There is a new circular going around to all the department heads. Apparently the matter was agreed upon by the state health director and some heads. Guess what was this circular about?
The circular states that specialists MUST teach house officers in their department. If not....brace for this...they must be reported to the State Health Director. Wah lau...whose bright idea was this?
Firstly I think this is a feeble attempt to rectify the increasingly poor quality housemans. Yes, now they are pushing the responsibility of training doctors to the extremely busy government specialists rather than addressing the underlying issue of poor quality students being admitted to the mushrooming medical schools to the various "dubious quality" medical schools. It's like blaming the examiner if a student cannot pass an exam. Yeah, blame the piano teacher if the child doesn't have any musical acumen.
Secondly, how do you enforce such a directive? How do you "force" someone to impart their knowledge? Can you? How do you prove that teaching did or did not take place? Especially in a field where learning takes the form of an apprenticeship. What action can be taken if a specialist did not teach his housemans? Sack him? Is it in his job description to teach housemans?
Thirdly, what is the ratio of government specialists to housemans? Considering the large number of graduating medical students nowadays.
Fourthly, what about Medical Officers? They do not need to teach housemans??!!
The specialist may be obligated to teach his housemans but is he legally compelled to? Teaching an apprentice is the perogative of the teacher. What is taught and how it is taught is the perogative of the teacher. And it depends on the apprentice's capability. Can you throw a monkey to a kung fu master and expect him to turn the monkey into Jet Li?
I think a better method is giving some incentive eg paying overtime after office hours for the specialists to teach housemans, as teaching housemans can be very time consuming. For example a senior doctor can insert a chest tube in 10 minutes but teaching a houseman to do it can take hours. After all if you have 40 patients in the ward plus some on the floor and another 40 waiting for you in the clinic, your priority is how to finish seeing all the patients in time for clinics...and how to find more beds for new admissions. If one were to spend teaching housemans at the same time, one might as well forget about going home that day.
Hmm...I wonder is this the result of some complaints by HOs?
What kind of grey matter does this Professor and Vice chancellor possess? Check out here. I'm not an expert on law but is there a provision to allow suing of a person for making a suggestion to open 10% of a university's place to non-Bumis ?
Is this how they are teaching law in this university? Just sue it ! Hahahaha. Thank you very much, not very interested to study in this university even if it is FOC...
The turn-over rate for my sports shoes are legendary. Recently my rather new shoes gave way again, not because the sole gave way but because the stitching gave way a little and became loose. And the result...my toe nail became loose and bled inside. The importance of getting a well fitting sports shoe cannot be over-emphasized. Anyway I got a new pair asap and well, it is much more comfortable than the old one albeit at a higher price coz I really don't fancy getting another toe black in colour.
Anyway soon after that I decided to buy another squash racquet to replace my Titanium one which was broken (temporarily I was using my beloved 12 year old graphite racquet ) and got a new one, lighter and supposedly better racquet. German product wor...I had high expectations. Alas, after 2 sessions of the game, look at what happened...just after a few really mild accidental hits on the wall, the racquet cracked! Just 2 days of using my new racquet. My 12 year old graphite racquet has taken many many harder hits on the wall without any problems (designed in Austria, made in China). So much for German technology.
Anyway if not for the "imperfections" of the shoes and racquet I wouldn't have the pleasure of buying a new racquet hahahaha...although it is going to be painful for the wallet. I just hope it's not going to break too often!
I used to be a perfectionist. Every base must be covered. Any possibility must be considered. Things must be done perfectly. There is no room for error. That has served be quite well...but then as I move along in life perspective change.
I think perfection is an over-rated virtue. Yes, aiming for perfection achieves many things. Aiming for perfection is a virtue sought after by some employers. Who wouldn't want their organization to function smoothly, efficiently without any problems ? ie perfectly. Who wouldn't want to score a perfect 100 marks in their exams ? Who wouldn't want to have perfect physical attributes?
However I think perfection is an imperfection in itself. Aiming for perfection shackles the imagination, it does not allow mistakes to be made, it does not allow room for much innovation and lateral thinking. Nothing goes wrong = nothing learnt. Perfection is like sterility.
And imperfection defines an entity as uniquely as their DNA. It makes a person who he is. Frequently imperfection strengthens the other virtues of the person. Being perfect is imperfect.
And I'm sure this "imperfect" one eyed cat is able to catch a mouse better than a "perfect" domesticated cat.
I'm really fed up with the political situation in our country...coupled with the obsession with race and religious matters. I think it's about dominance really...
And the fact that 5,000 students in a university protested at the suggestion of allowing 10% of other races to be enrolled just exemplifies how bad polarization has creeped into our education system. Check out here and here. So will we be seeing more race based universities? So much for national integration. I'm a little worried at how things are turning out these days. Maybe I should start having a back-up plan...
Anyway I decided to take my mind away from all these depressing political stuffs. Came across this fantastic video of Michael Jackson's Beat It song by Fall Out Boy. When the mood is right I just love rock songs!!! Wish I could be at a rock concert singing my lungs out right now. Oh and I just bought these 2 new music CDs (can't remember the last time I actually bought music CDs). Ok...maybe I'm a little out of fashion hehe
Just a ranting after a long day.
Have you wondered how much you knew about a person? Friends, colleagues, subordinates, superiors etc...
I've seen instances where "meek" House Officers turn into "monsters" once they complete their housemanship. I've seen House Officers who are "careless" became extremely conscientious Medical Officers. I've seen "famous consultants" who graced the cover of newspapers acting like a jerk towards his subordinates. I've seen quiet patients whom I rushed through consultation, who are the most appreciative later on. I've seen VIPs who acted as though the world owes them something and VVIPs who are extremely gracious and even willing to stay in 3rd class wards. I've seen people who are friends during times of need only.
In short, we can never tell a person by his looks, upbringing, religion, education, status or profession.
I wonder why some people chose to remain friends with jerks who are obviously in for his/her own benefit only? Why some people just cannot see through a person? I just wonder...Is it because the "friend" can crack a joke or two? Is it because he/she is good looking? Is it because it is entertaining to be around him/her? Is it because he/she is famous? Is it because he/she is rich? Is it because he/she is clever? Is this reason enough to remain as friends? I don't know but certainly I would think twice.
"We make them cry who care for us, we cry for those who never care for us, And we care for those who never cry for us" I find these words ring so true.
Maybe nobody is perfect. Maybe I'm too critical. But perhaps tonight I've seen another facet of human behaviour.
In the mist of the anticipated massive crackdown of illegal immigrants as highlighted in The Star, I hope the authorities will handle the children with due care and compassion. I hope they are not abused or left with the more criminal adults.
The kids I met played dangerously near the sea waters, without supervision. Their parents are not to be seen anywhere at all. They are not afraid of strangers, in fact they embraced me without fear or apphrehension at all. They are not violent. They did not attempt to steal my things. They did not beg. In fact, they look at me with curiosity and perhaps with a longing for love and opportunity. They smiled, they laughed and above all they wanted someone to talk to and perhaps pay them some attention !!!!
The people who should be penalized are the ones selling identification cards and those entrusted to guard our nation's sovereignty but chose to "close one eye".
Can we set up a protection center for the "parent-less" kids instead of deporting them? I would rather have my income tax be used for this purpose than to sponsor some person to space or to buy some Mercedes Benz to ferry some politicians...
I have a soft spot for kids.
One of my patient's mother offered me to take me to her village in a remote island in South China Sea. I agreed with a little apprehension at first because if the boat capsized at sea, well...sayonara. There are no communication equipments on board, no modern nagivation and no insurance. But I 'm glad my adventurous side got the better of me. And what I saw must be one of the last paradise on earth. This island holds about 100 houses while the smaller nearby island is uninhabited. We took about 2 hours by boat to get there after a 90 minutes drive.
Time stood still for a moment. It seems I'm transported back into a time where time is relative.
The traditional way of life and the sea co-existed for generations.
There were many sea creatures in nature or were caught. We saw turtles, flying fishes (really flying), sharks etc. We had a feast of lobster and abalone. It means nothing to them. Here we pay top dollar for them...I wonder who is rich and who is poor hahahaha
The poeple there are very nice. The children never looked happier. But there are a few stateless children too. Stateless because of the boundary we draw or because it doesn't really matter to them to get an identification card.
In a couple of minutes I'll be a year older. Yup...I'm spending a quiet evening at home coz my significant other is on-call. Decided to just lay back, look back and have a quiet dinner by the candle, with a chocolate cheese cake desert and perhaps a glass of Chivas ;)
I wish I was a party animal but I'm not. I wish I was as suave as Sean Connery or as stylo as Chow Yuen Fatt in "God of Gamblers" but I'm not. However I'm pretty happy with who I am. And I wish there was someone to share the moment with. It gets lonely at times.
Sometimes patients (and relatives ) do not like me very much as I'm frequently the harbinger of doom. Well, I have the unenviable task of breaking bad news to the patient (and frequently the relatives too). And of course as ridiculously as it sounds I do ask if they want to know the diagnosis.
I feel to give inappropriate hope or unreasonably high hopes to a patient is not right. Preparing a patient for death is just as important as giving hope to life. It's a tough balance. But when there is an 95% chance of a patient dying...would you prepare him for death or lift his hopes up for the 5% chance? Colleagues may disagree with me, but I'm being pragmatic and sometimes patient's relatives do not like to talk to me because of this.
I think preparing a person for death is extremely important. A person may have personal stuffs to settle, dark closets to open, people to forgive, ask for forgiveness etc etc. Giving inappropriate hope may deter the patient from doing things dear to him before he leaves this world. Patient or their relatives may start to look for futile treatments to improve the 5% chance. They may spend lots of money for dubious treatments (futile treatments are never a justification for desperation), numerous 2nd, 3rd and 4th opinions, makes excessive demands to their loved ones, ultimately leaving everything in a mess when they pass away. Not to mention the relatives later blaming the nurses and doctors and trying their best to find any minor fault which they think may have contributed to his (hastened) death.
The common reaction given by the patient (and more frequently their relatives ), especially Christians I must admit, is that perhaps a miracle will happen. Yes, a miracle can happen I agree. But we cannot make decisions based on the hope that a miracle will happen. Yes, you might survive a 10 storey fall by miracle, but would you bet on surviving the fall?
Preparing someone for death is difficult. It's unpopular, nobody likes to hear it, nobody likes to do it. And nobody will thank you for telling them chances are they are dying. Not in our Asian culture anyway. We avoid it, we give inappropriate hope, we pass the buck, we refuse to address it. But I think it's absolutely necessary at the risk of looking as if we are "taking the easy way out", for not trying hard enough.
I had a 90 year old rather frail patient with end stage kidney disease who needs dialysis. Everybody knows dialysis slots are extremely limited (we are not in USA or Europe) and nobody wants to "give a death sentence" to this patient. She may get a couple of "urgent" dialysis but long term slots are not available. So the decision was left hanging. And unfairly I feel, doctors pushed the decision to the patient's children! Hey dialysis is not risk free, the patient may well collapse during dialysis. What the patient's children said? They said " Doc, you do what you think is best. DO NOT ask us again for our decision (to dialyse or not). Several doctors have asked us the same thing many many times ". My colleague and I made the final decision - rightly or wrongly. I would have done the same for myself.
On the other extreme there are relatives of dying patients who wants "Everything to be done to ensure the patient lives for as long as possible", whatever living means to them, perhaps to avoid their own conscience of "killing" the patient. Prolonging death is unethical. Not to mention the extremely limited resources which perhaps could be used to save someone else.
Recent Comments
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dragonfly said:
Why, thank you :) Unfortunately the misses was at work. read more
on A quiet day ahead -
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charis said:
We talked about this ethical dilemma during my Gerontology Counseling class today. read more
on Hope and dying
Hopefully it will remain our country. I'm glad I took the trip. It was really rejuvenating. read more
on Paradise