flood....

I had read from the internet sometimes ago….the Malaysian Govt. Hospital currently is being crowded with House officer…..really stunning news to me..I remembered the structure of a medical staff in a ward :  1 specialist with 2-3 medical officers plus 2-3 house officers. When time is bad, 1 house officer was allocated to a ward. In surgical ward the condition was bad, when this HO of the ward shared the calls, when there is 3 HOs, it would be 3 days per call, when there is 2 HO, it would be QOD, when there is 1 HO – than it would be real “HOUSE OFFICER”, hospital = house….10 HO in a ward means 3 calls per month and the experience earned from doing calls is definitely beyond imagination…..

One HO would be taking care of 15-30 patients during those days… really busy but good learning environment…. The report claimed that 1 HO caring of only 2 patients….A bad consequence resulting of flourishing of medical school in Malaysia….There were 1 twin linked at my time –the IMU, the affordable one opted to do their senior year in the overseas, many of them obtaining a foreign degree and practicing license elsewhere. Some of them stayed back…. Later on load of private and govt medical school were set up to resolved the doctor shortage….the strategic was a successful in a sense that there were so many HO (and later MO) but there is still short of specialist….the final consequences is load of GP flooding the market….specialist is definitely commanding high fee at the moment; my mother in law told me she was admitted overnight (2d1N stay). The consultation fee was RM 400, 2 visits per day, 1 visit = RM100 in the ward…..our local NHI pay is RM 30-50 per day per caring an in house patient(specialist price of coz...)

I met one of my senior(neurosurgeon) during my last visit back to Malaysia at the airport. He told me a medical center run by one of our senior in Kedah offered him a pay of RM20000/months (guarantee minimum wage).

It would be a very bad practicing condition later on as the base of pyramid had become wider……GP earning less and competition and.....

Sometimes I would think of getting a job back in Malaysia, but my only option would be the govt service….. Just couldn’t bare to earn those money in a private practice…. Only the affordable being served….but still, it would be going back to the bureaucrat working environment, fighting for promoting(not for the pay but for the calls – more senior = less night calls..) and retiring at the age of 56 and wandering which medical center to practice in(back to what I dislike at the first place...)

If everything goes smooth, I would be saving enough studying fund for the kiddos by the age of 55 and maybe I would try to get a contract specialist job with the MOH then.….

from 1 to 3.....

 

Well, we had 2 colleagues reported in earlier this month. Two head of department was introduced. 2 middle-aged ladies with nursing background were introduced to us during the morning conference.

One was designated as head of admin, there other was introduced as head of medical affair.

The head of admin is posted to 2^nd flood admin room and in charge of admin and insurance claims(from the national health bureau).  The head of medical affair is posted to a desk just behind the registration counter. I could see their daily task were previously oversee by our ex- dept. supt. Of admin. Lem and I had a chat few days ago when we learnt about their present. It is a 1 for 3 situation. 3 persons doing 1 man jobs. Will it be more efficiency ? Time will tell, but the costing is definitely more .....

I had a call from our ex-dep supt last week, he had gone back to a small hospital where he had started….

confident ?

I saw the so called Anwar video clip…. The scenario looked like a very cheap joint – with the OKT leading the male into the room. The belly was way too big…. Definitely not him….Another tactic to defame someone…Sadly too said, the relevant party is so uncertain that they need to use such dirty trick to win….

GUTS......

 

I had attended this combined emergency network conference last week. Most of the time Lem would attend such meeting but since he is doing day shift he had asked me if I wanted to go. It was Thursday which I went off by 9am(by 8 to be exact, but I had to attend the weekly conference). The meeting was scheduled at 2 and end at 5. I could catch a few hour sleep but I had this class with the elder of the Church by 10, so the rest should be minimal.  Anyway, I took the offer when Lem asked me as he told me that the management would provide a 4 hours working pay. I am still 8 hrs short from the 180 hrs, so I took the offer. 4 hospitals were chosen to present a case each. I had prepared an AMI case which I had called up 5 hospitals before that patient was accepted.

The local rescue service also brought up a case which really stunt every one of us…

There was this 20+ young lady who is G1P0 currently bearing a twins. One of the twins had lost sign of life at 6 months. To salvage the other twins, the obstetrician had chosen to continue the pregnancy and let the still birth remained in the womb(it was a boy and a girl twins…)

At about 9+ months, the mother had visited a local hospital O&G clinic complaining of low abdominal pain. The obstetrician had seen her and discharged her. She returned to her house and found that the pain had become worsen and contraction was noted. A she was facing financial difficulty she had opted to call the local ambulance instead of going up north to a bigger hospital by herself even though the obstetrician had strongly recommended that if she gone into labour she should go to a bigger hospital for delivery.

The local rescue ambulance had responded to the call and she was sent to the local hospital which she had visited earlier that day. She was sent to the ED and the ED physician had called up the obstetrician for a consult. The obstetrician had told the ED physician that he had seen her earlier and nothing can be done by him as in his opinion, such case should be handled in a bigger hospital WITHOUT SEEING THE PATIENT IN THE ED.

The ED physician after receiving such call had asked the local rescue ambulance to sent the patient up north.

The rescue service had reluctantly accepted the situation and sent the patient over. The still birth was delivered on the way…..

The unacceptable and inappropriate part was – NOTHING WAS DONE during the patient transit in the ED, NO DRIP nor EXAMINATION DONE – not even a VE(vaginal examination…)

A very unethical thing to be done – just because the obstetrician was negligence and the ED physician had NO BALLS to do something which he had omitted in his training causing him INCAPABLE and INCOMPETENCE on his job…..

I shook my head – he is just peak of the ice burg, there are still many many incapable and incompetence board certified ED physician current working elsewhere….they would hesitate to raise their hand if an obstetric condition came in front of them and they would chose to pretend that they are not a doctor if no one recognized them….

Really wanted to speak out the full KNNECB word in front of them….

start of bad call....

 There call was bad lately – patient came in 20 minutes interval. I did not have a good rest but still able to survive the call. With Only 2 day shifts this month, my life is considered good. Even though there is a cut of working hour, I still get a plus on my pay slip after the increment.

However sometimes, I really feel that the health insurance is so cheap. With RM25, one can come to the ED and request for a specialist consultation compare to RM 60-100 in Malaysia.

In every 3 calls, I would meet have some drunkard sent to ED by the local rescue service just because someone saw him laying along the roadside and reported it to the rescue service or local police department. Those were merely enjoying a good nap along the road side after his enjoyed his drinks. But there was one guy who is the WOW (worst of the worst ) guy. He had once summoned the ambulance for generalized discomfort and later walked off straight from the ED and enjoyed his noodle soup opposite our hospital.

But sometimes you can also see irresponsible parents who brought their child to ED just because they felt their child is having a fever with their hand only – half of the time it was a false alarm.

Minus this reckless and irresponsible, I could have slept better.

My family was lucky as I treat my children instead of sending them to some ENT surgeon for pediatric consultation… Save a lot of time on waiting….

I wandered I would ever get away from this ED life….

radiation..

the nuclear reactor crisis in Japan had caused a little chaos around the world…indeed, peoples are so darn concerned about radiation – something so horrible and yet it can’t be seen…

as the level 2 hospital covering for the nuclear plant down south. We have to set up a drill annually. A scenario was set and a few experts would come down to us and oversee the process. A post mortem meeting and we learnt from it every year. However the maximum casualties we get is 2… I hate the drill – wearing the suit is an agony – most of the drills are held during the summer and the sweat was so terrible…

I had read a lot during the past 2 drills as I acted as the ED doctor instead of joining the de-radiation team….

Nothing to shout about as the level detectable was so low….it is all about odds and the choice of GOD....

Patient and families started to ask about radiation dose for CT and it was easier to talk them out of it…

Indeed the nuclear power plant is more eco than the traditional power plant however when disaster strike, nothing is safe…but what can we do? The only thing is to save more energy , to give up a more comfortable life, but I think it is worth everything, the obstacle is to convinced everyone to lead a modest life instead of a comfortable one(air con…..)

Back to my farming dream – I am seriously considering buying a agricultural land , but to do so in Taiwan, I have to give up my citizenship….a real struggle….

Settle...a new start

It is my first call of the month…the feeling is quite different today though…. It is a start of the new working agreement…

My title had officially changed to attending physician of emergency department( my previous title was attending physician (internal medicine). That means no matter what happen, I would be fixed to the ED….

I settle with a salary of a semi detach double storey house in Klang….well, It should be the highest salary I could get ever….

Working time should be same or less than what I am experiencing now…I could spent more time with the kids and Ving… the next task would be save whatever I could and prepare for the future….

My colleague told me that one of our ex-surgeon had brought a ED doctor(later I looked up the registry, he is an orthopedic surgeon working in a hospital about 60 km away…I think he is trying to change track…)  come to our ED and ask around…In the past, I would have a bad feeling about this – shuffling time again…but not this time….I am more secure with the new agreement…

I got a 10 k rm increment since mid of last year, a real miracle in this field…. a GRACE and I praise the LORD for what He had given me….