UbatMuda

Abortion: A Musllim Perspective

2012-03-09T19:45:00.000-08:00

When I was a medical student, one of the classes that I most enjoyed was Medical Ethics. Love it!

There were no right or wrong answers. All that mattered was your ability to justify your views.

I remember how much I really loved one of the ethical issues being discussed during my Obs&Gyn rotation. It was about abortion.

The way the western think about abortion is way different than the way the average Muslim medical student think about abortion. Sexual freedom is taught to be their legal rights as consenting adults. Even though the legal age for sex in Australia is 16, a 14 years old can consent to medical treatment. Thus, in the western country, you can write a whole thesis centered on the debate that has been going on about abortion between those who are pro-life to those who are pro-choice.

In the ethics class they would create certain scenario and ask you to give your response and justification. One of the example of such scenario was something like this:

You are a GP in Tumba Rumba. One day a teenager aged 15 years old comes to you requesting for oral contraceptive as she has become sexually active. Even though you know that teenagers can consent for medical treatment at the age of 14, you are also fully aware that the legal age for sex is 16. Would you prescribe oral contraceptive for her? (this is when we will argue ad nauseam about whether we will prescribe the OCP or not. She is 15, so she can consent to medical treatment. However she is not yet legal for sex. After arguing for half an hour over the best course of action, the scenario would be continued)

You then decide not to prescribe oral contraceptive for her. Two months later she came to your practice crying about being pregnant and blaming you for not prescribing oral contraceptive for her. She would like to have an abortion. What would you do? (This is when argument becomes more heated. Sometimes you can almost see who are the Muslims – well, we are the obvious ones with our hijabs – who are the practicing Christians, who are the non-practicing Christians, who are atheist, and who are the non-conformists, just by hearing the way they give their opinions. It was very interesting, I assure you. Oh, I miss my Ethics class)

Do you think she should keep the baby? (This is when we get to talk about the rights of the unborn baby vs the rights of the mother. We can talk about whether abortion can be classified as murder. We can talk about at what gestational age would an unborn baby have any rights?)

Would you tell her parents? (Of course, confidentiality issues would be a MUST in all our Ethics scenarios.)

The issue of teenage pregnancy was being openly discussed in our O&G ethics class. When I was doing O&G rotation in Australia, I happened to keep track of the news in Malaysia…about the rampant discarding of newly born babies that was going on in our streets. Most SHAMFUL! I wonder what would the Western say about our so-called Muslim values if they know about these abominable acts committed by our teenagers.
I was a 4th year at that time when I blogged about that issue here:

http://afizaazmee.wordpress.com/2010/08/18/discarded-babies/

I almost forgot all about that issue once I have left my O&G rotation and moved on to Paediatrics.

However one day, when I had been back in Malaysia for over 1 year, I came across ANOTHER article about discarded baby. This time, it happened in my home town. It came out in Metro. The baby was being put in a bundle and placed under a tree at Klinik Kesihatan Bandar Alor Star. Alhamdulillah, the baby was still alive and well.

The news shook me to the core. I wonder about WHAT would my Australian friends think if they knew about these incidents that are taking place in our Muslim country?

They would take one look at the article I had written in my O&G portfolio and snickered at it. In my O&G Portfolio I had written my opinion on abortion, giving it the Islamic flavor that would reflect my upbringing. Below was what I had written, quite a sharp contrast to what I was taught in my Ethics class. But the thing I love about studying in Australia is, the freedom of having an opinion that is dissimilar to that of your teacher. As a Muslim studying in a Western country, people EXPECT me to have a different opinion in Ethical issues and most of the time, they can accept our views as long as we are prepared to defend it. So I wrote on Abortion, hoping that my professor would understand that as a Muslim, whatever was taught in the ethics class will have to be filtered through the eyes of Islamic Jurisprudence. I could not simply agree to the western ethical stand each and every time. Besides, I was not planning of practicing in Australia.

My professor actually commented on my portfolio saying ‘Excellent reflective process.’ It truly made my day. So here it is, my take on Abortion when I was a Muslim student in a foreign country. (Be warned, that I was writing for a western audience, so do expect some things to be out of the Malaysian context)

ABORTION: A Muslim Perspective

The fact is such that the only perfect contraception is saying NO.

While Islam permits preventing pregnancy for valid reasons, it does not allow doing violence to it once it occurs. However, if the pregnancy poses a risk to maternal health, then abortion must be performed.

In Islam we are allowed to use any contraception to prevent pregnancy, but Islam also recognizes that this contraception is not totally perfect. So, the guideline is, if you fall pregnant regardless of the use of contraception, you should not abort the baby, unless there’s a specific harm to the mother medically. In the case of rape, it can be optional, depending on what the mother wants and depending on whether the mother’s mental health would be affected by bearing the baby of her rapist. But all rape victims should take all the necessary precautions, for example, taking the morning-after pill.

According to European Council for Fatwa and Research:
“Indeed abortion is forbidden in Islam whether it be in the earlier stages of pregnancy or otherwise. The extent of sin incurred varies according to the stage of pregnancy, so that less sin would be incurred if the abortion took place during the early stages, while it becomes increasingly haram (unlawful) as the pregnancy advances. When the pregnancy reaches 120 days old, abortion becomes totally forbidden and is deemed a form of murder.
However, the only condition under which abortion is allowed is when there is acual threat to the life of the mother confirmed by an official medical report that if the pregnancy advances any further, the mother may die.”

If I ever become an O&G specialist, I shall never ever perform an abortion unless it specifically poses a medical problem to the mother.

If you got pregnant because you have been careless enough and foolish enough to not use contraception, why are you crying now? You know that every action has its own consequences and part of being a good responsible adult is to bear them with dignity.
I believe that there are consequences that you have to bear out of your freedom of choice. I find it amusing that a lot of people talk to me about how Muslim women are oppressed and they couldn’t choose their own course of action, yadda, yadda, yadda…

What they don’t know is that there are reasons why we don’t choose a particular action:

1)Because the action is against our belief. So in the first place, we choose to believe.
2)Because we know that there are great consequences that you need to bear out of your action.

So, if you think you can’t carry the responsibility of being a mother just yet, or that the father was not the ‘right man’ (whatever THAT means) or that this is not the ‘right time’, then why didn’t you take steps to prevent the pregnancy from happening in the first place.

Granted that sometimes despite of everything that you do, despite of all the contraception that you use, accidents happen.

But you KNOW that there’s a chance of that happening. Your doctor would have told you all the estimate percentage of failure of the contraception that you had chosen. Yet, you had used your freedom of choice to choose to take that risk.

And now that you have to bear the consequence, again you choose to exercise the same exact ‘freedom of choice’ to abort. When does this freedom of choice end? People use the same expression ad nauseam to justify every action they do (bad or otherwise).

Our freedom is limited by other people’s freedom. Our rights are limited by other people’s rights.

This is exactly when our freedom of choice ends. Now that you have borne a child, your rights are limited by the rights of the unborn child.

Now they get into the debate of whether or not an unborn child has any right. And if an unborn child has any rights, at what gestational stage?

Really, who is the best person to determine all that? To those who are religious, they would say God is the best person to determine that since He created us all. To those who are atheist, they would use another justification and their reasoning varies and their answers would range from the very beginning of conception to the start of implantation, to 20 weeks of gestational age.

You are getting into a gray area, a muddy water. In these circumstance, people then choose whatever they want to believe based on their own private justification. There’s no uniformity and no consistencies.

So, people should think twice before they say that all the religious restriction on a woman’s sexual expression is limiting their freedom of choice. In Islam, we prefer to prevent than cure. You don’t have to deal with all these mind-boggling issues if you choose to follow the guidelines in the first place, (though some might prefer to call it restrictions) i.e to be married before you have sex and to make sure that you are ready to bear children before having sex.

But problems arise when people don’t want to follow what they call as ‘restriction’ and when bad consequence happens as a result of them not following the initial restriction, they start thinking that the bad consequence is ANOTHER restriction that they need to escape from. This cycle would go on and on until we stop and realize that we should take responsibility from our choice.

Sometimes a teenager knows better. No matter how much people frown on teenage pregnancy in Australia, I applauded their decision to carry the pregnancy through, regardless. At least, THEY know the concept of taking responsibility for their choice. Responsibility is the first lesson of adulthood.

For all these reasons, I choose to never perform an abortion without any valid reasons other than ‘the pill doesn’t work’, and ‘this is not the right time’, or ‘I was not with the right man’. You knew coming in that no contraception is 100% effective, yet you chose to take that risk anyway, so bear the consequence in a mature adult manner (of course my whole behavior and intonation will be adjusted accordingly as a health professional who has to counsel these cases in a sensitive, empathetic style.)

Patient's Story 2:the Doorless House

2012-03-07T02:26:00.000-08:00

I was doing a routine ultrasound examination when a nurse knocked my door..

“Excuse me Doctor,but do you remember the baby that you referred for jaundice yesterday?The mother didn’t go to the hospital.”

“What? Why?” I was really angry as the case was considered semi urgent(referred to the hospital,but the patient can go by their own transport as we have limited staffs and transportation ourselves).

“She said she couldn’t find a car to bring them there.”

“But she said it was Okay..and they can go there by themselves…Ask her to go now.”

A few minutes later the nurse came back when I was writing my report..

“Excuse me again,but she said she can’t go today,maybe she can arrange for the transport tomorrow..can she go tomorrow?”

“No!the baby’s SB(serum bilirubin:an indicator of jaundice) had already raised..we can’t wait another night.” I was angrier as I thought I was dealing with another stubborn parent.

Then my assistant told me “Err..Doctor,I’ve visited her house last week..I don’t think they have their own transport,they have just moved here and currently living in a small house with all of their 6 children,the house doesn’t even have a proper door,only a drape hanged instead..”

“What? Why didn’t she told me yesterday”regretting my earlier outburst…but quickly understood..It was not the 1st case,many before had said they have no transport problem but after further questioning,we learnt that they had actually walked a few miles to my clinic.

Why they lied? Maybe because of pride,ignorance or even shame.

Just a few a weeks ago..a grandmother came and begged to see me,earlier I had diagnosed her grandson with nephrotic syndrome and referred him to a tertiary hospital about 80kms away.The mother told me that she can bring her son there that evening but she really can’t,no transport no money. All she did was cried when she arrived home and asked for the grandmother’s help,the mak cik then walked 2 miles to my clinic and asked for my help.

For both of these cases,we provided them transport,I’m not sure if I’ve breached any rules/SOPs,but in my clinic,if a patient can’t afford it,we’ll provide him/her a transport even just for a routine appointment.It’s the least thing we can do for these poor people.

Sometimes,I think it’s amusing that there are people in our country who are living in mansions worth millions or billions but at the same time there are still people who can’t even afford a door for their house or send their sick children to the hospital.

Meeting them day by day makes me thank Allah everyday for his blessings for me and my family,and hopefully by helping out with what I can ,will make up for some of my own Nikmat and Rahmat.

Wallahualam.

Dibuang Daerah

2012-02-29T06:46:00.002-08:00

KECEWA

Sudah 2tahun lebih doktor muda bekerja di bandar metropolitan Kuala Lumpur. Dan dalammasa 2 tahun itu banyak rencana hidup yang dihadapinya. Ada satu perkara yangkerap melawati fikirannya. Berdepan kerenah segelintir pesakit yang sedikit egodan keluarga pesakit yang mengugut-ugut staf perubatan tanpa segan silu.

Pesakit metropolitan bukan calang-calang pesakit.

Doktor mudasedar beliau mempunyai tanggungjawab, bersesuaian dengan status ‘doktor’nya,untuk mengambil berat dan melayan dengan baik para pesakit. Namun janganlahsaja bercakap tentang hak pesakit, tetapi adalah tanggungjawab pesakit untukmembawa diri dengan sabar, menghormati dan menghargai usaha doktor dan jugastaf-staf perubatan lain. Peribahasa Melayu mengajar - orang berbudi, kitaberbahasa.

Doktor mudadan staf perubatan tidak meminta dan mengharap pun balasan daripada pesakit. Malahucapan terima kasih pun tidak diaharapkan. Cuma apabila doktor muda cuba melaksanakan tanggungjawabnya tetapipesakit sibuk menuntut haknya dan mengambil kesempatan atas ‘kebertanggungjawaban’itu, ianya menganggu keharmonian hubungan doktor dan pesakit.

Doktor mudasemakin hilang motivasi untuk menjadi doktor.

BAWA DIRI

Orang tuaada kata, 2 tahun pertama perkahwinan adalah bagaikan syurga. Tetapi 2 tahunpertama kedoktoran adalah bagaikan neraka. Selain budaya maki hamun di tempatkerja, doktor muda merasakan generasinya kerap dilabel tidak berdayasaing danpemalas pada kacamata masyarakat. Akibatnya doktor muda kadang-kadang terasa semakin pudar minatnya terhadap kerjayadoktor.

Jiwa dipenjara.

Doktor mudamembuat keputusan untuk membawa diri meninggalkan kota metropolitan. Berhijrahuntuk memulih jiwa doktor dan mungkin mencari makna kedoktoran sebenarnya. Membawadiri ke suatu tempat yang amat memerlukan bantuan seorang doktor. Di situlahlembaran hidup baru doktor muda bermula.

DUNIA LAIN

Bermusafir ke negeri orang.

Persis menuju ke arah destinasi.

Demi Malaysia tercinta.

Akhirnyatiba hari pertama doktor muda bertugas di sebuah hospital daerah. Perkarapertama yang beliau dapati, adalah sikap dan budaya kerja para pembantu pegawaiperubatan(MA) dan jururawat yang berlainan di sini. Mereka menghormati doktormuda sebagai rakan sekerja. Mereka lebih sabar, efisyen dan lebih berdayasaingdalam melaksanakan tugas.

“....maklumkanpada doktor.... jadi walau apapun berlaku, yang PENTING kita SELAMAT!” kataseorang ketua jururawat kepada stafnya, di depan doktor muda di tempat kerjanyadulu.

Doktor mudateringatkan zaman latihan perubatan siswazahnya dulu. Beliau berasa kecewakerana merasakan ada segelintir jururawat yang bersikap lepas tangan dalammerawat pesakit. Sehinggakan doktor muda musykil adakah ada niat dalam dirimereka untuk membantu pesakit. Atau ianya hanyalah sekadar kerja mencari makan.Yang lebih menyedihkan, mereka diajar oleh ketua mereka supaya menyelamatkandiri dahulu sebelum yang lain.

Ketika doktormuda sedang sibuk ‘clerk’ kes di wad, tiba-tiba kedengaran, “Doktor,pesakit.... katil ...... dextrostix high....” Apabila doktor muda toleh mencari dari mana datang suara, tidak kelihatan jururawat di pandangan. Inilah budaya DOCTORNOTED. Hanya sekadar memberitahu dan tidak mengambil berat tentang apakahrawatan sepatutnya diberikan pada pesakit.

Ada kawandoktor muda yang lebih teruk terkena. Selepas kerja di atas panggilan, keesokanpaginya dipanggil doktor pakar kerana tidak bertindak setelah diberitahu dextrostixpesakit tinggi. Beliau yang tidak tahu menahu tentang perkara itu, hanya dapatinamanya ditulis pada dokumentasi, Dr......... noted.

Jadi doktormuda rasa seronok apabila mendapat rakan sekerja yang profesional dan dapat bergantung pada mereka. Yang paling kelakar bagi doktor muda adalah apabila jururawatmembentang kes setiap pesakit di wad kepada beliau setiap pagi. Sangat berbezaberbanding di hospital besar.

SIBUK BAH

Ketara dihospital daerah, ratio doktor dan pesakit adalah lebih besar berbandinghospital di bandar metropolitan. Selain menjaga wad, doktor yang sama pada hariyang sama juga perlu menjaga klinik dan jabatan kecemasan. Terbukti sibukapabila rakan menyedari doktor muda semakin kurus(balik) sejak mula bekerja dihospital daerah. Teringat zaman latihan perubatan siswazah dulu.

Suasana tenang hospital daerah di petang hari.

Terkejutapabila perlu bekerja atas panggilan 20 hari dalam sebulan. Bagaimana seorangmanusia mampu bekerja sebegitu sekali? Rupanya kerja atas panggilan di hospitaldaerah tidak seperti di hospital besar. Di mana doktor tetap dapat pulang kerumah, mandi, makan dan kembali ke hospital terutamanya apabila perlu. Inisemua boleh dilaksanakan dengan adanya staf sokongan yang lebih berkebolehandan kerjasama yang baik.

Doktor mudafikir, mungkin dahulu kala, semua pembantu pegawai perubatan dan jururawatberkebolehan seperti di hospital daerah dan doktor boleh bergantung pada mereka. Oleh sebab itulah doktor pakarsekarang sering mengungkit bagaimana mereka menjaga lebih ramai pesakit semasamereka doktor muda dulu. Berbeza situasinya.

Doktor mudaperasan berbeza sibuk dulu dan sibuk sekarang. Sekarang walau sibuk pun, tetapada rasa kepuasan dan keseronokan dalam bekerja. Sebab dengan izin Allah swt,doktor muda membuat keputusan sendiri dalam merawat pesakit, tanpa perlu merujuk doktor pakar kecuali jikaperlu. Itupun melalui telefon. Jadi tiada siapa yang hendak menengking,mengutuk, menjerit dan memalukan doktor muda di depan pesakit.

BENCIDENGAN IZIN

“Dihospital daerah, kau akan jadi boss!” kata seorang doktor pada doktor mudasuatu ketika dulu.

Mungkindisebabkan masih dalam tempoh menyesuaikan diri, kesibukan dan tekanan, doktormuda dapati dirinya kerap naik angin kebelakangan ini. Habis staf perubatanlain yang menjadi mangsa. Makin menjadi apabila staf di bawahnya menganggapnyasebagai boss. Ketua jururawat di tempat dulu hanya pandang sebelah mata sahaja doktor muda, tetapi di sini mereka lebih menghormati.

Apabiladoktor muda cermin diri, beliau dapati diri semakin hampir menjadi orang yang beliaubenci suatu ketika dulu. Iaitu seperti pegawai perubatan dan doktor pakar yang sukamelepas marah pada orang di bawahnya. Kenapa diri jadi begini, bisik hatidoktor muda.

Doktor mudabermuhasabah diri dan tekad untuk berubah menjadi lebih sabar, pemaaf danberprasangka baik. Beliau mahu buktikan bahawa tiada alasan untuk menjadiseorang doktor yang memarahi tidak menentu. Sebaliknya memimpin melalui contohkepada staf perubatan lain dan insyaAllah kelak kepada doktor muda lain. Itulahyang beliau berpendapat gagal dilakukan oleh doktor-doktor tua kini.

MAKNAKEDOKTORAN

Walaupunbaru singkat tempoh bekerjanya di hospital daerah, doktor muda merungkaimungkinkah ini makna kedoktoran? Apabila seorang doktor ikhlas memberikan yang terbaiksetiap kali untuk merawat pesakit-pesakitnya. Datang lewat malam/awal pagiuntuk melihat pesakit, sabar dengan kesibukan ramai pesakit, kerja lebih masamemastikan semua pesakit diberi rawatan sepatutnya, meluang masa memberinasihat dan kata-kata untuk mententeramkan hati keluarga pesakit dansebagainya.

Jauh dari hiruk piruk kota metropolitan,
langit tetap temani diri ke tempat baru.

Dan bukannyarisau memikir, melaksana dan mendokumentasikan sesuatu untuk mengelak daripadadisaman pesakit dan keluarganya.

Masih jauhlagi perjalanan doktor muda mencapai makna kedoktoran. Namun beliau sudahnampak sipi-sipinya.

Tips Belajar Untuk Pelajar

2012-02-16T01:50:00.000-08:00

(ARTIKEL di bawah adalah artikel yang saya tulis khas untuk Persatuan Pelajar Islam Pergigian Universiti Malaya yang juga disiarkan di blog milik mereka. Justeru, maaf kepada anda jika dalam artikel ini saya menumpu kepada pelajar UM, walhal segala tips boleh diguna pakai untuk pelajar mana-mana universiti sekalipun.)

Menjejaki universiti pilihan, jangan menafikan perasaan yang tersirat dalam sanubari anda. Luahkan perasaan tersebut. Zahirkan. Tunjukkan. Buktikan. Bagaimana? Ikuti artikel ini sehingga ke penghujungnya. Saya akan membantu anda.Setelah berperang di alam persekolahan, diikuti pula alam matrikulasi, anda telah berjaya sampai ke tahap ini. Tinggal beberapa tahap lagi anda bakal meninggalkan universiti ini beserta ijazah yang menjadi identiti anda. Kemana-mana sahaja anda berpijak di muka bumi ini, orang mengenali anda sebagai seorang doktor.

Itulah yang anda idam-idamkan, bukan? Bergelar seorang doktor. Punyai pangkat doktor.Justeru, bagaimana anda perlu menzahirkan dan menonjolkan bahawa anda berasa cukup bersyukur dengan rahmat yang Allah berikan ini? Bahawa anda sangat berbangga bergelar seorang pelajar ijazah sarjana muda pembedahan dan pergigian? Bahawa anda cukup gembira diterima menuntut di Universiti Malaya? Bahawa anda cukup bertuah dididik oleh para pensyarah yang tiada tanding ilmunya? Bagaimana?
Jawapannya ada dalam perkataan DENTAL itu sendiri. Mari kita selidiki satu persatu.

Duduk
Saya mahu anda duduk. Terpulang kepada anda samada anda mahu duduk di atas kerusi di depan meja belajar, atau di atas katil yakni meja belajar kedua anda, atau di atas lantai yakni meja belajar ketiga anda, hatta di atas tikar sejadah sekalipun. Duduklah. Duduk sebentar.

Saya tahu anda selama ini mungkin tidak pernah duduk. Anda terlalu sibuk mengharungi detik-detik terindah selaku pelajar pergigian. Anda sibuk dengan kuliah, tutorial, discussion, assignment, homework, PBL, SDL, pesakit, klinik, requirements, denture, lab work, dan sila sambung sendiri. Anda lebih maklum.
Duduk sebentar yang saya maksudkan adalah muhasabah. Atau dalam bahasa teknologi dipanggil PAUSE BUTTON. Bercakap dengan diri anda sendiri.

“Siapa kata pergigian susah? Semua senior aku boleh lepas. Semua pun manusia biasa. Diorang lalui hari yang sama seperti yang aku lalui. Diorang dan aku tiada beza. Jika diorang boleh, aku pun tentu boleh.”

Ya, zahirkan rasa syukur dan bangga anda dengan duduk sebentar. Yakinlah bahawa jika orang lain boleh mengapa anda tidak. Cukuplah anda dimomokkan dengan kegagalan oleh sesetengah pensyarah yang tujuan mereka supaya anda bangkit bangun.

Sudah duduk sekejap? Sekarang, sila bangun dan buka buku.

Esok
Tolong jangan fikirkan tentang kegagalan anda di hari esok. Saya tahu sesuatu yang pasti bahawa anda sering menggambarkan anda bakal gagal dalam subjek-subjek tertentu dan bakal duduk di kerusi supplement. Atau kerusi repeat.

Saya masih teringat bagaimana adik-adik suka bertanya,
“Kak, bagaimana kalau saya kena repeat? Supplement?”

Soalan yang tiada jawapan. Kerana soalan itu tidak patut ditanya. Dan saya tahu ada sesetengah anda yang memang sengaja bertanya. Kerana bertanya itu kunci kejayaan orang yang bijaksana. Pertanyaan itu akan menjadi suatu motivasi untuk anda merancang kejayaan anda di hari esok.

Sebaliknya, fikirkan tentang kejayaan anda di hari esok. Fikirkan bahawa anda boleh memberi tumpuan yang baik pada hari esok. Fikirkan bahawa anda boleh menjawab soalan peperiksaan dengan baik pada hari esok. Fikirkan bahawa esok pesakit anda pasti datang untuk rawatan. Fikirkan bahawa esok anda boleh invest denture pesakit anda.

Ya, zahirkan rasa syukur anda dengan berfikir tentang kejayaan. Anda adalah apa yang anda fikirkan. Fikir beserta tindakan. Fikir-fikirkanlah. Dan?
Selamat bertindak!

Nasihat
Anda tidak boleh hidup seorang diri. Saya telah melihat sendiri bagaimana orang yang sangat berdikari dengan tidak mempedulikan orang lain mudah sekali untuk menempa kegagalan. Sila dapatkan nasihat orang yang berpengalaman. Tanya. Bertanya. Dan tanyalah.

Jadikan senior-senior anda sebagai batu loncatan untuk anda mengecap kejayaan. Jika malu anda tidak perlu pergi jauh. Buddy anda bersedia memberi bantuan. Tanya. Korek pengalaman mereka. Selidik bagaimana pelajar cemerlang mengisi masa-masa terluang. Belajar cara-cara menulis nota. Dapatkan segala nota-nota penting. Minta tips menjawab soalan peperiksaan. Semua ini hanya terdapat di kalangan orang yang telah melaluinya.

Terapi
Sehebat mana pun ada, tetapi jika anda terlupa untuk meluangkan masa 5 kali sehari (atau lebih) untuk menunaikan solat, anda adalah seorang yang sangat rugi walaupun anda adalah seorang pelajar pergigian dari sebuah universiti yang disegani.

Bertambah-tambahlah rugi jika anda sebenarnya tidaklah sehebat mana pun. Dalam kelas sering mengantuk. Buat apa pun orang tak suka. Muka asyik masam. Suka menyakitkan hati orang. Suka ambil kesempatan terhadap orang lain. Suka meniru hasil kerja orang lain. Malas membaca. Malas mengulangkaji pelajaran. Malas bertanya pensyarah. Alangkah ruginya.

Saya menganjurkan anda untuk terapi jiwa anda. Basuhlah dengan ayat-ayat suci al-quran. Sepertimana anda berkunjung ke salun kecantikan untuk terapi muka, kaki, tangan serta badan, begitu jugalah yang anda perlukan untuk jiwa anda.

Bersihkan dengan perkara-perkara yang membina iman. Solat. Puasa sunat. Bacaan al-Quran. Menghadiri majlis ilmu.

Ya, zahirkan rasa syukur dan bangga anda selaku seorang pelajar di universiti ini dengan mengabdikan seluruh kehidupan anda kepada pemilik kehidupan. DIA yang telah mengizinkan anda bertapak dalam bidang ini.

Arus
Tiada kejayaan yang boleh ditempa tanpa cabaran. Begitulah sebuah kehidupan bagaikan air laut ada masa surut dan ada masa pasang. Ada masa anda dihujani dengan pelbagai tekanan, ada masa pula sebaliknya. Itulah ombak yang sebenarnya membina kehidupan anda.

Jangan sedih jika anda tidak faham satu apa pun yang diajar oleh pensyarah. Jangan stress jika anda terasa seperti anda tidak tahu apa-apa pun. Jangan mengamuk jika gigi palsu yang anda buat dengan bersungguh-sungguh rupa-rupanya telah porous pada keesokan harinya.

Itulah arus yang akan memaksa anda untuk kembali ke pangkal jalan. Arus yang akan menolak anda untuk ke gigi air. Bangun daripada tidur. Tanyakan kenapa kepada diri. Kenapa tidak faham? Kenapa terasa seperti tidak tahu apa-apa pun? Kenapa gigi palsu ini porous?

Jawapannya ada pada diri anda.
Ya, zahirkan rasa syukur dan bangga anda dengan menolak arus yang mendatang dengan penuh berhemah.

Lekas
Pekerjaan yang paling menarik dan memuaskan adalah pekerjaan yang tidak bertangguh. Jangan bawa nota semalam untuk dikemaskini pada hari esok atau sehingga ke minggu seterusnya. Jangan mencari maklumat yang penting di hujung deadline.

Dapatkan koleksi soalan tahun lepas dengan segera. Bina kumpulan perbincangan dengan segera. Kemaskini nota kuliah dengan segera. Ulangkaji dengan segera. Bertanya dengan segera. Siapkan kes-kes penting dengan segera.

Ya, zahirkan rasa syukur dan bangga anda dengan segera. Berdoalah dengan segera.
Dan, berubahlah dengan segera. Semoga berjaya!

Seandainya Rasulullah SAW Bersama Doktor

2012-02-05T07:17:00.000-08:00

Saya teringat ketika di sebuah majlis meraikan pelajar tahun akhir, seorang tokoh yang saya segani memberi nasihat sebagai bekalan sebelum kami menempuh dunia pekerjaan.

“Nanti apabila beri rawatan kepada pesakit, jangan ingat tak ada yang menilai. Semasa awak belajar di sini, kami yang menilai. Sudah bekerja pun masih ada yang menilai.” Sambil jari telunjuknya dihalakan ke atas.

Kawan saya menyahut, “Oh ye ke Doktor. Ada penilai juga? Bos eh Doktor?”

“Memang ada yang menilai. Bukan siapa-siapa. Tetapi Allah SWT.” Sambil tersenyum penuh makna.

Saya muhasabah kembali diri untuk beberapa bulan di medan pekerjaan adakah saya sedar dan nampak bahawa Allah menilai setiap satu kerja saya. Istighfar.

Sememangnya kita semua sedia maklum bahawa ada pencatat di kanan dan kiri bahu untuk setiap satu perkara yang kita lakukan. Dan Allah akan menilai segala pekerjaan yang kita lakukan. Tetapi nampaknya kita sering terlupa.

Sempena sambutan kelahiran Rasulullah SAW yang dilahirkan 1433 tahun yang lalu, saya ingin kongsikan 5 situasi seandainya Rasululllah ada bersama kita, khususnya kepada para pegawai pergigian.

Beruntungnya para sahabat kerana mereka menerima segala butir nasihat secara terus daripada Baginda. Apabila tergelincir, Rasulullah memberi teguran. Apabila melakukan kebaikan, Rasulullah memberi pujian. Cuba kita bayangkan beberapa situasi sekiranya Rasulullah ada bersama kita. Agak-agaknya apa yang Baginda akan katakan kepada kita? Baginda mungkin menegur apa dan yang mana? Baginda mungkin memuji apa dan yang mana?

Situasi 1

“Assalamualaikum Puan. Sila duduk, saya akan buat pemeriksaan.”

“Tiga perkara yang boleh mengeratkan persahabatan dengan saudaramu iaitu memberi salam apabila bertemu dengannya dan menyediakan tempat duduknya dalam sesuatu majlis serta panggilah ia dengan nama yang paling disenanginya.”(Riwayat Al-Tabrani)

Cadangan:

Memberi salam kepada pesakit yang beragama Islam
Mengucapkan selamat sejahtera kepada yang bukan beragama Islam
Meraikan pesakit dengan mempersilakan mereka duduk.
Memanggil pesakit dengan pangkat yang bersesuaian dengan umurnya beserta nama sekali.

Situasi 2

“Doktor, bolehkah gigi ini ditampal? Saya rasa sudah lubang besar.”

“Memang besar. Kalau tampal pun mungkin sia-sia sahaja. Gigi tersebut perlu dicabut.”

“Sesungguhnya padamu ada dua sifat yang disukai Allah dan Rasul-Nya iaitu perasaan kasih dan pemaaf.” (Hadis riwayat Muslim dari Anas bin Masud)

Cadangan:

Ambillah sedikit masa anda memberi penjelasan dengan perkataan yang berunsur kasih dan sayang serta mendidik agar pesakit tidak berasa terlalu bersalah dan mungkin kecil hati.

Contohnya, “Lubang ini kalau Puan datang 5 bulan yang lalu, saya yakin InshaAllah masa itu memang dapat ditampal. Tetapi minta maaf, ia agak besar dan tiada rawatan lain melainkan cabutan. Tetapi terpulang kepada Puan apabila sudah bersedia untuk dicabut, kita akan cabut. Cuma, jika gigi tersebut dicabut lambat, mungkin akan sakit….seterusnya.”

Situasi 3

“Gigi Puan banyak sisa makanan. Pastikan Puan jaga ya kebersihan gigi.” kata Doktor.

“Yerlah Dr., very very the kotor!” sahut seseorang yang berdekatan dengan Doktor berkenaan.

“Kebanyakan dosa anak Adam adalah kerana lidahnya.” (Hadis riwayat Tabrani dan Baihaqi)

“Sesiapa yang beriman kepada Allah dan hari Akhirat, maka hendaklah dia berkata dengan perkataan yang baik-baik ataupun dia berdiam saja.”(Hadis riwayat Bukhari)

Cadangan:

Pelihara lidah daripada menggunakan bahasa-bahasa yang negatif seperti kotor, busuk dan sebagainya.

Mana lebih baik, adakah ini, “Gigi Puan kotor,” atau “Gigi Puan tidak berapa bersih terutamanya di bahagian…” dan “Saya ada bau busuk masa buat pemeriksaan tadi,” atau “Biasanya sisa makanan yang berkumpul boleh menyebabkan mulut yang berbau.”

Nampakkah perbezaannya?

Situasi 4

“Kita kan Doktor, semua orang hormat kita.”

Sabda Nabi SAW maksudnya: “Tidak akan masuk syurga orang yang di dalam hatinya terdapat sebesar biji sawi dari kesombongan.”(Hadis Riwayat Muslim)

Cadangan:

Pekerjaan sebagai seorang Doktor mungkin dipandang tinggi oleh masyarakat tetapi itu tidak bermakna kita berhak menuntut sedikit ataupun banyak penghormatan daripada sesiapa sahaja. Jangan terlalu taksub dengan pangkat sehinggakan kita bertindak sesuka hati kita terutamanya ketika berurusan dengan pekerja yang bekerja di bawah kita.

Situasi 5

“Ya Allah, permudahkanlah urusanku memberi rawatan kepada pesakit. Bantulah hambaMu ini untuk memberi rawatan yang benar yang dapat memberi kebaikan kepada pesakit.”

“Mahukah kamu semua aku beritahu( sifat-sifat) ahli syurga? Para sahabat menjawab . “Ya”, baginda bersabda,” Setiap orang lemah dilemahkan, andainya dia meminta kepada Allah, nescaya Allah mengkabulkannya.”(Hadis Riwayat Bukhari dan Muslim)

Cadangan:

Ambil masa di awal pagi untuk berdoa kepada Allah SWT memohon supaya setiap rawatan yang diberikan adalah rawatan yang benar dan bermanfaat untuk pesakit. Lebih cantik lagi kalau kita melazimi menggunakan kalimah-kalimah Allah ketika memberi rawatan, semudah kalimah bismillah dan Alhamdulillah. Jika kita biasa berdoa setiap kali sebelum makan, kenapa tidak kita berdoa setiap kali kita bertemu dengan pesakit?

Kesimpulan

Pekerjaan sebagai seorang Doktor menuntut kita untuk mempelajari menggunakan bahasa dengan baik dan penuh sopan. Ini adalah satu kemahiran yang tidak dapat tidak kita perlu pelajari. Kenapa?

Kerana pesakit kita adalah manusia biasa seperti kita. Mereka ada perasaan yang perlu dijaga. Jikalau kita perhati setiap pesanan Rasulullah di atas dan mengamalkannya, inshaAllah, pekerjaan yang kita lakukan akan menjadi seperti ‘tikar sejadah’.

p/s : Jangan menilai saya melalui tulisan-tulisan saya. Saya bukanlah seorang yang baik dan benar sentiasa walaupun tulisan-tulisan saya mungkin adalah tulisan yang baik dan benar(Istighfar). Apabila saya menulis, saya bercerita tentang pengalaman saya sendiri. Dan situasi yang keji itu juga adalah situasi benar yang saya lakukan dan artikel ini ditulis untuk menegur diri sendiri, serta disiarkan untuk manfaat bersama.

Akhir kata, seandainya Rasulullah bersama kita, tentu Baginda merasa bangga melihat umatnya yang bekerja dalam bidang professional masih mengamalkan setiap nasihat yang Baginda berikan. InshaAllah. Sama-sama kita usahakan.

Getting your money back from KWSP.

2012-01-30T22:45:00.000-08:00

Getting your money back from KWSP.

Assalamualaikum

Peace For Everyone...

I am now working the in the primary side of our health system and in the past year I have learnt some things that I never would have known working in hospital especially about allowances and claims(financial gain and stability are some of the reason of why we do our job right..)

Before that I would like to congratulate all the Medical Officers reading this for the overdue review and increment of our On Call Allowances,hopefully there are part of it for Infaq,InsyaAllah.

I would also like to offer condolence for the House Officers as your RM750 Critical Allowance were abolished and from what I heard most of you guys still have not receive the RM600 promised for the shift system,hopefully the sum will be paid fully later(though if it’s considered an allowance,most probably you would not be getting it,be prepared)

I assume that most of us already know that once we are HOs ,part of our salary are automatically put aside into KWSP(about RM400++) ,and once we’ve agreed to sign our pension scheme we are entitled to get back the sum collected by KWSP.

Here I would like to tell you guys the steps of getting your money back as soon as possible.

First and foremost,you are entitled to get it only if you have signed the Skim Berpencen(you are now a government servant till you’re 60)..

After a short while(in my case,nearly 2 years),the documents you signed will be sent to SPA,Human Resources in Putrajaya from your respective JKN via your Pusat Tanggung Jawab.You will receive a notification from your JKN for this.

Meanwhile you can easily check the progress of the process “Semakan Taraf Berpencen” here http://www.spa.gov.my/ and clicking Semakan Status Urusan Perkhidmatan (sometimes the portal are offline,so be sure to pray hard before logging in..)

After some processing there(a few months),the guys in Putrajaya will write a 1 page letter to your current management notifying that the process was a success,which will arrive at an amazing speed of one month++.You will hopefully be notified of this(I went to check myself at the office)

Once they received this notification,your salary will be updated promptly( around 2 months),and you will receive the pay without any KWSP cut(you can comfirm this by checking the E-Penyata Gaji site which annoyingly can only be opened with Firefox and Internet Explorer)

Then you can go to your nearest KWSP office(just a mere 145kms for me) and check your balance,approximately 45% of the total sum is yours. They would then give you some forms to be filled,some of them must be signed by your current employer/superior(most of us won’t be able to do this in a day),and remember that all copied documents must be presented with the original and verified by a grade A officer.

If all goes well,you’ll receive the full amount in your account soon(it’s still a mystery even for me)..

Wassalam...

P/s:These are the steps I’ve taken...your PTJs(Pusat TanggungJawab) may differ and hopefully are more efficient...mine is considered OK...and if you’ve been moving around it may take longer...

Housemanship - My Two Cents

2012-01-26T05:42:00.000-08:00

I was an IB sudent studying in Kolej Mara Banting when I first heard about the three types of medical teaching philosophy that are in existence.

Those are namely:
1)Traditional
2)Integrated
3) Problem Based Learning (PBL)

Each of them stem from different school of thoughts, different opinions on how best to study medicine.

I am the product of PBL who at times wished to go traditional. And I have heard of the traditional med students who wished for integrated or PBL.

Yup, the field always seems greener on the other side, folks.

But the point of my bringing up the whole issue is to demonstrate that our teaching is not static. There will always be someone who thinks that we could have learned better when we were students if only they had implemented this or this or that. So they come up with ideas, all for the sake of making it better. The ideas will be examined, analyzed, shredded to pieces by discerning eyes. Once the ideas are found to be able to stand the test of logic, reasons and rationale, then plans will be made to carefully and gradually implement the ideas.

The key to on-going civilization is ideas! Innovations!

Being static is not an option.

Do you have any idea on how to make housemanship a better learning experience to prepare us to the real battlefield of diseases once we attained the rank MO-ship?

Previously, it was taught that putting a lot more hours into housemanship will increase your exposure to diseases and management, and thus would prepare you into becoming a good MO. Thus, the on-call system (sometimes EOD), the exhaustion, the denied physiological state of drowsiness and sleepiness, the GUILT of being made to believe that you won’t be a good enough MO if you don’t do on-calls.

Okay.

I have other ideas. I am not saying that my idea is the best and it SHOULD be implemented. I am just using this medium in Blogger Ubat Muda as a sounding board to test what sorts of training would make a good MO. And I would like to hear ideas from others too. I am sure a lot of us have some ideas of what would make housemanship a better training program.

Let’s discuss it.

***

I was quite incredulous when I read the opinion of a houseman who thought that we should bring back the on-call system because he felt that housemen need the hours.

Okay.

Let’ s say he was right.

Let’s say we do need the on-call hours.

But to do what?

To do more Brannulas?

To do blood taking?

To be informed by staff nurse that Pak Cik Ali has some temperature so that we can then order T. PCM and tepid sponging and then start taking Blood Culture?

To be informed by staff nurse that the patient in the acute cubicle has low BP – so that we can then run some fluid fast and then do hourly BP and then KIV start some inotropes if indicated after informing MO?

Granted we also clerk some new cases that come into the ward, but most of the time we just carry out the plans already ordered by our MO who was on-call in casualty.

Well, of course setting brannulas is important for patient who is on IV antibiotics. Of course blood taking is important when the patient is suspected of dengue and you need to monitor her/his FBC.

But when they said that we need the extra hours to be a better MO…are we supposed to devote those extra hours to be doing the above in the wards? Or to go to casualty and clerk new cases, and come up with a diagnosis and then decide on investigation as well as appropriate management plan for this patient?

Doing brannulas/ blood taking/ and order simple things like ‘run fluid fast’ or ‘T. PCM stat’ during oncall would not make us a better MO. It would not even make us a better houseman because we would already be doing those during office hours anyway! If you are already an excellent blood sucker, sucking more blood during on-calls would not make you more excellent than you already are. Like wise, if you are already an excellent brannula setter, setting them for an extra 100 times won’t make you any better. So what is the necessity of rendering our housemen exhausted and lethargic by hiding behind the reason that ‘they need the hours to become a good MO.’ The hours that they put in – that you say they need – should be devoted for doing something that will make them become a good MO, right?

Be smart!

If they need the hours, put them in casualty! Make them come up with diagnosis and appropriate investigation and make them come up with proper management plan from casualty! Make them use their brain because that’s what they will be doing once they become an MO.

If you want them to be tired, AT LEAST, make them tired for the right reason.

However it’s true that we need housemen in the wards too. It’s true that Brannulas still need to be set. It’s true that someone still need to take routine blood investigation from a dengue patient. It’s true that someone should be around if patient collapse.

But you see, my point is, the houseman can do all that without you hiding behind the reason that they need the hours to be a good MO. Why do we have to make them so tired going on-call for doing something that is YES! NECESSARY! – but won’t make them a good MO. Let them feel fresh to learn the most during office hours. If they are too tired from having worked for more than 24 hours on the previous day, do you think they will be able to absorb as much the next day, during office hours, when they need to maximize the use of their brain.

Don’t just work hard. Work smart!

***

Imagine this scenario.

Imagine a teacher who teaches add maths to a class of 25 students.

The teacher knows that at the end of two years, she needs to make sure that the 25 students will all be ready to answer the add maths questions in SPM. At least ready enough to pass.

So she reasons that in order for the students to pass Add Maths, the students need to do basic things ; multiplication, division, factorization, quadratic equation, differentiation, integration. They spend hours memorizing formulas that they know they will need to use when solving mathematical problems.

The Teacher spent the whole two years asking the students to practice all the concepts that they need to master in order to be able to pass SPM at the end of two years.

The exam day arrives at last.

The students are shocked! They are shocked when they find out that the questions come in the form of long paragraphs that they need to ponder and decipher and APPLY the concepts that they have learned. They are confused because the question is not as straightforward as ‘Do differentiation’ Or ‘factorize this equation’.

And at last only two students out of 25 pass Add Maths that year.

The teacher is very angry. “I teach you for two years! We even have Kelas Tambahan for you to keep doing quadratic equation and differentiation and integration bla bla.”

“But the questions in the paper were DIFFERENT than the one we are used to.” One student answered back.

"Ah alasan! How come these two students Ahmad and Ali pass? It’s because they have the initiative to study beyond what is taught in the classroom.”

Ahmad and Ali smile. They have a secret to their success. They both went to a tuition centre for ONLY two hours per week. In that two hours, they were taught how to apply the concepts that they learned. They were given past year questions and they were given questions in the form of long paragraphs just like what came out in the SPM.

Silently they want to say, “Oh teacher, we don’t need to spend all those extra hours in the classroom doing repetitive stuff on basic concepts. If only you had just spent 2 hours per week doing the real thing that we need to face during SPM, we would all have passed.”

***

We need to be able to set brannulas

We need to be able to do blood taking.

We need to be able to do procedures.

But we don’t need to do them for two years (siap sampai tak tidur and on-call lagi!!) to be good at those. In fact, that would NOT help us to become a good MO

What we need to do:

-interpret ABG – come up with possible Differentials.
-interpret CXR - come up with possible differentials
-interpret ECG – come up with possible differentials.
-interpret CT Brain – come up with possible differentials
-interpret MRI – come up with possible differentials.
-Decide on which antibiotics to use after patient is not responsive to one.
-Come up with management plan for all those differentials.

It doesn’t matter how many times we do on-calls….if we don’t spend the extra hours doing the right thing, we will never be a good MO. Might as well we don’t do the extra hours and come to work fresh and smiling and more receptive to learn by ourselves.

***

This is only my humble opinion on the current housemanship training. We should spend extra time thinking the way our MOs think!

Not everyone is like Ahmad and Ali who has the initiative to seek outside resources. Besides, by rights, the teacher should have recognized from the very beginning what sort of training is beneficial and what sort is not so necessary. By rights, regardless of anyone having extra initiative, the teaching should be successful simply looking at the amount of hours the students already put in to study. Work smart, remember?

I am not entirely convinced of my ability to become an MO even after 1 year of housemanship now. I am very scared to be all alone out there.

And I am discussing this issue not for the readers to agree with my opinion. If anyone disagree with what I have written, please say so and give us a solution. I would like to hear them. Maybe…we can make a few suggestions to the ministry.

What does everyone else think?
Let's discuss this.

Anatomy of A Medical Student

2012-01-22T04:55:00.000-08:00

Assalamualaikum..

Pelajar perubatan boleh dikatakan macam mini Doraemon. Dalam poket whitecoat ada macam-macam jenis barang. Kalau tak bawak, nanti pensyarah tegur dalam nada sinis. "Mana alat-alatan anda?" Lepas tu semua tersengih-sengih macam kerang busuk.

Pembaris - nak ukur jugular venous pressure
Tendon hammer - nak uji refleks
Calculator - Sebenarnya pelajar tak perlu sangat (dan dah ada dalam telefon masing-masing)
Steteskop - tahu kan fungsinya. :)
Tongue depressor (macam kayu aiskrim) - nak tengok anak tekak dengan lebih jelas
Kapas dan stik oren - nak uji deria
Jam - WAJIB! nak kira nadi dan pernafasan
Measuring tape - penting untuk periksa ibu mengandung, pesakit hydrocephalus, ukur bengkak kaki dll
Penlight - banyak fungsi

Lagi? Buku rujukan! penting jugak nak terus cari apa-apa yang tak difahami. Kalau simpan nanti dah balik penat, dah basi.

Dunia dah semakin canggih
Tapi ikut juga keaadaan. Sekarang teknologi dah canggih, orang bawak internet ja dalam poket. Doktor tanya, search, google. Dah banyak ebook, application canggih yang boleh dimuat turun dalam telefon/ipod/ipad/tablet masing-masing. Hah canggih kan pelajar perubatan. Doktor pun tak marah dah sekarang kalau pelajar belek-belek telefon waktu kelas. Silap-silap, ada doktor yang suruh pelajar cari di internet.

Kata orang pakai telefon bimbit mahal kerana nak bergaya, sudah tak valid lagi dah. :)

Berbalik kepada 'alatan', sebenarnya tak semua kena bawak. Ada yang boleh ambil di hospital mengikut keperluan.

Contoh lain yang tak ada di sini :

- sarung tangan - untuk sentuh pesakit atau jika nak tolong buat prosedur apa-apa
- tuning fork - untuk uji pendengaran atau deria pesakit terhadap gegaran.
- face mask - untuk perlindungan diri dan pesakit
-opthalmoscope - satu set termasuk untuk telinga harga lebih kurang RM700. Tak semua pelajar sanggup beli.

Dan paling penting, bawak otak dan fikiran. Jangan tertinggal di bilik pulak.
Ada soalan? Kemukakan dalam komen.

Stand up for yourselves

2012-01-16T20:21:00.000-08:00

Working at a KKM hospital is satisfaction 5% and heartache 95%. It’s not because we got no satisfaction treating the patients, but from up top to down bottom, rotten apples are everywhere. In government service, everything is about seniority. Everything is about hierarchy. Everything goes by what the boss says.

This system of hierarchy actually serves to protect the main KKM clients – the patients. A specialist with 15 years of experience certainly would give much more accurate and decisive treatment than a one-month old houseman. But the system also opens up another door – bullying. Bullying has been a culture of KKM doctors since forever. The main reason for this bullying – for YOU to learn. Whether it’s really the best teaching method, nobody can say.

A houseman does not outrank the nurses. The nurses rule the ward, they know how the works are being done all this time while the houseman keep changing every few months. They determine whether we had done things correctly or not, whether this form and that form are filled in correctly, whether our work is complete or incomplete, whether we can have meals or breaks during our shifts. I certainly don’t remember myself outranking the PPK because last I heard, I was told to “Jangan kacau saya boleh tak? Kalau doktor nak urgent, pegi hantar ABG ke lab sendiri lah! Saya banyak kerja ni!”

A houseman is at the bottom of the food chain. It’s so easy to bully a houseman with the reason “so that you can learn”. Me, I cannot tolerate bullies. I don’t stand up to every bullies in my workplace, but when I do, I make life messier for them.

When I was in medical posting, there was a discharged patient who is ex-IVDU with Hepatitis C positive, supposedly in radiology for a CT-scan, but was sent to our stable ward without any notice whatsoever for a venofix. The reason being; they couldn’t fix it down there. At that time there were only 2 houseman taking care of 30 patients. Medical being medical, with so many transfer-ins, discharges, bloods, referrals, charting, procedures, summaries etc, we just do as asked without asking questions, sometimes without knowing the cases. So my colleague at that time saw this patient and tried to insert branula for him. She was really in a rush as she has loads of other referrals to settle.

She attempted few times, but couldn’t get any because the patient’s venous architecture is no good. Frustrated and rushed, she made another try, and poked her own finger! She was crying after she got the needleprick injury. She was so stressed up. But she hasn’t known the case yet. Only after few minutes she got that needleprick, she discovered that the patient is ex-IVDU and Hepatitis C positive! And then she was even more panicked than ever.

I did feel pity for her and feel angry at the radiology MO who sent the patient up for us to fix in a branula. So I sent a memo back to the radiology MO saying that we couldn’t fix a branula and in the process of trying, a houseman got a needleprick injury, so please do your own job without pushing the work to us busy housemans. And I went straight to see one of the hospital administrator in director’s office to talk about this incident. I brought up the issue “Why should radiology push a patient to medical for venofix?”. Yes, radiology pushing venofixes to houseman is not a new thing. I was called down to radiology several times for venofixing. But I was so pissed off that day because one of us houseman got needleprick for helping out radiology.

And the said MO got a good yelling. But one of the radiology consultants wasn’t happy that I stood up. He wasn’t happy that I spoke to the administrator and wasn’t happy on how I wrote the memo. So he came to my ward and gave me a big yelling. You houseman with attitude, when I was a houseman blabla, needleprick injury no big deal, I will tell your consultant to extend you in medical etc etc etc.

I was happy I stood up for that. I heard that there was no more unnecessary bullying like that happening again across departments (radiology bullying medical houseman). The medical consultant actually backed me up and praised my courage for standing up like that. And I was NOT extended in medical. But I got a very big stare every time I walk down radiology department, arranging for ultrasound, CT and MRI for my patients. Damn, I made lots of enemies already…

You can see how miserable most KKM staffs across the board, one blaming another, save your ass first before someone else’s. That’s because they do not speak up. So they can just complain at the back. And this includes specialists that complain too many houseman and taking the frustration to the poor housemans. Houseman cannot do anything about our numbers, they also can’t do anything about it but they don’t want to speak with higher ups in fear of retribution, so they take out on the houseman.

So, if you don’t like how you are being treated, firstly, DO NOT EVER ACT LIKE THEM. Seriously. Secondly, speak up, but choose your battles well. You cannot want to win every time.

Remember, the bad things in the world happen because good people don’t speak up.

Its Just An Acute Appendicitis

2012-01-11T00:00:00.000-08:00

Salam,

Today I would like to talk about appendicitis. This is merely general information to all of you(non doctors) out there and I hope by the end of this topic, it educates patients to be more alert and seek treatment as soon as possible.

What is appendicitis? What are the symptoms and why do I choose this topic among all others? Of course, this is an emergency surgical case that if we took even a second of delay, it has higher chance to progress and contribute to higher mortality and morbidity. Appendix is a blunt end hollow organ filled with lymphatic tissue. Well, it plays a role in our immunity, especially in children.

It is located in right lower abdominal region(its most common place). The symptoms are simple - sudden onset of pain, pricking-like, increasing in severity, aggravated by food intake, fever(on and off), nausea and vomitting (these are the most common symptoms I usually see among my patients).

Well, as a surgeon, we see the patient as a whole. Besides appendix, there are several organs located exactly at the same location where appendix is situated. We have Meckel's diverticulum, cecum, ureter, ovaro-fallopian tube(for women) etc.

So please do not feel irritated when the doctor ask you as well other questions, because they need to exclude other diseases as well. Who knows, it could be urinary tract infection with appendicitis, or urinary tract infection alone or even appendicitis alone..sounds complicated isn't it?

After all clinical examinations are conducted and diagnosis established, we go in!

For me, I have already done 10-20 appendicectomy, yet still have a kind of feeling while doing appendicectomy. It's just like playing cards....yeah right! Because we never know what we will encounter while going in until we see the last part of abdominal layer..sound interesting right? It could be easier or harder than before.

The palpitation begins just before the incision is made and I guess it will end only after the operation is completed. We never know how is the condition of the appendix, is it perforated, suppurated? Will it be hard to find? Will there be lots of adhesion, that the appendix cant even be visualized and mobilized?!!

But even the 'simple' appendicectomy can be converted to laparatomy if the appendix is severely damaged or involves the caecum. This is how cruel appendicitis can be to someone.

Well guys, this is neither a medical lecture nor CME, so take it easy. It is just a general information which I'd like to share with you guys. From its clinical presentation to the surgeon's feeling while opening up in search for the appendix. :)

Have a good day. :)

EDITOR: Dr Aizat is currently serving as a junior medical officer in Surgical Department, in one of Malaysia's government hospital.

Doktor@Locum

2012-01-07T20:14:00.000-08:00

Salam,

LOCUM

Satu kelebihan yang diperolehisetelah menjadi pegawai perubatan, adalah membuat locum secara sah di sisiundang-undang. Selain menambahkan pendapatan (penting bagai doktor-doktor yangbakal berkahwin), ianya juga menambahkan ilmu pengetahuan kita. Seperti kataseorang doktor senior, “Kita sebenarnya banyak belajar bila buat locum.”

Kalau orang politik menggunakanslogan ‘dekatilah rakyat’, maka ‘dekatilah pesakit’ dengan membuat locum. Adaperkara yang kita tidak akan belajar dan rasai dengan hanya bekerja di wad danhospital.

?URTI-IST

Doktor GP klinik swasta sepenuh masa selalu diperlekehkan oleh doktorhospital sebagai pakar URTI(upper respiratory tract infection) dan malah kawansaya berseloroh doktor buat locum klinik sebagai URTI-ist. Namun ketika locum,berwaspadalah kerana kadang-kadang boleh menerima pesakit berpenyakit sepertiectopic pregnancy, Dengue hemorrhagic fever dan sebagainya.

Ada juga penyakit kebiasaan tetapitidak dilihat di wad seperti atopic eczema, allergic dermatitis, scabies, tineacorporis dan banyak lagi penyakit kulit yang lain. Kita perlu membezakan danmerawat dengan efektif. Saya bersyukur pengalaman bekerja di JabatanDermatologi banyak membantu.

MENCARI DOKTOR

Sewaktu locum jugalah kita belajar untukmendengar luahan hati pesakit. Datang dengan mengadu sakit kepala, akhirnyapesakit meluahkan perasaan yang terbuku di hati dengan tangisan. Semua akibattekanan hidup zaman sekarang. Tekanan seorang pengurus wanita terhadap persaingandi tempat kerja, tekanan seorang isteri yang tidak dapat melahirkan anak.

Ada seorang guru perempuan 50an yangmerasakan terhina. Setelah perompak mencuri komputer riba milik sekolah dirumah, beliau diasak-asak oleh pihak sekolah untuk membayar ganti harta sekolahmalah berulang kali menerima surat amaran tindakan tatatertib daripadakementerian. Beliau kata sudah berdekad berdedikasi bekerja sebagai seorangguru, beliau tidak pernah mengambil cuti sakit, sudah 3 kali menerima anugerahguru cemerlang. Tetapi merasakan sumbangan seumur hidup beliau begitu tidakdihargai sehinggakan dilayan seperti seorang pencuri. “Duit itu saya bolehcari, tapi ini bukan soal duit doktor.”

“Maaflah doktor saya cerita semuani.”

Apabila dibawa isu ini kepada rakankaunselor, mereka mengajar sedikit sebanyak cara membimbing pesakit sedemikian.

KANDUNGAN

Di hospital kita merawat pesakitmengandung dan membantu melahirkan anak. Di klinik locum, kita mengkhabarkanberita gembira bahawa mereka atau isteri mereka mengandung. Ada yang terlompat-lompatgembira, ada yang rasa lega dek tekanan daripada keluarga.

Ada yang selepas tahu merekamengandung bertanya, “Ada apa-apa tak yang doktor boleh buat?” Tergamam diriapabila diminta menggugurkan kandungan. Lidah kelu tidak tahu apa yang ingindijawap.

Seorang rakan doktor kata, “Jawablah begini: Janganlah gugurkankandungan ni kak, kerana mana tahu, antara anak-anak akak, anak inilah yangsanggup menjaga akak bila dah tua nanti.”

AMBIL KISAH

Ada kalanya kita tidak tahu apapenyakitnya dan ini pastinya merisaukan seorang doktor. Iaitu memberitahupesakit bahawa kita tidak tahu apa penyakitnya. Terlalu ego sehingga kita rawatsecara simptomatik, tanpa memberitahu apa penyakitnya. Mungkin lebih baik jikakita rujuk pada doktor lain atau ke hospital.

Ada ketikanya kita terjumpa penyakityang jarang dijumpai di klinik locum seperti lupus erythematosus, scalppsoriasis, acute generalized exanthematous pustulosis dan sebagainya. Selepasdirujuk ke hospital, ambillah kisah tentang pesakit dengan menelefon merekakemudian hari, untuk mengambil tahu tentang keadaan mereka terkini. Ini jugadapat mengukuhkan pengalaman memberi diagnosis sesuatu penyakit.

MENCARI DOKTOR 2

Saya kerap bersembang bersama stafklinik. Selain membina hubungan yang baik bersama staf, ianya juga peluanguntuk kita pelajari tentang selok-belok membuka klinik, terutamanya apabila bertanyadengan staf senior.

Antara faktor yang menyebabkanpesakit kembali ke klinik yang sama adalah hubungan yang baik bersama doktor.Doktor haruslah sudi mendengar masalah pesakit dan melayan mereka dengan baik.Sehinggakan ada pesakit yang datang ke klinik bertanya hari apa Dr. ZZZbekerja, dan datang pada kemudian hari.

Bila saya tanya ada tidak pesakityang datang cari saya, rupanya ada juga. Rasa lebih bersemangat untuk bekerja.Patutlah ada pesakit yang tanya nama saya. Ingatkan nak saman.

DOA

Selesai solat di bilik rehat doktordi klinik locum, terlintas hati untuk mendoakan sembuh penyakit pesakit-pesakit.Harap kita semua amalkan sedemikian.

"Kualiti Hidup Saya Terjejas"

2012-01-04T00:00:00.000-08:00

Ada segelintir masyarakat yang mengganggap bahawa kesihatan pergigian bukanlah isu utama dalam kehidupan mereka. Mereka merasakan kualiti hidup bergantung kepada sejauh mana organ dalam tubuh mereka boleh menjalankan fungsi dengan baik. Contohnya, keupayaan jantung mengalirkan darah ke seluruh tubuh dengan baik serta keupayaan organ-organ utama yang lain seperti ginjal dan hati dalam menjalankan fungsi masing-masing.

Tahukah anda bahawa bilangan gigi yang normal adalah 20 batang untuk kanak-kanak dan 28 ke 32 batang untuk dewasa? Tahukah anda juga bahawa gigi adalah tulang yang paling kuat pada tubuh manusia? Tahukah anda bahawa gigi geraham atas mempunyai 3 akar manakala gigi geraham bawah mempunyai 2 akar? Tahukah anda bahawa setiap satu morfologi(bentuk,saiz) gigi adalah berbeza-beza? Tahukah anda bahawa setiap gigi mempunyai setiap fungsi yang berbeza dalam memastikan makanan dibawa dengan selamat ke dalam usus perut? Tahukah anda bahawa gigi mempunyai 3 lapisan utama yang mempunyai karakter mikroskopik yang berbeza-beza sesuai dengan fungsinya yang berbeza?

Dan tahukah anda bahawa Allah menciptakan gigi dengan sebegitu banyak ciri-ciri istimewa bukan dengan tujuan yang sia-sia? Namun betapa ramai masyarakat kita hari ini memandang enteng tentang penjagaan gigi seolah-olah gigi yang begitu kompleks penciptaannya itu tidak memberi sebarang makna kepada kualiti kehidupan mereka.

Benarkah begitu?

Jika anda benar-benar menghargai dan mensyukuri gigi sebagai salah satu nikmat daripada Allah, kenapa anda tidak berusaha untuk memastikan gigi anda dijaga dengan baik?

Justeru, saya akan kongsikan kisah seorang pesakit saya yang akhirnya mengetuk dahi mereka sendiri kerana alpa dalam penjagaan gigi. Sebelum itu, ingin saya ingatkan bahawa saya tidak menuding satu jari kanan kepada mereka untuk mengatakan mereka memang patut menyesal. Tidak juga 5 jari kanan untuk mengatakan mereka patut menanggung kesannya, apatah lagi 5 jari kiri untuk mengatakan mereka yang bertanggungjawab sepenuhnya di atas kealpaan mereka itu.

Tetapi jari-jari yang ada di kedua belah tangan saya ini ingin sekali saya tuding ke arah semua doktor pergigian yang mempunyai tauliah tetapi gagal menyampaikan maklumat tentang kesihatan pergigian, juga kepada badan-badan kerajaan atau bukan kerajaan termasuk swasta yang menyulitkan lagi proses rawatan kepada mereka, serta sesiapa sahaja yang terasa patut menyalahkan diri mereka sendiri, khasnya untuk mereka yang mempunyai ilmu tetapi tidak mahu beramal dengan ilmu mereka.

Semoga kisah ini menjadi salah satu wadah untuk saya menyampaikan maklumat tentang kepentingan penjagaan kesihatan pergigian kepada masyarakat. Semoga anda dapat melihat kaitan antara gigi dengan kualiti kehidupan yang baik.

Seorang pesakit saya bermusafir dari Indonesia ke dua buah hospital yang tidak dapat merawat kesan trauma yang dihadapinya 2 minggu yang lalu. Beliau akhirnya ke hospital tempat saya bekerja untuk mendapatkan rawatan. Rahang bawahnya patah, bersilang dan gigi di rahang bawahnya bertindih akibat daripada kemalangan. Tisu sudah bersatu. Rawatan yang ada hanyalah mematahkan kembali rahang bawah dan mencamtumkan kembali yang bersilang kepada asal. Rawatan berjaya walaupun sepatutnya pesakit terus mendapatkan rawatan dalam tempoh kurang seminggu selepas trauma sebelum tisu bercantum.

***

Dari jauh saya melihat satu susuk tubuh yang dibaluti dengan pakaian yang indah. Dari atas ke bawah tertutup kemas selaku dirinya merupakan seorang muslimah. Beliau dipanggil masuk apabila gilirannya sudah tiba.

Saya memandang wajahnya yang bersih dan berseri-seri itu. Seperti biasa selepas memastikan pesakit tiada sebarang masalah kesihatan yang berkaitan, saya bertanya apakah masalahnya.

“Mak Cik akan pergi haji sebulan lagi.”

“Ya kah? Alhamdulillah.” Saya memberi respon.

“Tetapi Mak Cik risau tak ada gigi. Atas depan tak ada. Bawah tak ada. Tepi-tepi ni pun tak ada.” Sambungnya sambil jari telunjuk dialihkan ke kawasan yang dimaksudkan.

Mungkinkah Mak Cik ini berasa sukar untuk makan? Mungkin segan untuk bercakap? Atau segan untuk memberi seulas senyuman? Atau sisa makanan sering tersekat di kawasan yang tiada gigi? Boleh jadi juga gigitan sudah tidak seragam kerana ketiadaan beberapa batang gigi?

Atau ada gigi yang goyang akibat tekanan yang tinggi kepada gigi yang masih ada ketika mengunyah? Atau?

Beliau menyambung. Wajahnya yang tadi tampak tenang kini melahirkan kedutan di kiri dan kanan.

“Mak Cik tak dapat nak mengaji!”

Tersentap saya mendengarnya. Sambungnya lagi,

“Doktor, susah Mak Cik nak sebut huruf-huruf tertentu. Bunyi lain, maksud jadi lain. Memang Mak Cik tak menjaga gigi. Tapi Mak Cik tak sedar bila tak ada gigi rupa-rupanya bukan sahaja susah nak makan dan nak bercakap pun segan. Tetapi bila dah nak pergi haji baru Mak Cik rasa sukar hendak mengaji.”

Kualiti hidup anda ditentukan dengan bagaimana anda melihat erti kehidupan itu sendiri. Jika anda merasakan hidup anda bererti apabila anda boleh membaca al-quran dengan baik, maka ingin saya tekankan bahawa gigi anda yang tiada memang mengganggu kelancaran sebutan huruf-huruf tertentu.

Memang gigi palsu dan tanaman gigi (dental implant) boleh memberi penyelesaian, namun tiada yang sebaik gigi original dan rawatan itu sendiri ada pro dan kontranya. Tidak semua pesakit sesuai untuk rawatan yang dinyatakan. Tambahan lagi, rawatan itu bukanlah penyelesaian kepada masalah yang dihadapi.

Jadi anda bersetuju dengan saya bahawa gigi memberi impak kepada kualiti kehidupan anda? Mungkin saat ini sempena sambutan tahun baru 2012 kita patut mengambil sedikit masa untuk merenung bagaimana kita ingin menjadikan kehidupan kita lebih bererti. Apa sebenarnya yang memberi erti kepada hidup kita?

Jika kita ingin menjadikan kehidupan kita adalah sepenuhnya beribadah kepada Allah sepertimana yang dinyatakan dalam surah Adz-Dzaariyaat ayat 56, saya ingin tegaskan 2 perkara.

Pertama, kebersihan adalah sebahagian daripada iman. Islam mengajar kita untuk sentiasa memastikan kebersihan, maka tidak hairanlah mengapa Rasulullah sendiri membersihkan gigi setiap kali sebelum solat! Gigi yang bersih memberi jaminan bahawa anda menjaga kebersihan. Justeru semakin banyak bilangan gigi yang berlubang menunjukkan betapa anda bukanlah seorang yang pembersih. Adakah itu wajar untuk memanifestasikan tahap keimanan anda?

Kedua, kekhusyukan dalam beribadah menentukan sejauh mana bernilainya amalan kita di sisi Allah. Perbuatan yang tidak khusyuk mungkin melahirkan kesan yang tidak dikehendaki. Buktinya betapa ramai masyarakat yang bersolat tetapi masih melakukan maksiat. Saya melihat ramai pesakit saya merasakan kesakitan pada gigi sukar untuk dikawal. Ia sakit dan mengganggu aktiviti seharian mereka.

Sebagai seorang Muslim, adakah kita berasa mudah untuk khusyuk dalam solat jika gigi sedang sakit? Mungkin kita akan mempercepatkan solat? Malah kekadang ada yang langsung tidak solat. Apatah lagi ibadah sampingan yang lain. Memanglah kita tidak minta untuk sakit. Tetapi sakit gigi bukanlah suatu proses yang berlaku dalam tempoh sehari atau seminggu.

Tahun masihi 2012 adalah tahun baru yang diraikan oleh seluruh warga dunia. Setiap tubuh pasti mengharapkan tahun baru menjanjikan kehidupan yang lebih bererti untuk mereka. Saya ingin menyarankan anda untuk menjadikan tahun 2012 sebagai tahun permulaan anda untuk menjaga kesihatan gigi.

***

Beberapa pesakit datang mendapatkan pemeriksaan gigi,

“Are you coming for check up and scaling?” Saya bertanya kepada seorang pesakit yang berusia pertengahan 20 an. Dia adalah perokok.

“Yes, Dr. I want new teeth for new year!”

Saya gembira mendengarnya walaupun saya mengalami sedikit kesukaran ketika melakukan penskaleran(cucian) gigi kerana beliau adalah seorang perokok. Perokok sering mempunyai gigi yang lebih kotor berbanding bukan perokok.

Pesakit yang berusia awal 50-an ini menghidap kanser hidung dan tekak, Nasopharyngeal Carcinoma, NPC. Kalau giginya bagus pasti tiada apa yang perlu beliau risaukan tentang hakikat bahawa 11 batang giginya perlu dicabut untuk mencegah komplikasi akibat rawatan radioterapi kelak!

Nasihat saya, berjumpalah dengan doktor pergigian dan dapatkan pemeriksaan gigi segera. Keyakinan anda untuk berada di tengah-tengah masyarakat juga dipengaruhi oleh keadaan gigi anda. Dan orang juga mungkin menilai anda dengan melihat bagaimana keadaan gigi anda.

‘Kotornya.’

‘Ada hitam di tengah-tengah gigi.’

‘Nafas berbau.’

Sekarang anda bersetuju dengan saya bahawa gigi mempengaruhi kualiti kehidupan anda? Jika ya, dapatkan pemeriksaan segera!

Nota kaki:

Daripada Ibn Umar r.a. berkata: Rasulullah s.a.w. bersabda : “Jadikan bersugi itu satu amalan, kerana ianya (bersugi) menyihatkan mulut dan merupakan kesukaan kepada Maha Pencipta.” (Hadis Riwayat Al-Bukhari)
Jika tidak menyusahkan ke atas umatku, aku ingin menyuruh mereka melambatkan solat Isyak dan bersugi (menggosok) gigi setiap kali mereka hendak melakukan solat. (Hadis riwayat Muslim)
Sesungguhnya Allah SWT menciptakan jin dan manusia tidak ada tujuan lain melainkan hanya untuk beribadah kepada Nya sahaja dan hanya beribadah itu sahajalah jalan yang dapat menyelamatkan jin dan manusia di dunia dan di akhirat nanti. (Az Azzariyat : 56)
Sesungguhnya solat ku, ibadah ku, hidup dan mati ku adalah untuk Allah Rabb sekalian alam. (Hadis Riwayat Muslim)

Response To : Housemen Need The Hours

2011-12-18T00:41:00.000-08:00

Salam

This is a response to a letter by Dr Johan Ariff Juhari to The Star, published on 17th December 2011.

I praise the positive attitude to learn, shown by young doctors like Dr Johan. But I believe that as a house officer in his first posting, it is too early for him to make a fair judgement on our training system in Malaysia. What more in Orthopaedic Department, my colleagues would agree that his view doesn't reflect the reality on the ground.

We young doctors who demand changes are wrongly portrayed as pampered with bad attitude, due to unfair selective descriptions perpetuated in the media. On our talk with Dato' Dr Hassan, our current Director General of Health, I as a sixth poster house officer at that time, urged him to make the change to the system, even though there were people who were against it, especially the senior doctors. We would like to thank him for his courage to enforce the shift system.

We believe that the sudden influx of young doctors is compensated with the introduction of a longer 2-years housemanship training programme comprising of 4 months stints in six departments. These experiences have made us a more all-rounded young doctors. Senior housemen are more calm in handling emergencies and more well trained in doing manipulations such as rapid sequence intubation(RSI) than a minority of senior doctors, in my observance.

Not belittling the importance of exposure to patients, we have observed senior doctors, handling pediatric or pregnant patients, who had not had experience working in Pediatric or Obsteric & Gynecology departments, within the previous 1-year housemanship training programme. We as senior housemen sometimes do feel that we are in a better position to manage these patients.

Young doctors hope that we stopped looking at patients as mere 'intermediary' for training, but rather their health and rights as the central pillars of our healthcare system. We need to admit and remind ourselves that overworked doctors especially trainee doctors are hazardous to patients.

Rather than defending the status quo, I urge my fellow colleagues to use that extra hours to sharpen and deepen their knowledge to what they had learnt during their working hours. This is a change to a routine work-exhausted-home-sleep-work daily cycle.

As my colleagues who worked in university hospitals, where housemen intake are less and work are more, said, "I just do the work, but sometimes I do not have the time to learn what I am doing."

With the new shift system, we hope our fellow generation of doctors would strive and push themselves to become better doctors than the previous generation in terms of knowledge, skills, ethics and profesionalism.

Patient's Story 1:Pak Cik's train..

2011-12-12T06:54:00.000-08:00

As doctors,we spend a lot of time talking to patients and some of them have such interesting stories and habits that made them more memorable than the usual "cough and cold"

I have the habit of telling the most memorable ones to my wife during our long commute to Kuala Balah and one day she said"I think you should write them"

So here goes,it may be nothing to others,they may not learn anything from this..but I think..should write this..

Pak cik's train...

When I was in my medical posting, I was attached for a few months at hospital Kuala Krai along with two buddies of mine.

Our usual workday consist of doing rounds in the ward,with the MOs or specialist,doing the chores they ordered,then going down to the clinic to see outpatients.

There I met an interesting patient,a pakcik with heart problems and was admitted to our hospital a few months before.

He lives in a rural village deep in Gua Musang and the only way he can come for follow ups is by a train after trekking for a few kilometers from his village.

The problem was that the train will go through his village only in the morning and later in the evening.

If he takes the morning train,he would arrive near midday to the station in Kuala Krai and after taking the bus/taxi to the hospital he'd arrive at noon,when the clinic was already closed(we only open till 1 pm).

So, still keen for our follow up,he decided that the best way was to take the evening train 1 day before his date,spend the night on the hard aluminium couch in the waiting area of the clinic(he can't afford accommodations and have no relatives in Kuala Krai)!

He never complained and in the end we only noticed what he was doing after a few follow ups...

Some of us collected money to help him with the commute even though he never asked for it.

A few months ago,I met a friend still working in Kuala Krai and asked her about the pakcik,she told me that they now made an exception just for him,the doctors will see him at 3-4pm so that he can catch up his both of his trains...no more sleeping on the couch

So busy doctors out there..You may be tired with a throbbing headache from the sleepless night before,but remember when a patient comes to you,he may be spending the cold night on the couch spending rm40 for the trip while he makes only rm5 perday...ask him..

Wallahualam

Kebahagiaan Doktor Di Tangan Anda

2011-12-05T01:59:00.000-08:00

Semua jadi teruja. Ada kaki yang menari mengetuk lantai. Ada tangan kiri dan kanan saling berpaut. Ada yang mulut terkumat-kamit membaca sesuatu. Ada yang tersenyum seorang diri. Ada juga yang termenung.

Saya pula memang tidak senang duduk sejak tadi. Kaki dan tangan tidak seirama. Berdebar-debar menanti nama dipanggil.

“Doktor Yuliana.”

Terus saya bangun dari kerusi dan bergerak beberapa langkah ke hadapan. Sampul surat berwarna putih itu saya ambil dengan kedua belah tangan dan digenggam erat di sisi kanan tubuh. Sesampai di tempat duduk, semua sudah riuh. Saya terpinga-pinga.

“Yu, sampul surat putih ini kualiti murah. Boleh tembus dalam.”

“Ha?” Saya menyahut dengan kening terangkat.

Seawal tadi pihak urusetia program induksi ini telah memberi amaran supaya membuka surat tawaran penempatan bekerja setelah selesai semua nama dipanggil. Tetapi nampaknya kemampuan berfikir di luar kotak oleh sesetengah pegawai pergigian yang baru dilantik ini sedikit sebanyak mencacat keterujaan.

Saya memandang sampul putih itu. Tersenyum melihat nama di depan beserta alamat rumah. Nafas ditarik dalam sambil mata tertutup kemas, mulut saya berbisik,

“Akhirnya.”

Lantas sampul surat putih itu diangkat tinggi melepasi kepala. Cuba dihalakan ke arah lampu terang di siling dewan ini.

“Aish, tak nampak pun!”

Sampul itu diletak kembali ke atas meja. Suara-suara keterujaan rakan-rakan semakin menjadi-jadi. Saya sedikit tidak tentu arah. Hendak buka tidak diberi kebenaran. Arahan itu dihormati. Perlahan-lahan saya menekan sampul putih itu dan tertembuslah tulisan yang lebih 2 bulan saya nantikan.

***

Keesokan paginya. sekali lagi saya menerima sampul putih. Kali ini keterujaannya sedikit berbeza. Kali ini tiada pula amaran untuk tidak membukanya. Namun, saya berasa cukup berat hati untuk melihat isi kandungan di dalam. Dengan kalimah doa, akhirnya terteralah ayat-ayat yang tidak dinanti-nantikan.

TUAN/PUAN,

DENGAN DUKACITANYA DIMAKLUMKAN RAYUAN ANDA TIDAK DITERIMA.

Penyataan ini cukup menerangkan segala isi kandungan surat tersebut. Saya tidak mampu menatap keseluruhan isi surat. Titik demi titik air membasahi pipi dan bertambah deras dengan perasaan yang berkecamuk. Mata menjadi kabur dan segala hiruk pikuk dalam dewan diabaikan. Kawan-kawan mendekati dan memberi pelukan semangat, beserta kata-kata pemangkin untuk jiwa yang lemah.

Hanya satu perkara yang menekan saya daripada untuk terus berfikiran positif dan menerima ketentuan Allah dengan redha.

Keluarga.

***

Pagi berganti petang, petang berganti malam, malam berganti pagi membawa kepada putaran masa yang tidak pernah berhenti meninggalkan kita. Ia diibaratkan sebagai nyawa kerana terlalu berharganya masa itu kepada kehidupan seseorang bernama manusia.

Sudah hampir setengah tahun saya di sini. Sudah 5 bulan, sudah 20 minggu, sudah 140 hari, sudah 3360 jam, sudah 201 600 minit dan sudah 12 096 000 saat.

Kinek tok, kamek udah pande kelakar Melayu Saghawak! (Sekarang ini, saya sudah pandai berbahasa Melayu Sarawak!)

Makna kata, benih yang baik jika ditaburkan di tanah yang bukan kebiasaannya pun dengan keizinan Allah pasti boleh tumbuh dengan baik. Semuanya terletak atas diri kita. Bak kata pepatah melayu, masuk kandang kambing, mengembek. Masuk kandang harimau, mengaum. Itulah adaptasi yang kita perlu lalui. Jika tidak sekarang, mungkin suatu masa nanti.

Jika dahulu air mata menjadi pengiring kepada sebuah perjuangan di perantauan, kini tiada setitis pun yang jatuh di kepulauan borneo ini. Tidak setitis pun sejak kali pertama kaki saya menjejakkan di sini pada Julai 2011.

Menyorot perjalanan kehidupan kita, semuanya mempunyai kisah yang berbeza. Kisah-kisah ini wajar diteladani untuk manfaat bersama. Memang pada awalnya negeri ini tiada langsung dalam senarai penempatan bekerja yang saya idam-idamkan. Memang ia jauh. Sejauh beribu kilometer dari kampung halaman.

Tahukah anda bahawa Sarawak adalah negeri terbesar di Malaysia juga pulau ketiga terbesar di dunia yang mempunyai kepadatan penduduk lebih 2 juta di atas tanah seluas 124,449.51 kilometer persegi? Tahukah anda bahawa Sarawak mempunyai lebih daripada 26 kumpulan etnik termasuklah Iban, Cina, Melayu, Bidayuh, Melanau, Kayan, Kenyah, Lun, Bawang, Penan, Kelabit, Kedayan, Bisaya, Berawan, Lahanan, Sekapan, Kejaman, Punan, Baketan, Ukit, Sihan, Tagal, Tabun, Saban, Lisum dan Longkiput?

Saya tidak dicampakkan di sebuah pulau yang terasing. Sebaliknya saya ditempatkan di sebuah pulau pelbagai etnik yang tidak terdapat di mana-mana negeri di semenanjung!

Allah ada mengingatkan orang yang bersyukur kepada Allah akan diberi nikmat yang berganda-ganda. Orang yang rugi adalah orang yang tidak tahu bersyukur dan menganggap setiap sesuatu yang berlaku adalah musibah yang menjejaskan keharmonian kehidupan mereka. Sebagai hambaNya yang serba daif siapalah kita untuk mengandaikan bahawa kita tahu nasib kita di masa hadapan. Dia tentu lebih tahu.

"Jika kamu bersyukur maka Aku (Tuhan) akan menambah (nikmat) itu kepada kamu.” (Ibrahim:7)

“Boleh jadi kamu benci kepada sesuatu padahal ia baik bagi kamu, dan boleh jadi kamu suka kepada sesuatu padahal ia buruk bagi kamu. Dan (ingatlah), Allah jualah Yang mengetahui (semuanya itu), sedang kamu tidak mengetahuinya.” (Albaqarah:216)

Justeru, selaku pekerja di bidang profesional, kita perlu sedia maklum bahawa ilmu yang kita timba selama bertahun-tahun perlu sedia dipraktikkan dan berkhidmat dengan mana-mana hospital atau klinik di seantero Malaysia. Anda perlu bersedia untuk dihantar kemana-mana sahaja di kawasan-kawasan yang kekurangan pegawai perubatan dan pergigian terutamanya Sabah dan Sarawak dengan masing-masing memiliki nisbah 1:2248 dan 1:1709 untuk pegawai perubatan(1). Bagi pegawai pergigian bilangannya agak kritikal iaitu Sarawak kekurangan 50% tenaga profesional(2) ini manakala Sabah memiliki nisbah yang besar iaitu 1:20,000 berbanding 1:7000 seperti yang disasarkan(3).

Saya sendiri melihat betapa ramai sahabat-sahabat saya di bidang perubatan mahupun pergigian tidak dapat berkhidmat di tempat yang mereka inginkan. Ada yang membuat rayuan sehingga sanggup tidak berkhidmat lebih 2 bulan kerana menanti keputusan rayuan oleh Kementerian Kesihatan Malaysia.

Ini baru cubaan pertama untuk kita yang baru mula bekerja, belum lagi yang lain-lain. Cubaan penempatan yang sebenarnya patut lebih mudah kita hadapi bagi seorang pelajar di bidang perubatan dan pergigian jika hendak dibandingkan dengan pelbagai cabaran yang telah kita harungi semasa belajar dahulu.

Andalah yang memilih untuk menjadi bahagia. Anda ialah bakal doktor ataupun sudah bergelar doktor. Kebahagiaan doktor di tangan anda.

Bahagia hanya untuk anda yang redha.

Doktor Yuliana kini berkhidmat sebagai doktor gigi di Hospital Umum Sarawak.

Rujukan:

Houseman shift system - it's not all bad as portrayed

2011-12-02T10:23:00.000-08:00

There is a lot of talk about the houseman shift system lately, and I heard a lot of feedbacks be it from the mouths of the doctors, the newspapers, social media like facebook, twitter, and blogs. I am one of the lucky few houseman who has got chance to experience housemanship in two ways; first half of my housemanship doing oncalls and second half doing shifts, equally divided three postings each. And I have the privilege to make a comparison between the two.

Since the beginning of an era, the main complains of doctors anywhere in the world are that they are being overworked and underpaid. Now that houseman are not overworked and underpaid anymore, why do we still complain? We should have been grateful that the whines of the past 50 years have finally realized in 2011! I really really bet you that all those who have been thru housemanship would really wish that their work hours were less back then. Heck even I wished for lesser work hours when I was in 1st till 3rd postings, when the oncall system was in place.

I was quite opposed to the idea of the shift initially. But as I go through it, I don’t think it’s all bad. As I mentioned in my previous post, the number of houseman is increasing. The government cannot possibly increase the number of patients to cater for the increasing number of houseman. To force us do more frequent calls will not increase the frequency of the patients we see as we are forced to do calls with few other houseman, about 3-4 houseman in one ward. Shift system makes us see more patients more frequently albeit in a shorter period of time.

The result of lessening the work hours are inevitable; we shall see much less patients and thus allegedly lacking clinical exposure. The good old consultants may claim that in their olden days they saw much more patients, they did more oncalls, they had more horror experience with their bosses, they managed the ward, the clinic, the operation theater alone as houseman while their bosses came in to work late, some even play golf.

With due respect, in the olden days the mortality rate is much higher, in the olden days you could not possibly be taking care of 40 patients and finish your work perfectly, in the olden days the diagnostic investigations were not as available and lavish as the current days, in the olden days there were not so many treatment options and patient care guidelines, in the olden days the nurses were damn good and efficient not having to call houseman for a simple IV line, in the olden days time is not wasted on petty documentations, in the olden days there is much less medicolegal cases, in the olden days you don’t even know what HIV is, some subspecialties were not known to mankind, some recently classified diseases were not even disease yet. Really, I do not think of anything to be proud of back then. And we do not appreciate horror tyrannic bosses as we do not appreciate a hostile working environment.

I do not mind listening to the tales of the specialists on how it was during their good old days. It actually gives me more inspiration to strive harder. But you can not, really can not, expect things to be as same as the olden days. Things change. So should the working attitude.

This lessening of work hours have implications on houseman clinical exposure as well. Some specialists have been proposing for entrance and exit exam of housemanship, with continuous department level assessments. I do not mind that at all, given that it is somehow true that clinical exposure has been much less and some HOs bring quite the worrying attitude, even to the other HOs. If the higher ups are really keen towards producing safer medical officers at the same time lessening the work hours, they must find a mechanism to assure the public that we are safe doctors.

So yes, we work lesser hours. That gives us more quality rest time and social time, like any other normally functioning human being. Apart from physical health, mental health is also very important. We do not want any doctors to be fatigued or psychotic or depressed. If you think that the current medical officers and specialists are really great with their mental health, try to be more observant. Few of them are really just making other people’s lives more miserable! No, they are not teaching or scolding houseman at a clinical error. They simply swear, they yell, they degrade and humiliate their juniors, they make people feel awful all the time. Do you think a normal human being would do that? I understand that as a houseman in the good old days you were also being constantly harassed and insulted, and claims that made you a better doctor. But does it make you a better human being? Does Allah almighty give you the rights to insult your juniors? I don’t remember He gave those privileges to His prophets.

Previously housemen are just being scorned within the walls of the hospitals, but now they humiliate housemen in newspapers and social media. The reason is they want the public to know how lousy we are, and watch out for the graduates of this and that countries. I do not know what good that can do. They mentioned that housemen are being spoiled and mollycoddled, but in fact the public should be more worried about the mental health of some medical officers and specialists as they are the clinical decision makers who are fatigued and psychotic. Lucky I only met few people like this in my hospital. These people ask respect from us and yet they treat houseman like idiots. And we have to respect them, how??

Some of medical officers are not without irresponsible attitudes. I remembered there was one patient who was seen by neuromed in Emergency Department the day before, but I mistakenly referred to another neuromedical MO as a new case. After she did her 3 page review, she yelled at me “Why are you refering this case to me? This case was refered yesterday to another MO! Why didn’t you call him? Why do you waste my time doing all this useless shit?!”… Excuse me, a patient is a useless shit?? I admit my mistake for the wrong referral, but to say that a patient is a useless shit??? Some other MOs did not even come when called for help or opinion. Some even said “ask your houseman friend lah how to manage.” Some MOs become over-apprehensive when a case is refered to them. They specialists mentioned about a lot of houseman with lackadaisical attitude, but what about your MOs? Irresponsible MOs with attitudes are far more dangerous, don’t you know that? Some of them are just psychotic beyond borders because they are allegedly stressed out.

I have worked with some MOs and specialists who really teach houseman. It is long and tiring rounds but the rounds are brain stimulating. The problem is some of them prefer resting time or doing administrative works over bedside teaching, and scorn us for being low in quality. Ironically they work in a teaching hospital. Yes it’s annoying if a houseman doesn’t know the basics, but if you do not even teach, you can’t put blame on them. I am not proposing breastfeeding, I am proposing tighter supervision. Some houseman even get the basics wrong that you must really correct. If you are concerned that housemen are of low clinical quality, then you should do something about it. If not concerned, please take your rest time, and make peace about our quality.

I do feel shame that my bosses (the medical officers and specialists) are working harder than me. There should be a mechanism to limit their working hours as well. A fatigued medical officer and specialists are more dangerous than a fatigued houseman. A fatigued houseman after an overnight call can still function like a robot, following orders from the superior. But a fatigued medical officer and specialists will endanger patients as they are the ones giving orders and supervising the juniors, and they are bound medicolegally.

I am two postings away from becoming a medical officer. I do not mind doing oncalls all over again as I had done it before and I enjoyed doing oncalls. But as more of my batch of houseman are becoming medical officers, I hope that the government revises the working hours for medical officers as they are currently the most hardworking group of doctors, covering the houseman’s works especially when the housemen go home after their shifts. As I mentioned, I do feel embarassed that my medical officers are working harder than me.

Why am I writing this? Because I find it true, to myself at least. When I started my first posting as a houseman in surgical department, I always dreaded coming to work everyday. There was once I had a sleepless call due to multiple emergency operations. I couldn’t help my colleague at 4am to take morning bloods in the ward as I was still in Operation theater till 7am. The next morning rounds, I was so screwed by the specialist for not taking LFT of a patient post op. He pulled my tie to him and threatened me with extension, in front of patients, nurses and my colleague. I explained to him I was in operation that time, but he just said you houseman are making lame excuses, so stayback till 11pm tonight. Mind you I was postcall and it was a weekend! And that kind of things did not happen just once.

My temper back then was very unimaginable. I honked on the roads all the time, I was really a reckless and fast driver, I yelled at waiters and customer services, and I was swearing curses like I don’t care, even to my parents. I slept dreaming of my dreadful bosses. I look tired even when I am not oncall or postcall. After starting shift system at my fourth posting, I found out that I have been much less stressful, even I forgave a driver who accidentally hit my honda city quite easily. And frankly, I feel happier coming to work each morning, and I do not feel like quitting medicine as much as I have posted in this blog before.

I now love my job as a doctor. I want to brush up on my clinical skills, though I know it takes some time. And I do care about my own health, physically and mentally. Change in the working attitude really needs a paradigm shift. Few specialists already on board for lessening work hours. We hope the other majority follow suit. Please take note that a physician burnout is no small issue. I am sure those who are medical officers and specialists now wished their housemanship in the past to be less tedious and less dreadful.

For further reading

http://www.kevinmd.com/blog/2011/10/life-medical-resident-mexico.html

http://www.kevinmd.com/blog/2010/08/burnout-doctors-stressed-physicians-hurt-patients.html

Kenapa Nak Jadi Doktor?

2011-12-01T08:34:00.001-08:00

"Kenapa nak jadi doktor?" Rasanya itu soalan skema, skrip standard mana-mana tempat dalam Malaysia.

Serasa sejak sekolah rendah, kalau disuarakan yang cita-cita hati nak jadi doktor, mesti soalan "kenapa?" menyusul.

Kalau zaman muda, berhingus dulu, pastilah jawapan sebegini yang keluar.

"Saya nak tolong orang yang dalam kesusahan."

"Saya nak jadi kaya."

"Doktor disanjung masyarakat."

Kalau kini soalan itu ditanya pada rakan-rakan pelajar perubatan, skema jawapannya masih sama. Cuma ada tambahan, mungkin.

"Mak ayah suruh."

"Saya minat biologi, Tak pandai matematik."

tak kurang yang menjawab " im born to be a doctor. WOW!"

Walau apapun sebab luaran anda, pastikan sebab dalam anda kukuh

Kerana bidang perubatan tak seindah yang kita nampak secara lahiriah atau superficial macam dalam drama atau filem.

Kata professor saya, tak cukup sekadar hasrat nak membantu orang. "Bagaimana nak membantu orang, kalau diri kamu sendiri kelak tidak terbantu?"

"Kamu bersengkang mata, tak cukup tidur. Kena herdik dengan pesakit, kena marah dengan doktor pakar lagi. Staf tarik muka dengan kamu, betul kamu rasa niat kamu nak 'membantu manusia lain;' itu dapat menyelamatkan kamu? Keluarga kamu terabai, makan pakai suami entah terjaga entah tidak? Betul kamu jadi doktor hanya atas sebab mahu tolong orang, disanjung, atau kaya?"

Professor senyum sinis, pelajar-pelajar perubatan yang mendengarnya ada yang termenung panjang, ada yang tersipu-sipu. Tak kurang ada yang mencebikkan muka.

Jadilah apapun yang kamu mahu. Jadikanlah ia kerana Allah, kerana agamamu.

Lalu professor itu tersenyum lagi. Diajaknya semua pelajarnya berfikir.

"Ayuh kita betulkan niat."

Dalam hidup kita, akan ada banyak perubahan. Contoh senang.
Tahun ni kita suka makan kuih cara, tahun depan mungkin kuih lapis pula.

Bagaimana minat kita boleh berubah, jadi jangan disandarkan pilihan kita pada minat semata-mata. Minat boleh berubah. Pada bila-bila masa. Teguhkan minat dengan niat.

Pekerjaan ini merupakan satu ibadah. Ya, menjadi doktor satu ibadah, menjadi tukang kebun juga ibadah, menjadi pekerja kantin juga ibadah. Betulkan niat anda.

Jom! ^_^

Dr dah ramai, dr muslim, belum ramai lagi. - Konvo UiTM 2011

Housemanship

2011-11-27T07:49:00.000-08:00

Alhamdulillah. Sedar tak sedar sudah satu tahun saya bergelar seorang houseman. Housemanship adalah antara fasa yang paling mencabar bagi seorang yang ingin bergelar seorang doktor dan ingin memilih bidang perubatan sebagai cabang kerjaya pilihan. Setelah menghabiskan satu tahun, ini bermakna saya masih lagi mempunyai satu tahun untuk dihabiskan sebelum ditauliahkan dengan sijil pendaftaran penuh oleh Majlis Perubatan Malaysia yang membolehkan saya praktis di mana-mana sahaja di Malaysia.

Sedikit pengenalan mengenai konsep housemanship. Seorang houseman ialah doktor pelatih yang baru sahaja menamatkan pengajian di mana-mana sekolah perubatan dan berada dalam satu period pemerhatian dan penilaian sebelum dia boleh dilepaskan untuk berkhidmat dan bertanggungjawab penuh di atas segala keputusan yang dibuat terhadap pesakit. Housemanship adalah satu proses untuk kita menterjemah apa-apa yang dipelajari semasa sekolah perubatan ke dalam bentuk praktikal. Inilah masanya untuk kita aplikasikan apa yang dipelajari dengan realiti dunia sebenar. Kalau dahulu tempoh latihan housemanship hanya mengambil masa selama setahun, saya fikir sekarang akibat kebanjiran graduan-graduan oversea, maka kerajaan terpaksa memanjangkan tempohnya kepada dua tahun. Saya rasa ini merupakan langkah yang wajar. Bakal-bakal doktor yang datang dari pelbagai sistem yang asing ini perlu diintegrasikan dengan system yang Malaysia amalkan untuk mengelakkan kekacauan kelak. Selain itu, dari empat posting sahaja dalam masa satu tahun, sekarang kami berpeluang merasa enam posting dalam masa dua tahun. Enam posting ini adalah Jabatan Perubatan Am, Jabatan Pembedahan Am, Jabatan Orthopedik, Jabatan Paediatrik, Jabatan Obstetrik dan Ginekologi dan juga Jabatan Kecemasan. Di sesetengah hospital sudah ada yang menawarkan pilihan untuk menjalani latihan di Jabatan Anestesiology buat para houseman. Walaupun mungkin ada yang akan argue bahawa kini kami terpaksa melalui waktu kesengsaraan yang lebih panjang, namun sebenarnya banyak perkara positif yang dapat diambil.

Hospitalku yang permai.

Hidup sebagai seorang houseman sebenarnya adalah penuh dengan cabaran-cabaran yang saya rasa bukan semua orang mampu hadapi. Semasa system on-call masih diamalkan tidak lama dahulu, adalah perkara yang biasa untuk seorang houseman tidak tidur selama 36 jam tanpa henti. Semasa hari on-call dahulu, biasanya saya akan punch-in ke hospital pada pukul 7 pagi seperti pekerja pejabat yang biasa. Pada pukul 5 petang, biasanya rakan-rakan yang tidak on-call sudah boleh pulang macam pekerja pejabat yang biasa juga namun para doctor yang on-call akan tinggal di hospital sehinggalah 7 pagi keesokannya, lalu disambung dengan waktu kerja seperti rakan-rakan lain yang baru sahaja punch-in sehinggalah pukul 5 petang hari tersebut. Kalau bernasib baik bolehlah tidur 2-3 jam sewaktu para pesakit semuanya ok, namun kalau kena hari yang kurang bernasib baik, meletakkan kepala di atas meja selama 10 minit pun sudah dikira bertuah sangat. Sudahlah begitu, secara purata seorang houseman diberi kuota cuti 8 hari dalam tempoh suatu posting yang sepanjang 4 bulan tersebut. Ada sesetengah boss department yang baik hati membenarkan cuti tambahan hujung minggu sebanyak 2 hari dalam sebulan. Ada pula boss yang tegas tidak langsung memberikan sebarang cuti lain kepada houseman. Houseman tersebut terpaksa bekerja selama 7 hari dalam seminggu dan memohon cutinya yang berbaki 8 hari tersebut kalau ingin berehat. Atas desakan banyak pihak, sistem on-call kini sudah dimansuhkan dan diganti dengan sistem shift. Namun implementasinya masih berhadapan dengan pelbagai masalah sehingga menyebabkan masih banyak hospital yang mengamalkan sistem on-call. Secara jujurnya di hospital tempat saya bekerja di mana sistem shift sudah diamalkan, para houseman lebih gembira dengan kehidupan mereka sekarang walaupun masih terdapat pelbagai masalah dengan kualiti kerja yang dihasilkan. Mungkin saya akan ulas berkenaan perkara ini kemudian.

Selain tekanan masa kerja yang membebankan dan sangat meletihkan, seorang houseman juga berhadapan dengan tekanan daripada para superior mereka yang terdiri daripada para pegawai perubatan dan pakar perubatan. Kena marah di hadapan pesakit, rakan-rakan dan staf hospital yang lain adalah perkara yang menjadi rutin harian. Perkara ini sebenarnya mungkin well-justified kerana para houseman biasanya lebih cenderung untuk membuat kesalahan-kesalahan bodoh (akibat mamai dan kepenatan) seperti terlupa order ubat-ubatan yang penting untuk pesakit, terlupa hendak review pesakit dan sebagainya. Houseman yang mamai dan penat ini bekerja dengan para pegawai perubatan yang mamai dan penat juga, ditambah pula dengan para pakar yang penat dan stress sebab terpaksa membetulkan atau menanggung akibat daripada kesalahan yang dilakukan oleh para houseman yang mamai dan penat ini juga. Bak kata mat saleh, the vicious cycle continues. Secara kesimpulannya, bekerja sebagai seorang doctor adalah kerjaya yang penuh dengan stress factor dan seorang houseman perlu bijak menangani stress untuk survive.

Tidak ada gunanya jika hanya pandai teori semata-mata. Houseman yang baik juga perlu bijak berkomunikasi dengan pasukan tempat kerjanya. Kebajikan para pesakit akan lebih terpelihara jika semua pihak bekerjasama. Adakalanya houseman sahaja yang bertungkus lumus membuat kerja sedangkan staf-staf yang lain bergoyang kaki, sibuk bersembang sambil mengunyah-ngunyah kudapan di pantry hospital. Pernah juga terjadi akibat ketiadaan/kekurangan orang sepatutnya di dalam wad, para houseman pula yang terpaksa mengambil alih tugas mereka. Dalam masa yang sama, seorang houseman walaupun bergelar seorang doktor, tidak boleh bertindak mengarah staf-staf lain yang lebih rendah pangkatnya ibarat mereka itu amah Indonesia. Houseman yang bossy biasanya akan dipulaukan oleh para jururawat/staf sokongan yang lain dan ini seterusnya akan menyusahkan kerja seseorang houseman di masa hadapan. Malah ada juga yang dikenakan oleh mereka dan menanggung akibat dimarahi oleh superior kita. Di sinilah terletaknya kebijaksanaan seorang houseman untuk berkomunikasi dengan baik, memupuk silaturrahim yang mesra sesama anggota hospital dan dalam masa yang sama memastikan setiap kerja yang diamanahkan kepada setiap orang berjalan supaya para pesakit tidak teraniaya. Apabila suasana bekerja yang mesra dan harmoni, biasanya seseorang houseman itu akan lebih bersemangat untuk datang bekerja dan memberikan servis yang terbaik kepada para pesakit. Saya pernah berada di dalam sebuah department yang kerjanya hanya mencari salah orang apabila sebarang masalah berlaku terhadap para pesakit. Kita pun berasa meluat hendak datang kerja. Saya juga pernah terdengar cerita seorang houseman wad NICU paediatrik di sebuah hospital lain yang dimarahi oleh boss sebab seorang ibu tidak menyusukan bayinya yang baru lahir atas alasan bayi tak mahu menyusu. Kelakar bukan?

Ular ini yang telah mematuk pesakit saya siang tadi. Adalah penting untuk mengetahui spesis ular tersebut kerana lain ular, lain kesan bisanya terhadap badan. Maka cara kita merawat pesakit juga berlainan.

Walaupun kerjaya sebagai seorang doctor adalah penuh dengan liku-liku cabaran dan onak duri, sebenarnya kerjaya ini dapat memberikan kepuasan kepada orang-orang yang dapat melihatnya dengan penuh hikmah dan mengambil sisi pandangan positif. Sebagai seorang pelajar perubatan dahulu, biasanya lingkungan sosial saya adalah di kalangan rakan-rakan yang sekepala, senasib dan boleh dikatakan berada dalam suatu tahap keterpelajaran dan pemahaman yang sama. Bila menjadi seorang doktor, barulah saya berpeluang untuk bergaul dengan semua lapisan masyarakat. Ya, tidak ada pekerjaan yang berhubung dengan lingkungan masyarakat yang seluas ini melainkan dalam bidang perubatan. Dari golongan pegawai tinggi kerajaan, pegawai professional, suri rumah, pelajar IPT, makcik pakcik petani di kampung, warga asing termasuklah pendatang tanpa izin, golongan pondan dan maknyah, penagih dadah, dan orang kurang upaya, seorang doktor perlu bijak mengubah bahasa dan lenggok badan yang digunakan untuk berkomunikasi dengan semua golongan ini. Bila kita bercampur dengan mereka semua, hati kita biasanya akan menjadi lebih lembut dan lebih memahami. Tidaklah semua benda kita akan kritik sahaja. Sebagai contoh seorang pakcik tua dari kampung yang selalu ponteng temu janji dengan klinik pakar. Selalunya pesakit-pesakit begini akan datang kemudian ke jabatan kecemasan bila keadaan mereka sudah semakin melarat dan tidak dapat diselamatkan. Selalunya kita akan cenderung untuk memarahi pesakit-pesakit begini kerana mereka cuma menyusahkan pihak hospital sahaja. Bila diselidiki barulah diketahui bahawa punca kenapa tidak datang temu janji adalah kerana tidak ada duit hendak menaiki teksi ke hospital. Hendak naik bas, tidak boleh jalan. Hendak tumpang kereta anak, sudah diabaikan oleh anak-anak. Bila kita lebih memahami kisah-kisah mereka, kadang-kadang terasa seperti hendak menitiskan air mata pula.

Walaubagaimanapun, saya berasa bimbang apabila melihat sesetengah rakan sejawatan saya yang tidak mempunyai expectation yang realistik berkenaan dengan kerjaya ini. Ya benar, mungkin title doktor itu kelihatan gah di kaca mata masyarakat. Dr. House juga kelihatan sungguh macho dikelilingi oleh para pelakon lain yang tampan dan cantik-cantik belaka. Hakikatnya yang sebenar bukan begitu. Saya kadang kala berasa sedih mendengarkan keluhan rakan-rakan sejawatan yang asyik mengeluh gaji tidak cukup. Sebagai seorang yang berpendapatan RM3500 sebulan, sebenarnya sudah lebih dari mencukupi untuk hidup dengan begitu selesa. Saya rasa ini merupakan salah satu punca kepada kebejatan perkhidmatan kesihatan kerajaan. Apabila semua doktor demand bayaran yang tinggi, kerajaan pun tak mampu bayar maka mereka berhijrah ke hospital swasta. Dalam masa yang sama, kebanyakan masyarakat awam pula bertegas hanya mahu bayar RM 1.00 bila berjumpa dengan doktor di klinik kerajaan. Doktor semakin kurang di hospital kerajaan, pesakit pula semakin ramai. Doktor yang tinggal berhadapan dengan tekanan kerana terpaksa melayan begitu ramai pesakit yang kadang kala menunggu hingga 5 jam untuk berjumpa dengan doktor di klinik. Dalam masa yang sama tidak adil pula untuk menyalahkan doktor yang meminta bayaran lebih apabila kita memikirkan situasi kerjanya yang begitu mencabar. Masalah ini semuanya kait-mengait dan tidak wajar jika kita hanya mahu menyalahkan satu pihak sahaja.

Banyak yang saya pelajari sepanjang satu tahun bergelar houseman. Saya belajar bagaimana untuk bertenang berhadapan dengan situasi kritikal, menguruskan tekanan, menghormati dan memahami pesakit, berkomunikasi dengan boss dan juga orang yang lebih rendah pangkatnya dari kita dan yang paling penting saya banyak belajar tentang makna kehidupan dan kebergantungan dengan Tuhan.

Buat para pelajar perubatan, jadilah seorang doktor yang ingin menjadi seorang doktor, bukannya kerana hendak mencari sumber mata pencarian. Kerjaya ini sepatutnya begitu innate dalam diri kita seperti kita menjadi anak kepada ibu bapa kita dan seperti kita menjadi hamba Allah yang bertanggungjawab. Kehidupan sebagai seorang doktor adalah sangat menarik sebenarnya. Insya Allah saya akan berkongsi lebih banyak kisah-kisah menarik dan buah fikiran saya di masa hadapan.

Shall I Compare Thee To A Summer's Day

2011-11-26T15:40:00.000-08:00

No one likes to be compared.

No one, but NO ONE likes to be compared unless the comparison is made with them being
the more superior. Of course.

Perhaps, it’s a middle child syndrome. Perhaps it’s just me. Growing up, I absolutely loathed being compared to my more brainy elder sister. My parents, I was certain, did not love me enough. Or loved me less, I thought.

But later, MUCH later, I came to realize that comparison can be viewed in a positive light if one could actually sit and reflect on the basis of the comparison being made.

Just forget the hurt. Forget the emotional defense we erect against the (imagined) feeling that we are not appreciated. Do not even speculate of the feeling that the comparator may have about you when he/she makes that comparison.

Do not torture yourself in that manner, I beg you.

Turn the situation around and make it beneficial to you.
Sit and reflect.

****
“Look this is terrible. When I was in Australia….” I could not stop myself had my life depended on it. I gave myself a mental shake to just quit the tirade before I start.

But I COULD NOT.

I told myself, people will get tired of hearing you comparing Malaysia to Australia. Or they will hear what you say thinking you are a snob; someone who after 5 years of being abroad, has totally gone berserk making this and that comments about Malaysian Health Care system. Or they will think that you are trying to broadcast the fact that you are overseas grad. Macam bagus, chet!

But look, I wouldn’t compare if I didn’t care.

I couldn’t help it. I care. Too much. I am not an outsider, working overseas, looking at us critically. I am an insider, working in Malaysia, looking at us critically.

My parents can criticize me and compare me to my sisters all they like. With them, the intention is clear; they want me to be better. Not the best, but better. But would I tolerate the same treatment from strangers? Of course not (well, not meekly and not without serving them one or two of my branded sarcasm). Because the intention is questionable. Why would you criticize me when you don’t have any stakes in my success nor my failures? Unless you, as a total stranger can SOMEHOW convince me that you love me like my parents do and want all that is good for me, you must be either a busybody with nothing better to do, or you are a chronic impulsive backbiter, or you are just the sort of person who likes to criticize just for the sake of criticizing; criticize in order to hurt or brag.

But I have stakes in the success or failures of the health care system in Malaysia. I chose to work here.
Whatever I say that may hurt the feelings of anyone in the system, hurts me just as much. Let’s not our disagreement in what is only my opinion, spring forth from my limited knowledge as a mere mortal, cause friction against us who works in the system. Let’s disagree, COURTEOUSLY. Ladies act like ladies; and gentlemen behave like gentlemen. Have we so quickly forgotten the restrained elegance of our ancestors when they deign to have a conversation?

“Tuan hamba yang bijaksana, hamba khuatir kelancangan kata-kata tuan hamba akan menyebabkan kita terjerumus ke dalam daerah binasa. Hamba fikir tuan hamba terlepas pandang akan beberapa perkara penting sewaktu melontarkan buah fikiran tuan hamba sebentar tadi.”

Masha Allah, it’s hard to be offended if everybody can converse in that way, don’t you think? Everyone competing to top one another with regards to not only who can say the best of things, but who can say them in the best of manners!

To quote Imam Syafi’e "Never do I argue with a man with a desire to hear him say what is wrong, or to expose him and win victory over him. Whenever I face an opponent in debate I silently pray - "O Allah, help him so that truth may flow from his heart and on his tongue, and so that if truth is on my side, he may follow me; and if truth be on his side,I may follow him."

With that framework firmly in mind, let us begin this discussion.

***
So, how do Malaysian Health Care System compare to that of Australian?
Comparing two complicated health care system is quite impossible without the right direction of looking at things.

It’s not as easy as saying “They have this, they don’t have that. But we have this, and we don’t have that.” It would be too simplistic and not fair to either system.

For example, the internship program in Australia is characterized by careful supervision by your boss (registrar, advanced trainee or specialist). They don’t get to do procedures so much. They are more or less, a clerk. But then, they are not expected to be independent once they have finished their internship. Even if they are posted to other non-tertiary hospitals (our equivalent of district hospitals), they would still be supervised by their seniors. There is not much GREAT need for them to just go ahead and do procedures while they are an intern because those skills can still be learned under supervision when they are no longer an intern. Supervision is expected throughout your training. Besides, how MUCH attempts do you need to be supervised for before you are competent enough to do it on your own? Remember episiotomy? I have never done one as a student! But when I became a houseman, I witnessed two episiotomies, I attempted one under supervision, and then I did the rest on my own. The same can be said for peritoneal tapping, plureal tapping, peritoneal dialysis and so on and so forth. The dictum of “See one, do one and teach one” is true. So for the interns in Australia, there is no great need for them to do procedures because their health system is designed for them to be closely supervised until they themselves become a specialist.

But for us in Malaysia, the housemen must be able to do procedures after housemanship is completed because we will be posted in the district hospitals where there won’t be any specialist to guide us all the time.

So, for everything that they do or don’t do, and for everything that we do and don’t do, there are reasons behind it and it wouldn’t be fair to simply compare at face value. The reason lies on how the health system is designed.

That’s why you cannot simply mix and match one system with another.

You cannot aim to work like the interns in Australia with the aim of being an independent MO in the district. That would be dangerous. And, we cannot expect them to work like us with so many procedures to be done because they are taking care of a lot more patients than we do. While we only take care of a few patients in our cubicles, they are taking care of 30 patients scattered all over the hospital.

So it would be really difficult to compare without going into details regarding the reason that lies behind it.

Why don’t I simply tell you how they work over there, and you can make the comparison on your own?

The interns over there work in a team. The team consists of a specialist, a registrar (our equivalent of an MO), an intern and sometimes a medical student. So if you are doing medical posting, you will be with the same specialist and the same registrar for a few months. That’s your team! If the chemistry is right, you will enjoy getting to know each other and work together as a team. If anything happens to any of your patients, you know exactly who to call who would know about the patient in details.

Your patients are not in any particular ward. You cannot just say “Oh, now I am working in ward A”. Instead, your patients are scattered all over the hospital.And you will be taking care of them from the day they are admitted until the day they are discharged.

We have this term called ‘on-take’. So let’s say on Sunday, specialist A is on-take; that means any medical patients admitted on Sunday will be assigned to be under the care of specialist A…regardless of which medical wards the patients end up to be. So some of the patients may be at ward A, and some others might be at ward B, C, D and so on.

During office hours, the casualty doctors will call the registrar in team A to see the medical patients. But the registrar in team A do not have to be on-call at night. We have one medical registrar working at night in casualty who would see the cases and later pass them over to team A in the morning.

Team A will know about these patients because at 8.00 am every morning, there is a morning meeting (breakfast provided, too *wink wink*) where all specialist and registrars and interns would gather. They would discuss a few ‘bizarre’ case that was admitted that night, and passover the patients to the specialist who was on-take that day.

So on Monday, it would be specialist B who is on-take and each day it would be different specialist until you get back to Sunday.

So can you imagine how the work load is like? On Sunday, team A would have lots of new cases (their patients can be as much as 20-30)…but as the week progress they will be discharging a few patients already without taking anymore patients for the rest of the week. By the time they get to Thursday, team A may only have 10 patients. And then on Sunday, they will have another influx of new cases.

You will be given a list (printed by a clerk) of who your patients are and in which wards are they in. The list will have one empty columns where the interns can write what need to be done at the end of the rounds. If team A is also an infectious disease team, then team A will also round the infectious disease patients.

Clinics will be on the day when you are not on-take. So for Team A, clinic would probably be on Tuesday and Thursday. Not on Sunday.

All specialists will do the full rounds on the day of their on-take to know all the new cases and discharge a few patients to allow for some empty beds. Some specialists do rounds everyday of the week. But most would only do the full round 3-4 times per week. When they have clinics, they will do partial round, seeing only critical cases.

So your real best friend is the registrar who you will be with day in and day out. Sometimes, the registrars will help you with discharges when they are too many. You will do procedures with the registrars too. The registrar will help you out because you are a team….the smooth running of the team depends on both of you. If the interns couldn’t cope, the registrars will pitch in. Besides, during the day when your team does not have any clinics, what else would the registrar do after rounds, right?

Well, if the interns can cope, the registrar can go to the library and study, of course. Usually you are quite free during the days when you are not on-take and no clinics. It’s quite common to see registrars and interns studying in the library.

The interns start working at 8.30. The registrars sometimes comes at 8.30 too. The specialist comes at nine. The interns would update the investigation done on the previous day. At nine, they would go and see their patients together. Interns are not expected to know the cases well when patients are first admitted. But they will know the case well as the week progress, since they are seeing the same patients daily.

In one particular week, (usually Wednesday), there would be compulsory intern teaching from morning until noon. All interns would attend, and the registrar will take over the interns role for that day (except for the discharge summary, of course, but some even do that! Such registrars are angels in disguise!) so that the team will continue running. There is no need for the interns to sacrifice their teaching day just because they are worried that no one will carry out the orders of that day. The academic part of being a doctor is very much supported and they make the week as such that you will have one busy ‘on-take’ day, and then as the week progresses and a lot of patients under your team are discharged, you will become less and less hectic and will be able to go to the library and study.

As you can see, that kind of schedule is beneficial for everyone. We all have exams, right? The registrars can study as the week progress and become less hectic, the interns also have their own academic program without them having to worry about who will carry out the urgent orders for the patients, and the specialist can also have a few days of free times for their journal articles.

And they are able to do all these without feeling like they have not attended the patient properly; they are able to be ‘academic’ yet their mortality rate is better than ours who saw patients everyday (sometimes TDS!!) and work 36 hours straight some more!

They also have weekends off, except if it is their turn to do weekends call. They will be working the same amount of hours as the office hours.

After a few months of being in a team, working during office hours, it would be your turn to work afternoon or nights. If you work in the afternoon, you will start from 3.00pm to 11pm for a week. If you work at night, you will start from 11 pm to 8am and then attend the morning meeting for one hour. You will do this for a week (so that you don’t have to adjust your circadian rhythm quite so rapidly) and then go back into your team after 2-3 days of holiday. During pm and nights, you cover half of the medical wards (and the other intern will cover the other half) mostly attending unstable patients and do the brannulas. You don’t have to cover ICU, CCU, CRW….that’s the anaest’s kingdom and you are not needed. The anaest manage their patients by themselves.

Clerking new cases are already properly done from casualty. You don’t need to re-clerk the patient in the ward, as what needs to be done would have already been done before patient came into the ward. In the morning would be soon enough for the patient to be seen again.

For unstable patients, they have the term MET Call (Medical Emergency Team call). This is basically a 24 hour service system that rapidly responds to calls from medical staff about patients that meet the MET calling criteria. The MET consists of a medical registrar, intensive care registrar, and an appropriately accredited nurse from the ICU. There’s no need for you to call the medical MO who is busy clerking case in casualty. The RRT will come with resuscitation bag (like a luggage bag) where all the equipments are kept. They can come quite fast, less than 3 minutes.

But how do you know when to sound the alarm? Do you wait until the patient collapse first and only then sound the alarm?

Well, they don’t wait until the patient collapse before sounding the alarm, of course. They have rapid response criteria or MET criteria, which when I was a student I could remember quite well. But basically it consists of the vital signs that exceeds certain limits. The nurses will let you know about any patients that fulfill the MET calling criteria, you have to decide whether or not you need to sound the alarm. The decision bit is the hardest part as we try to encourage interns to treat the patients and not the numbers. However, you won’t get scolded for any false alarm as long as the patient meets the criteria because the aim of the MET call is to PREVENT adverse outcomes (namely cardiac arrest, severe respiratory depression, ICU admission) rather than to react to the outcomes. But you have to at least evaluate the patient’s baseline vital signs before calling the MET, and after having done that, you will be able to justify why you call them.

So I’ll feel safe working nights over there. I know if I am worried about any patients who may or may not collapse, I can always sound the alarm and the MET call people will come. They will first come and then ask what’s going on while assessing the patient. There’s no need for you to call the Anaest and present the case first, and then wait for the decision of whether or not they think you have justified yourself enough to call them. They will come first, and then later if they think the patient is fine, they will teach and discuss with you like academicians and professionals do.

When they discharge patients, they will discharge the patient back to the patient’s GP (In Australia, a GP is a specialist; like FMS). So you will give the discharge summary to the GP as well. All patients will have one GP. If they don’t have a GP, they won’t be able to access Medicare (their subsidized medical care). Usually, they’ll be seeing the same GP for the rest of their lives unless they move elsewhere and need to change GP. In that case, the GP will transfer the patient’s files and mailed it to the new GP. This is good in terms of we don’t need to worry about the follow up of the patients if it is a general medical patients. There’s no need to follow up hundreds of patients in the hospital clinics. Unless you think the patient needs special attention, only then you schedule the patient to see a cardiologist/chest/infectious disease/rheumatologist/ gastroenterologist etc etc. Otherwise, the GP is more than adequate when it comes to managing the patient’s primary health care. If the GP feels she couldn’t handle the patient within her expertise, she could refer the patients to the specialist clinic as well.

Actually it will take a whole lot longer than one post to talk about any health system. But I will just summarized what do I find different between our system and their system.

1) They don’t get to do procedures like we do. They have less clinical experience than us. However it depends on which shoes you are on. If you are a patient, you will say I would like someone other than interns to do my episiotomy, right?

2) They have a lot of supervision until they become specialist themselves. While we are expected to be independent in the district hospitals.

3) They respect the academic culture. They don’t just tell you to go to teaching while at the same time leave you to worry about the radiological investigation that need to be done that they had ordered STAT!

4) They don’t have to work hard, missing the sunrise nor sunset, in order to be efficient.

5)You will be caring for the same patients from the day they are admitted until the day they are discharged. There is no such a thing where you have to suddenly be in charge of a patient whose file is already as thick a a novel and you have to study through them.

5) They would disagree with you, they are annoyed with you and you will know it too. But you don’t know it just because they scream at you. No, they can find other subtle ways of letting you know that you need to improve. Very creative, them!

I hope that this will give a clear picture of the working culture in Australia compared to in Malaysia. But everywhere you are, you get the good and the bad. Let’s make it a point to make sure that the good outweighs the bad.

Assalamuaaikum, and until the next posting, insya Allah, take care

Suara Doktor Muda

2011-11-17T18:34:00.001-08:00

KEDOKTORAN

Bidangkedoktoran adalah sebuah bidang pekerjaan yang mulia. Meringankan kesengsaraanseseorang manusia adalah satu perbuatan suci, yang suatu ketika dulu dalamkepercayaan pagan dikaitkan dengan kuasa keTuhanan.

“Kita tidakakan benarkan polis tangkap seseorang pesalah yang datang mendapat rawatan dihospital.....” kata seorang doktor pakar.

Sekaliketika bekerja atas panggilan di Orthopedik, protokol menuntut pembedahanseorang warga asing ditangguh dahulu sehingga bayaran dibuat oleh pesakit.Pesakit itu juga merayu untuk dibenarkan makan kerana sudah lama berpuasamenunggu untuk dipanggil. Hari yang terlalu sibuk menyebabkan saya tidak dapat berhubungdengan doktor yang lebih senior. Akibatnya saya dimarah oleh registrar keranatidak melaksanakan apa yang terbaik untuk pesakit, bukan apa yang pesakitmahukan.

Begitulahkeunggulan etika kerja kedoktoran. Namun imej kedoktoran kini sudah tercalar.

CABARANKINI

Dunia telahberubah menyebabkan pesakit sudah berubah. Maka bidang kedoktoran juga semakinberubah.

Dulukesilapan dilakukan doktor dimaafkan oleh pesakit. Mungkin pesakit sendiritidak tahu doktor telah membuat kesilapan(yang kecil). Dulu apabila pesakitmati, keluarga percaya doktor telah buat yang terbaik. Sekarang keluarga akanpercaya doktor telah membuat kesilapan.

Dulu HO yangmembuat semua appendicectomy di hospital kerajaan. Kini ada pesakit yang tidakmahu HO menyentuhnya langsung. Ada doktor yang angkuh berkata, “Dulu masa akuHO, blablabalalala.....”

Merekatidak faham bahawa dunia sudah berubah.

SERANGANMEDIA

Ceritanya begini,generasi doktor muda telah diserang pelbagai tohmahan daripada media. Dikatakanakibat melimpahnya jumlah bilangan doktor baru lulusan dalam dan luar negarayang dipersoalkan kualitinya, para pegawai perubatan siswazah(HO) tidakmendapat latihan yang sepatutnya. Malah mereka dilabelkan dengan frasakegemaran doktor tua, tidak kompeten.

Apa yangmengejutkan, kita generasi muda rasa seperti ditikam dari belakang, apabilarakan sekerja daripada bidang kedoktoran sendiri membuat tohmahan secaraterbuka di media. Sepatutnya ianya dibincang dan diselesaikan secara dalaman.

Tidakkurang pula doktor muda, ibu bapa dan malah pesakit sendiri yang mengadu dalamsuratan ke media akan sikap doktor tua dan juga suasana kerja yang teruk.Mungkin mereka juga patut membincangkannya secara dalaman.

Masalahnyatiada ruang diberikan kepada doktor muda untuk bersuara. Itulah masalahnya.

BEZA MINDA

Doktor mudadilabelkan sebagai pemalas, manja, tidak kisah tentang pesakit, tidak sanggupbekerja lebih masa, tidak profesional dan segala sikap negatif lain.

Namunmereka tidak menceritakan sebahagian lagi cerita di mana mereka dimaki hamun didepan rakan sekerja dan pesakit, dijerit, dimalukan, diugut dilanjutkanpenempatan dan pelbagai tindakan destruktif lain. Doktor tua memerintah sepertipanglima tentera.

Kebanyakan doktor muda keluar universiti dengan semangat meluap-luap untuk mengamalkan ilmuyang mereka pelajari dan membantu masyarakat. Mereka bukanlah pemalas danmanja, tetapi mereka sebenarnya telah hilang motivasi bekerja apabila diperlakukan sedemikian.

Kami kisahtentang pesakit kami, lebih berbanding doktor tua yang hanya 2 jam berada diwad. Manakala kami menjaga mereka sepanjang hari dan malam. Titik nokhtah.

Doktor tuamelihat kerja untuk jangkamasa yang terlalu panjang adalah pengorbanan yangsepatutnya dibuat oleh setiap doktor. Doktor muda melihat kerja sedemikianmembahayakan bagi pesakit kerana mengundang kesilapan berlaku. Ianya jugamelanggar hak asasi seorang pekerja.

Sebenarnyagenerasi doktor muda memerlukan inspirasi, dorongan dan panduan ringkasdaripada doktor tua. Kerana itulah yang akan membuat mereka berusaha,bersemangat dan memberikan yang terbaik dalam kerjaya mereka. Dimalukan dandimaki tidak menjadikan kami doktor yang lebih baik.

Sebahagiandoktor tua memilih dengan sedar, mengamalkan budaya kerja negatif. Mereka meluahkan perasaan marah, angin tidak baik pada doktor muda, tetapi bertopengkan kononnya ingin melatih mereka. Ramai doktor tua tidak bersikap profesional.

Saya inginmeminjam kata-kata mereka. Ini adalah kepimpinan yang TIDAK KOMPETEN.

PERLUBERSUARA

“HO tu apa?HO itu Hamba Orang.”

Kita doktormuda dijadikan seperti hamba kerana kita sendiri pilih untuk menjadi hamba.Kita tidak bersuara dan membenarkan diri kita diperkotak-katikkan. Hanya turutsaja perintah. Ya, kita rasa penat bila bekerja dan takut dilanjutkanpenempatan. Penat dan takut – kita benar-benar seperti hamba.

Kita tidakboleh berharap bahawa perubahan itu akan berlaku secara beransur-ansur. Berharapapabila kita menjadi doktor tua nanti, kita akan mengubah budaya kerja.Lihatlah sebahagian daripada doktor muda yang sudah berkelakuan seperti doktortua. Jika tunggu sehingga tua, kita kelak akan sedar betapa banyak sampahditinggalkan mereka, dan kitalah nanti yang perlu mengutipnya.

Doktor mudajuga perlu sedar, usaha ini bukan untuk kepentingan diri kita semata-mata,tetapi kepentingan rakan sekerja, bakal-bakal doktor, pesakit dan juga deminegara tercinta. Jangan kita pentingkan diri sendiri dengan berdiam diri danmenunggu perubahan berlaku.

Doktor mudaperlu mula bersuara.

Ultras Doktor Muda
'Until the last rebellious HO'

SEBUAHCERITA

Dulu ketika saya seorang mahasiswa perubatan,rasa tidak sabar untuk mula bekerja dan mengaplikasikan ilmu yang telahdipelajari. Namun sebaik bekerja, rasa terkejut. Terkejut terhadap suasana danbudaya kerja kedoktoran di Malaysia, tanah tumpahnya darahku. Menyaksikanpenderaan mental dan emosi terhadap diri dan rakan sekerja lain.

Sewaktu lalu di bahagian radiologi JabatanKecemasan, di sebuah hospital kerajaan ,terdengar tangisan di sebalik pintu. Ingatkan ada anak kecil yang tersesat.Saya tolak pintu dan terlihat seorang rakan HO dari jabatan lain menangis disitu. Dia malu dan cuba tutup daripada nampak air matanya. Tetapi bila cubabertanya kenapa beliau menangis, dia tidak dapat tahan lagi tangisannya.

“I’ve tried my best.... I really do!!.....butthey still say I am incompetent.....isk isk.” Aaah, perasaan apabila dimalukan dan dilabelkansebagai tidak kompeten di depan khalayak ramai.

Doktor muda perlu sedar, mereka inilah antaragolongan yang kita perlu lindungi. Ada sesetengahnya sudah menjadi MO, adaramai juga yang telah berhenti. Ya, ada kawan saya yang telah berhenti akibattidak tertahan dengan penderaan sedemikian. Doktor tua kata mereka inilahgolongan yang lemah dan tidak layak menjadi doktor.

Mungkin inilah antara peristiwa yang menanamdalam diri, secara separa sedar, semangat keberanian untuk bersuara. Untukmelindungi rakan seperjuangan kita.

Tidak pelik masalah mental bakal menjadimorbiditi tertinggi di masa hadapan, kerana doktor sendiri mengalami tekananmental melampau.

Medan Perjuangan

2011-11-07T00:12:00.001-08:00

PENUBUHAN

Dua orang blogger berbincang dan bersetuju untuk menubuhkan sebuah blog kompilasi. Sebuah blog yang akan mengumpulkan penulis-penulis di kalangan doktor muda muslim. Apabila suatu usaha itu berlandaskan niat yang baik, maka usaha itu disertai oleh pejuang yang lain.

Blog ini bertujuan untuk membina perpaduan atas ukhwah Islamiyyah di kalangan doktor generasi muda. Sebagai satu ruang untuk kita berkongsi fikiran dan pandangan, pengalaman susah dan senang. Dengan harapan hasilnya, melahirkan generasi doktor muda berwibawa daripada sudut perspektif Islam.

Dengan adanya ruang ini, diharap doktor muda akan mendapat ubat bagi kelukaan jiwa akibat suasana kerja yang negatif. Agar memberi sokongan dan semangat bagi kita terus berusaha menjadi doktor berkaliber.

Kerana kami juga melaluinya.

PENTAS

"Kata-kata orang muda bagaikan ubat yang pahit. Tetapi kalau tidak makan ubat, bagaimana 'sistem kesihatan' akan bertambah baik."

Begitulah mengapa blog ini dinamakan UbatMuda. Sebagai pentas untuk doktor-doktor muda melahirkan buah fikiran dan berdebat secara ilmiah mengenai isu-isu yang akan mempengaruhi masa hadapan mereka. Kerana kita kini hidup dalam dunia yang mendengar apa yang selalu dikatakan, dan bukannya apa yang benar.

UbatMuda adalah medan perjuangan.
Bagi mereka yang menjadikan penulisan sebagai medan perjuangan.

HARAPAN

Untuk berubah menjadi lebih baik, doktor-doktor muda dijemput untuk menyumbang artikel-artikel karangan sendiri. Dengan percambahan idea, insyaAllah akan membawa kepada persiapan dan keberanian, yang akhirnya dimanifestasikan dengan tindakan.

Salam perjuangan.