Response To : Housemen Need The Hours

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.

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

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

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Kebahagiaan Doktor Di Tangan Anda

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:

1. http://www.mstar.com.my/cerita.asp?sec=mstar_berita&file=/2010/4/23/mstar_berita/20100423143752
2. http://www.bernama.com/bernama/v3/bm/news_lite.php?id=496663
3. http://www.utusan.com.my/utusan/info.asp?y=2010&dt=0427&pub=Utusan_Malaysia&sec=Sabah_%26_Sarawak&pg=wb_05.htm

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

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

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Kenapa Nak Jadi Doktor?

"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

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Housemanship

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.

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Shall I Compare Thee To A Summer's Day

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

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Suara Doktor Muda

KEDOKTORAN

Bidang kedoktoran adalah sebuah bidang pekerjaan yang mulia. Meringankan kesengsaraan seseorang manusia adalah satu perbuatan suci, yang suatu ketika dulu dalam kepercayaan pagan dikaitkan dengan kuasa keTuhanan.

“Kita tidak akan benarkan polis tangkap seseorang pesalah yang datang mendapat rawatan di hospital.....” kata seorang doktor pakar.

Sekali ketika bekerja atas panggilan di Orthopedik, protokol menuntut pembedahan seorang warga asing ditangguh dahulu sehingga bayaran dibuat oleh pesakit. Pesakit itu juga merayu untuk dibenarkan makan kerana sudah lama berpuasa menunggu untuk dipanggil. Hari yang terlalu sibuk menyebabkan saya tidak dapat berhubung dengan doktor yang lebih senior. Akibatnya saya dimarah oleh registrar kerana tidak melaksanakan apa yang terbaik untuk pesakit, bukan apa yang pesakit mahukan.

Begitulah keunggulan etika kerja kedoktoran. Namun imej kedoktoran kini sudah tercalar.

CABARAN KINI

Dunia telah berubah menyebabkan pesakit sudah berubah. Maka bidang kedoktoran juga semakin berubah.

Dulu kesilapan dilakukan doktor dimaafkan oleh pesakit. Mungkin pesakit sendiri tidak tahu doktor telah membuat kesilapan(yang kecil). Dulu apabila pesakit mati, keluarga percaya doktor telah buat yang terbaik. Sekarang keluarga akan percaya doktor telah membuat kesilapan.

Dulu HO yang membuat semua appendicectomy di hospital kerajaan. Kini ada pesakit yang tidak mahu HO menyentuhnya langsung. Ada doktor yang angkuh berkata, “Dulu masa aku HO, blablabalalala.....”

Mereka tidak faham bahawa dunia sudah berubah.

SERANGAN MEDIA

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

Apa yang mengejutkan, kita generasi muda rasa seperti ditikam dari belakang, apabila rakan sekerja daripada bidang kedoktoran sendiri membuat tohmahan secara terbuka di media. Sepatutnya ianya dibincang dan diselesaikan secara dalaman.

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

Masalahnya tiada ruang diberikan kepada doktor muda untuk bersuara. Itulah masalahnya.

BEZA MINDA

Doktor muda dilabelkan sebagai pemalas, manja, tidak kisah tentang pesakit, tidak sanggup bekerja lebih masa, tidak profesional dan segala sikap negatif lain.

Namun mereka tidak menceritakan sebahagian lagi cerita di mana mereka dimaki hamun di depan rakan sekerja dan pesakit, dijerit, dimalukan, diugut dilanjutkan penempatan dan pelbagai tindakan destruktif lain. Doktor tua memerintah seperti panglima tentera.

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

Kami kisah tentang pesakit kami, lebih berbanding doktor tua yang hanya 2 jam berada di wad. Manakala kami menjaga mereka sepanjang hari dan malam. Titik nokhtah.

Doktor tua melihat kerja untuk jangkamasa yang terlalu panjang adalah pengorbanan yang sepatutnya dibuat oleh setiap doktor. Doktor muda melihat kerja sedemikian membahayakan bagi pesakit kerana mengundang kesilapan berlaku. Ianya juga melanggar hak asasi seorang pekerja.

Sebenarnya generasi doktor muda memerlukan inspirasi, dorongan dan panduan ringkas daripada doktor tua. Kerana itulah yang akan membuat mereka berusaha, bersemangat dan memberikan yang terbaik dalam kerjaya mereka. Dimalukan dan dimaki tidak menjadikan kami doktor yang lebih baik.

Sebahagian doktor 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 ingin meminjam kata-kata mereka. Ini adalah kepimpinan yang TIDAK KOMPETEN.

PERLU BERSUARA

“HO tu apa? HO itu Hamba Orang.”

Kita doktor muda dijadikan seperti hamba kerana kita sendiri pilih untuk menjadi hamba. Kita tidak bersuara dan membenarkan diri kita diperkotak-katikkan. Hanya turut saja perintah. Ya, kita rasa penat bila bekerja dan takut dilanjutkan penempatan. Penat dan takut – kita benar-benar seperti hamba.

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

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

Doktor muda perlu mula bersuara.

Ultras Doktor Muda
'Until the last rebellious HO'

SEBUAH CERITA

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

Sewaktu lalu di bahagian radiologi Jabatan Kecemasan, 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 di situ. Dia malu dan cuba tutup daripada nampak air matanya. Tetapi bila cuba bertanya kenapa beliau menangis, dia tidak dapat tahan lagi tangisannya.

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

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

Mungkin inilah antara peristiwa yang menanam dalam diri, secara separa sedar, semangat keberanian untuk bersuara. Untuk melindungi rakan seperjuangan kita.

Tidak pelik masalah mental bakal menjadi morbiditi tertinggi di masa hadapan, kerana doktor sendiri mengalami tekanan mental melampau.

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Medan Perjuangan

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.

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