Friday, September 28, 2012

Serve Vs Work


There are tremendous distinctive features between the two verbs above.

We always hear conflicts between nurses vs doctors, vs ppk's, vs lab technicians, vs radiographers, and what not.

I might sound a bit of holier than thou but this is generally the reason why I seldom argue with nurses or ppk's.

Apart of victimitis theory which I wrote umpteen times before - Work ; this is about the nobility of the job.

Well, don't you agree that it is kind of paradoxical, that when you are doing a noble job, you are not working. You are actually, serving.

Now, we juniorest doctors are always unhappy with the PPKs (PPK is the person who was employed to do some odd jobs / housekeeping job, like a Porter, in the ward, for example sending patients to another place, collecting food, sending blood samples to labs, etc)

Me too, when I started working, was always annoyed by PPK who to me did not do their work at all.

Not just the PPK, the nurses, the lab techs, the radiograhers, who are supposingly be our supporting staffs, when they are not as supportive, or working as hard as we are (well, everyone including Prime Minister thinks that he is overworked) then we cant help it but to be angry.

For example when we ask for the patient to be sent to Xrays at night, it would never be done. PPK not free. Then you find them sleeping. Then you rightfully felt angry isn't it?

Of course you can, you should.

I wouldn't say that I am like a priest like dat, dont feel angry, and ever forgiving.

Probably I was also one of the lazy people and rather useless when I started working at younger days, so I can kind of understand them easier than some other people.

My lack of anger towards them has to do with my understanding of the enormous distinction between serving and working.

When your job, is associated with nobility, best example ,as a Doctor, you are not actually working per say.

You are serving. And according the Maslow, you are motivated by self actualisation, which drives you work up to or even beyond the expectations you have for the nobility you are associated with. (no I just come out with this crap myself)

What I meant is that when you are a PPK, you dont have that nobility associated with you, oh well, most of them. I mean say you worked so hard during the night time, and by right you should be sleeping the next day, but you are taking care of your children. How are you going to explain to your wife, darling I am helping doctors saving life therefore I am very sleepy?

But if you are a doctor, even if you mistakenly went into the ladies, it is still okay probably when they think that you had been saving lives all night, it is out of fatigue. The same is unimaginable for the ppk.

That is the reason why you get really committed, really serving, Nurses and PPKs in district hospitals. Because in the close small community, they all still have the nobility intact with them. People will still let a lady who is donning nurse uniform to cut queue in supermarket, the respect to their jobs is still there.

But unfortunately, we see shifts in paradigm regarding the nurses and sometimes, but rarely, even doctors in big cities. I can sadly say that we no longer have that nobility associated with the job of nurses anymore.

Then, it is very difficult to ask them to work as hard as a doctor. It is just a job only.

But of course, the flip side of the argument, you are paid to do a good job.

If you cant do it, leave.

Oh well, of course this is valid in economy reality, cant do it, leave.

But if you stand in their shoes, you see it another way.

Perhaps, the saying, No one is not lazy all the time. Lending the words from someone; We all have our moments.

Wednesday, September 26, 2012

Budget


Dearest PM Najib;

I have some simple request/suggestion la in terms of if you would have ask me where to spend money which makes most the difference in people's life in my opinion.

I think if we put more money to hospital without a directed approach, nothing going to come out. The one needing most money is always the ones having the least kickbacks so it is the one that no one wants to talk about or take it further.

Examples are aplenty. Just go to any Diabetic patient, asked them what is Diabetes, what they know about how to take care of themselves.

Most likely you get very disappointing answers.

My point Mr PM, is when it comes to allocations, we tend to give the most money to the tangible goods. For example, the late but better than never Hospital Shah Alam, or the far from civilisation but better than none Pusat Jantung Sarawak. These are multi BILLIONs projects and dont get me wrong, they are necessary but question: are we stepchilding other priorities?

Pardon me but my negativity and anti-establishment instinct is telling me that all these constructions, material developments all of those involving contracts usually have kickbacks for certain people and therefore in Malaysia where money politics are halal, we are more than happy to have that kind of development. Dont shoot me yet, this is personal, and I agree to disagree.

I just felt that if I am a politician, why not? I get a new hospital for my rakyat therefore I can sleep well at night, I am using none of my money, but most importantly, I get a new, good friend. We cannot deny rumours la, when the two tenderer who profited from the projects I mentioned above are full with political connections.

I just felt strongly that because it is a health related issue. You can build a 100 storey high building and give it to your son to build I have not much of an issue as compared to you spending more money, with slower progress, and poorer result, when you are building a hospital for Shah Alam.

Just, too, much. Healthcare is to me a human right.

Well done if I havent offended you by now.

Back to the issue of Diabetic patients, you see why I digress to the issues of building hospitals and constructions etc is because I think if I spend 1million on educating 10000 diabetic patients in Sarawak, I will see less heart attack, less strokes, less leg amputations, longer lifespan, better family health and so on, better than spending 1 million to buy these 10000 patients a new diabetic medication from certain contractors pharmaceutical company.

And the reason why we are not putting resources in patient education, is because this cannot be done under contract to another fella. It is not a contract per say.

And how I would need to spend the 1 million? Just give RM100 to every Community Nurse (you dont even need doctor to do this) who are able to make the patients all understand their disease, their medications, their monthly check up of blood markers showing good sugar control and etc. I think that is more rewarding than, contracting newly invented medications because only the well, educated people who understands their disease can benefit from the new medications.  

PM;

One issue that I am very particularly interested about is rural healthcare. At times I think we spent too much money to upgrade our grand tertiary hospitals in major cities, of which we have a lot of specialists, oh well cant deny that human likes to live in city, a proven fact that drives the surging of civilisations since Egyptian times,

And if the way we measure doctors to patients ratio for Election purpose is just the total number of citizens divided by number of doctors, then we are getting just the numbers right.

I think if building new hospital is too much, or buying expensive machines is too difficult, or getting specialists to work in districts are too inhumane, at least we make sure the journey to transfer patient to our main hospital is acceptable. The hospitals' ambulance is at the state of sadness la. Its shaky like rollercoaster, new ambulance not working, cannot complain as the company managing the assets are rumoured to be politically connected, how la. Very sad la...dahla sebagai doktor hospital tak boleh selamatkan nyawa, nak hantar pi hospital besar pun tak leh. Geram no?

Lastly,

If you want me to ask question is that I want to know what is our future healthcare plan? Every year we spent so much money, and we are still spending a lot of money here and there even in the hospital u can see our medications are sometimes more expensive ones than the private hospital, but I think our prioritisation is getting it all wrong.

The healthcare must be fair and no kickbacks/unfairness can be tolerated lo, when it comes to life, the one and only one to everyone, to you to me to the uncle sitting in the bus, i think kenot la with this kind of progress.

Your governement intended to do ONE CARE - i fully support integrated plan with the private, but we need reassurance that this is a well planned, no close suspicious tender thing around the corner. I know it is difficult because as someone in power to decide where to spend the money, the predators are all over you.

People dont come to you to just say hie. They want something.

Tuesday, September 25, 2012

Listen

I went back to Penang last week, had the usual supper chat with my old schoolmates.

I find that really, as we went down to our own pathways of life, the work we do, the things we see, the people we meet, differs.

and when this happens, our views, understanding, perceptions would be different.

Of course there are a number of things that we share in common which binds our friendships together.

It is funny that when and I take a look at myself, I find the change has been significant.

There is no need to make everyone sees this world the way you see it,

There is even no need to make everyone listens to the way you see the world.

Then why you blog and write all these shits you might ask?

Well, I didnt ask you to read isnt it.

All of us are human needing medium to express ourself.

And all of us have our breaking point to which we will break and mentally exhausted.

Some of us has it early, Some of us has it come a bit later.

Whatever it is, everyone has their stories.

A smiling, random nurse for example, who knows she was divorced by her husband just last week.

Everyone has their stories.

But not everyone has people to tell to.

Be happy if you are one of the people chosen to listen.

All time favourite EMO picture.

Bcoz, not many people choose me!!! LOL.


Sunday, September 23, 2012

TTM


Today I am going to ramble abt one of my many many theories and thinking.
There is this thing which I termed as Ttm.
Think too much.
I have tendencies to ttm. I usually ttm so much so that many of my life changing decisions are made.
Today, i went to pee. Then i think i ttm again.
And then as u can see from the picture above.
The fella that design the arrangement is damn thoughtful.
You see, self flushing infra-red sensors are expensive and consume electricity. Sometimes it doesnt work.
What the designer did was amazing.
There are 5 urinals.
He put the urinal of manual flushing in both corners. Then one more in the middle.
This design is based on a known fact that men do not pee beside each other and the most popular site is always the corners.
And when the corners are taken, we go to the one most away from the corners, and mathematically, it points to the middle one.
So in the end the manual flushers which are more cheaper, cleaner as well coz we are more inclined to push it ourselves after each pee, due to a sense of altruism in men. But if it is automatic sensor, we tend to leave it to the sensor.
Blame the sensor la if it didnt flush.
Lol.
However, this time I decided to pee using the 4th urinal. Using the automatic one.
Blame the sensor ok.
But actually I saw it flushed well.
Rambling complete.
Thanks for reading.
Published with Blogger-droid v2.0.8

Saturday, September 22, 2012

Another rambling. I know you guys like it. :)


Attending course can really up your knowledge level. I would definitely attend more courses!
Whatever course. Even a gp course i learned so many things. Surprisingly, on how to clinically appraise articles.
I guess aging has negative effect into doing something not so seemingly beneficial in short term for example reading.
Maybe;or it is just me finding excuse lol.
Hmmmm...anyway...another 1 month to go...to go where? The paradigm shift is very ganas. For every referal i make to Orthopedics, i think for myself: would I be able to do it myself? Or what would I do if i am refered to?
It is just blardy 1 mth to go!
With so many things hanging so so loosely, now quite difficult to see even 1 mth ahead.
The so called the top scorers, actually when it comes to making decisions, especially big decisions, we will just follow the current, the waves to sweep us around.
Oops, again i like to generalise...okla...not we. Prolly just me.
Increasingly and seemingly this world that I know, is bigger than what I ever think.
Ever ever think.
Certain things are not what I know it is.
Humility is certainly the key to be happy.
Ego is the biggest downfall. Trying very hard to kill off my ego.
But I think some of my theories still work. (By calling it theory actually is very egoistic... I just realised that)
If you tell people that you are poor, you are not that poor. Real poor people dont go around telling people.
Similarly, thinking that you are great just make u less great. Really great people do not think they are.
Like me. HAHAHAHA.
It is funny that we put on alarm every night. Not knowing whether we would wake up the next morning, alive. It is called; faith.
I want to have that faith that it is still possible.
Published with Blogger-droid v2.0.8

Friday, September 21, 2012

Knowledge

I m currently back in Penang to attend a course - teaching course for general practitioners.

Kind of out of place really, coz mainly the attendees are general practitioners.

To me, the GP skills and knowledge is very important to be a doctor in the family, at your own home. When someone close to you is having a cough n flu, and the first person they think of is you, a mere "go see a GP (or A&E)" is not really good enough.

I agree that medicine is a field where the revolution of skills and knowledge is ever changing. Constant updating is important. But basic knowledge on general presentations to doctors is as important.

People always think that doctor knows everything.

Old generation maybe. Myself, heck no.

For example today the speaker talks about contraception. Huwah, cant remember much from the days of O&G.

Dangerous actually. And we have a lot of young doctors doing locum everywhere

Eyes doesnt see what brain doesnt know. And when that happens, it hit your ego and confidence badly.

And on an unrelated note, the brain actually cant do everything that the heart wants to do. And when that happens, it hurts, bigtime.

Published with Blogger-droid v2.0.8

Monday, September 17, 2012

Santubong

The signboard at the foot of Mount Santubong

The first stop: The Choo and Cheng's Peak

2nd stop; The Joshua Dilemma's Peak

In between dunno where and where...just snap picture while awaiting

 On the top with some of the groupie, the rest went down liau

 Peaceful canopy view.

Sunset. If you see this during hiking, you are in deep shit. Fly, dont just run. Jungle dark means hiking difficulty increased by 20000%. Hahaha...to me la.

My personal note to congratulate the 3 big weights who made it quite high up there. It is not how fast, how high you climbed that impresses me, it is your mentality to take on the challenge.

Thank you for the good feeling. 

Tuesday, September 11, 2012

Demotivating

I find this very disturbing.

A few days ago, my colleagues who was on night duty, had their picture taken by patient's relative while they were sitting on the nursing counter, eating biscuits and talking.

Apparently the relatives were not happy that they didn't attend fully to their relatives.

Case in point: This patient has been attended, treated, off the treatment, awaiting the observation time to pass before medically deemed fit to go home. (I respect the confidentiality)

My superior talked to the relatives to get them delete the picture but in vain.

Well, this article is to discuss this very wrong behaviour from my point of view.

Now if I am operating a restaurant, it is perfectly fine for you to take picture of the food with a cockroach it in and publish it online or even report it to the health authorities to get me sued.

Our society has not reach the level of granting the cockroach privacy nor rights to defend itself against photographed.

However, in taking picture of another person eating, talking, this is a clear breach in privacy.

So what if they are eating and talking by the table?

Let say I was photographed in this scenario, and after discussion with you in a perfectly professional manner explaining why we are not standing by your mum the entire night as you would imagine the best kind of treatment to your beloved one, and you still refused to delete the picture.

So I went to the nearby police station, making a police report that I had been photographed against my will by this unknown male in my workplace.

And I have been feeling that there's someone following me for the past one week, especially when I was at work, walking from carpark to my working place.

I felt it is a chinese man, of more or less same build of this man.

I had professionally asked to see the picture he had taken in my workplace where he claimed that he was there because his mother is treated there but he refused to show me if it contains my face inside.

I am feeling very uncomfortable and wish a legality action against him, and to protect my privacy and safety, unable to perform my duty for a foreseeable future.

I would not settle for any settlement, and wish to pursue this case to the highest level of justice available in this country.

----------------------------------------------------------

Now he might think that if he bring this to press he will have all of us in trouble.

No I beg to differ.

What if I tell you there's a patient right in front of nursing counter, who is a post RTA patient and the doctors wished not to make use of their resting time when there is not many patient at 3am to eat in pantry, instead they personally care that in the unfortunate event he collapses, professional help in form of a medically trained doctor would be there just 3 steps away.

It is 3am in the morning, with not many patients around, I think we should rethink our utopian imagination of what one human,

in the form of a doctor,

would do.

It is demotivating that after all the time we sacrifice for, okay, probably not as many as you would think, but fair number of lives we have made better,

and this is what we get in return.

A picture of us, eating.
An accusation that we are lazy.

Whatever

They said everyone needs sometime for themselves.

Time to think about your future, your present, and your past.

Time for yourself is always been said to be the time whereby you are not doing anything but to worry about things.

and worrying, I fully agreed is a waste of time. 

It does not change the outcome.

But of course, this, dont worry be happy, is easier said than done.

We constantly worry about things. Very funny, in order to worry, you have to have free personal time. 

I dont know about woman, whom they said can multitasking, but I personally am very happy when I am busy when I am sad.

Are you with me? too complicated a wrongly grammared sentence?

LoL. 

When I have a problem and a reason to be sad, I would be happy if I am busy doing something. Then I would be forgetting the reason to be sad. At least of that moment.

Being sad all the time, is depressing and pathological. Come on it is physiologically impossible to think of sad things all the time..

Why am I saying all these?

I find one of the favourite time I have in A&E, is what I termed as FBC moment.

It is the less than a minute you spent, all by yourself, looking at the FBC machine, with the arrow moving from one arrow, to the other, to the other, and  the other, then RINSING, then result printing...then FBC moment is over.

This FBC moment gives me a chance to quickly check my FB (facebook, not full blood) when I am happy.

It also provide me time to look at my phone to see if I have any pending msg from ppl I am waiting for msg when I am happy.

But unfortunately, it also gives me a time to think, what am I doing now, why am I not happy, if I am not happy. 

When I was younger, I find hiking is the "moment" I spent with myself.

I hiked most of the evenings, by myself, and I love the personal moments I spent with myself.

In hiking, the only thing in mind is to get to the top.

The narrowly directed, fully focused mind is very, reassuring, that the moment you were free, when you suddenly think of the worry that you had for the whole day, but hours after forgetting it, you would be like...ah, forget abt it, I didnt bother to think about it for hours and time still pass like normal. Earth didnt stop for me.

Thursday, September 06, 2012

Justice seen to be done.

There's this open truth, and yet, a sad one, that the nicer you are, the more you get bullied.

Or the one who kept quiet always get all the ill treatment.

For example, the doctor's who has no qualms about their postings tend to be sent to the furthest, most unwanted edge of the jungle.

We have seen time and again that there are many who make noise, go to complain with the press la, politicians la, always ended up get what they wanted.

Last week, I received a transferred patient from Hospital Sri Aman, a 72 year old kind old uncle with hearing and speech impairment since born and was admitted there for pneumonia. Such a nice uncle, he makes no qualms about being pushed here and there, poked here and there. Always smiles when you asked him things, as he hears nothing, until his relative spoke to him in very Loud voice.

He has a subdural hemorrhage, bleeding outside the brain's outer layer in simple terms. He needed admission and operation.

Because the ward is still busy, he was put to wait for a bed, booked for him.

Then came another patient, 40 year old, self employed man from Hospital Sibu. Relatively better groomed than the other patient, well and no known medical illness, flew over to Kuching for further management. He has a CT head done in private settings, and unfortunately had a similar diagnosis with the uncle above. He needs admission and operation too.

This second and younger patient is quite a nice person to chat. His wife and relatives were a little bit demanding. Asking for chairs for them to sit, asking when to go up the ward, asking this asking that.

They also demanded a side room for him, citing reason that the bleed in the head might deteriorate if it is too noisy in ward.

They were told off by my nurses in A&E dont deal with beds arrangement.

You know what?

They went up to Neuro Ward to do the same thing again.

And when they were told not only no sideroom, there were no beds, as one and only bed is booked.

and the unthinkable:

They pressured the ward to admit the 40 year old patient first.

*******************************
I was angry when I heard of the story.

I felt this is not right. at all.

I called up the ward, tell the nurse I totally understand that they are under huge pressure from the demanding relatives.

I said I dont mind who get admit first, but if this 70 year old is not admitted tonight and stranded in the corridors of A&E, the relatives (WHICH IS ME BTW) is not going to let it go.

In the end, the ward called back, telling us that they going to admit both, putting the 70 year old in a bed, and the 40 year old on the trolley for the night until bed available.
_________________________________

It is easy to say things when we are not at the front line.

It is easy for one, like me to say that the family members of the 40 year old should not do this and that.  I mean I can understand your point of concern regarding the care for your beloved, but sometimes, there must be minimal level of justice, conscience, and civic mindness. Especially if you are educated.

Similarly, it is easy for some people to blame the ward nurses to be succumb easily to the pressure and unfairly treating the quiet ones.

But if you are there at the forefront of the situation, dont you think that by settling the noisy ones, you would have a quiet night then?

Same concept with my argument that it is easy to say that the guy who bribe the police is wrong, but if your son is caught with drugs and paying some money will settle the problem would you think twice?

If after whatever you do in the morning up until evening, you can introspect and still have a good sleep, then you can feel good about it.

We are all human, not ANGel.

Tuesday, September 04, 2012

Written?

I was having a short rest, sat on the chair by the nursing counter in A&E.

It was a heavy night. 

I barely have time to drink or to pee for the past dont know how many hours.

But the temptation to sit rather than to do anything else is overwhelming.

I stared blankly in front of me, and there was a mother holding the  ?1 year old baby. 

Baby was crying crying crying crying...  and from where I sat, about 5-6 metres away roughly, I can see the red eyed mother trying very hard to calm the baby down.

Pacifier....tried...failed...

Rocking movement....tried...still crying....

I asked the nurse what is it that they are waiting?

"Waiting for bed, too many admissions today, no more beds upstairs."

It is kind of sad.

Then I think back to my childhood, I have never been to hospital all my life. My mum even skipped some vaccinations for me because lost my baby records, and kept shifting house when I was younger.

and still, I grew up to be rather healthy. and smart (someone said)

It does sometimes convinced me that everything in life is already written.

Sometimes you made a choice that already been chosen for you. 

But not all.

The written plan by a higher fella up there; will bring you to a particular junction. 

You then choose, the choices that was given, as arranged.

Your choice then will lead to another junction, whereby another set of pre-determined choices, but still, it is your choice. 

Difficult to buy this thinking isnt it?

Sorry, I totally bought it.


Fate decides who walks into your life.

You decide,

who you let to walk out.

who you let to to stay.

who you refuse to let go.