When You're A Doctor...

When you're a legit doctor and have been in service for over five years but your family members still insist on bringing your grandmother to a specialist to adjust her blood pressure medications.

Happy International Doctors Day

Apparently today is International Doctors Day. 

When I decided to embark on this journey, I couldn't quite foresee how extensive it would be, and how much I would be changed by the conscious choice to embrace the Hippocratic Oath. 

The field of medicine is so vast, and I'm forever thankful to have been exposed to wonderful mentors and had the opportunity to rotate around a variety of departments until I found a field to call my own. 

There is so much I have had the opportunity to learn as a doctor - to speak gently, to break bad news, to be able to stand by my patients in their grief, and on the other side of the spectrum, to share their joy and thankfulness. 

Sometimes the learning curve isn't just about the science and the knowledge. 

I learnt to dream big from my specialists in infectious disease, who played a crucial role in getting RVD drugs introduced and subsidized in Malaysia. I gained confidence and overcame a fear of public speaking through my orthopaedic postings. I learnt the importance of teamwork through my emergency rotation, and how to appreciate the importance of primary care through my community posting. 

I'm thankful to have had the opportunities I've had in my short career so far, and it's changed me as a person for the better. To my fellow colleagues, wherever you are and wherever you are going, it may seem like an uphill battle at times, and it may seem like the world doesn't quite understand - but medicine truly is a calling. 

Keep fighting the good fight. 

Happy Doctors Day!

Why Do I Bother Being A Doctor?

Being a doctor can be tiring. 

There are moments on the job where I wonder if it is a path where I truly should be on, in those selfish moments of fatigue or uncertainty, in those harried moments of a patient’s life slipping through as we frantically try to bring him back, in those quiet moments where I doubt my capabilities. 

There are moments where work seems non-stop, where we seem to be fighting a losing battle against the collective ignorance of a community. 

There are moments where I don’t know enough, or I don’t know at all. 

At times like this, it really is important to sit back and evaluate what I’ve decided to do, and search deep within myself to ask why I continue to do what I do – in a job that is sometimes thankless, definitely underpaid and ever so often, feels like a losing fight. 

Why do I bother?

I bother for you, the father who told me how life was never the same after his heart attack, and how he wished he had taken better care of his health in the past. 

I bother for you, that little old lady who was ever so thankful at the advice I gave for her diabetes and her sugar control, and her appreciation at being advised holistically. 

I bother for you, the student who managed to quit smoking after attending a quit smoking program – a hard won battle where many others have failed. 

I bother for you, the young boy who lost his leg in a motorcycle accident, and found the strength to proceed with a leg amputation and learned to walk again. 

 I bother for you, the harried mother who thanked me at being able to give her sick child some relief, even though I felt it wasn’t much relief at all. 

There are many instances that I remember making me smile, making this job a little less thankless, and that keeps me grounded as to the blessing of health that I have, and the opportunity I have to help others. Sometimes it’s in the rare instances that twinge at your heartstrings and reminds me that this job is truly a privilege, and one that I need to perform to the best of my abilities. 

We all have to find our reasons. It is only when we truly understand what we do that we can find the strength to continue, wherever in life we may be, or whatever we're doing.

Yet Another Loss

When I first received the text from a specialist in my old hospital, my heart caught in my chest. Yesterday, the medical fraternity lost another doctor to the clutches of fatigue, in a scenario that is unfortunately all too common for us in this field. 

Dr Afifah was a medical officer in my old hospital, and her story strikes too close to home. I cannot imagine what her family and loved ones are going through, and can only pray that they find the strength to pull through these difficult times. 

We've all been there. 

We've all known someone who has fallen asleep for a microsecond at a point when we were too tired during our jobs; from the harmless swerve of the steering wheel, to the more sinister material or physical losses. 

 We've all made jokes about how tired we were, complained about how little sleep we've had, told our little anecdotes about how we've fallen asleep on patients - as if it's become something so absolutely normal in the course of our daily lives, almost like a badge of honour in our job as doctors. 

Perhaps we were luckier than our other colleagues who did not do as well. The concern among senior doctors is the prevalent belief that your skill is equivalent to the amount of hours worked. That by getting rid of the oncall system we'll produce less efficient doctors, that the health of our patients will be compromised. 

There are too many things to be taken into consideration, many sides to the tale, but as a medical fraternity, it is important to sit down objectively and figure out a system that will strike that balance between medical competency and the wellbeing of us doctors. 

Truth be told, that could have been me. 

It could have been any one of us.

Musing About the Government Health System

Sometimes I think we doctors continue working in the government because it keeps you grounded. 

You see patients who need you, not those who can afford your services. You see those from all walks of life, from the scared old lady who has no idea why she’s ended up in hospital, to the poor uncared-for gentleman whose children have abandoned him, to those individuals who feel entitled to certain services because of their class and rank. You really do see it all. 

You learn that patients are the same, regardless of who they are, or what they earn – all blood, muscle and tissue underneath our different skins. They’re the same uncertain individuals underneath that bluster, but it’s the way they deal with their illnesses that makes all the difference. 

There are times when working in the government sector is tough and disillusioning. There are times where you feel like you want to just see patients, but being a doctor is more than just patients, and as the administration work piles up, it is easy to become jaded with the system – until you remember your patients. It’s them that keep you there, like a life line that reminds you every day why you do what you do. 

Sometimes it feels like you haven’t done enough, or you cannot do enough, and there are days where you despair because humanity is much too harsh at times, and we have all had those moments where we’ve all become a bit too involved with our patients, only to realize we have to slowly pull ourselves back and find that balance between our professional selves and ourselves. 

You see your patients, day in, day out, and cross your fingers that you don’t burn out. It is the core challenge that lies with most clinicians these days.

The government system has its pros and cons, but what I would love most is a greater flexibility at work. A system of shared hours for those who wish to balance a personal and professional life, and a public/private clinic division – an incentive that I’m certain would help retain the number of specialists, and give them the opportunity to focus on their areas of interest.

It’s a pipe dream, but all dreams start from somewhere. In the meantime, I still look forward to work, and hope that every day I’m doing a little bit of good for the world.

News Should Be More Than Words on A Page

I often find it frustrating to read the news, especially when I feel that there is a lean towards sensationalist journalism than actual investigative reporting. It is disheartening enough to realize the news is full of doom and gloom, from the subject of rape to the decapitation of young children, and most reporting seems to be a mere glossary of the events come by. 

It was particularly jarring to read the headlines of the papers today, which proclaimed ‘Naked Doctor Found Dead in Hospital Alor Gajah’. 

Now, there is news, and there is news, and there is a way to report news. 

The language of the reporting, which was plastered in both Malay and English newspapers is particularly disrespectful. We are not so far removed from death that we ignore the fact it is an actual process that has happened to an actual human being, and thus still deserves some measure of respect. And to a government doctor, a profession that traditionally implies a certain generalization of character which has chosen to serve other humans in need. 

Was it absolutely essential to emphasize how this poor individual was found naked, in the toilet? 

Was it essential to conjure up that image of this person, immortalized in death in the news, in a less than dignified state? 

Do these reporters even realize that this was an individual, whose family was probably in shock over the news, and to hear the death of their son announced in such a way while they were still grieving, is a slap in the face? 

This was an individual who had chosen the sacrifice of time in the field of healing, one who had been on night duty attending to these patients the night that he passed away instead of being with his loved ones as so many of us had the privilege of that very same night. 

The basic tenet of humanity, to even allow this individual a passing of life with some respect seems to have been lost in the dredges of what is considered news, and what editors expect will sell newspapers. 

I think it is time that we remember that the news reports real-life stories, of real people, not just words on a page with no link to those that they are writing about. 

I support the protest made by Dr Jim Loi, President of MPCAM (Medical Practitioner’s Coalition Association of Malaysia) requesting a public apology for the distasteful article that had been published and is now doing rounds on the Internet. 

**Edit: It was later reported that the doctor involved was suffering from a chronic illness of sorts and there was no suspicious circumstance regarding his death.

Start to A New Life

It's been a busy enough start to this chapter. 

Working in a government clinic, where things are done manually, where patients bring in books filled with doctors notes where I scratch my head to decipher the writing of the previous doctor to come to conclusion with the diagnosis - is a far cry from the ease of using a computerized system that I was used to in my previous hospital. 

I see about 50 patients on my own, and half the time I'm desperately trying to remember the official clinical guidelines off my head so I can make a decision based on good clinical practice as opposed to just starting something based on experience. 

I realize the burden of healthcare and how it stretches across the board, to these well-meaning kampung folk who come in and listen to your spiel, and hope that your clinical skills are enough not to miss the things that shouldn't be missed, and that your conversation with that little old lady about her diabetic medications should be remembered. 

 I'm tired at the end of the day, but it seems worth it. 

Times like this I'm glad I do what I do.

Now I just have to keep the momentum and keep learning the things that I do not know.

Reporting for Duty

This week marks my official transfer as a doctor in Selangor to a medical officer in Johor. 

I reported to the Johor State Department of Health on Monday and discussed with the officer in-charge regarding my posting, requesting Muar as I had family in the area. 

For those who are unaware of the intricacies of the government service, young doctors completing their housemanship in Klang Valley (which include Selangor and KL) are required to do a minimum of one year service in the district Those who are married are given priority to be as nearby to their partners as possible, depending on the availabilities of openings per state, which is very much a transient thing. 

For a majority of us who have grown up in Klang Valley, the uprooting process is something unsettling, especially since the process is sometimes fraught with administrative challenges. During your final posting as a houseman, you are given a form to fill in where you fill in your top three state preferences to be transferred to. If all goes well, you usually get an answer about a month before you finish your housemanship with a reporting date of approximately a month after you finish. 

You can call the officer in Putrajaya to check the status of your application as well (which I would advise, considering forms can get lost or delayed, in which case you have to deal directly with your human resource officers at your respective hospitals). If you are unhappy with your placement, you are allowed to appeal in hopes that the ministry will consider your appeal, should there be circumstances that merit your appeal. 

The downside of the whole process is the fact that when you’re given the reporting date of the state you are leaving for, you do not actually find out the actual hospital or clinic you have been assigned to until the actual date itself – such is the fate of us government servants. It is inefficient in the least, and doesn’t relieve any of the stress of relocating in the first place, without being able to organize accommodation or ask for advice regarding the areas you are being sent to prior to going. 

In addition, I was informed that because it was nearing the end of the year – and the government allocation per state and district for health services was rapidly dwindling, there was a possibility I would not be able to claim my relocation allowance. Sigh. 

While I do understand the need for us junior officers to go out to the district and learn the ropes of the health industry ground up, I do wish it was done in a more orderly fashion – one where we would have the ability to plan in advance. 

Relocating is never easy, even as a single person as myself, without the extra baggage of family to worry about – and without the promise even to be able to allocate accommodation for us officers at our placements, it does cause additional stress to the individual, and the government loses out on work hours from we officers who are forced to take leave to organize our move the week we actually report for duty. 

Thankfully, there were openings in Muar for medical officers and I made the two hour drive down to then report to the District Health Office. Just remember that you'll basically be filling in the same forms that you filled as a houseman - if your human resource officer didn't inform you what to bring (as I wasn't informed) - make sure you have a copy of your transfer letter, your reporting letter, your full registration, your KWSP form, your salary number, a copy of the front sheet of your bank statement and details for your statement of assets. Delaying these documents will delay the process of transferring your salary from your previous workplace to your latest one. Bring along passport sized photographs as well (I'm uncertain if this was a standard number for every state but I had to bring in four pieces).

Considering the hassle I had prior to actually reporting for duty, I was pleasantly surprised during when I reported to Muar – all the officers I met were so friendly, and were very helpful in advising me regarding the administrative duties I had to fill up. The first officer I met made the effort of introducing me to every single officer in the District Health Office (I have to admit I could barely remember their names by the end of it all). Unnecessary maybe, but it was a nice effort on her part. The staff members I met at my assigned clinic were also lovely, and most of them took the effort to welcome me to my service in the district of Muar. 

It was a very different experience from being part of a big city hospital and I think I am looking forward to what the experience will be like. I start my official duties soon, and I choose to take this opportunity to learn what I can. 

For those who have undergone the process, I salute you.

For those who will be undergoing your transfer soon, take heart and be positive.

A Period of Change

I know I’ve been delaying, but change has always been something that scares me a little bit. 

I’ve moved around many places, learnt to assert my independence through dealing with the needs of daily life, and survived through it all – but every single time it comes around to having to leave again, I have a mental freak out. 

This time it involves me leaving home to move to Johor for my district posting as a medical officer. 

Johor. A mere three states down South, between three to five hours away depending on which area of the state. I can’t imagine what I would feel like if I had to move somewhere further, like some of my colleagues who have been transferred to Sabah or Sarawak. 

It’s not the location. It’s the thought of change. 

I had the same feeling when I first had to leave Australia to move back home to Malaysia – a sense of trepidation, mixed with excitement. The thought of starting that new chapter, of meeting new people, and doing something new. 

Ironically enough I’ve always loved trying out new things, and I’ve always liked meeting new people – all issues that suggest a natural propensity for embracing change. However I’ve always seen that as a short term issues, of hellos and goodbyes – nothing like the act of moving from one place to another. 

There’s so much to miss and I’ve enjoyed and appreciated my time as a houseman in Sungai Buloh Hospital. 

It was one of the busiest periods of my life, from being oncall to transiting to the shift system; from the early hours at work to leaving late when needed. From the initial fear of procedures and diagnosis to a more comprehensive understanding of treating patients and dealing with the stressors that came with the job and the people involved. 

I learnt not just how to treat the disease, but how to treat patients as a whole, and a certain work ethic that came from watching my bosses deal with patients. I learnt from my colleagues, juniors and seniors alike, and learnt about the type of doctor I wanted to be. I learnt from my patients, those lessons that taught me humility and patience and the value of dignity. 

My specialists were fantastic and despite the hard work, I loved it. I would not have been the same without the training I’ve received and I can only hope this will be something that I am able to carry with me throughout my life.

On my transfer letter, my head of department even made the effort to write me a personal note on my transfer letter that left me warm and fuzzy and near tears at how one of the most senior doctors in the service made the damn effort to leave a personal note on a letter. Cost him nothing, and meant everything to me.

Change is here. It is inevitable. 

And despite my fears, I will face this head on, and learn what I can along the way.

May Allah bless my path.

 

Only Hope

There are times in my career that you realize what some things are all about. 

A patient in my ward deteriorated today. It wasn't something new - patients in the medical ward deteriorate all the time. Sometimes it's a progression of the disease. Sometimes, despite everything we do, it's their time to leave the world. 

He remained a medical conundurum of sorts, an elderly man who had been perfectly well on his anti-TB medications, save for some kidney complications. He suddenly started coughing up blood and ended up being electively intubated, ventilated on a machine to help him breath. I still remember him struggling as we intubated him, insisting that he could not breathe. I still remember taking his wife aside and telling her to be strong, and that hopefully he would survive this ordeal. 

Sometimes we sit there doing our best for patients, pulling out all stops in hopes that we will find that answer to the disease, to support the patient as their immune systems battle whatever underlying problems they have, and we forget that sometimes you need to put everything aside and start again. 

New diagnoses, new avenues of investigations. 

As we spoke to the family, I am reminded that a large part of our jobs include those beyond the patient - their families and loved ones, and despite us doing all we can, we must always prepare the family when a patient deteriorates. Telling family members is sometimes the most difficult part, and the most profound. Trying to express to them that perhaps it would be kinder to let the disease take it's course, and be prepared for the worst to happen. I don't hold back from participating in that grief, I know that their sadness is precipitated from the news that I tell them, that it is because of the possibility of their loved one dying that I've had to break these news. 

I know this is where I should be. 

I hope he survives this weekend and that when I come to work on Monday he will still be there. I hope that we have done something to help make him better.

I can only hope. But if it comes to that, I hope we have prepared his family to deal with the aftermath of that loss.

To Be Thankful

If you could live your life over, would you have chosen the paths you do now? 

I am at a point of my life where decisions need to be made; at crossroads with my career and an uncertainty over what will happen over the next few months. 

Who knew that being a doctor counted as a critical service? Long hours, a grueling job which is occasionally a thankless one, and pay that sometimes seems inadequate compared to the work we put in. 

Being a doctor is definitely not something for those who are not willing to dedicate themselves to service. 

I am thankful that I love this job. 

The hours are long, but every minute extra spent can make a difference in someone’s life, and every minute spent is pahala. 

The job is grueling, but it builds character – or reveals it – and helps you walk through the shoes of others who are less fortunate. It trains you and tests you so you are aware of your own inadequacies and fallacies, and keeps you humble. 

It is thankless at times, but even the most thankless of days is still one spent improving the life of another individual. 

Our pay may not be as high as those working in the private sectors, but Alhamdulillah, it is comfortable enough to live through. I have enough to live comfortably, to have clothes on my back and food on my table, and that is something in itself to be grateful for.

I am at a point of my life where I’ve had to evaluate my path, and found that perhaps it is not always the road not taken that makes all the difference. 

I wouldn’t have had it any other way.

There is still a lot of improvements that can be made in the working lives and the training of young doctors, and we are still far from being a country that emphasizes a work-life balance, but we are hopefully heading to a direction that will bring this service and our country from strength to strength.

It will be interesting to see what will happen in the years to come.