it is spoken within an inner circle of pals. On and off we do blurt out some expletives, but is it great to make it as a habit? We have heard swearing, expletives, vulgarity uttered on a daily basis, most of the time behind close doors. The irony is that some people seemed to idolize people who uttered them, whether explicitly or secretly. What is so great about it? It is certainly easier to blurt out an expletive than to construct a courteous sentence.
I've had House Officers who came to the department, not bothering to introduce themselves to the Head of Department or their specialist and started working in the wards as though they place belong to them. Some do not even bother introducing themselves to the Sister of the wards either. For crying out loud, if you visit a friend's house, common courtesy dictates you inform the owner of the house that you are coming to visit, isn't it not?
How often do people remember to use the term "Thank you. I appreciate it"? Whatever happened to common courtesy and manners? Isn't there any other way to converse other than using expletives? Politeness may not be as entertaining as swearing but to me it indicates humbleness, softness in character and perhaps finesse. Although there are great pretenders out there, it isn't a reason not to be polite. I remember how I would receive a big slap on my face from my parents whenever I utter any languange which is remotely vulgar during my childhood. Alas we can't do that to the adults who uttered vulgarity at their whim and fancy.
However I can avoid people with only vulgarity in their vocabulary. If not I may forget how to converse in a civilized manner.
