Occupational Health Doctor: An Alternative Pathway after Housemanship

I mentioned about OHD a while back. The reason why I chose this field was because:

  • It’s a relatively unknown field
  • It’s something quite different
  • No oncalls. Yass!

Chance had it that I was given the opportunity to pursue this pathway so I give thanks to God for that. Truth be told, I had zero inkling what occupational health is all about before I went for the course conducted by NIOSH.

Occupational health was and still is one of the subspecialty under the domain of Public Health in Malaysia. However the pathway now to become a recognised Public Health specialist is much more difficult compared to few years ago.

I got a lot of new knowledge after attending the Occupational Health Doctor course. For your information, NIOSH (short form for National Institute of Occupational Safety and Health) acts as the agency responsible for training and research, whereas DOSH (Department of Safety and Health) is the enforcement arm that swings down the bat of justice hard on those unscrupulous employers that exploit and harm workers.

The current training format of OHD is one of short course where training takes place over 9 days split over 3 weekends. In this very short period of time, the amount of information they’ll cram into you is staggering. One would have to learn about the different terminologies, new way of thinking, adapting clinical knowledge into industrial setting, relevant laws and regulations and so on. Not to mention the myriad occupational diseases – which would be the clinical side of things.

The course I went for costed me about RM3k and it included all textbooks and food. It was held at the NIOSH office. We also had the opportunity to conduct a mock workplace assessment at a construction site (which is normally closed to the general public) to try our hand at identifying workplace hazards and come up with control measures, which is bread and butter for a practising OHD.

As to the exam.. well, that’s a post for another time. I haven’t sat for the exam yet.

I came to understand that OHD is a very popular supplementary qualification sought by a lot of doctors in the country. After attending the course, I realised why. A lot of the laws and regulations which employers and industrial companies have to adhere to require some interventions of which only qualified OHDs have the authority to conduct.

The lecturers allude to the lucrative side of the career- hard to see why. OHDs are high in demand by big multinationals and GLCs, and having this qualification puts you in good stead of clinching a good job offer in the private sector should you think of quitting the government at some point in the future.

That being said, becoming and OHD doesn’t mean you become a specialist. It’s just an extra qualification which qualifies you to do certain things the general public or practitioners from other fields couldn’t. While it can potentially be lucrative, it’s completely up to the resourcefulness of the doctors themselves to venture into business (depending on which side of the country you’re in).

Some final thoughts – OHD is one of the things I’m glad I forked out my hard-earned money for. It’s definitely a breath of fresh air compared to the usual things you see in the hospital wards. It can be dry at times, but the exposure to the technical side of things is essential for you to grasp the intricacies of this field and become an expert in it.

Always remember the adage, if you’re good at something, never do it for free.

Life after Housemanship: Now What?

It’s been 4 months after I officially finished my housemanship.

I’m pretty sure a lot of people had the same doubts as I had when I was nearing the end of my housemanship. Yet I consider myself decisive when it came to making a decision for myself.

Many people would settle for one of the big 7 specialisation – Medical, Surgical, Orthopaedics, Paediatrics, Obstetrics & Gynaecology, Anaesthesiology and Emergency Medicine. A lot would settle for serving at rural clinics or Klinik Kesihatan.

As for myself, I have not an inkling of idea what to do with myself in the next 30 years. And I shudder to think of being oncall for the rest of my life. I don’t see myself being in the clinical side of things. And I absolutely hate calls. Lack of sleep and the heavy patient load has taken it’s toll on my body and health and I loathe to imagine how I would end up if I continue doing something I hate for the next few years.

So that meant almost all of the specialties is a no-no for me. In Malaysia, that leaves only going into administration or continue being a general clinical MO as viable pathways.

I have always liked Public Health as an alternative and for a time that became my goal. Unfortunately, in Malaysia, that would mean having to go through PhD before one gets recognised as a specialist eligible for registration in the NSR. Not to mention the “mentor-mentee” program (which I have absolutely zero idea about) and having to serve in district (at least that’s how it is in Sarawak).

I shudder to think of being bonded with the government for another 7 or 10 years if I do decide to go for the local PhD route. It would mean having served at least a quarter of my life in an invisible bondage of service.

Another option came up and I chose take it – Occupational Safety and Health. Granted, it is not a specialty by itself. But I went for the OHD course anyway and found myself quite interested in the field. That’s a story for another day.

There are a lot of different fields available in Malaysia as our healthcare system improves every year – nuclear medicine, pathology, radiology etc. Even more obscure ones are those who serve in the military, of which I’m pretty sure are only reserved for those who graduated from the RMC or Universiti Pertahanan. At one point I even fantasised of joining the army as an army doctor but that would mean forfeiting my life once my parents find out and kill me.

Well, for now, I’m content, and I haven’t felt this way in a long time. And that’s saying something.

Quitting Housemanship

Qutting Housemanship

stressed doctorShould I quit housemanship? To be honest, this question has crossed my mind countless times. I came near to my breaking point barely 2 weeks into my HOship in O&G rotation. I can understand too well the stress of being in a completely new environment, feeling like an idiot and having no idea how to function. I know too well the feeling of inadequacy and the anger at myself for having spent 6 years abroad with nothing to show for. If you’re a houseman on the verge of quitting, then I hope my writing would help you decide, if only a little.

Should I Quit Housemanship

That being said, I still think, no, you shouldn’t quit housemanship.

Yes, it is the toughest thing I’ve ever done in my entire life. Slogging 2 years without adequate sleep, enduring harsh criticisms from superiors, having the nagging feeling that you’ve forgotten to do something right – all these is part and parcel of working as a lowly HO in Malaysia.

Yet as I grow older, I saw housemanship as a period where one can achieve tremendous personal growth. Just bear in mind that no other profession gives you the opportunity to develop yourself in such a short period of time. At least, no other profession requires you to perform and not kill somebody at the same time.

The need to perform well under pressure will hone you into someone you’ll barely recognise 2 years down the road. Whether that pressure made you into an amazing healthcare provider or a horrible boss who will just continue the vicious cycle for the younger generation is another matter entirely.

It all boils down to one essential word: grit

Grit

If you haven’t read the book by Angela Duckworth, I highly recommend you to. Her book has opened my eyes on high performance and tenacity. Her research shows that, no you don’t need talent or a high IQ to be successful in life. All you need is the passion and the perseverance to persist to the end.

Yes, housemanship will break you.

You will be driven to the edge of your abilities.

You will be pushed past your limits.

Yet if you persist, if you hold on to that one word, believing that all difficulties will just help you develop that grittiness, then you have the essential quality called The Growth Mindset. It will carry you far in life.

Personally, for me, I held on, and I am forever grateful to my friends and family who helped me through it. I strongly believe the 2 years shaped me into a more mature and courageous person who will not easily take no for an answer. All the harsh treatment only made me develop a kind of mental toughness and tenacity to persevere through the shitty phase in life.

I will spare you the usual arguments defending our current HO training system. I personally think that it has much room to improve. Look past that, however, and you’ll realise that housemanship is a valuable training ground for you to rapidly become a capable adult. All the experience you garner through the period will help you in whatever field you choose, even outside of medicine.

Dear housemen, don’t give up. Fight on. When all else fails, just remember, pain is temporary, but growth is permanent. Everyone has the capacity to grow, and you can too.

 

Bako National Park

Yesterday was Labour Day and I decided to make full use of it by visiting one of the more famous attractions around Kuching – the Bako National Park. After 28 years of staying here, professing to be a local Kuchingite, frankly it’s a little embarrassing to have yet visited an easily accessible national park.

The park itself is situated approximately 37 km from the city.

How to go to Bako National Park

We started our journey from Kuching at 7.30am by car and reached the Bako National Park car park and boat jetty within 40 minutes. There is scarcity of parking spots around the area so we were lucky to have arrived early. By 8.30am the jetty was already packed with throngs of tourists and day trippers (especially so since yesterday was a public holiday).

Park entrance fee is RM10 per person for Malaysians, and it costs RM30 each person for the return trip by boat to the national park itself. The journey by boat takes 20 minutes.

The boat stopped at the beach and we had to disembark from it straight into the water. That was a bit surprising, yet we took off our shoes and waded through the water anyway. That was, as I later found out, the Teluk Assam beach. It was quite a walk to the park HQ – photo opportunities abound along the way on the vast expanse of sand.

teluk assam
Disembark from the boat onto the beach straight
teluk assam
Vast expanse of sand

Bako Hiking Trails

There were numerous hiking trails to choose from, some of them are closed so we went for the most popular routes – Teluk Pandan Kecil and Teluk Pandan Besar. One has to register at the park HQ before starting the journey.

After a quick breakfast of fried noodles, off we went merrily into the jungle. The flora and fauna is amazing – we saw long-tailed macaques and wild boars up close. No sight of proboscis monkeys though – they’re at a different part of the national park. The initial flat parts of the trail in some parts consisted of wooden walkways over mangrove swamps, but it quickly gave way to steep rudimentary steps perched on tree roots which turned out to be a testing exercise in physical strength. We reached the fork at the trail to Teluk Pandan Besar after almost 2 hours of huffing and puffing. By this time the mid day sun blasted its heat without mercy at us, testing not only our strength but endurance.

bako

teluk pandan besar
Teluk Pandan Besar viewpoint

Teluk Pandan Besar Trail ends at a cliff which affords a spectacular view of the South China Sea and a secluded but inaccessible beach below. After taking photos we quickly left as the heat was too much to bear. We hiked back to the fork and made our way to Teluk Pandan Kecil and after another 30 minutes of torture, made it to what is supposedly the end point (judging from the number of people taking photos and even having a picnic there).

Finally made it

We were about to turn back and start on our journey back towards the HQ when a fortunate stroke of serendipity happened. An elderly gentleman told us it was actually possible to take a boat straight back to the HQ. So off we went, making our way down the steep descent to the beach below the cliff.

We arrived at a secluded beach which was really tranquil. Save for a few hikers, jolly swimmers and the boatmen, we were the only ones around.

Pure tranquility

We took a boat together with another foreigner couple and the boatman took us close to what is arguably THE place to be in the whole park – the magnificent Bako Sea Stack.

It is one thing to be seeing this thing everywhere in tourist brochures and even textbooks, and an entirely new experience to be seeing it up close, with the choppy seas around us.

We reached the HQ at about 2pm, exhausted yet fulfilled. I kept thinking about the chance encounter with the stranger. What a stroke of luck! If it weren’t for him, we wouldn’t have known that it was possible to take a boat straight to the HQ, with the added opportunity to see the sea stack up close.

Bako sea stack
Ain’t she a beauty?

If you’ve never been to Bako National Park, I highly recommend you to pay a visit.

Housemanship Experience – Part Two

After 2 gruelling years, I have finally completed my compulsory house officer training.

Anyone who has been through it would tell pretty much the same things – shitty working hours, exhausting workload, toxic environment – sometimes to the point of annoying those who are not in this field.

“Yeah yeah we get it. You have been through hell, bla bla bla. What else is new?”

Well before I get into that, let me recount my experience from my last 3 posting. (Click here to read my experience from the first 3 rotations)

Surgery

Surgery was one of the toughest posting for me in terms of workload. Back then there was no off days, so that means puny HOs have to work continuosly without break for 4 months, with only a weekend pass in between (or was it 2? I can’t remember).

Oncalls were terrible affairs as you’d have to work 30 hours, and if you were placed in one of the surgical subspecialties, it stretches to 36 hours straight. I had the pleasure of doing back to back calls for a week, which meant that the only time I went home was every other day just to shower and sleep.

I had no idea how I did it back then.

The only time I enjoyed myself was during my rotation in urology. Bosses were nice there. Other than that, let’s just say I’m glad I don’t have to step into the operating theatre anymore.

Paediatrics

Ah, the dreaded department. The one that invokes a sense of impending doom in the hearts of every puny HO.

To be honest, I quite liked the rotation in paediatrics. I guess it was because it being the 5th rotation, everyone from my batch went into the posting together. So that means friends whom you could count on, and in housemanship, teamwork means everything.

I started off in the nursery, then the general wards, then came the rotation in paediatrics intensive care unit, and finally paeds oncology. Paediatrics was the one department where they hammer the sense of carefulness into you everyday. You have to pay attention to every single tiny little thing. You are dealing with tiny little humans after all. A simple mistake can cost lives.

I was fortunate enough to have had the chance of working under some of the smartest and most dedicated people in paediatrics. My time in PICU was spent just trying to not make any mistakes and trying not to shit my pants as I cower in fear in the shadow of the famous consultant there.

That being said, paediatrics was the one posting that thought me the value of perseverance. It was where I saw first-hand the true meaning of doctors being healers. It was where I saw miracles happen.

Emergency & Trauma

Ah, ED. The jungle.

The chaos in ED would make anyone rip their hair out in frustration. Luckily I went into the department together my batchmates as well, and like I said, teamwork is everything.

I would say I learned the most in this department. It is where one get to integrate everything they’ve learned in previous departments and apply it in real life, and sometimes in hair-raising situations. I’ve lost count the number of CPRs I’ve participated in.

The hours are long and the work is exhausting. Add to that the various shenanigans one has to put up with people who treat the ED as their personal pharmacy/free medical consultation clinic, it’s easy to hate the place. Yet strangely I found comfort in the chaos.

In short, ED was fun, and it was over in a blink of an eye.

Finally it was over

My last night shift in ED was a relatively peaceful one. And before I knew it, 2 years of hell was over.

Pictured here with the other survivors of housemanship

To be honest, it didn’t feel as liberating as I thought it would be. With the completion of housemanship, one becomes a medical officer, and that actually is the scary part.

There’s no one to breathe down your neck anymore, yes, but you’ll have to start being the one who makes decisions that will impact another human being directly. The responsibility is tremendous.

I just hope that when the time comes, I’ll be able to make the right decisions¬† to the best of my ability.

End of Another Year

I cannot believe it’s already the end of 2017, and even more perplexed to find myself struggling to remember what has happened for the past year. Everything seems to be a blur, a life lived as though I wasn’t in control, a life in which things happened before I could comprehend the full magnitude of it all.

All I know is, I have more or less settled into life as a HO in this hospital. The daily grind, the exhaustion, the toxic people I deal with daily at work – all these things have definitely changed me, and I hope for the better. Things don’t seem as difficult as when I first started. I guess that’s what they mean by grit – the more you put yourself into uncomfortable territories, the more you grow and adapt. It doesn’t matter whether you like it or not, what matters is just turning up and getting shit done.

Then there was another life-changing event that happened right at the beginning of the year that seemed to throw a wrench into everything. Yet I know I walked away from it a changed man who has a different worldview now. Alas, life is never a fairy tale. Yet there’s always a silver lining in everything, and when things seem to be darkest, that’s when the slightest sliver of light becomes a ray of life-giving sunshine.

That being said, 2018 represents a new beginning, a chance to wash away all the filth and start on a clean slate. It also represents a major fork in my journey in life since I have to make a career pathway decision pretty soon.

Here’s to another great year, and hopefully it won’t be another blurry, forgettable one. Happy new year folks.

Hospital food chain

House officers are quite literally on the bottom of the hospital food chain.

There are at the consultants and head of departments, the gods of medicine whose mere presence makes everyone scuttle. Pray they won’t ask you questions during ward rounds.

Then there are the specialists who supervise the show in the ward. The ones who make important life or death decisions, the tough clinical judgements.

Then there are the registrars whom we look up to, who are training to become the next generation of specialists, those that the MO’s turn to for guidance.

Then there are the MO’s, those that actually run the show, those that we depend on for our daily instructions.

Then there are the staff nurses, without whom the ward will totally come to a standstill. They are the ones who actually administer medicines, who nurse the patients back to health, who provide tender care to the sick people in need of human touch.

Then there are the JM (jururawat masyarakat) whose job scope I’m still trying to figure out. lol. They help take vital sign measurements, collect blood products, escort patients if needed.

There are the PPK (pembantu perawatan kesihatan) who are vital to ensure smooth running of the wards. They deliver food, send whatever documents need to be sent, collect whatever stuff needs to be collected. They are basically the messengers of the hospital.

And don’t forget the radiographers, the technicians, the cleaners.

So where does a house officer fit in?

Right at the bottom of the food chain.

We are no one.

We work. We get up at 5am and toil until evening everyday. We get screamed at for no reason and swallow our pride, even when the person screaming is not our direct superior. We take the scolding for mistakes we did or did not do (doesn’t matter, it’s always our fault). We try to get a little better everyday.

We are there when the post operation old gentleman needs a little help ambulating. We listen when the old grandmother cries in the middle of the night because her son didn’t visit her that day. We make travel arrangements to make sure the patient from some rural village gets to reach home and not get stranded in the middle of the jungle somewhere. All the while not expecting to get praised for it. Because that’s our job, and everyone expects us to do it.

When the truth sinks in, when you realise medicine is actually more of a lifelong calling and that everyone started off being nobody, that’s when you accept being at the bottom of the food chain isn’t so bad.

Besides, it’s only for 2 years right?

I still wanna quit clinical medicine though. Hahahaha.

Housemanship rants: settle your own shit

It’s no secret that housemen work their asses off doing what we call ‘joblists’ and scurrying around like rats frantically trying to complete what has been planned for the patients before their superiors do their rounds, day in and day out.

Sometimes, one would come across something a task in the joblist that was planned the day before or the shift before that hasn’t been done, and when that happens, one can be forgiven for grumbling and silently cursing the previous HO who didn’t do it. It’s what I call leaving your shit to other people.

Why does uncompleted joblists evoke such a big emotional response? Because the HO in charge for the day would face the consequence even if he or she know nothing about the plan for the patient the day before. No such thing as “not my patient” or “I didn’t review the patient yesterday”. Because ultimately every patient is your patient. So if something wasn’t done, and you have the luck to be the one who’s taking care of said patient, then be prepared to either pull a Superman stunt to do it before rounds or swallow the wrath of the MO’s or specialists.

“Why wasn’t it done?”

Why indeed.

Never mind the fact that we are humans and we can’t duplicate ourselves.

Fact is, leaving shits to other people is a daily occurrence. I have been guilty of it, and I have also been at the receiving end of it. Most of the time I would just do it and not complain. Why? Because why bother getting yourself worked up over something that would take your two or three minutes to settle rather than confront others.

Granted, there are certain species that regularly leave behind nasty excrements for others to clean up, and these people deserve the scolding.

I recently got to know that FY house officers in UK can just handover whatever is left in their joblist to the next shift and go home.

Wow.

Maybe it’s because UK people are generally nicer. Or the fact that its way easier to do things there, everything is computerised etc.

It doesn’t work that way here unfortunately. We still have to send bloods manually by walking to the lab 3 mins away, and trace the results manually ourselves via the only computer and take photos of the result through a glass screen like some kind of Paleolithic age cavemen (at least that’s how it is in SGH).

And whatever happened during your shift, you have to complete everything, even if it means staying beyond your working hours. Never mind the fact that we don’t get overtime pay.

It’s manageable if you have good rapport and have a deep sense of teamwork. When you have teammates or friends that understand you’re exhausted, and they cast the yoke upon themselves and pull the weight together with you, facing the shitstorm together – when it happens, housemanship becomes something quite enjoyable. All because you have friends that do understand what you’re going through, and you’re not alone.

But when you’re working with selfish people who grumble or disappear for no reason and you’re left all alone to settle all the pending jobs, and at the same time getting scolded for not getting things done fast enough, that’s when your morale would drop like a stone, and going to work feels like torture. I’ve been there and it’s not a nice feeling.

Housemanship is a tortuous journey. Everyone is tired. Everyone makes mistakes. Everyone leaves shit for others. But it would be slightly more bearable if everyone sacrifices just a little bit to help their fellow colleagues. Teamwork is key. Life wouldn’t suddenly be a bed of roses, but it wouldn’t suck that bad either.

Housemanship Experience – Part One

I’ve finally completed my third posting of my housemanship. It’s quite amazing to look back and contemplate the journey I’ve been through.

So you might ask, hey, how it’s like being a houseman? Well, I’ll try my best to summarise my experience working here for the past 1 year.

Obstetrics and gynaecology

I started off in O&G. Anybody who’s done O&G as their first posting will tell you that it’s a killer department and many got extended. Imagine being new to this whole field, not knowing how to function and suddenly you’re handling not just one but two lives (the baby and the mother). In the first week I dreaded going to work everyday, and sometimes I’d wake up in the middle of the night in cold sweat, heart racing, frantically trying to remember where I was.

The palpitations were the worst. It’s just sort of a background noise, the subtle sense that something is wrong, and I’d be nervously thinking what did I miss during the day. Truth be told, I broke down within 2 weeks of tagging and seriously considered quitting. But I couldn’t quit, so I soldiered on with the support of my family.

I’ve had my fair share of screaming, scolding, berating from the medical officers. Granted, they were trying to hammer the finer art of OBGYN into me. But it’s definitely not a good feeling when you get shouted profanities at by your medical officer, or being chased out from the cubicle for not being able to write entries in the case notes. I was so clueless back then. One also had to learn through errors and mistakes especially when it comes to assisting the surgeon in the operating theatre. They don’t teach you that in medical school.

Oh AND to top it off, there’s the KKM logbook to fill and our hospital’s O&G department required us to perform a caesarean section under supervision in order to pass the posting. So yeah. Definitely was interesting, but nerve-wrecking.

Miraculously I survived.

Medical

So off I went to my second posting. Medical department is where one learns the art of managing basic medical conditions with the hope that housemen would be able to handle patients safely once they’re on their own, or at least that’s the hope. Truth be told I was still pretty clueless and I didn’t know why certain things were done that way or why certain investigations were ordered. In hindsight, I should’ve asked more.

It was a very hectic department with seemingly endless joblist, and you’d be so busy doing the tasks that there’s not much time left to actually learn how to manage patients. Time were mostly spent doing mundane things like drawing blood, sending bloods, tracing said blood results, requesting imaging like ultrasound, referring cases for interdepartmental consults and so on.

All this probably led to me being more efficient in prioritising importance of tasks and forced me to manage time well. Plus, MO’s are very nice in general, so though the workload is high, it wasn’t that stressful, unless when you’re oncall at night and things could go wrong, which it did in my case. That’s story for another time.

Orthopaedics

Orthopaedics is supposed to be a way more relaxed department, or so everyone says. It was, in a way, except for the fact that we have a slightly, erm, stricter HOD and things can get tense during morning handovers.

Otherwise, there’s actually less joblists to do in the wards, and we get rotated to the emergency department to handle all new orthopaedics referrals. That means having the chance to play around with plaster of paris, applying casts or backslabs ourselves and getting the chance to do manual reduction of fractures in the ETD. For those who are more keen to do things with their hands, orthopaedics would be a very nice place.

By this point in time, third posters were expected to be more functional, and of course you’d get screwed badly too if things don’t go smoothly in the wards. That being said, by the third posting everyone who’s still surviving HOship would’ve developed a unique ability to remain poker-faced, nodding and apologising robotically despite the most vicious remarks by the superiors.

Oh and of course you’d have the chance to enter OT again and assist in some interesting surgeries.

Final thoughts

When I first started HOship, I never expected it to be this tough. I pushed on anyway, and time passed by so quickly and before I know it, one year has already passed. I now look forward to the day I finish my housemanship and being a little less clueless, a little less dangerous and a little bit more useful to those I serve around me.

Click here to read part 2!