Tuesday, July 22, 2008

What Exactly is Housemanship?

Lately, the new batch of housemen does not seem to be happy. Apparently some housemen (yes, THE new batch) are very unsatisfied with their jobs. Ya they have been making noises, but lately they're making more. Most of them made complaints about long-hours work, too much workload, always got to miss meals, always get scolded, work stress is depressing etc. And one of the HO's parent (apparently the over-protective type) even personally called the hospital director, complaining that the "36 hours on call" is unacceptable and it made her son "stress till constipated for 1 week (she can't possibly be serious)" and she requested on "less call, regular meal time, and can go off work on time" for her son.

This is just not so right.
I'm just wondering, do they ever know what exactly is housemanship? What was their expectations before they start working, or even before they chose to study medicine? Did they think it's gonna be easy?

First of all, housemanship is a training. A TRAINING. Not honeymoon or whatsoever. It's never easy. You'll do everything under supervision, and your knowledge, attitude, responsibility and endurability etc is tested, before you can be fully registered as a practising medical officer.

The "on-call" is 36-hour working and it's been there for ages and already like setting a "trademark" for doctors' work. Yes, it's tiring, for sure but I can assure you that this is the one of the most vital parts of your learning. Let me just quote my good friend, Steve's saying: "Being on call is clinically, physically, psychologically, socially, spiritually, and technically challenging. So, Bravo! to all doctors who had endured housemanship."

I can honestly tell that I learnt the most from calls. It's the time you learn to (or forced to because you're alone on the night) be independent handling and managing the patients. And talking about long hours, have you heard of back-to-back call? Meaning 2 calls in a row? What about a stretch 3-calls? And, the ultimate, 4 calls?

The shown punch card is of my worst month in surgical posting when the housemen were in awful shortage, and we had to do stretch calls. Note that those are active calls, so go figure how many hours of working was that. But I DID NOT complain. Nor did my mom.
(To all the respectful seniors, i'm not trying to show off at all. Just to put as an example. I'm sure there are some of you who had even worse time than it)

So the conclusion is, pls stop complaining. Housemanship year is crazy/mad/whatever-you-call-it but every medical officer has gone through it. If you think this is unacceptable, pls re-evaluate yourself before you have doubt on this working system.

And a piece of advice to all concern and over-protective parents: It's time to let your child go and learn. There's bit of suffer for him/her, but it's all for his/her own good.

I can bet with you, if housemanship has turned into a relaxed, goyang-kaki 9 to 5 job, in the end of the day, you'll most probably call the hospital director again and say,

"I want to complain! How come my son/daughter is now a fully registered doc but he/she doesn't seem to know anything one?
Did you all train him/her properly or not?"
Related post:


Joethew said...

once decided to take this road,shud be prepared to suffer..this's not an easy road..complaining & grumbling doesn't make things better..

Owners of Snowy said...

harder path will definitely shape us into a better doc:-)

shinyin_jocelyn said...

honestly, i am not sure whether i will be strong enough to get through my 2 years of housemanship... i know it'll be hard work, it'll be slavery, it'll be hell.. and i'm counting on the little things- the passion, the minute appreciation, satisfaction, to keep me going... and i wonder whether do people break during housemanship....

i suppose the new HOs were complaining, being a form of defense mechanism to ventilate.. but if i complain to my dad/mum, they'll probably kick me out... haha! my parents ain't the type who would call the school to complain...

p/s: can i link your blog to mine? i loved your blog! it's nice to know what i'll be facing in the coming years, like a preparation ^^

A FRP said...

Hi, allow me to leave my comment here.. :) I totally agreed with u!!! :) should learn as much as possible during the housemanship. I noticed that the 'younger generations' nowadays are too manja!! Not to say doctor, House pharmacists also got such attitude. Simple thing also cant handle themselves. Sad right? Really cant understand...

Darren said...

Don't worry shinyin, i'm sure you can survive *my intuition*
I was once so worried as you, but things went fine..as long as the attitude is on the right path, it should be no problem=)

Ya sure you can link me, i'll link you back too! Wanna hear more your piano playing ha.

Darren said...

a frp: Hi thanks for the comment;)
Ya the younger generations..ha now generally the comment for them is like that..in fact, some are also complaining of salary not high enough. For that i really feel like throwing 2 questions on their faces:
1. Do they know that a call before their time was only RM25 per call? compared to now RM100..they should learn to appreciate!

2. Can please improve own performance before asking for further increase of pay?

Sound a bit harsh i know but i think they should think about it..

sus said...

hi. got to ur blog from my fren's blog. just started reading some, but ald addicted. lol. =p
anyway, i'm gonna be out for hsmanship next year too and has been listening to some of the seniors talking about theirs. sounded pretty harsh...haha.
probably they were just feeling wiry about being have to serve hsmanship for 2 years. but i guess the government won't create a fuss of asking us tot work half a year extra without a concrete reason.
i'm up for the 2 years and hopefully i won't be letting my MOsssss down. lol...hopefully well-equiped by then, but still, will definitely need a lot of correction, i guess working life is never the same as med school huh?

Darren said...

Hi sus welcome..and getting addicted is good=D
Ya HOship is now 2 yrs for you all..should be a better training..and the casualty posting should be fun! (if you come to taiping then you'll see me hehe)
I guess you dun have to prepare much for HOship..probably just 2 simple tips:

1. Try not to rest too long before you start it. Coz when you start there'll be too many new things to learn so u won't have much time to revise what u've learnt before.

2. Always face things with a positive attitude! That will practically solve every obstacles;)

Good luck!

Li Ying said...

Hey there Darren! I've promised you this so I better leave my comments bout new generation of HO now (including those dysfunctional ones): (From my experience...)

1. A HO who was postcall (ask Darren bout this term) left me 5 branulas not set in and one of them is a Chinese uncle with massive bleeding from upper gut, and there were only one regular size branula in. Only half an hour before he died did i realise he was left with only one branula in for the whole night! And no passover to senior HO too. When asked, lots of excuses given. Worst still, this particular HO complained bout other HOs whom the whole world know how hardworking and efficient they are, as being lazy. She didn't even know how to interpret a simple CXR showing large pneumothorax!! Puhleez..

2. Lately, one of my colleagues received a referral from HO in maternity ward for a baby with 'double anus', with faeces coming out from both openings. Interesting huh? Thinking of a congenital anomaly? When the baby arrived in SCN, lo and behold, it's just a 'dimple over the coccygeal region' which is NORMAL! The reason she thinks it's a double anus is because the faeces contaminated the dimple, making it look like it's an anus! What a good laugh we had in SCN that day!

3. Nowadays, HO is so cocky! Last time we used to address ourselves as 'so and so' without a Dr title in front, when speaking to MO or specialist. The world is changing now. A HO called up wanting to speak to an MO..when introduced myself as Teoh, she said 'I'm Dr x from labour room', demanding me to go there now. When I reached there and smiled at her, what she did was to stare at me for a while and walkaway...sigh...

Darren, nowadays things are so different. Last time when we were in OG, we used to call up lots of hosp to book ventilator, right? Now, they are so manja until Paeds has to help them in searching ventilator. And I'm sure to condemn the shift system they are using now!

Lots more to share..but I think it's enough for the day.

Wake up new HO, you are no more Mama's boy or Daddy's girl!

P.S.: I have the worst experience in OG but my parents never complained to Pengarah.

Darren said...

Wow LY what a comprehensive complaint to the HOs!

1. For the 1st case, ya i know who's the HO but i didn't know the patient died! Gosh i think the HO is responsible..if she thinks she's not sure/ not able to handle she should call for help or inform MO! She should be baked la...

2. OMG the HO really made some history-breaking findings. Do i know him/her? Kinda curious..hehe

3. Ya biasa la..they're that polite nowadays. They'll just see you as transparent! Never even greet people..

4. And one more thing i wanna complaint, the last CME that we had, not only they all came late, they were chatting quite loudly at the back! Paid no respect to the speakers at all..i think pengarah should sound them la...sigh dunno how to teach them..

Li Ying said...

Of course you know who is that HO. She made herself famous since her first posting in Medical.

Yup, couldn't agree more with you bout the last CME, especially during Dr Eni's briefing about CPD logbook. They are not aware how important that logbook is to them.

Have a nice day pal! Two days off for me before NRP and MO CALL NEXT MONDAY!! HELLLPPP!!!

Darren said...

Hmm there are quite many "famous" HOs la..can't really guess..nvm just tell me next time;)

Ya bet they didn't know the importance of CPD book! It's ok, soon enough they'll suffer the consequences..

Oh it's ur off day la..i'm doin night shifts for these 3 days. Good luck for ur NRP (in fact, piece of cake la hehehehe) and ur coming call! I'm sure you can do it la dear friend!;)

passer by said...

To li ying,

in medical school, seniors always complain about their juniors,

in hospital, mos/senior HOs always complain about the fresh HOs.

it's a cycle..never end.

Some HO might make mistakes or even stupid mistakes,you can laugh at them personally but don;t make joke about it and called them 'dysfunction'. They can learn from mistakes.

I personally think that addressing herself as DR. is completely fine, it is just a title..nothing more than that. In fact, she is really a doctor, what's wrong with that?

things are changing, systems are changing to make Hos' life easier. It is completely normal. It marks the improvement of health system so as not to treat HOs as 'slaves'. Out of jealousy, you condemn. why don't u compare yourself with the previous old HOs?? I'm sure their workloads are very much greater than yours.

As i said, it is a cycle...never end.

btw, i like this darren's blog.

Li Ying said...

Dear passer by..

From your comment, I guess you must be a HO yourself or somewhere near that. I'm not calling them dysfunction because of the examples given as above, because I know that HO in person (1&2) and worked with her before and I know things she had done before.. as in leaving you as her colleague alone in the ward when she's off for a weekend off with no replacement? I don't mind about the HO who called herself Dr until the way she spoke to me and react to my friendly gesture. And I'm not the only person complaining...

You'll understand if you have such workmate or colleagues or when you are an MO (or probably you are one already) the feeling of having reliable vs non reliable HO. I'm not in this position to comment yet but ask any of the seniors, like you said, the cycle goes on.

I'm making this entry anonymously, not mentioning who he/she is. Is it of a great matter to you? Are you one of them?

It's normal to talk about our experience and funny things happening around. As long as we keep it anonymous, i think it's acceptable. We are not publicly humiliating anyone, just sharing.

And another point, do you think things are changing to make HO's life easier? Do you think HO are 'slaves'? If you think HO's life is easy, then you have not experience the real thing yet. Coz ask darren or anyone, HOship is never easy. And I don't condemn because I'm just more than a year ahead of the current batch, not much of changes. I should have been celebrating the current system with the new batch too, if really the new system is for the best of us. And i know clearly that my previous seniors have more workload and stress and responsibility than I have at hand now...and I really appreciate their advice and experience.

I'm not the kind of MO who would go shouting at HO..but if really you are placing yourself too high, don't blame if people are trying to push you down.

eelainee said...

wow, a war flame is in progress??

passer by, as you said, the cylce is like never ending, complaint of the subsequent batch is like a norm...

but not all of them! unless you experience it, you will never understand it.. We do put ourselves in the shoes of the HO, but, the number of HO is increasing, but why the quality of work is going downhill? and on top of it, the basic manners has fading???? li ying has a HO addresing herself Dr but in a rude way, i have a junior who is even worse! not addressing myself, nor introducing herself, but just call me "eye MO" and ordering me to accept case!

if they are keen in learning, we will show the way, but the thing is they never bother to check the patients themselves first and refer case because being called? what is this? when ask them to examine to tell the findings, they will raise their tones and just say "My MO examine one and ask me to refer only, i do not know any thing one!"

the second obnoxious attitude is the lie! i have one HO, referring a case to me, straight away telling me the fundus findings- without telling me the history, the pupil and so on... when i asked if she has dilated the eye to check the fundus, she said no... wow, can get good fundus findings without dilatation of eyes, so i asked her to teach me how to examine fundus without dilatation... then she paused and told me that she did not know how to check and did not check....

well, maybe the previous senior batch also complained about us, but, we never ever dare to fight back in such way! We do understand that the HOship is busy, but the number of HO is increasing , and subsequently, they become slacker and lazier???

there are HOs who are famous to MIA... especially when they are on call, and hence the other colleagues need to replace them... a few of them will abscond and leave all the ward tasks to the MO and the other poor HO, who has already loaded with their own jobs!

Li Ying said...

A toast to Elaine!! A truth from the mouth of a real MO, finally...;>

titep said...

first time here,
leaving a msg bcoz
my name is shin yi , which are surprisingly similar to
shinyin_jocelyn ?

and i m a 4th medical student
i believe u can be a real good doctor

Darren Lee said...

Hi shin yi, thanks for droppin by=)
Enjoy your final 2 years!
Hope to see you more often here;)

Anonymous said...

An emotional post, true in most parts but not addressing the issues of socioeconomic impact which hospitals in the UK and US have adopted policies for change. I won't argue the points here because basically, labour laws are not applicable to MOH policies in housemanship. There are people in MMA who are fighting for change, and the old chant that "we have gone through it so should you" is more tradition and rite of passage than sense.

Another passerby.

Joo Joo said...

Joo joo..
hi darren..i'm currently a 2nd yr medical student..recently found your blog..and i really love the article..pray tat i'll survive during hsmanship thou i still hv a long way to go..hehe=)

Darren Lee said...

Hi joo joo, welcome welcome=)
Enjoy ur student days! Feel free to ask if you need any help..;)

Joo Joo said...

oh..i just knew (from ur previous blog comment) tat u r from imu too..hehe..i'm from imu also..but batch of M207..=)

hamidah said...

hi darren
just find out ur blog from dr blogroll
ur blog is very interesting...
thanx a lot..
for me HO is the real time to test urself..r u good enough to be a dr?..
i 've done mine at klang hosp...sure u can imagine the nightmare..
anyway keep blogging....

Ernie said...

HI Darren,
I am a just a secondary school leaver, waiting for SPM result.
I am in planning of pursuing my career in Medicine, or rather, my ambition as a doctor.
So i wish i can know more about this particular career before i can really and officially make up my mind to gear towards this direction.

But there are something i am confused about.
1. what is the responsibility and work of an OH? (i presume HO as houseman officer)
2.What is the difference between internship and housemanship? aren't they the same?
3. What is the criteria or aptitude which one should possess in order to become a successful medical officer or doctor?

your answers will mean too a lot to me. TQ

Darren Lee said...

Hi Ernie, thanks for the ques. I believe these are all common question marks in the mind of everyone planning to do med, and it's not easy to answer in just few sentences. Mind giving me your email add? I'll reply to your e-mailbox.
C ya;)

Yasmin said...

Hello everyone.
my oh my.. i love this entry and comments. Great Great Exposure!
I'm in my final year of clinical rotation, and we medstudents have complaints too! U have to admit it, everybody does.. because nothing is perfect. I.e, we complain about our staff whose too busy to be our teachers, we complain of the system that made us wait for them.. when we can better use that time to examine patients, practise some skills, etc. If only we’d try to understand that they have operations, residents to teach, residents to examine, conferences to attend, money to make.. ofcourse we’re the least of priority and maybe we wont be that noisy. (but my friend argues that if they couldnt make time to teach, dont be a teacher because theyre eating gaji buta--good point eh?)
I think those complaints arise from lack of understanding. When i first heard the challenge of housemanship, i do whine and sighed. But when i know the purpose, the advantages-the whole point of it, i think i need it. And I only got to know them because my staffs, residents and seniors shared their experiences.. (while they’ve been complaining about us lazy-pampered-spoilt students and comparing ourselves with them). Ho ho. We went through different times, but we share the same goal. These notes are not in the books (thankfully can be found in this blog! :P). We seriously did not know. So, please kindly, share with us (your juniors) your experience :)
So, yeah.. nothing is ever going to change if we complain and leave it, at that. Cycle continues. However sickening complaints may be, they’re valuable feedbacks we can use to work for improvements. Make a difference. Back to..our attitude.
In my case, I absolutely love to hear MO's complaints about anonymous HO's here (no HO reputation harmed). I got to know the expectations, the common mistakes, or errors that can cost somebody’s lives... helped alot! Note that u’ve at least make a difference to me, and my cycle ends...HERE. Thank u doctors! :)

Darren Lee said...

Thanks for the comment. It's always good to hear the feedback from the readers. Glad that you like it;)

Anonymous said...

this is something i have never ever read.very detailed analysis.

Anonymous said...

I just added this weblog to my google reader, great stuff. Can't get enough!

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