Category Archives: Medicine

Dear anti-vaxxers you have your views, now listen to mine…

Posted on July 2, 2016 | 1 comment

I read with dismay when a young man compared death from preventable diseases to death from road traffic accidents and that all these were the will of God. There was a public outrage in Malaysia and that young man has since removed his post. I have no idea if he has repented but I believe ignorance is deadly and based on recent events, contagious. Indeed all men must die, but not all have to die stupid.

I have a nephew who was born recently. I only get to see him on Skype daily. He lives in another country. I was looking forward to seeing him this year but due to the outbreak of diphtheria in Malaysia, I advised his parents to postpone their visit as my nephew hasn’t completed his vaccination schedule. My fears are not unfounded. This is the reality we are living in; where our lives are dictated by your decision. And your decision not only affects the present but the future that has yet come to pass.

Beyond sense and reason which has failed in our communication with your kind, I ask that you try to employ one other method. Instinct. Do you instinctively feel that your child is safe without vaccination? Do you instinctively feel secure knowing that your child will recover regardless of the infectious disease that we have been trying our best for generations to avoid? Do you instinctively feel impervious to all manner of infectious disease because you are protected by powers beyond that is comprehensible to mere mortals?

If you seek within the depths of your heart and find that it is difficult to honestly answer these questions, then you should listen to what I have to say. And listen well.

 

Vaccines are safe
I state the obvious first. I understand and empathise with those who feel that vaccines are dangerous as they cause a multitude of other defects which can be harmful and detrimental to health. Let’s assume that this is true. Are they worse than death or the defects caused by the infectious diseases which can be prevented by vaccines?

Let’s start with polio which can cause disability and suffocation if it involves the breathing muscles. Assuming your child recovers from polio, he may never run or play like a normal child.

Diphtheria affects your child’s breathing. In severe forms, it can affect the heart and nerves leading to death.

Pertussis is known to cause violent, uncontrollable coughing which makes it hard to breathe for a child. It can be deadly for babies less than a year old.

Vaccines prevent this infection by developing the immunity in your child by imitating the infection. This imitation does not cause severe illness but allows the immune system to develop its arsenal of weapons called ‘antibody’. In case your child is exposed to these infections in future, this antibody will prevent the infection from spreading to your child by eliminating the threat early and preventing your child from getting sick. If you know your ‘enemy’, you will be able to defeat them. It’s as simple as that.

So the question that begs for an answer is this. Do you want to be facing these diseases alone or you want the vaccines by your side forming a protective shield?

Or you sincerely feel autism is far worse than death? The choice is yours.

 

Doctors don’t make money from selling vaccines
A mother of a newborn child once told a friend of mine who was trying to convince her to vaccinate her child, that the reason doctors are adamant about vaccination is that they are making money from vaccines. You must be a special kind of human being in order believe this to be true.

What you don’t realise is this. You have been poisoned and manipulated to despise doctors and modern medicine so others can make money from your fears and ignorance.

Let’s assume your doctors are indeed making money from vaccines (which in most countries are given for free under their national health programme), are the alternative medicine practitioners doing it for free?

I challenge you to do this; if someone comes to you and says that vaccines are a propaganda of certain individuals who want to take over the wealth of the world, just ask them if the alternative they are proposing is free. Are these dates, herbs and holy water ingested purely out of the goodwill of these practitioners without expecting any monetary payment in return? That will be the last you hear of their goodwill and sage advice.

Since I can also be accused of writing this for monetary gains, let me state that I am an adult cardiologist and not one involved in administering vaccines.

 

You endanger other children
The most unacceptable outcome of not vaccinating your children is when they become infected and spread the infection to other innocent children.

I am sure you have heard of the concept of ‘herd immunity’. We contain the spread of infection when vaccinated children form a barrier around others who cannot tolerate vaccination due to defects in their immune system. And some are too young to complete their vaccination schedule and as such, they are vulnerable to these deadly infections.

Your decisions are responsible not only for the spread of these infections to your children but also countless other innocent lives. Have you spoken to your fellow anti-vaxxers whose children are dead or maimed after being infected? Have you seen any unvaccinated child recover and their parents tell you it was worth the experience seeing their child go through this? Have you forgotten that you live today because your parents made the right decision to vaccinate you when you were young?

Unless you live on an island surrounded only by your fellow anti-vaxxers, remember that you don’t have the right to endanger the lives of other children.

 

Some of your intentions are pure
I will not vilify all anti-vaxxers of being greedy and evil. I know some of your intentions are pure. You honestly feel vaccines are more harmful than the diseases we are trying to contain, so you chose the lesser evil.

Does it scare you when your child develops a fever after vaccination? It happens because your child has a healthy immune system which is now producing the aforementioned antibodies.

Does it frighten you to see the rise of autoimmune diseases, environmental allergies, life-threatening food allergies, ADHD, seizure disorders, asthma, and cancer? But your grandparents were vaccinated and so were you. Why now the rise?

Why can’t it be due to the processed food and unhealthy eating habits? Why do you steadfastly hold on to the belief that vaccines are responsible? Do you have any credible studies to back you up?

Some use the word of God and religious texts to counter the logic behind vaccination. Regardless of the religion you practice, God is merciful and kind. He would not want you to suffer when you already have the tools to save yourselves.

Ignorance and ego are twin beasts that devour you from within preventing you from gaining sense and perspective. So I beg this of you, read and reflect on what I have written here. I am here for you and your children. I am not the enemy. And you are not mine.

 

I want to live in a world that is safe for all children. The world where I am not shackled by fear and trodden by the injustice inflicted upon me by others.

It is as Thomas Sowell once said: “It takes considerable knowledge just to realise the extent of your own ignorance”.

 

 

 

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Dear doctors, be kind to each other.

Posted on May 9, 2015 | 195 comments

I met a young doctor who used to work with me recently. I had just completed my night rounds in the hospital and I was leaving for home.

And then I saw him. He was unkempt, exhausted and appeared famished. Worst of all, he looked like a man who has totally given up on being a doctor. He appeared hesitant when I asked him what was wrong, but I could not just leave him there.

After much persuasion and insistence on my part he agreed to join me for a late supper. While he ravaged through his first proper meal of the day, he finally opened up. He has started working for the past week in a new speciality. Though the hours are longer, it was not an issue. He was well aware of the sacrifices he was expected to make.

However, the degradation, humiliation and constant harassment have finally taken their toll. He was literally chased out of the ward just minutes before he met me because he could not remember the details of a patient he clerked. He was not allowed to refer to his notes and had to recite the lab results by heart like a trained poodle. The words were abusive, hurtful and condescending. And worst of all, it was said right in front of the patient.

He finished his meal and stood up to leave. And as he left he said this “Please don’t worry about me. I will be fine”. I was not convinced. The shame of being publicly humiliated is not a stain that washes easily.

The doctor-patient relationship often takes centre stage, but the epitome of good clinical practice depends on how the doctors treat each other. The medical profession is filled with fragile and vulnerable egos that often have trouble working with each other in a genuine collaboration of trust and mutual respect.

We complain, argue, fight and obsess for the sake of our patients, but do we dare reflect for even an iota of moment our actions and attitude towards our fellow caregivers?

So what went wrong in the noblest of professions and how do we fix it?

Stop the stereotyping of doctors 

“The surgeon knows nothing and does everything. The physician knows everything and does nothing. The psychiatrist knows nothing and does nothing. The pathologist knows everything, but always a week too late”.

“Surgeons are egomaniacs, anaesthesiologists are lazy, orthopaedic surgeons are meatheads, obstetricians are mean and brain surgeons think they are God”

There isn’t a single medical speciality that has not been ripped apart and ridiculed.

As I continue to mature and evolve in clinical practice I have encountered a variety of doctors. And most of them share a common trait.  They live under a grand delusion that their speciality is the only one that matters and worth doing. They have strong negative feelings about doctors who have chosen a different career path and have a deep seated urge to insult them at every opportunity they get.

This has to stop. Every facet of medicine is equally important.

As a clinical cardiologist I depend on the primary care physicians to detect and refer their patients to me early for cardiac interventions. It would be near impossible for me to screen all the patients with coronary artery disease in the population. I lean heavily on the cardiac surgeons for cases not amenable to minimally invasive interventions. The endocrinologists help us manage the difficult diabetics who need expert fine tuning of their insulin regimes. The emergency physicians are crucial front liners in diagnosing acute cases and stabilizing them prior to sending them to the cardiac care unit. The intensive care specialists help us manage the ventilated patients and are crucial to the running of our cardiology services.

Every single doctor provides an important aspect of patient care which complements the work of the other. We work like a grand complex machine where every part is imperative to the running of sound and safe clinical practice.  We are all equally important. And that is the often forgotten ‘stereotype’.

You don’t need to criticize or challenge other doctors to earn respect 

I read an article recently where a rival oncologist told the parents of a young patient with incurable cancer that he could have saved her life had she been brought to him earlier. He completely disregarded the considered opinion made by the oncologist who actually managed the patient from the beginning. His actions were borne without actually consulting the managing oncologist and in that one frivolous statement completely shattered  the foundation of trust the parents had on the treating team. This unnecessary disagreement between doctors often compromises the best interest of the patient.

Rival doctors often spread malicious lies about their colleagues. I have a friend who works in an established private centre and a rival cardiologist once told one of his patients that “he was a far more brilliant cardiologist” and that my friend was less experienced than he was.

Another surgeon told personal details about another doctor to his patients including mistakes he made as an intern and his unfortunate marital problems. 

Just recently I overheard a junior doctor thrashing his ward colleague in front of the nurse’s station. He knew I was within earshot and yet continued to speak ill of his colleague who happens to be a trustworthy, humble and talented doctor.

This leads to lack of trust between doctors and dents one’s reputation. A patient is unlikely to respect a doctor who openly criticizes another and may feel threatened you would do the same to them. 

Bullying is not a necessary evil for training doctors 

One of my mentors told me prior to my training as a physician that one of the most important attribute I was expected to develop was a thick skin to criticism and condescension.

Each doctor invariably undergoes a different form of bullying throughout a long career. It can be as subtle as denying one the privilege of referring to a patient’s chart while presenting a case just seen barely fifteen minutes ago amid a flurry of admission. Or it can be downright humiliating like being called ‘stupid’ and ‘incompetent’ during morning rounds for an incorrect answer.

I have seen senior surgeons screaming at their residents and interns during surgery for seemingly simple or negligible errors. Every small mistake during surgery is magnified out of proportion and a running commentary will follow suit on how the doctor ‘does not have what it takes to be a good surgeon’.

Physicians are often in a foul mood early in the morning if the lab results are not available on time although the interns would have personally delivered the blood samples to the lab technicians. The interns will face the brunt of their anger knowing full well they did nothing wrong.

Radiologist are often condescending when interns request for an emergency CT scan as they are an easier target compared to the senior consultant whose orders the interns are carrying out.

Family physicians and general practitioners are often the object of irate registrars and consultants who feel they contribute nothing to proper patient care not realizing the crucial role these primary care physicians play in screening patients prior to sending them to tertiary care.

A paediatrician may swear at a doctor for missing an intravenous cannulation on a preterm neonate and then adopt a serene demeanour when facing the parents of the child.

We often excuse doctors who are bullies because they are ‘great with patients’ and are ‘brilliant clinicians’ or ‘gifted surgeons’. This hurts the profession more than you can imagine.

Doctors trained in this hostile environment will foster deep resentment towards their peers. It becomes ingrained in their psyche. Once they get better and more confident they will develop the same impatience that was shown to them towards their junior doctors. And they will in turn become the very bullies they once despised.

This never ending vicious cycle will continue and the interns will mature into senior doctors thinking that bullying and condescension is a necessary tool for training doctors. 

Bullies are cowards. Period. There is no way we can justify the actions of those who continuously seek ways to make the lives of others miserable. Since bullies only respond to strength, the medical hierarchy should start becoming much stronger. Cultures that shun the bullies making them look weak instead of the recipient should be fostered. This is easier said than done as the bullies often sit at the top of the food chain but cultures change because people are committed and steadfast in changing them.

Good and honest communication saves lives 

Newly minted doctors need proper training to become competent and safe. They should be encouraged to ask questions and any uncertainty regarding a patient’s management will be cleared during the rounds. The young doctors learn by observing the intricate process of decision making that goes into managing a patient and in time they will become better clinicians.

Suppose a senior registrar or a consultant barks at every question as it is a ‘waste of his precious time’ or that ‘you are supposed to know this’. The junior doctors will hold back their questions or doubts for they are preoccupied with fear of appearing incompetent or lazy. They fall into the trap of placing emphasis on trying to save face and look like they know what they are doing at all times rather than admitting ignorance.

The interns will dread the clinical rounds and will only perform the most basic of duties such as tracing the lab results, writing the discharge summary and updating the progress notes. They will immerse themselves in paperwork and avoid spending time preparing for clinical rounds.

Since the interns and junior doctors are often the ones manning the wards after clinical rounds while the consultants and registrars are engaged in the busy clinics, subtle deterioration in a patient’s clinical condition can go unnoticed. The interns who lack proper clinical training to detect such dangers or even the ones who may suspect something wrong but hold back in apprehension out of creating a false alarm, may not alert the senior doctors until its too late.

The patient’s care is severely compromised and the interns will retreat further into their shell as they will be blamed for this unfortunate event. If the interns try to defend themselves and argue back, they will be blackballed throughout their career in medical practice and labelled for insubordination. 

And shame does not encourage improvement. The culture of blame and punishment fosters more mistakes and fatalities. Doctors do not report their errors for fear of retribution.

And our mistakes will work its way down to affect the patient’s lives.

The  doctor-patient relationship paradigm depends closely on the doctor-doctor relationship. Bad and damaging cultures foster a hostile atmosphere that erodes trust, tarnishes good communication and promotes disrespect within the medical community. The role doctors play in harming each other ubiquitously affects the patient’s care, however unintentionally. 

If we work in an environment where we are kind, tolerant and respectful of each other, we will in turn be more humane to our patients. Young doctors will be nurtured in a system that is steeped in kindness and compassion and they in turn will become sound clinicians who resonate the same values. 

It is, as Plato once said “Be kind, for everyone you meet is fighting a harder battle”. 

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Dear medical interns/house officers, it’s time you learned the truth

Posted on October 14, 2014 | 7 comments

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This was not written as a self-righteous article to indulge my sense of accomplishment in medical practice. Although I am an internal medicine specialist and a fellow in cardiology, I have achieved nothing if compared to the legends in my field of work. I will not start with the dreaded phrase “During my time…”. I will start by telling you only this… I am going to tell you the truth. At least, the truth the way I see it.

Medicine is difficult if it is seen only as a science.
It is an amalgamation of arts, science and social skills. If you approach your patients with the sole purpose of diagnosing a disease purely on a scientific basis, you will find it difficult.

Textbooks are useless. Patients cannot speak your “language”. They can’t quantify sputum, they forget to notice when their eyes first turned yellow, cannot accurately recall the pattern of their fever and if their stool color has changed over the past week. And that’s what makes them human.

You need to learn the art of history taking and physical examination to coax this out of them. And nurture the ability to treat your patients with respect and dignity they deserve. This cannot be taught in medical school. You will learn this in life. Or rather in the wards.

Internship is physically exhausting
A house officer wrote to a local news daily recently, that he or she is exhausted with internship training. There was an immediate surge of response to this letter. Most of them criticized and condemned the sheer audacity of the author for claiming the training is exhausting when it has been revised so many times to make it better and easier for the young interns to cope.

I will not resile from their position. Nor will I rescind their opinions. After all I am nobody to judge.

In all honesty, training during internship is tough. It drains you in every way possible. But what you fail to remember is the necessity of this training and this ’fleeting moment’ will pass once you complete internship. You are not going to be an intern forever. The ability to function while being sleep deprived is an important attribute for an intern. If you don’t know how, just ask your parents how they managed when you were a toddler. That will set you straight.

Just keep your head down and get on with your work. Only experience, hard work and nerves of steel fostered during your internship years will end up making you a better clinician.

You cannot compare internship training with other countries you have probably studied or worked in briefly. Every system is there for a purpose. To suit the needs of their society and healthcare demands. No system is perfect regardless of the country you work in. They have their flaws and will continue to improve as the demographics of their society changes.

When working hours are reduced, the clinicians complain they cannot pass the necessary skills to the interns and when the hours are increased the interns claim fatigue. This becomes a never-ending vicious cycle of bitter resentment towards each other.

You can choose your preferred area of speciality once you complete your internship training. If you want the working hours of an office clerk, this is the time. No one will fault you for wanting to spend more time with your family. And if you choose to enter a demanding speciality you cannot live under the delusion that you are a better doctor and your work is more worth the while. You define your life with your own rules and don’t impose these rules on others.

I have said this before and I will say it again… Training of doctors should best be left to the practicing clinicians. Keep the politicians and the general public out of this.

Internship is emotionally draining
After a day of being sleep and food deprived, getting your ward in order for the early morning rounds and making sure all the clinical notes are in the correct files, a harsh word from your consultant or superior for a small irrelevant mistake can hurt you deeply. I have felt it before. We all have. It is as if they only focus on your mistakes and not the hard work or effort you have so selflessly given.

I admit it. We sometimes become complacent. We assume it’s interns job to do the work and that you should not ask for a reward or a pat in the back but mistakes should be reprimanded. I apologize. I have been guilty of this too and I pledge to do better.

Do not be afraid of bullies whose only existence is by making the lives of others beneath them miserable, not realizing how pathetic their own lives really are. There are bullies everywhere and not just in medicine. And since bullies only respond to strength, you should be prepared to be much stronger.

And then there are those who push you hard, to become better clinicians and a better person. Their methods may vary but they have your best interest at heart. They are not bullies. And you should have the wisdom and the mental finesse to know the difference.

Do not demand for lesser working hours. Instead demand for better training and teaching. Expose the flaws in the existing system which interferes with your progress as a clinician. Take your superiors to task for not living up to the expected standards. Drag those who hide behind the veils of bureaucracy into the light. Don’t allow the paper pushers and keyboard warriors change the course of your destiny. It is your right to become the best doctor you can possibly be. Don’t let anyone tell you any differently.

There is a beautiful quote by George Bernard Shaw, “ I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations.”

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The single doctor: What you need to know before marrying one

Posted on October 11, 2014 | 2 comments

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I met a patient during her follow up. She was doing well after her coronary stenting and was free from chest pains. She has started gardening and recently enrolled for dancing classes. I was happy for her. Just before leaving the room, she turned and asked the question most single doctors dread… “Are you still single? ”.

I am.

“I have a niece I want you to meet. She is beautiful, intelligent and well mannered. She will take good care of you. She read law in England. We have had quite a few proposals. But I told my brother you are the best person for her. Shall I speak to your parents? Do you have your horoscope with you now?” she blurted out in a single breath.

I have faced this before. And I am always prepared. I told her I was very flattered to be considered but I was too busy working in cardiology that marriage is something for me when I am more settled in life.

“Don’t wait too long. My niece will not remain young forever. And neither will you”.

Indeed. Thank you.

Single doctors are a common breed. Not exotic. But common. We live among you (the rest of the world), and as much as we can, we don’t want to attract attention. But we fail. Miserably.

Let me tell you all that I have heard and witnessed. The good, the bad and the ridiculous.

Doctors make the best spouse because there are caring and sensitive
It’s true the way doctors care for the welfare of others can at times supersede other professions. This law is not inviolate. Caring for another person is an inherent character. It’s also something you need to build and work on. It also depends a lot on how you were raised. You don’t necessarily have to be a doctor to learn to care and be sensitive to the needs of others.
The profession comes with an unavoidable responsibility to care but the onus falls on the doctor to reciprocate in kind. And not all doctors do. There are some who have been numbed by the profession that they don’t care anymore. Death and suffering becomes a routine. So do they now make bad husbands or wives? Obviously not. It just a way they react to the demands of the profession.
And if you want someone to come home in the evening after losing a patient who bled to death on the operating table and ask about how your day was and if the dog has had its bowel movement, you are married to the wrong person.

Marrying a doctor is a ’sound investment’
If based solely on a financial point of view I don’t think this is entirely true. Doctors earn a decent income and unless you are in the private practice, the sum is modest at best. Inflation and lifestyle expenditure within the upper middle class bracket doesn’t help either. Marry an investment banker. Now that’s a real ’good investment’.

Doctors should marry someone who can take care of them
The profession comes with endless responsibilities. And no illness comes with an appointment. For the doctors, the job isn’t ’eight to five’. And having a person to attend to your needs at the end of an exhausting day is a blessing.
But many doctors I know become complacent. They take the sacrifices of their spouses for granted. It is in no part helped by the fact that in certain societies the burden of the household falls solely on the spouse who is married to a doctor because the doctor is assumed to be always busy. Not a very fair deal of you ask me.

Marrying a doctor is a step up the social status ladder
Let me give you a short preview of the not too distant future. Doctors aren’t a rarity like they once were. Due to the incessant mushrooming of medical schools, let me paraphrase AirAsia’s famous slogan… “Now everyone can become a doctor”. So get that silly idea out of your (or your parent’s) head.

Doctors are well bred and well mannered
True. Unless you give us a reason not to be. Just like the rest of the human species we are prone to tantrums, labile emotions and rantings. We become less well mannered and irritable when people try to challenge our years of medical education with snippets they got from the internet last night while smearing night creams on their puffy porcelain faces. Beware. We are not as nice as we are made to seem.

Don’t marry a woman who is a doctor, she will be too busy to take care of you and your children
I came across a saying recently, “When you are dead, you don’t know that you are dead. It is only difficult for the others. It is the same when you are stupid”. That’s sums up what I think of people who make these statements. Some of the best mothers and wives I know happen to be doctors. It’s not about the profession as I have mentioned before. You have to work on being a good mother or a wife regardless of what you do. It comes easier for some who are born with certain innate abilities and for others you need to work just a little bit harder. Doctor or not, you need to learn to live a life balanced between work and home.

I leave with a quote from one of my favorite poets, Rumi, “Don’t be satisfied with stories, how things have gone with others. Unfold your own myth.”

And that is the truth…

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Dear doctors, love thy nurses

Posted on May 2, 2014 | 40 comments

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A senior nurse in my hospital retired from service recently. I have known her since the infancy of my career. A gentle and loving lady, highly capable and brilliant with her patients, she was one of the most respected nurses in our Intensive Care Unit (ICU).

A few months after her retirement, I bumped into a former patient of mine who was treated for a severe lung infection a few years ago. He is currently pursuing a degree in engineering. Over a cup of coffee, he asked if I knew where the nurse who took care of him was staying. He had been to the hospital and was told of her retirement. Naturally, I was curious to know why he wanted to meet her after so many years. His answer still resonates within me.

“To thank her for being alive. She was with me the whole time I was admitted. When I was afraid, she held my hands, wiped away my tears and helped me pray. She fed me and kept me clean. She moved my body often, so I did not develop pressure sores. And never once did I see her flinch at the sight of my excrement. When my cough became chesty and I had difficultly breathing, she sucked out the secretions. When my urinary catheter hurt, she removed it and convinced the attending doctor I didn’t really need one. She was there for me all the time. And I will always be grateful to her”

I have always believed being in medicine is a calling. Doctors are trained to be kind, gentle and compassionate. We devote our time and energy to care for our patients, to give them a sense of orderliness, security and comfort to name but a few. I was wrong. I merely gave the orders. My nurses carried them out. And often they went beyond the call of duty for our patients. They breathe and bleed compassion and dedicate their lives for a single purpose. To care for the sick and ailing.

I wrote this piece so they can be heard and appreciated. And for them to know, that I am grateful. Immensely.

 

Nurses endure abuses from patients
Physical and verbal abuses from ill and confused patients are part of the nursing routine. A young nurse once mentioned that if she gets home without a stain on her scrubs, her husband would think she did not go to work and was having an affair!

I have watched nurses being slapped and kicked while they tried to restrain aggressive patients. Being spat at is common. Learning to duck while things are thrown at you is an important attribute. Patients will try to sink their teeth into someone the moment they are restrained and since the doctors only give out the orders, the nurses become the victims.

Some will miraculously escape from their restraints, confounding even the likes of Houdini and lash out if anyone comes within ’striking distance’. It’s near impossible taking their vital signs, let alone feeding them. And when you’re done with one, there will always be another.

Nurses are also forced to dance attendance to the patient’s relatives who demand explanation for a particular treatment administered by the doctors. They become abusive if they can’t meet the doctors and vent their frustrations on the nurses. They become condescending, rude and downright vulgar with their words. I remember a young couple reducing a nurse to tears, all for the sole reason their child was kept fasted prior to a surgery and then it was cancelled. It’s not her fault. I cancelled the surgery. And she bore the brunt of their anger.

And yet very few nurses actually complain. They bear no resentment towards the doctors or their patients. They swallow the pain and their pride and continue to endure. They do it best and make it look so simple. And very few of us actually realize that.

 

Nurses do the ’real’ dirty work
When I need any specimen from a patient, be it phlegm, saliva, pus, blood, urine or stool, I can always count on my nurses.

No boil is angry enough, no discharge too foul-smelling and no feces too odious for my nurses to refuse their job. They will get it done. And while constantly being exposed to health hazards.

They are my gladiators and they will wear the ’battle scars’ of their efforts albeit not too proudly on their white uniforms or scrubs till their shift is over.

Confused and demented patients often confuse a space by the window for a latrine and they can choose the most inconvenient of times to empty their bowels there. And the nurses have to clean it up, while putting on hold the passing of duty to the next shift, which by the way, rarely ends as scheduled.

And I have always wondered how they manage to have their meals after all the ’assaults to their senses’. Being a nurse is probably one of the most effective methods of losing weight! Now there’s the silver lining.

 

Nurses have great physical endurance
Nurses work on a rotation basis. They can work during the morning for a few days and revert to working in the evening for a week and then a few days of night shifts before they get a day off. The timing of their shifts is such that their sleep patterns are disturbed. When they finally get the hang of a particular shift, a new one starts.

They rarely take days off from work even if they fall ill because other nurses have to cover their shifts.  And they will have to replace it later. Shortage of nurses further compounds this problem.

Nurses have to learn to hold their bladder for a prolonged period of time, far beyond the capacity of a normal functioning human being. They learn never to give in to the excruciating pangs of hunger while being on the job. Break time is for feeding the patients and to complete their nursing report. A preterm neonate in an incubator can deteriorate within seconds the moment your back is turned. A teenager with dengue fever in shock needs constant monitoring of his fluids. An elderly man with diabetic ketoacidosis needs his insulin infusion updated so he does not go into hypoglycemia.

Constant vigilance. It becomes ingrained within the nurses. A deep-seated unshakeable belief.

 

Nurses help the doctors more than they know
Upon graduation from medical school, interns often find themselves wandering aimlessly in the hospital corridors. Do you remember who showed you the way?

Was it the consultant who was diligently preparing his case against the next legal attack a patient’s lawyer was lining up? Was it the registrar who was too busy studying for his clinical exams? Or was it the patient who made you feel like you were too young to be in the room with her?

Who stood next to you when you were too afraid to draw a patient’s blood?
Who answered ’he is old enough’ when a patient wanted to know your age?
Who helped you insert a cannula at two in the morning when you have tried a dozen times and failed?
Who gave you that pat on your back and told you ’you’ve got this’ when a patient collapsed and needed CPR?
Who made you look good in front of your consultant when you did not know the correct antibiotic for meningitis and she whispered it into your ears as she walked out of the room?
Who did all the dirty work in the labour room but allowed you to bring the baby to the mother?
Who assisted you in your first surgery with a ’malignant’ surgeon and taught you all the tricks to survive him?
Who made you the cup of coffee when you have been up for 36 hours?
Who gave you their shoulders to cry when your seniors bullied you and called you ’stupid and incapable’?

That’s right. It’s always been them.

Unfortunately, some doctors develop selective memory loss once they have found their footing. They attribute their survival in medicine to their singular efforts alone with very little help from others especially the nurses who are now beneath them.

The humble tone of their voices turn condescending. The downcast eyes become fiery. The hesitant steps move more purposeful. And their ego swells disproportionate to their actual talents. It’s the bitter truth. Fortunately, they are the select few.

And yet the nurses never leave our side.

 

Nurses have a life outside of the hospital
It is difficult to imagine having a social life once you enter the nursing profession. It is infinitely much harder if you have a family.

After her shift is over, she has to rush home and cook for her family. She has to help her children with their homework and listen to her husband complaining about her job although she pays the utility bills every month. She does the laundry and the dishes because she can’t afford a maid. She bathes the dog and feeds the cat before her head finally hits the pillow. And the next day the cycle repeats itself.

Despite their sacrifices, their work requirements and timing cause a strain in their marriage and often leads to a divorce. It must hurt when they have given everything till there’s nothing left to give, only to learn it isn’t enough.

 

It is difficult for us to fully comprehend the sacrifices nurses make on a daily basis. Gratitude alone isn’t enough. There is a beautiful quote by Rumi meant for lovers,

“You have no idea how hard I’ve looked for a gift to bring You. Nothing seemed right. What’s the point of bringing gold to the gold mine, or water to the ocean. Everything I came up with was like taking spices to the Orient. It’s no good giving my heart and my soul because you already have these. So I’ve brought you a mirror. Look at yourself and remember me.”

There will always be dark days. But remember, it’s my turn now to be your light. Thank you for everything. Sincerely.

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Ten life lessons doctors learn from their patients

Posted on April 18, 2014 | 3 comments

It has been said, that in your last moments, your life flashes before you, reenacting the scenes, up to the point where you are ready to move on. As a doctor, I have cared for and watched after many patients and I have found a constant among those plagued by ailments and suffering. Regret. It is the single most important burden many carry to their deathbed. And their burden has taught me how to live my life.

Money is not evil, lack of it is.
Start reading and researching on financial planning early. Invest and keep your finances secure and balanced. Many patients cannot afford the best healthcare when they most need it simply because they did not anticipate and save in advance. If you live in a country where healthcare isn’t free or subsidized, it would help tremendously if you could obtain a health insurance. Plan your expenses judiciously and always save up for retirement. It would be too late to start when you fall ill. The mental anguish of not being able to work and provide for your family can gravely affect your recuperation.

Start taking care of your health now
Health is a precious asset. In most countries, the common causes of mortality and morbidity are due to preventable and modifiable diseases. Heart disease, diabetes, high blood pressure and dyslipidemia are related to your diet and lifestyle. So start eating healthy, go for regular exercise and get proper medical check ups. Reduce the sugar in your diet and count your calorie intake. Start teaching your kids to care for their health and get the whole family involved. It is infinitely far better to cook and eat at home for you will be in control of what you put in your food. A sound health will enable you to lead a more wholesome life.

Travel to new places
It is a constant regret among my patients that they did not travel enough when they were young and healthy. Traveling to new places enriches you in more ways than you know. It creates new bonds, strengthens current relationships and rekindles lost passion and romance. If life is moving too fast and it’s draining your soul away, take a sabbatical and work in a foreign country. Immerse yourself in a new culture with new people and get a fresh start. You may never know how it could change your life.

Don’t hold grudges
It is very difficult for a doctor to watch his patients die. It is worse if you have to watch them die alone. Cherish your friends and loved ones. Don’t allow petty arguments to ruin years of friendship and love. Keep your ego locked up. Sometimes, it’s better to apologize and move on regardless of whose fault it might have been. Forgive generously if you have been hurt. If you think of someone who means a lot to you, call now. Don’t wait. If you love someone, say it now. Don’t let them slip away. Time is cruel to those who keep love and friendship locked within. Look past the imperfections for to be loved is the only perfect thing in the world. And it the only thing that makes sense.

Your family is a gift
Spend time with your family as much as you can. Don’t work too hard. And don’t bring your work home. Find the right balance. Be present when your children are growing up as your presence can influence their formative years. Show up and be there for them when they need you, for one day they will do the same for you. If you have not told them how much they mean to you, say it now. Never hesitate. Go forth. Steal that kiss, hold that hand a while longer or hug them a little bit closer. And always remember; to have a family is a privilege and a gift, not a birthright.

Don’t remain in abusive relationships
I once had a patient with chronic kidney disease who refused dialysis. She finally revealed that she would rather die than to remain married to her husband who has been abusing her for years, and yet she continues to endure. Don’t choose to be unhappy in a relationship. It does not matter how long you have been in it. If someone truly loves you, they will never hurt you in any way. Have the courage to walk away towards a life and a person you truly deserve. And you will be happy.

Don’t settle in life
Fear of the unknown and being relatively comfortable with their current life has forced many people to settle for something very different from what they really set out for. They cast their dreams aside and grow old yearning for something that was always within their reach, but the walls they have built around their psyche, blocks them from attaining it.

Lead a righteous and honest life
Don’t lead a life shackled by deceit and envy. Be genuinely happy for the achievements of others. This is a world of abundance. It is filled with more than you could possibly want. Don’t be lured by the temptation to cheat and manipulate others. Never knowingly or consciously hurt someone especially the ones you love. The guilt will eat you up and stain your conscience for life. And it will never wash away.

Reflect on your life
Take some time off your daily routine to reflect on your life. This is important. Upon reflection we can obtain a sense of direction and conviction, to realign our lives the way we want it. Difficult and unpredictable circumstances can lead us astray and it’s important to have a sound bearing and clear conscience. As John Dewey once said, “We do not learn from experience.. we learn from reflecting on experience.”

Get closer to God
The answers we have all been looking for have always been there. We just didn’t know where to look. Regardless of your religious beliefs, God is a constant and He will embrace you, even in your most shattered form. Ask and He will give you the answers. Surrender and He will show you the way. Fall and He will raise you up.

 

As I write this down I am reminded of each and every patient whose shared experiences made me the person I am today. Some may have passed on and to them I dedicate this quote by Kahlil Gibran,

“For what is it to die but to stand naked in the wind and to melt into the sun?
And what is it to cease breathing but to free the breath from its restless tides, that it may rise and expand and seek God unencumbered?
Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountaintop,then you shall begin to climb.
And when the earth shall claim your limbs,then shall you truly dance.”

And to all of them, I am eternally grateful. Thank you.

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It’s the doctor’s fault.

Posted on February 22, 2014 | 187 comments

I came to clinic at 9.15 am the other day. I was held up in the wards and was fifteen minutes late. My patient, a 40 year old housewife with poorly controlled diabetes was fidgeting outside my room. She was unhappy. I could tell. She entered my room and started berating me for my seeming lack of consideration for her time. By the time she was done, I had apologized a dozen times. We started with the consultation and to my chagrin, she forgot to bring her home sugar monitoring chart. Her blood sugar control was abysmal and her kidneys were starting to leak protein. She was obese and still gorges on fast food despite being counseled by a dietician. She has defaulted her appointment to the eye doctor because she felt ’her eyes are just fine’. She has not been taking her medication for the past week as she was visiting her sister and forgot to bring it along.

Before walking out of the room she had the temerity to say this: “ If only you could spend more time with me, you could have treated my diabetes better. You just had to be late.”

My years of training in medicine kicked in: “I’m sorry. It’s my fault. It won’t happen again”

She walks out. The next patient walks in. And the cycle repeats itself…

This is a common scenario faced by doctors. We bear the brunt for everything that goes wrong in a patient’s life. The poorly managed disease, the horrid weather, the ungodly waiting hours, the uncomfortable waiting room chairs, the grumpy nurses, the lazy attendants and at times the odious smell that emanates from the person sitting next to them.

We face these frivolous accusations and absorb them, giving our patients an outlet to vent their frustrations and anger. We tell ourselves, “This is part of the job”.

We live by the same mantra regardless of our nationality, color, religion, race or creed… “The patient is ALWAYS right”.

I have listed the following complaints based on my experience and that of my colleagues.

 

The doctors are inconsiderate towards the patient’s time. 

You are probably right. We are inconsiderate. We are inconsiderate for abandoning our health so you could be healthy.

We are inconsiderate for skipping our meals and not giving in to the excruciating pangs of hunger so we could monitor your fluids when you are down with severe dengue.

We are inconsiderate for not returning home to have dinner with our family and loved ones because we are too busy consoling yours.

We are inconsiderate for missing our daughter’s dance recital or our son’s football match because your child was admitted to the intensive care unit and without us being there, will probably never make it through the day.

We are inconsiderate for forgetting our wedding anniversary because our mind was filled with the thoughts of our patients undergoing complications in labour.

We are inconsiderate for placing our patient’s well being above all else, including our own personal time. We should have considered our family and friends before spending so much time at work. We are very inconsiderate indeed.

 

The doctors are selfish and spend very little time during consultation with their patients

An average doctor sees ten to fifteen patients in clinic and this number varies according to hospitals around the world. The larger the pool of doctors, the lesser the number of patients they see, and the amount of quality time they are allowed to spend with their patients increases.

Bearing in mind this simple logic, if the consultation time runs from 9 am to 1 pm, which is exactly four hours, and in a clinic with roughly ten patients per doctor; we are only allowed 24 minutes per patient.

This does not take into account the walk in patients, the forced bookings, the late comers, the ’missed appointments’ who decide to turn up on that day, the ’selective amnesiacs’ who got their appointment dates wrong, and finally the ’self anointed VIPs’ who probably donated a few dialysis machines and built the entire south wing of the hospital.

If you have been to a hospital, have you ever wondered why our clinics don’t finish on time? Have you ever wondered why the doctors are still seeing patients during their lunch hour? Have you asked your doctors if they have had their lunch or at least a bite to eat from morning?

If you do, I guess you will find out how ’selfish’ they really are.

 

The doctors have ’special preference’ over certain patients compared to others

You are absolutely right! We won’t even bother denying this.

Picture this scenario. A patient presents to the emergency department with a massive heart attack. Time is of essence. In case you didn’t know, every second wasted is detrimental to the patient’s life. The doctor knowing this well, rushes to the emergency unit, pushes the patient to the cardiac care unit and performs a life saving procedure called ’angioplasty’. He may have to leave his clinic or the wards, where the stable patients are waiting to see him, who are at present in no danger whatsoever, except probably a bit annoyed of having their discharge from the ward delayed.

We may have to delay your MRI appointment for an hour, as patient may come in with a spinal cord injury requiring urgent radiological diagnosis and surgical intervention.

A pediatrician may take an hour of her time to review a child in an acute cubicle but may only spend minutes with your child who is well and awaiting discharge.

We recognize the ‘frequent visitors’ to our emergency department. And we know the ‘funny feeling’ you have around your fingertips at 3 a.m can wait while we attend to a patient brought in unconscious after an accident.

There are times the operating theaters are fully booked, that we need to postpone elective surgeries to accommodate urgent life threatening cases. We can’t proceed with removal of a lipoma from your hairy back if a mother with fetal distress arrives in labour. If an emergency Caesarean Section is not performed in time, we could lose both the mother and her baby.

You can’t imagine our trepidations when we approach your bed, as we prepare ourselves mentally for the verbal abuse that is about to follow, knowing in full knowledge that you have fasted the whole night prior to surgery.

You will inadvertently be mad. We know. And we can’t help it. We do have ’special preferences’. But what you don’t realize is this; it’s best not to be one of our ’special preferences’.

 

The doctors are supposed to know everything about us and don’t have to keep looking at their notes

Patients have accused me of showing little interest in them if I can’t recall every detail of their symptoms, admissions history and medications, especially if I have to keep referring to my notes.

I am often left embarrassed by the cynical looks some patients give me when I am unable to answer all the questions. Even when I say with all honesty , ’I will look into it and get back to you’, the disparaging remarks can be quite hurtful.

I have often wondered if a lawyer is able to recall with exact precision every case he has tried? Can a teacher recall at will the details of every one of his students examination results? Will a bank manager remember every single detail of his client’s account?

 

The doctors are responsible for our health and it’s their fault if we don’t get better.

We are responsible for our patient’s well being. Only a fool would say otherwise.

We can continue to admonish obese diabetic patients to lose weight and control their diabetes but they don’t heed our advice. They return time and time again for more medication and continue deteriorating and get upset with the doctor when they develop complications from the disease. They assume it’s our responsibility to fix things as they pay taxes.

We can only counsel a patient with scarred lungs to stop smoking and to be more compliant to their medication, but if they choose to continue smoking and disregard our advice, are the doctors to be faulted when they have done nothing to help themselves?

It’s still difficult for us to comprehend the unrealistic responsibilities placed on doctors.

 

There is a quote by Rumi, “Out beyond ideas of wrongdoing and rightdoing there is a field. I’ll meet you there. When the soul lies down in that grass the world is too full to talk about.”

We are not perfect. We are not trying to be. But our patients often forget as they tend only to look at the ’thorns’ in their lives, that we, the doctors, are ’patients’ too.

And it is not always our fault.

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I AM A DOCTOR: The myth buster

Posted on December 2, 2013 | 40 comments

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It is the time of the year again, where the old ends and the new begins. Where we seek reassurance from the baffling resolutions we never meant to keep.

It is also a season for young students to decide the course of their career. Fresh faced and bright-eyed, full of hyped up myths and legends, they will inadvertently have one ambition in mind. A dream they have kept repeating from childhood or rather a mantra that was repeated to them : GROW UP AND BECOME A DOCTOR.

I am here to tell you what your parents conveniently forgot. There are things to consider before foolishly embarking on a journey not meant for you. In short, I am a myth buster. But in reality, I AM A DOCTOR.

 

Myth number one: The hard part is getting into medical school.

This is not the hard part at all. The real challenge is remaining in medical school till you graduate. The numerous exams and assessments will leave most of you gasping for reprieve.

My advice to you is to go to the nearest book store and browse through the medical books. Have you seen them? Do they look shiny and thick? Good. Now imagine spending your weekends with them. For the next five years!

Clinical exams on the other hand are unique to medical schools. Two examiners will observe your every move as you attempt to demonstrate the multiple clinical signs taught only once during your ward rounds. Mass production of doctors by a single medical school is a myth. A significant number would have dropped out by the time you graduate.

 

Myth number two: Internship training is not as difficult as it sounds.

You are absolutely right. It is infinitely much harder. Every decision you make will be scrutinized and criticized. Some senior doctors will humiliate you for simple errors.

There may be times your ignorance might be detrimental to a patient and you may lose a patient during the course of your internship. Recovering from the loss is hard, especially if there is a chance you could have prevented it. The guilt will eat you up, forcing you to drop out of clinical work. And this guilt will stain your conscience for life. It will never wash off.

 

Myth number three: Doctors are highly respected in the society

This may have been the case in the previous centuries but as our society becomes more affluent and educated, they invariably become more demanding.

Walk through the corridors of any hospital in major cities, wearing your white lab coat and stethoscope, you would be hard pressed to find any layman who greets you with a smile or a respectful nod to say the least. Forget about “good mornings” and “good days”.

Since the lawyers are fast becoming the bane of our existence, our daily work consists of evasion tactics to prevent lawsuits. A new form of medicine is being practiced now and it has superseded the “clinical medicine” that was taught to us. It’s called “defensive medicine” and it is being practiced throughout the world.

Unnecessary investigations and treatments are administered, which bleeds our health resources dry, just to protect ourselves from legal attacks. An example would have to be the fast emergence of resistance to most antibiotics due to injudicious use, which if seen from another perspective, stems from the practice of defensive medicine.

 

Myth number four: Patients will always be grateful to the doctors

Before you start filling up the forms to enter medical school, you need to get one thing embedded in your mind.

Most patients will never say “thank you” or “you did your best doctor” if they get better. They will assume it’s their birthright to get better once they see you and it is your duty to make them well as they pay taxes.

I have been in this service for seven years and out of the thousands of patients I have discharged home safely, I can say less than a hundred have expressed their gratitude. Most would be complaining about the time it took for the doctors to prepare their discharge notes and plan subsequent follow-up appointments.

Then when they come back to see us in clinics, they will complain about the waiting time, not knowing you would have been starving the whole morning, just to start the clinics early to reduce the waiting time of the patients. After the consultation, you would be the one thanking them, and they will be rushing for the door to get the next cab home, so that they can be back in time for lunch with their family. And before I forget, lunch is a luxury you don’t often get.

 

Myth number five: Patients always place their full trust in doctors

If I have not deterred your interest in medicine up to now, I guess this will do it.

You are no savior. Remember this, and remember it well.

You don’t walk into a ward with the authority of a royalty and tell your patients you are going to start some form of treatment for them regardless of how they feel about it because they should just trust you. You had better find another job because their lawyers will sue the pants off you.

There is something called “patient autonomy”. It is they who decide to pursue any course of treatment and this is based on the quality of communication between both parties.

You can’t force a Jehovah Witness to receive blood transfusion even if she is bleeding away after delivery and would rather die that see a drop of blood enter her veins. In a bustling labor room, you might get a few requests at the same time for a female doctor to attend to patients with specific religious beliefs when there are no female doctors around. I have had patients who insist on seeing only a particular doctor knowing well he is on leave, while the infection eats away their foot, vehemently refusing other doctors and medical interns to come near them.

Official complaints to the administrators will follow suit if we don’t comply to their every wants and needs. Media bashing and Facebook groups with ridiculous demands are only a tip of the iceberg. The internet age has created many pseudo-doctors who assume they can challenge your treatment plan and knowledge based on a few articles they have read online. They will quote everyone and if possible even their neighbor’s cat which according to them recovered from appendicitis without any surgical intervention (True story!) .Go figure.

 

Myth number six: Sleep deprivation is a thing of the past

Sleep deprivation will remain in your present, brought forward from your past and linger on in your future. Medical interns will suffer the most. Depending on the sub specialty you choose, sleep deprivation will follow you like a shadow. No amount of adjustments to working hours will prevent this because the diseases don’t come with an appointment. As you climb higher up the ladder, responsibility increases exponentially and sleep quality reduces dramatically. Sounds poetic but it’s true.

 

Myth number seven: Doctors are guaranteed a job for life

Get this idea out of your head. Due to the blossoming of medical schools in most countries the supply is fast overcoming the demand. Some countries can’t cope with the number of doctors being churned out every year, that stringent entrance exams are enforced prior to permanent placement for internship. Requirements for specialty and sub specialty trainings are stricter now than they used to be.

Legal ramifications and higher costs in setting up private hospitals and clinics are fast reducing the number of experienced doctors who tend to live on their pensions and lead a relatively stress free life. The only thing you are guaranteed is the title in front of your name, which after a while numbs you and loses its sense of appeal.

 

Myth number eight: Doctors make lots of money

Doctors make a decent living. We don’t mint money if that’s what you’re after. If you are motivated by money I suggest you find another way to earn it. You will never be happy in this field. It’s just not for you. And it’s not your fault if you are motivated by financial riches. Just don’t use the pain and suffering of others for your own gains. There are other ways. Please find it.

 

Myth number nine: Life is easy for doctors in some countries compared to others

I don’t have to travel around the world and speak to every doctor, living or dead alike to tell you this. Life of a doctor is never easy, regardless of which corner of the world you work in. If it’s easy, then you’re not doing your job right.

Each country has its own challenges and any reasonable clinician with a sound insight will tell you the same thing. Perhaps they will venture to add-on some that I have missed out. You can try running but you will eventually end up where you started.

Living conditions and pay structures may change but human nature remains a constant throughout the world. Since our profession deals with human ailments and diseases, handling their behaviors and concerns conjointly falls on our shoulders. This is where the interminable difficulties lie, not in the diseases, but in the unpredictability of human responses.

If you do find or hear of a country where the doctors there have it easy, do let me know. I will swim there or drown trying. 

 

Myth number ten: Doctors are busy but they still have time for their family

Finally, if you have been reading patiently up to now, courageous and steadfast in refuting most of the myths, telling yourself “I know what I am getting into”, then this is the last weapon in my arsenal.

If you love spending most of your time at home with your family, if you see yourself being around your children when they grow up, if you want to be there for your wife when she is pregnant with your children, hold her hands while she delivers your baby, if you yearn to witness the first few steps your child takes, then this unfortunately is not your path.

Medicine will take up most of your time and very little will be left for your family. Many marriages have broken down for this reason alone. Children have grown up blaming their parents for not being there for them during their formative years. You will miss the important anniversaries, dance recitals and football games. Do you think a mere job is worth all this?

For now, this is all I have. I have painted a bleak picture. You have just seen it. And all of it is true.

 

So do you still want to become a doctor?

If your answer is still a resounding “yes” then I will let you in a secret. The important piece of information withheld up to now, meant only for those who truly deserve it. I have no regrets as well. Do you know why? Because we are the select few chosen to ease pain and end suffering. It’s a selfish act of being selfless. For one good day in this profession, I am willing to weather a hundred bad days. For a single smile of gratitude, I will brave a wave of indifference. For a person to be returned to their family, I am content if I only get to kiss my child goodnight.

I wake up every morning with a reason to live. It is profoundly better than those who wander aimlessly in a life of wealth and comfort. There will always be dark clouds. Even if I can’t see the sun, I know it’s there. And this sun is invincible. I hope you see it too someday.

 

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The forgotten doctors

Posted on November 5, 2013 | 2 comments

Paucity of attention is a serious crime. Lavishing undivided and undeserved attention is a mental handicap. I find it fascinating that there is intense scrutiny over superficial ripples on the languishing plights of a certain group of caregivers but then fails to even scratch the surface of a plight far worse than theirs.

I am a young physician working in the district hospital of Lahad Datu. I don’t blame you if you don’t know where it is. I didn’t too when I received my transfer letter. It’s located near the east coast of Sabah, but I am not here for a geography lesson. Neither am I here for cheap publicity. I am here solely to testify to the working challenges faced by doctors in remote districts of our country. 

District hospitals face the most arduous of challenges daily. Increasing patient load in district clinics and hospitals is just a paltry issue. Population increases exponentially based on the quality of health care. It is the lack of trained doctors manning these centers that should be addressed. The ministry of health took significant steps in addressing this. Medical officers, graduating specialists and senior consultants are transferred from major cities to ease the burden and uplift the services in these remote districts. But the lack of manpower still prevails. Where did we go wrong?

Most doctors have associated district hospitals to career suicide. Slim chance of a transfer back to the main hospitals in bigger towns have also been cited as a reason. Lack of basic amenities to quench their thirst for entertainment is a prevalent criteria. Families, spouses, multiple breeding children are among the reasons quoted in almost all the appeal letters cluttering the desks of the administrators in the ministry. Some have refused and have even resorted to selective memory loss when it comes to reporting for duty. Given the amount of latitude afforded they go unpunished and even obtain cancelation of their transfer on ridiculous grounds. I don’t deny there are genuine reasons for refusal to serve the districts but I am often left puzzled by the difficultly in being away from home for half a year compared to two or even four years of speciality training. The logic baffles me.

The ministry should make its stand clear. All medical officers, graduating specialists and consultants are given a finite time frame to serve the districts. They should be transferred immediately to any hospital of their choice once they have ’done their time’. No pun intended. If it’s their choice to continue serving the districts then so be it. Do not allow them to hold you ransom for promotions later for their conscious choices. If the velvet glove does not work then it’s time to reveal the iron fist.

It must be made compulsory for all new specialists to serve the districts during their period of gazettment. It should be made as one of the criterion for gazettment. A revision on a reduction in the period of gazettment for specialists serving the district hospitals should also be seriously considered. Moreover, these doctors should be given a significant precedence for subspecialty training over their peers who have refused to serve these hospitals, barring of course the consideration towards special reasons and requests. I believe it is a fair deal. With these efforts in place, graduating specialists will be queuing up to serve not only the interiors of Sabah and Sarawak but the deep bowels of our rainforests as well!

Medical officers in the district should be prioritized for speciality training. It is heartbreaking to digest if medical officers in districts have to compete on equal grounds with their colleagues in bigger centers for a place in speciality training. We should give them a reason to believe that their time serving the poor and needy is appreciated.

Why serve the district you may ask? You serve for the very reason of our existence. We exist to serve, to give a sense of orderliness to the chaos of diseases and to bring forth a sense of security to our patients. It is our duty to sweat blood and grind our sinew for this purpose alone. Don’t the people living in the interiors deserve better healthcare? Can you avert your eyes from these humble folks ravaged by poverty when all they ask is to be given fair and safe treatment? What is the use of our government pouring funds for state of the art facilities in these hospitals without anyone to man them? Good clinical practice and safe medicine starts and ends with the clinicians.

Finally, I will bring to your attention an often disregarded fact. In order to produce competent and safe doctors to empower our districts, we need to continue or improve our current training of young doctors. This should best be left to the practicing clinicians without the interference of the compassionate public and concerned politicians. Please don’t make it impossible for us to do our jobs.

I leave with a quote by George Bernard Shaw,  “ I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations.”

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So I heard that you wanted to become a doctor…

Posted on April 27, 2012 | 9 comments
Most of us live in an ideal world. This world exists only in our minds. If there is a distortion and when reality sets in the truth is pretty hard to swallow for most.
We hear of many talented and brilliant youngsters with strings of achievements wanting to become doctors. Their proud parents no doubt played a major role. This article was written bearing them in mind.
Allow me to introduce myself. I am a physician working in one of our general hospitals. Hospital Sultanah Bahiyah, Alor Setar to be exact. I have been in service for more than 5 years now and in this short span of time I have been forced to swallow and digest many truths about my career. Along with that a great many myths have been dispelled as well. I will tell you all about it.
I was a high achiever in school but I never wanted to become a doctor. There, I have said it. My friends who knew me from high school would tell you just that. I wanted to be a lawyer specializing in criminal and constitutional law. I was that focused from young. Medicine never crossed my mind. If at all I had a second choice it would have been journalism but certainly not medicine. It was due to some unexpected turn of events which placed me in medical school. My father played a major role in this. He has always known me better than I have known myself.
Lets start with life in medical school. The first two years is all about hard work. Make no mistakes. You will not have as many assignments as others but that will be more than made up with the number of exams you will have to sit. Each exam will leave a wrinkle on your face and if you have a part time modelling career planned I dont think acne is the current fashion trend. Depending on the medical schools some will have an exam almost every 4 to 8 weeks. It may just be a simple exam to most but it carries cumulative marks for your finals. Your study materials may weigh more than you at times. And all this to be completed within eight weeks. Sadly, this is just the beginning.
The final three are known as the clinical years. If you are from a respectable instituition you will be expected to examine and learn from patients during bedside teachings. To the uninitiated I will tell you how it goes. You will be brought to a patient during rounds in the morning. Your clinical professor will then proceed to show you and maybe a dozen others how to elicit a clinical sign. Your colleagues will then hover over the patient with some craning their necks to get a better look. With luck it may make sense to you but if it doesn’t, all of you will still nod your heads in unison in fear of being labelled slow, lazy or stupid!  Some of these signs you may never encounter during your daily ward rounds but will miraculously appear during exams without fail!
Your clinical exams are another issue altogether. Two hawk eyed examiners will watch your every move as you attempt to demonstrate the myriads of clinical signs that they presumably taught you during your bedside teachings. Guantanamo Bay may need these individuals. Without uttering a word they can make your heart race and your mind go blank in an instant. Some perspire so much during these exams that when they come out of the exam hall you would think that they visited a waterfall! Failures are common especially if you do not live up to their expectations. Mass production of doctors by our medical schools is a myth. You have no idea how many have been culled and are running around like headless chickens now!
If you are lucky (or unlucky!) enough to graduate there is more in store. After the fuss of graduation (where you will be forced to don dignified clothes the size of Brazil and take numerous flash photos that can sometimes be detrimental to your retina!), you will then proceed to housemanship training. If you thought medical school was bad enough you aint seen nothing yet!
You must have read about house officers. Their plight is often highlighted in the media and are garnering more attention than the presidential race in the United States. House officers training lasts for 2 years. You will rotate among the major departments in the hospital. During this four monthly rotation you will be expected to learn and manage patients with supervision from a senior doctor. Depending on the senior doctor or your own performance life may never be the same again. Your mistakes will be scrutinized and picked upon. You may think of it as a humiliation especially if its done in front of patients but this is the norm. Mistakes in an office might cost someone a fat contract but mistakes in the ward might cost a patient’s life. You will realize there arent that many broom closets in the hospital for you to hide and shed tears when this happens. It may remind you of the many ‘Scrubs’ episodes (where the senior doctors practically devour you for breakfast, lunch and dinner and leave some for supper that night) and its not as glamorous as ‘Grays Anatomy’.  Sleep deprivation is no longer an issue at this point because due to the current change in the training system you will only be expected to work 60 hours a week.
The lesser hours may not be a boon for many. If you do not make full use of your training during this limited time further horrifying events might follow.
I will paint you a scenario. After housemanship training you might be sent to a district hospital with the nearest general hospital a ferry ride away. You will then be expected to work 36 hours straight without sleep, single handedly manning a casualty department of a district hospital. A patient might come in the wee hours of the morning and worse still if its an ill child with a reversible illness. You will then be expected to perform a procedure you have only seen once during your entire housemanship training. Your seniors are conveniently not contactable. How are you going to perform? Its a life saving procedure and you have only seen it once. If you are lucky or talented enough you may get it in your first attempt. But what if you are not that lucky? What if the child dies because you could not do it? Can you look the mother in the eye? Sleep deprivation might become the natural order after that. And thats the bitter truth.
Upon completion of housemanship you might want to further your studies in a preferred speciality. Studying medicine was already bad enough but working at the same time is plain torture. Taking care of young toddlers during this period is not an added advantage. If your training requires being away from your family and rotating among the different hospitals in our country it requires divine-like patience and perseverance. Some exams requires you to fork up exorbitant amount of money for each sitting. Since failure rates are high and the exam fee might cost more than your monthly pay, you might end up being slightly better off than a waiter in the end.
After becoming a senior doctor or a specialist you will then be given many responsibilities. One of which may include training of young doctors. If you are as lucky as I am (most of the time) you will be given the chance to work with bright and enthusiastic house officers. Some unfortunately are not that lucky and may end up in private practice or take up another career path altogether.
Why take up medicine if all that I have painted sounds like entering ‘hell’ and consorting with the demons?
Medicine is a vocation. Its a divine calling. Its a selfish act of being selfless. Its a priviledge bestowed upon a select few to serve mankind and to alleviate their pain and suffering. Gratitude in the eyes of patients and relatives once healed of their disease and ailment is priceless. Your teachers will become your pillars in life. They will pass on to you the time honored traditions of being a doctor which in turn you will pass to the next generation. Thats how it has always been. If you have done your work sincerely and passionately they will proudly accept you as one of their own. Unless you are a soldier fighting side by side in war, the friends you make during this period will become your lifeline. Some of them have done so much for me while expecting so little that I would gladly take a bullet in their place.
You may not have enough time with your family as others might have but you would have returned someone back to their family. You would not have enough sleep at times but when you do, you will sleep with a sound conscience. You may not make as much as your friends in other ventures but your patient’s will consider your very presence invaluable.
Finally, you may ask me this. Do I have any regrets in being a doctor? I do and there is only one. Its that I never realized this earlier. When I wake up every morning I cant think of myself doing anything else but this. I would not change a single thing about my life because it has brought me exactly where I want to be. Its a pleasure to learn, treat, teach and in turn be treated. I count myself blessed to feel this way. The journey so far has been worth the while. And I can still keep on going.

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