Source: well.blogs.nytimes.com
The past week has been interesting. I have read articles written by mistreated houseman, aspiring medical officer, wise specialists, the MMA President and even Director General of Health himself over one single issue that has been going on for years; Houseman having a non-productive working environment, overworked, humiliated and what not. As far as this issue could be stretched and argued, it will never stopbecause every few months, there will be new batch of housemen reporting for work, experiencing the real world of medicine and all of them, has something to say. So the cycle continues.
Leverage
As of today, I’ve been working for almost 8 months as a houseman in a tertiary hospital in KL. Some may say that working in KL gives me a lot of leverage; being closer to home, family and friends, so called many houseman in Klang Valley. and the truth is my housemanship phase is just the same as every other person who’s going through it. Every time someone asked me which department I started with, a smirk will definitely follow my answer.
“Obstetric and Gynaecology (O&G) department.”
I bet you are having one right now.
Responsibility
I never really told anyone how I felt before starting my housemanship. Most of the time I put on my confident face and appear relaxed. Work is not a big deal for me at that time. It happened that the very first day I reported, was my first day of tagging in the labour room as well.. My friends and I were given a short briefing by the specialist in charge plus a few pages of instructions and their expectations We were introduced to the computerized system and the way things work by our senior housemen, trying to absorb as much as we could on that day. This is it, I told myself. Welcome to the real world where everything falls under your responsibility. I took a step back and had a moment of reality check. I am dealing with lives now. Two lives. The feeling was surreal; a mixture of anxiety, overwhelm and self-doubt. In fact, the feeling continued when I changed department. I was so stressed out to start my first oncall in the Medical department because I was scared I will choke if there were to be an emergency. My colleague had to talk me through it. Housemen are the front liners who will first detect and manage if something goes wrong with the patient. Your bosses have a lot in their minds and the slightest bit you can do is be thorough with your job and point out to them if the sugar or blood pressure is not well controlled or how many days have they been on antibiotics. That’s your responsibility.
Say please, thank you. Put on your deaf ear.
If there is a competition in the first few weeks of work, it would be called “Whose day was the worst?” Why? Simply because the notifications in my WhatsApp may reach hundreds every day. Friends in various hospitals were updating how their day went, the meals they skipped, how crazy their working hours were, how mean were the staff nurses and specialists acted and how unequipped they were to be given such responsibilities on their first day of work without any proper guidance.
My day? Pretty much the same with the rest of them. Though I made a promise to myself to not complain and take things personally. I vowed to learn as much as I can during the tagging period. Indeed as new houseman, especially a first poster, you are at the bottom of the hierarchy. Some nurses and specialists will ridicule you for the silliest thing. Blaming you for being slow. Questioning which medical school you graduated from and pointing out how insufficient you are. They would tell you to write an explanation letter for a menial issue. This is where I put on my deaf ears. Nothing these people say will make me any less competent than what I aim to be. Indeed it requires a lot of patience, perseverance, mental, emotional and physical strength. It is a new phase that demands your utmost adaptability.
In my hospital, we have seasonal shortage of houseman. My colleagues and I had to do a 36 hours shift, we had to work almost 90 hours a week, only two person to take care of a busy general ward on a weekday and the list goes on. Basically, we are overworked. We complained about it, channelled it to our superiors, requested from human resource to increase the number of housemen intake, nagged to our nurses but that is as far as it goes. The next day we would come to work and still do our job.
The key words to survive this phase are “please” and “thank you”. Be humble and never be afraid to ask, even the smallest thing. Say please when you are asking a favour from anyone. Thank them for their help. My nurses and medical assistants had thought me a lot of things during my posting when I wasn’t sure about a lot of stuff like to reconfirm my vaginal examination findings or the dosage of medications to be given to an end stage renal disease patient. It does not cost you a thing to be polite and willing to learn.
Resilience
At some point of your life, there will be a dark pit that teaches you about humiliation, hard work, life’s reality, expectations and resistance. This is how you grow and learn. Yes, it is all a cycle and we need to change it. Change by doing; BE BETTER, BE DIFFERENT, BE RESPONSIBLE. And your work will speak for you. The bosses will not be mad senselessly. There will always be some of those but isn’t that normal? “Just suck it up and work”. Those are the exact phrase my colleagues and I used to keep going and ignore the ridiculousness of the issue that some superiors like to raise. No matter how efficient you can be, when your superiors are in the wrong mood, you will be a susceptible tool for them to vent.
Besides, if everyone acts the same, where would the excitement in the world come from? And you will not have any interesting story to tell in years to come. I have been shouted at in front of all the staff, humiliated by patient’s relatives, cried over stress at work and drained to the core when there is not enough housemen. But each time, EACH TIME, I learned something new. We all learn something new.
Voice out. Enjoy. Be smart. Support.
On some days where the work load is too overwhelming and the team you are working with is being difficult, be sure to voice out what is necessary. Office politics are normal; you have to know how to play along. Have a stand in the things you are sure with and comfortable about. Do not let anyone step on your head or take advantage of you. Have a mechanism that helps you to de-stress and recharge. By all means, any way you like to let loose and forget about work temporarily. Go back to your family, sleep, sing, cry and pray if that makes you feel good.
Also, it is important to enjoy what you are doing. I am still fascinated over the new things I encountered daily. To be able to feel the diamond shaped pelvic outlet, how red alert was activated during a cord prolapse, to see the rectus abdominis muscle dancing upon being touched during a Caesarean Section, how my face turned pale and held my breath for the longest time when the baby did not cry once they were born. Those new experiences kept me going, humbling even. But you know what is the best part of my job? When I am confident enough to decide on simple things to make the patient better and my superiors trusted me with it. Appreciation is short while but trust, will take some time to be earned.
Another thing each houseman has to remember is to back each other up. You only have one another. I learned this best from my colleagues. We teach and help each other as much as we can. After the release of “Budak Baru” video, many of my fellow houseman voice out that change is needed to ensure a better working environment. To achieve this, we need to start now, together, regardless which posting you are in or your seniority. Better work ethics and teamwork produce optimum result which will slowly change our horrendous working environment. Buy each other lunch, help each other with ward work so you can go back earlier, be each other’s support system. Be extra smart and take care of yourself first. Steal 2 minutes of your time for a toilet break or 15 minutes to eat something. Those minutes you use for yourself will not kill a patient but 10 minutes of non-intact concentration will.
Positivity
A few months back I read an article titled “Junior Doctors Doing The Impossible”. It was published in The Star newspaper acknowledging our work. It shows that we are doing the right thing. We have touched hearts and souls without our realization.
So what made us special to continuously making this an issue? Indirectly portraying us as weak though what we aim by voicing out to the media is to find justice and exert a change. Was it because we studied longer? Is our job more noble than others? Our pay is not worth the job? Talk to your budding friend in other fields, they are facing the same thing, sometimes even worse. But they did not write to the papers. I wonder why. The truth is, everyone has their moments. How you react towards it will determine your composure. Bear in mind that the MOs and specialists had gone through the same phase we are going through. Perhaps you questioned the amount of work they do but they are the ones who will be doing the decision. While we go back without a care in the world wondering if our decisions to start a medication or treatment will affect the patient’s life.
Above all, this is just my opinion. Everyone has their take over this issue. Do I not wish to be doing some art related job and have more time to myself and family? Indeed I do. But as of now, I am blessed in a lot of ways at work. For that, I thank a lot of people; from the Radicare worker who asked if I have eaten, my awesome supportive colleagues, the efficient staff nurses, the medical officers who scolded but taught me how to make the right decisions, my registrars and specialist who bought us food when they saw how hardworking we worked and the patients, for nagging, being demanding but at the same time believe and understand that housemanship, is indeed a very tough period anyone could ever experience. To all housemen, take as much positivity as you can on every encounter and divert all unnecessary negativity. I am not saying that housemanship in my hospital is all sunny and breezy, I have my fair share of bad days where all I want to do is drop everything and leave, but a wise friend told me that this is just a work and do not let it consume you.
Dr. Anis Nabillah is a house officer working in a tertiary hospital in Kuala Lumpur. She is also an editor for the Malaysian Medical Gazette.
References:
- http://www.thestar.com.my/Opinion/Letters/2014/03/08/Junior-doctors-doing-the-impossible/
- http://kpkesihatan.com/2014/12/10/response-to-the-article-trauma-faced-by-some-housemen-in-hospitals-by-disgusted-malaysian-kuala-lumpur-dated-8th-december-2014/
- http://www.thestar.com.my/Opinion/Letters/2014/12/11/Were-blessed-to-be-in-a-profession-that-helps/
- http://www.thestar.com.my/News/Nation/2014/12/12/90hour-week-impossible-MMA-HOs-entitled-to-a-day-off-after-working-up-to-70-hours/
- http://www.thestar.com.my/Opinion/Letters/2014/12/08/Trauma-faced-by-some-housemen-in-hospitals/
nash,
thank you for sharing this….it really encourage me to be a better doctor,can you share the real life experiences with detail as a houseman in the hospital so that i get the picture and be prepare for the worst scenario eventhough i still have long way to go…
hxvxv