the change ....

 

Making referral and receiving referral were 2 different things.

Making referral was a sign of showing weakness and receiving referral were a declaration that we are capable.

Well, some of those at the tertiary center would be too authoritative and would treat referral doctor as junior or incompetent one.

I had met rude surgeon who had asked detailed questions that made the referral look like a resident reporting to the tutor. I hated that and I sworn that not to present such stupid/arrogant attitude toward my comrade while receiving any referral.

But yet sometimes, you would get some referral which was…..

I received a call sometimes back in which an elderly male was referred for chest pain and elevated cardiac enzyme. Routinely, we would ask the relevant unit to upload the EKG12L to our LINE chat. The EKG uploaded later had however shown prominent STT elevation over the inferior leads and the patient should be diagnosed as STEMI undisputedly. I quickly called them up and asked them to prep the patient and PCI would be performed as soon as the patient arrived. Never bite on your colleagues no matter how incompetent they were, however you do feel odd when receiving some referral….the southern tip of this island is a very secluded area; manpower drain was the norm and even surgeon who is not well train in medicine had to take the stand in ED.

We were facing similar situation since few months ago.

The management had decided to split the roster arrangement into 2 parts. The ED roster would be done by the HOD and the ward roster would be done by the admin head.

The previous roster was actually manipulated solely by K. He would try anything to filled up every hole on both the roster. However, there were always rules to follow. No continual shift of more than 12 hours, no overlap shift covering both ED and ward. Our shift was a mess as we need compromised our shift to enable K to covered most of the shift upstairs. No kidding, K was doing 15 shifts in ED and 12-13 shifts upstairs. Severe violation of working restriction however we are not considered as labor and nothing to shout about.

The reshuffling of roster making was a great news to us. Our shift was prioritized and our roster looked nicer. We were getting streak of off days and night shifts instead of getting intermittent off shift which burnt off half of our vacation.

The impact was striking as the ward roster had left many blank spot and boss and some surgeons who did not do calls had to fill in. K was unable to continue his fill out all the spot plan and sought to find other locum elsewhere.

The management had however tried to barred him to do extra locum which frustrated K. K had complaint to me on a few occasions. I had sensed that his intention to leave and finally talk to the management. I told him that the south would gladly take over capable big gun like K and we would lose him in very soon should the barring measurement continue. The plead was heard and K was happily ever after.

The first and second month was chaotic for the ward roster. Last minutes call and overlapping had started to emerged as it was the only solution to the situation. By the third month, the management had totally given up and over lapping and continual shift (aka alternative unit nonstop shift for indefinite hours) started to exist. 

The gate to Hxll had finally opened; now, more than 30 shifts are applicable to a single person as arrangement of back to back calls which continued stay for 72 hours in the hospital had started to exist.

Over relaying on a single person to make up the ward roster would be a disaster when the person quit, as for me…none of my business…

The roster was pretty sweet for most of us and I had lots of streak vacation to plan for activity….