Angry Doctor

Monday, January 18, 2010

When I was a houseman...

angry doc used to work with a (not much more) senior colleague who used to start every other discussion with the phrase "when I was a houseman...".

Prof Lee now does the same in her latest article in the papers:


Time to reverse 'narcissism epidemic'
The young today are more self-centred and less driven, possibly due to their upbringing

The principal of a mission school invited me to give a talk to his teachers recently.

'The purpose of inviting guest speakers to the school is to open up my teachers' minds about new possibilities and the demands of the real world,' he told me.

I was unable to give the talk but volunteered one of my doctors, an old boy of the school and a superb and compassionate doctor. I told the principal: 'My perspective on the education of these relatively elite boys is to teach them that they owe society a duty.'

The principal agreed, but observed: 'Unfortunately, given the changes in Singapore... my teachers are increasingly pushed by larger societal forces that worship the relentless pursuit of academic excellence as a means of material gain... While there is nothing wrong with pursuing academic excellence, it cannot be an end in itself.'

I and many other senior doctors have noticed that a significant percentage of newly graduated doctors are more self-centred and less hard-working than we were.

For example, there are more house officers with each passing year, and in some departments, there seem to be too many of them. The total work has not increased much, but this is divided among more house officers. Yet house officers complain that they are stressed out and they cannot cope with the work.

When I was a house officer, there was no payment for being on call. As a medical officer, I was paid $40 for the first four calls in the month, and $100 for each subsequent call. There were no mandatory maximum or minimum number of calls for house officers or medical officers.

But some time after 1990, house officers were not allowed to do more than six calls a month and medical officers were not allowed to do more than four calls. House officers are now paid $110 a call on weekdays and $150 on weekends. Medical officers are paid $210 a call on weekdays and $300 on weekends.

We used to have to do eight to 10 calls a month, and the number of patients I saw each time I was on call was considerably more than the numbers seen by house officers and medical officers today.

But despite having to do less work, junior doctors apparently have less time for self-study today.

Consequently, many training programmes now set aside 'protected time' during working days for them to study. In addition, most departments have structured teaching programmes for young doctors - a far cry from the bad (or good) old days when there was no time during working hours for structured teaching and most of us learnt from patients or senior doctors. And to reinforce our knowledge and ensure we missed no crucial information, we would read a standard textbook from cover to cover.

All of the above would appear to be exceedingly difficult for the present generation of junior doctors. For some years, I wondered whether this was the fault of our medical school or indulgent parents."

angry doc belongs to the generation of doctors who benefitted from the enlightened view that doctors should be paid appropriately for their time on calls ($40 for an overnight call would be way below minimum wage if we had one) and that they should not (in theory) be made to work more than six calls a month. Nevertheless, his personal record was 11 calls in one month, and he can remember a few where he did not catch a single minute's sleep.

Housemanship in his days was tough - angry doc has seen it reduce grown men and women to tears - and even then angry doc heard his share of "when I was a houseman" from his senior doctors. angry doc is willing to bet that as a houseman, Prof Lee too got her fair share of "when I was a houseman" from her senior doctors, who remembered how housemen were better in the days of the Raj.

Do junior doctors have it easier these days? Certainly. But that precisely why the changes Prof Lee mentioned (limiting number of calls, structured training, protected time) were implemented - we want to make learning a less stressful experience than what we went through ourselves, and we want it to be safer for everyone.

Does it matter that the youths of today are 'less tough' than we were? angry doc doesn't think so. The whole point of training for junior doctors is to produce doctors who can function in their role in an efficient and safe manner. They may not have to do 11 calls a month, or take blood for 40 patients in one morning, but they face a more demanding generation of patients (and relatives), and the volume of new information and evidence they have to assimilate and incorporate into their practice is enormous. The old challenges are not the challenges they *need* to face today, just as we did not have to face the challenges that they face today when we were housemen.

At the end of the day, when angry doc is ill, he doesn't want a tough doctor who has done his 10th call this month, or a humble guy who thinks he owes society a debt - he wants someone who is rested and has had plenty of time to learn about the condition for which angry doc has been admitted for. It matters not to angry doc that the doctor might have a "positive" opinion of himself - as long as he can do what his job grade requires, it is not an "inflated" view.


Monday, January 11, 2010

Look Back In Anger

It's a little late to post a look-back of the year, but here goes anyway...

The past 18 months have been a time of change for angry doc - some good ones, some bad, but most of which he thinks he has brought upon himself.

angry doc's opinions on many subjects have changed. Not surprisingly, this also meant that people's opinions of angry doc have also changed. Curious thing is, you sometimes don't even know what someone's opinion of you is until he or she tells you that his or her opinion of you have changed. Even more curiously (or curioser), angry doc realised that he doesn't really have an opinion of himself anymore, if he ever had one before.

angry doc doesn't know how often he will be blogging this year. It's not just because he will be busy with work (you are never too busy to blog, really), but because he is not sure he sees the point of putting his opinions down anymore.