Living in an Epidemic

When I was reading about the Ebola outbreak last night, I thought of my time in Taiwan during the SARS epidemic. So I went back to the diaries I kept during this time and found couple of interesting entries. I was there as a Fellow in one of the world famous plastic surgery units during 2003. A Fellow is a young doctor who travels to another hospital unit to train for a specified period as a ‘trainee’ doctor, usually to learn from a specific doctor or a particular procedure/technique.

I have left this entry unedited, as it is a true perspective of an Australian living in Taiwan during the SARS epidemic, both as a doctor and local resident.

25th Aug 2003

It’s been more than two months already since the first wave hit Taipei. I still remember the panic that hit the city during that first week; it was when they closed down Ho-Ping Hospital in central Taipei, with all its patients and staff isolated within the hospital. It was constantly being aired on the news and the hospital exterior was being videoed 24 hours a day, a bit like reality TV. There were scenes of flying badmington cocks over the railings of the balcony, and I remembered the presenter reporting that it was great to see that the occupants of the hospitals keeping up their spirits, and exercising to keep fit. The comments from my male colleagues in the TV room at the time were less than polite. I think something was mentioned about there are better things to do when you are couped up with a whole bunch of young nurses. *eye roll*

Then there were news of individuals who were to be isolated at their own homes because they’ve been in contact with SARS suffers. After which, news of non-compliant isolated individuals venturing out of their homes were reported with the police were called to herd them back home. They have now posted guards around quarantined buildings to stop residents from ‘escaping’. Cases were on the rise, another hospital got shut down, and the mortality is starting adding up.

I have missed my chance to go home. Four weeks ago our department director gathered all the overseas Fellows in his office to let us know that if we wanted to go home and leave the country, he would still be happy to write us a certificate for our fellowship and recommend us for jobs back home. There were 7 of us, two from Harvard in the US, 2 from Italy, 1 from UK and another from Ukraine. The Ukrainian and I stayed. It was really a blessing in disguise, because now, instead of elbowing other Fellows out of the way for an opportunity to do cases, we are both operating more than 12 hours a day. I joked to my concerned parents back home that I spend so much time in the operating theatre with its filtered and uni-direction airflow, I am probably at the lowest risk of getting any respiratory virus. They weren’t amused. Wherease my boyfriend just said that if I got SARS, he wasn’t coming to visit. I’d like to believe that’s anger and frustration talking. I can understand why he’s so pissed at me. I think I would be too if our positions were reversed.

The one thing I have discovered about living in this SARS epidemic is that there seem to be more pregnant women than usual at the moment. One nurse mentioned to me that since we have to take our temperatures every day as required for all hospital staff, she has finally managed to get pregnant during her last cycle as she knew her exact ovulation date. A fellow colleague also mentioned that you can pick the pregnant nurses during this epidemic, as they are usually the ones wearing an N95-grade mask. These are heavy duck-billed masks which have viral filters and are very hot and uncomfortable. Most staff members such as myself (who want to breathe and admittedly am a bit blasé about the whole thing) just wear the regular light ones.

Oh well. You’ve gotta learn to see the bright side of life when living in an Epidemic.

Administration has been harping on about wearing the right masks, but I seriously believe that if I wash my hands (which are raw from scrubbing all day), and keep away from sniffling, slobbering people, I’ll be fine. I have been avoiding public transport as much as possible. I have blistered on my feet because it takes me one hour each way, walking to and from work. After 8pm, I just sleep in one of the spare beds in the Burns Unit. I suppose I am like every other deluded doctor at the moment, we think we are being ‘adequately’ careful and probably invincible.

A thought just occurred to me. If I die in this epidemic, I won’t be able to hear ‘I told you so.’

Well, I guess if I am not back tomorrow, you know I am being ventilated in ICU with SARS.

 

 

Doctors are the worst patients

chestxrayphotobomb

There are plenty of reasons why doctors shouldn’t get sick. The best one being – we make the worst patients. I, of course, am no exception. Despite having had plenty of practice in the past of being a patient, somehow, I just don’t seem to learn. Every time I get sick, I am always a doctor, trying to be a patient.

So why are we such bad patients? Because we think we know better. We are the one saving lives, and sometimes we refuse to admit that we are the ones that need saving.

6 weeks ago, I caught a viral infection, not hard when you work with sick people all the time. I kept working, because as far as I was concerned, if I wasn’t intubated on a ventilator in intensive care, or in a casket, I was not sick enough to stop working.

Reason #1: We don’t realise how crap we really feel until we stop worrying about how crap everyone else feels. When you are deeply buried amongst blood and gore during an operation, you concentrate on what’s in front of you, rather than the tightness and clogging in your own lungs.

Two weeks later, instead of improving, I developed a hacking cough which sounded like I was trying to expel my lungs in piecemeal. As I was struggling for breath whilst talking to patients in my clinic, one of my colleagues suggested that I go and have a chest x-ray done. I did. I looked at it with my colleagues (bear in mind we are both plastic surgeons who rarely ever have to look at chest x-rays), we decided that my lungs looked normal, that I would live and carry on. However, just to be on the safe side, I texted a photo of my x-ray to my husband, who is a lung surgeon, and looks at chest x-rays every day.

Reason #2: For every doctor who self-diagnoses, there is an idiot patient.

I received a text from the husband. Go and see a real doctor. I shrugged it off, he was obviously happy to look at everyone else’s x-rays, but couldn’t spare two minutes looking at his own wife’s x-ray.

Reason #3: Sympathy is sparse when you are married to a fellow medico (and surrounded by friends who are doctors). You have to be showing signs of multi-organ failure before you get breakfast in bed.

I carried on with my afternoon operating list, during which, couple of times I had to sit down because I felt light headed from being short of breath. I felt tired, and was taking more care than normal, but the list went on smoothly without a hitch.

Reason #4: It takes a sledgehammer to slow  down a surgeon. Because we are so focused on our work, we often don’t realise we are pushing our bodies to the limit until we collapse in a heap.

I got home late that evening, at which point my husband looked at my bluish lips, my ashen complexion and yelled, ‘What the F$#@ are you doing at home? You should be in hospital.’ He pulled up the x-ray photo I texted him and shoved it into my face, ‘you have right upper and middle lobe pneumonia.’

Reason #5: When we self-diagnose, we either completely miss the obvious, or become total hypochondriacs with the worst over-diagnoses. In my case, it was the former. Also, note to self- I obviously am not qualified to read a chest x-ray.

I climbed into bed in my work clothes. I couldn’t think of anything more mortifying than going into hospital for a cold and cough. There was no way I was going into hospital for this. So exhausted was I that I fell asleep within 10 seconds.

Reason #6: We never think we are sick enough to seek medical attention.

The next day, as I was doing an early morning ward round, I ran into a friend/colleague who is a general physician. He took one look at me, frowned at the sound of my wheezing and coughing, and promptly declared that I needed to be admitted to hospital for treatment. I told him that I had a full clinic, and will have to check into hospital later that evening. He suggested that I get myself into hospital as soon as possible; I told him that I couldn’t cancel all my appointments and let my patients down at such short notice.

Reason #7: We think that the Earth would stop spinning without us, and that our patients couldn’t possibly survive without us.

The day was particularly long – like a train in slow motion. Several patients looked at me in concern and told me I didn’t look well. I asked my secretary to shift all my appointments and operating lists for the next few days, so I could be admitted into the hospital. Some patients were angry and upset, some complained that they are busy people and already had arrangements in place for their booked surgery. Apparently my illness was going to interfere with their plans. Some were worried that their treatment were delayed and felt that I was neglecting them.

Reason #8: Some of our patients think they couldn’t possibly survive without us.

So I checked myself into hospital that evening. I was put on oxygen, given nebulisers, antibiotics and tucked into bed to rest. It was only when I was forced to do nothing that I suddenly realised how terrible I felt. My chest felt tight, my ribs ached, and my body gave in to the continuous coughing that rattled my bones. My limbs were like jelly and my muscles barely contracted, behaving like useless slabs of soft meat patties. I couldn’t sleep as the call bells pealed throughout the night, sounds of doors opening and closing interrupted my light slumber, and occasional moans and yells from other patients made me toss and turn. The next morning, the physiotherapist spent half an hour bashing on my chest to clear up the clogging in my lungs. We then decided to venture out of the room for a walk, and that is when I saw one of my own patients walking down the corridor on her zimmer frame with her physiotherapist. I looked down at my pyjamas in shame and high-tailed it back into my room. I started thinking about leaving the hospital.

Reason #9: Even though as doctors, we spend the majority of our lives in a hospital, we actually really hate staying in one.

When my physician came to see me, I spoke to him about the possibility of having my treatment at home. He was able to adjust my antibiotics and decided that I could be discharged as a ‘hospital-in-the-home’ patient, where I will be going home with my IV cannula in place, and just come back to day hospital for my IV antibiotics, physio and nebulisers once a day.

Reason #10: A colleague will always assume that as doctors, we would be trust-worthy, compliant, sensible patients. WRONG.

As soon as I arrived at home, I headed to the study and switched on my laptop. I reviewed all my dictation and letters, chased up lab results of my patients and caught up on some bookkeeping for my practice. The day after I was discharged, I had a case which could not be cancelled, so I asked my anaesthetic colleague to remove my IV cannula so that I could scrub for surgery, then to replace it after surgery before I headed back into hospital for my treatment.

Reason #11: We know how the system works and we have connections. Doctors will always find a way to circumvent treatment regimes to suit their activities.

But as I sat there at the end of the day, with the IV antibiotics dripping into my veins, and the nebuliser oxygen mask on my face, I suddenly felt so tired. So tired of it all, of putting on a brave face, of carrying on as if nothing is wrong when I felt so unwell, of worrying about my patients when I should be concerned for my own health, and most of all, I was just simply tired. My bones ached from exhaustion, and my mind was so worn out, it was completely devoid of any emotions.

Mentally, I was waving a white flag. My body was shutting down because it had reached its limits, and it was time I surrendered to the consequences.

Reason #12: It is terrifying for doctors to admit that we, despite our abilities to help people and save lives, are just like everyone else, mere mortals, in bodies that have limits.

After four frustrating, agonising weeks, I am finally on the slow road to recovery. It is only now that I have started to contemplate changes in my life, ways of improving my health, and strategies of looking after myself. In a moment of déjà vu, I felt that I may have been down this path before. Regardless, I was, at last, being a sensible patient.

That is, until next time.

Old Shakey

Doogie Howser2

People write passionately about discrimination in Medicine: sexism, racism and even fattism (yes, there is such a word, I checked). Today, I want to talk about Ageism.

Ageism = Prejudice or discrimination on the grounds of a person’s age. (Oxford Dictionary)

Like all forms of discrimination, it goes both ways. There is ageism from the doctors to the patient, and then there is ageism from the patient to the doctors. The latter is the cause of my ongoing angst.

When am I going to see the real doctor?

This is actually something I get on a regular basis, usually after spending 45 minutes with them, taking a history, examining, diagnosing and explaining their treatment options. I suppose I should really consider it as a compliment. I do know I look young for my age. I know I don’t look like I am about to turn 40 (*sigh*). This can be attributed to both my ethnic background, but also to the fact that I don’t smoker nor spend much time in the sun (I do, however, sport a very unattractive sallow chronic ‘fluorescent tan’.) Yes, I do look after myself, but despite being a plastic surgeon, I have yet found a colleague trusty-worthy enough to stick needles or scalpels in me, and I am definitely too chicken to do it to myself in front of the mirror (unlike some of my colleagues – *winkwink nudgenudge*). So, no, my youthful appearance is not chemically or surgically enhanced, all I can blame it on is my genes.

So, why, you ask, am I complaining about looking young? Well, here’s a list of reasons why my age-inappropriate appearance doesn’t exactly make my job easier.

I don’t mind having someone young for the cough and colds, but can I please have someone older for the serious stuff?

I am not having someone fresh out of medical school operating on me.

You are too young to understand my problems

I need someone who are older and know what they are doing.

You look younger than my granddaughter, how old are you?

I am not being judgemental, but you are too young, I want someone who’s competent.

I have a very complex problem, I need someone with a little bit more experience.

The standards for the young graduates nowadays are not like the good old days, I want an older doctor who has been through the real training.

I want a doctor who is at least my age.

Now, what in the world makes you think you have the right to ask for my age? You are saying it isn’t being judgemental. But it is. You are judging my capabilities as a doctor by my age.

These patients feel that because of my age, I lack experience and should only treat the ‘easy’ stuff. There are two incorrect assumptions here. Firstly, the inferred ‘lack of experience’ by my age. Most people don’t realise that to become surgeon, one has to finish medical school, gain basic medical experience working as a junior doctor before being selected via a rigorous process to become a trainee in surgery. The surgical training program can range from 3 to 7 years, depending on the actual specialty, any sub-specialisation training within that specialty, and any additional overseas training to gain a wider perspective. At the end of which, one has to go through a series of very stringent assessments before a specialist qualification can be granted. I was at least 10 years out of medical school before I became a fully-qualified specialist surgeon. All I can say is, if 10 years of working and training (and not forgetting the 6 years of medical school before that) doesn’t constitute ‘enough experience’, and my qualification ain’t worth shit to you, then go ahead and set your own definition of ‘experience’.

Secondly, the patient’s assumption what ailments are ‘easy’ to treat and what aren’t, may not exactly correlate to true clinical relevance. A cough and cold may be easy to treat, but it may also be a manifestation of something more sinister. I would never presume a cough and cold as exactly that – I am a plastic surgeon after all – I always refer the patient back to their Family Doctor, as that is something those doctors would have more knowledge of. Patients who infer that they know what is ‘easy’ and what is not, show not only a total lack of awareness for the complexity of medicine, but also their disrespect for their doctor’s judgement. What may appear to be ‘easy’ may just be a harbinger for an underlying problem which is very difficult to treat, or it may just be the tip of the iceberg where surgical complexity is concerned. One of the most critical aspect during our training is to be able to recognise when we are out of our depth. If your doctor admits to needing a second opinion or assistance of another specialist, you should be grateful that you have found someone who will not take risks with your health.

People think that lack of ‘life-experience’ due to age is a deterrent to being a good doctor who could understand the issues of the ‘older’ population. This myth is easily busted when I look around at my colleagues. Which one of us isn’t jaded by what we have seen during our careers? We have seen it all. Birth, Life, Death, Disability, Misfortune, Pain, Suffering, Drug Use, Crimes, Abuse, Deviants, Perverts, the Insane, Murderers, Liars, Malingerers, Sadness, Grief, Anger, the list goes on. Some of the things we see and the frequency in which we see them, gives us multiple life-times of the so-called ‘life-experiences’. Sure, we may not have experienced any of these ourselves personally, but sometimes watching somebody we care for going through it and feeling utterly helpless can be just as real to us as the person who is experiencing it. Many of us view some of our patient’s misfortune as personal failures, and they take their toll on our own mentality.

Each specialty also has their demographic of patients; to assume that we have no inkling to a patient’s particular age-related issues is really quite ignorant. Most of my patients with skin cancers are elderly; I understand they may have issues getting to and from hospitals, care at home and simple matters such as attending appointments for dressings. We organise nursing home-visits for their dressings, and sometimes, arrange suitable surgery dates so that their family can take time off work to care for them. Most of my breast cancer patients have young children. We fit their appointments around school pick-ups and their surgeries out of school holidays so they can spend as much with their children as possible. Doctors are not unaware of our patient’s personal situations; we are not blind to possible social issues surrounding health problems. We, ourselves, have elderly parents, young nieces and nephews, friends outside of medicine and older/younger siblings. Often when we meet new patients, if they are not of similar age or demographics as ourselves, we can still relate them as one of our own relatives or friends.

So you think we don’t have enough ‘life-experiences’? Well, tell me, have you ever had to listen to a mother’s heart-breaking sobs in the middle of the night while she is sitting next to her dying 3-year-old baby? Have you ever had to spend two hours stitching up a battered wife’s mangled face and then watch her leave with her husband because she refused to report him despite your best efforts in counselling her? Have you ever stood in a room, watching a whole family saying goodbye to a man dying, while you are busily pumping him full of morphine because you know there’s nothing else you could do for him? Have you carefully removed a brain tumour from a patient who only hours before, had a psychotic episode and scratched, punched and spat at you? I could go on, but did you just say you were abused as a child? I have lost count of the number of child-abuse victims I have seen, but I understand everyone’s story is different. A different variation of the same……

Education has changed dramatically over the years, and this has definitely influenced Medical Schools. Standards are different, and they are different for a reason. The emphasis in medical training has changed, from purely scientific rote-learning to a more holistic clinical approach. Yes, I may have bitched and moaned about some of these changes as a teacher, but I can see why these changes needed to happen. To be honest, I don’t envy the students and trainees nowadays, an explosion in medical knowledge and technology over the last two decades has added a phenomenal amount into their core curriculum. Some of which I have yet to catch up with because it bears no relevance to my current sub-specialty. When I attended medical school, notes were written on paper, lab results were given over dial phones (yep, I am that ancient), X-rays were on films and put up on light-boxes, blood pressures were taken manually, pulses were counted with a pocket watch, surgical drills and saws were hand driven (not powered by electricity or gas). Back then, the list of diseases I needed to exclude for any presentation could be written on half a page, the number of tests I needed to do could be counted one hand and the number of ways I could treat it could barely fill a chapter in a textbook. Things are so different now, possibilities in Medicine are endless. Medical education nowadays place importance on basic core knowledge so that a graduate is not expected to know everything, but rather, to be able to pick out and apply relevant components of their knowledge to clinical situations. Most importantly, they need to know how to approach the problems and where to source the information they require. The point of today’s schooling is to generate a doctor that thinks, rather than one that relies on a checklist. So give your young doctor a chance, you might be surprised, he/she may think of another approach to your chronic problem. Something that is different to the same old thing which hasn’t been working for you.

We all know that we are getting old when we think everyone else is looking younger, especially when we see our pilots boarding the same plane we are travelling on. Commercial pilots start their careers in their late 20’s and to a lot of us think they are just kids, really. They are responsible for hundreds of lives for hours, but their age does not reflect their capabilities in getting all of us to the correct destination, safely. Why? Because of their qualifications. No airline would put a pilot at the helm of a plane unless he/she has passed all the requirements and assessments, whether they are young or old. In fact, once the pilots have reached a certain age, they have to be re-assessed for their ‘fitness’ to fly.

Some patients actually admitted to coming to me because their previous surgeon was getting old and I looked young (if only they knew!). Some do so in the hope that I have more up-to-date knowledge on new techniques, new technology or new approaches to their chronic problem. Some change surgeons because they have become concerned as their previous surgeons are deemed to be ‘too old’ to still be operating (ageism in the opposite spectrum), whilst some disliked the more paternalistic approach and ‘old-school’ attitude of their previous older surgeons.

Some older surgeons nearing their retirement have insight into their decreasing capabilities. Their eyes aren’t as sharp anymore, their hands have started to tremor, or they are now on several heart medications and struggle to cope with long cases. They cut down on the number of cases they take on as well as limit the type of operations they do. Many become surgical assistants to their younger counterparts. When I first started, I had one of the retiring Professors of Surgery as my regular assistant. It took a long time for me to adjust to giving him orders and correcting him when he is not doing something right. The nursing staff used to giggle when I would say, ‘Would you mind sewing that drain in for me, Sir?’ But it was a very happy arrangement. Prof could still get his hands dirty without the stresses and responsibilities of a surgeon, at the same time, I had instant access to any advice I needed. Not to mention the stories he used to tell as we were operating, those were gems to learn from. He would always tell me that he was not there to judge my competence, but to be my assistant for procedures I was more than capable of doing on my own.

So next time you meet a young doctor, don’t ask them how old they are, ask them what their qualifications are. And if they are just learning, give them the benefit of the doubt, because you could contribute so much to their education and experience by sharing yours with them. You never know, when your doctor retires, and when you are much older, they will be the ones in their prime, in charge of your health.

So you still want a doctor who is at least your age? Ok then, why don’t you go down the corridor and see Old Shakey next door?
Doogie Howser

* Disclaimer: Please do not take this blog as a disrespectful post to generations of surgeons before myself; I fully acknowledge the fact that their expertise could not be surpassed by myself. I am deeply appreciative of their willingness to share with me all that they know, as well as their unfailing support to me as a fellow surgeon, despite my age.

 

 

Hospital Fashion

 

*The latest fashion on the hospital corridor catwalk*

The latest fashion on the hospital corridor catwalk

Am I getting old? Am I becoming a prude? Am I behind in the fashion trends? Or am I just jealous? I am totally appalled at the attire of the female interns and medical students these days because I have had enough of skimpy dresses, mini-skirts and porn-star platform stilettos in my clinic and ward rounds. I think it is time for me to be a bitchy old female surgeon and write a fashion rule book for my young novices.

Rule # 1 Cover up

There are many reasons why short skirts and low cut tops are just not very practical when you are a doctor. Basically, there is a lot of bending over to do. In clinics, when you have to examine patients, you are constantly bending over. Now, there’s nothing more humiliating than having your undies on display or having your boobs pop out when you are crouched down to look into a patient’s throat. On the ward, when you are taking blood or putting IV cannulae in, again, you are flexing those hips and putting your bum into the air. Don’t forget, usually there’s somebody right behind you, either it be the person accompanying the patient, another doctor, a nurse or even one of your colleagues to enjoy the view of your derrière hanging out under the hems. As for those puppies in front, it is awfully distracting for everyone concerned not to stare at the deep canyons of your v-neck, or the shadows behind an unbuttoned blouse. Imagination of lies beyond those valleys has an uncanny ability to lure one’s attention. Similarly if you are sitting at the desk, short skirts ride up, and a crotch on view is particularly attention-seeking. If you cross your legs to avoid that scenario, the skirt will move up more, displaying the milky-white flesh of your naked thighs, which have a visually enticing power of their own. You want your patient to actually listen to what you are saying? It would be best if you redirect their captivated interest away from your exposed flesh.

So girls, button up, cover up and let those hems down. You don’t want to give your elderly patients a heart attack or the disinhibited psychiatric client a stiffy. Don’t be surprised if one of the 90-year-old’s in the Dementia ward sneaks his hand up your backside, or a 30-year-old in the trauma unit talk to your boobs. The only place where you are safe to prance around half-naked is in the intensive care unit, where the majority of your patients are unconscious.

Oh, and see-through clothing does not equate to covering up, especially when you wear hot pink lacy bras and thongs under a thin white dress. That’s called beach-wear.

Rule #2 Lycra is not attractive

What is the story these days with squeezing your body into clothes two sizes too small a-la-Kardashian style? Trust me, you can look amazing in fitted, tailored clothing that allows you room to move without having to suck it all in with a rigid sheath that makes you look like the Michelin man when you bend over (see? there’s the bending over again).

Tight clothing doesn’t let you move. You would be surprised at some of the positions you may have to be in when you are a doctor. Contortionists only have to hold a position, but doctors not only have to coil into positions that require expertise in a game of twister, but also perform medical feats at the same time. I had to dress a patient’s foot wound once, squatting on the floor with my head upside down. If you are ever involved in chest compressions on a patient who has collapsed on the floor, those tube skirts may not hold when you kneel over the patient with your legs apart, and the bum-hugging pants may split if you have to hunker down to secure an airway.

Also – trust me on this one – tight clothing does not constitute covering up. It can be rather revealing in faithfully outlining certain parts of your anatomy; visible thong lines, beaming headlights and camel toes are just a few things that come to mind; all of which are seriously distracting in life-and-death conversations.

And if you really think that tight clothing flatters your figure, the names whispered behind your back are usually not as complimentary. Health workers love to give each other nicknames, and I really don’t think you would want to be stuck with Dr Bootylicious in a place where you may want to advance your career in the future.

"You will not be going to clinic in that outfit, young lady!"

“You are NOT going to clinic in that outfit, young lady!”

Rule #3 Wear shoes that will save your feet and your patient’s lives

Tottering on 10 inch heels on a surgical ward round is not attractive, especially when you are trying to balance files, clipboards, gloves and your phone. Unlike physician rounds, surgeons don’t round with file-trolleys that you can lean on, and we also walk really fast, as most of us have to get to the operating theatre or clinic by 8am. So if you can’t keep up in those ridiculous shoes, no one will be slowing down for you.

A survey was done to show that 15-20km was the average distance an intern or resident has to walk during a working day. You will soon learn that one of your jobs is being able to be at 3 places at the same time. When they build hospitals, they usually try to put all the surgical clinics, preadmission clinics, surgical wards, and the operating theatres as far away from each other as possible. They also put in ultra-slow lifts that fits no more than 10 people, so you will find yourself racing up and down the stairs out of necessity. The moral of the story, wear shoes that will save your feet, because you still have a long long long way to walk for the rest of your medical career.

Wear something covered. I know some men have feet fetish and find pedicures irresistible, but having glamorous open sandals will not protect your pretty toes. Imagine walking around with vomit between your toes all day or even slipping on pee as you walk. As doctor, you will also be handling a lot of sharps, and having one of your tootsies stabbed with a fallen needle or nail ripped off by a drug trolley may just make it a rather bad day at work that you could do without.

Most of all, if there is a Code Blue (cardiac arrest), you need to run. Murphy’s Law dictates that the area where your patient has collapsed would be the furthermost place from where you are when it goes off and none of the lifts will be working. So, if you are teetering on your heels, you might as well start making your way straight to the morgue. Because by the time you have staggered down there in your stilettos, the patient would have been declared dead and bundled up into a trolley on his way for a coroner’s review.

*This is what happens when you run on stilettos*

This is what happens when you run on stilettos

Rule #4 Hospital lighting is not kind to heavy makeup

Unlike the romantic, flattering illumination of disco and restaurants, the hospital is brightly lit night and day. Hospital fluorescent bulbs do not give a warm soft glow; instead, they paint your skin in a starkly pale blue shade. It is exceptional for clear vision when one is perusing pages and pages of patient charts and examining every abnormality on a patient’s body. It is also particularly revealing for showing up every imperfection of your skin and each granule of make-up. The thicker you lay it on, the harsher it looks, until those dark eye-shadows and red lipsticks become a portrait of Alice Cooper.

alice cooper

The other thing you will learn is that lengthy days are detrimental to your facial palette. What may begin as seductive thick mascara on eyelashes and carefully layered blue shadows on eyelids will become the makings of a vacant racoon stare after 48 hours on-call. The blush would make its way down from the cheekbones to your nose, so you’ll look like you have a runny nose. While the lipstick will either be completely chewed off or will have migrated onto your teeth. Half of your powder and foundation would have rubbed off, so your forehead will be particularly shiny in the brilliant lighting. Overall, the picture becomes rather unappealing even in a horror movie.

Rule #5 There is a reason why we got rid of white coats

White is a colour reserved for dinners without Spaghetti Bolognese and Chilli Crab. White is suitable if you don’t plan to land on the ground while playing tennis, and it is definitely suitable for your wedding unless you have very clumsy relatives.

If you wear white to the hospital, be prepared for it to be used as a virginal canvas for body-fluid-art. Most colours of organic liquids go very well with white. Poo-brown is an earthy contrast to a pale background, although there can be unpredictability to the exact shade and texture depending on the source. While blood-red is always visually stunning when splashed generously, although the colour does turn coppery if left for long periods. Sputum-Green has just enough shade to make a warm pastel base whereas bile from projectile vomiting tends to veer towards turquoise; Pus-yellow can be used to enhance the warm tone of the overall canvas. The sanguine stain of Urine-gold can be a bit tricky to see on white, but sometimes when there is bleeding in the bladder, hues of Haematuria-rosé are a little bit more noticeable. These are often complimented by regular ink-blots made by the leaking pen that never leaves your hand. The beauty of this art-work is that it is eternal; no amount of scrubbing, baking soda, washing powder or dry cleaning will completely removed these physical mementos of how you acquired them.

"I told you not to wear white if you wanted to shoot people."

“I told you not to wear white if you wanted to go out and shoot people.”

Rule #6 More bling, more bugs

I do understand that these days, fashion is all about accessories. Style is almost entirely judged on how people decorate their outfits, rather than the actual garbs. Well, all I can say that you will just have to accept that doctors cannot be part of the current ‘trend’.

Some hospitals have banned ties for men – as it was found to be the main source of cross-contamination between patients. It was not uncommon to see these ties taking a swipe at patient’s groins, or a dip into a pus-filled wound. Nurses can’t wear bangles, bracelets, and rings, because no amount of hand washing will disinfect these as potential bacterial-carrying vehicles.

So, young female doctors and students, I would advise that you leave your blings, danglies, chains and scarves at home – unless you like being a free taxi for bacteria, or keen to bring your work home, literally.

Rule #7 You are not auditioning for a Shampoo commercial

Meredith Grey drives me nuts. I just don’t understand how anyone could see what they are doing with that mousy hair floating around her face constantly. You might think flicking those luxurious locks on ward rounds is eye-catching, until you accidentally smack it into your senior registrar’s face. Long hair has a lot of perils in hospitals. Like the tie, it can take a dunk into cavities where you may not want it to go. You could inadvertently tickle your patient when you are bending over the patient (there it is again!). It could get caught on bed rails, IV poles, monitoring lines and plaster saws (yep, seen that happen). When you are doing a procedure, hours of preparing a sterile field can be instantly swept away with your hair. Bangs and hair in the eyes can also be detrimental to your vision, which may not be so helpful when you are placing fine stitches or handling fragile body parts.

Tie those loose alluring locks away from your face, ladies – you may find it disadvantageous to your modelling career, but at least it will save your day job.

"Maybe if I cut my hair, people will think I am a real doctor."

“Maybe if I cut my hair, people will think I am a real doctor.”

Now I know these rules are harsh, and I am not aversed keeping up with what’s in vogue. I am as much into the latest trends as the next fashion-conscious female. I am not advocating dressing-down either, as crack-showing skater jeans and ripped off-shoulder T shirts are not exactly confidence-inducing attire for the sick and injured. There are ways to look beautiful without being inappropriate, it is about retaining your individuality in the role you have picked to play in society. You have chosen to become a doctor, not a model, not a tart, and definitely not a hooker.

Just remember, the hospital is not a night-club. You are not going on a date (and if you are, it is rather sad you are having it in a hospital, so get a life!), neither are you selling your ‘wares’, and advertising your ‘goods’. If you are dressing up to snare a rich doctor husband, you would be setting your trap for the wrong kind of men. There are plenty of playboys in the medical faculty, as there is definitely no shortage of male doctors who think they are God’s gift to women. These ‘hot’ charismatic egomaniacs are more interested in the junk in your trunk and the boobies in your bra than your personality. They are more concerned in accumulating notches on their belts, and having available booty-calls on speed-dial, than learning about your aspirations. You would be mistaken if you think by attracting their attention, they will be willing to marry you/help you get the job you want/get you out of trouble/recommend you for a promotion.

I am not suggesting that we should masculinise our appearance, but there are ways of being feminine without flaunting ‘sexuality’, and being gorgeous without over-embellishment. Dressing elegantly in appropriate attire will go a long way to instil confidence in your patients. Your seniors will take you seriously and be more than willing to share their knowledge with you. It will not upset the nurses (who are stuck in unflattering uniforms with colours that make them look like tampon packages), and draw attention away from those higher up the ladder than yourself. And believe it or not, professional dressing will actually make you sound smarter than you really are. You want the men to stop ogling at you; you want them to look at you in awe.

So, Ladies, save your reputation, your career, your feet and your patient’s lives. Next time you pick your apparel for work, channel classics such as Jackie Onassis, Audrey Hepburn and Grace Kelly.

JackieOnassisAudrey HepburnGraceKelly

 

The Expert Opinion of Medical Students

med student

Ok. I am an old and cranky surgeon. And this post is going to make me sound positively ancient. It starts off with

When I was a medical student……

Is it just me, or are the medical students these days getting more brazen, opinionated and full of self-importance?

I used to love clinical teaching. Our students used to turn up early on consultant ward rounds, some with prepared case studies of patients on the ward, and helped out our residents and interns with preparations of the round. In the operating room, they used to stand quietly at the head of the patient, peering over the anaesthetic drape and asked intelligent questions. Questions that showed they had checked what was on the list and read about it the night before. They stayed until the case was finished, whether it would be 6pm or 1am. They were eager to scrub in if they were offered the chance and absorbed information like sponges.

Nowadays, they turn up on the ward round at the same time as me, with no idea of the patients on the ward, nor their names and procedures, let alone their histories. The interns and residents struggle with charts, dressings and memorising lab results for each patient, whilst the students look on with vacant smiles, hands firmly tucked into their pockets.

When I was a medical student, I used to arrive an hour before my consultant, print out a patient list, and write out all lab results next to their names for the intern. I would then put all the charts onto a trolley, opened to the latest page, and stamp in the date, ready for the round. While the round is happening, I would carry a box of gloves so that the senior doctors can open the dressings, and be the official scribe in the notes while decisions are made and patient discussed. I would hand the latest lab results to my intern and make sure he/she was aware of any abnormalities. I never spoke unless spoken to. My role was to be helpful to the junior staff and be a thirsty sponge to absorb all the information bantered around my head.

Over the last few years, something changed in our medical students. I don’t know why these young minds are being poisoned, but I sure would like to correct whatever delusions some idealistic non-clinical academic lecturer are feeding them. Whatever fibs they are being told – may work great in theory and on campus, but disastrous if they really want to gain the most out of their clinical attachments. The attitude these beliefs breed in our medical students, alienates them from the real doctors in the ‘real’ world.

1. You are an important member of the clinical team.

Then they get fed this bullshit story about how once there was a patient nobody knew why he was dying and some medical student came alone, discovered the diagnosis and saved the patient. It is an Urban Legend, people. Don’t come onto my team thinking you are going to discover some astonishing fact, talk to us as if everything you have to say is of utmost importance, and please don’t look at us expectantly for a thank-you for your effort. Oh, I don’t dispute that sometimes the medical student finds something that no one else on the team knew, but it is often either of small significance, or most commonly something that would not have changed the big picture.

Nope. You kids are not important. You earn your importance. If you put in the work and help out with the team, then maybe, just maybe, you are useful. Students are actually economic burdens. Teaching takes time, time cuts into efficiency, and decreased efficiency means less thorough-put. Less thorough-put means I don’t meet my KPI (key performance indicators), and failure to meet my KPI means I don’t get my bonus. Oh, and did I mention that I don’t get any extra pay for being a teacher or having students on my team? So to cut a long story short – teaching you kids cost me my bonus. For those who put in the work, I consider it worthwhile, I’d be happy to give you my bonus just so you can stay on the team longer and learn more, because sometimes listening to my students talk intelligently makes me puff up with pride.

You are also not so important that you can call me ‘Tiff’. My intern, residents and registrars call me Dr Tiffany, and that’s forgivable because I have a unpronouncable surname (thanks to my Eastern European husband). So, at the very least, you could do me the same courtesy. Yelling down the corridor, ‘Hey, wait up Tiff’ is just not acceptable behaviour for a student on my team. Why the hell would I wait for you when you are late to the ward round anyway?!?!

2. As a medical student, you have ‘rights’

Hahahahahahaha. Sorry, I had to laugh at the absurdity of this concept. What ‘rights’ would you be referring to?

Last month, we were doing a six-hour operation which started at three pm. The student was scrubbed in to help with some retraction. As a ‘reward’ for his efforts, the senior registrar showed great patience and took her time teaching him how to stitch. When it turned six o’clock, the student wanted to be excused. The registrar made a comment that if he stayed, he could practice more suturing and close one of the wounds. His reply was, ‘I am not paid to be here. I am only here to learn. As a student, I have the right to leave when I have done my allocated hours.’

The registrar looked at me and said, ‘Great. Dr Tiffany, why don’t we all just leave the patient on the table and go home? I think I am  on the 40th hour over my allocated hours for this month. The anaesthetist here is on his 37th hour, How about you?’

Another example of the so-called ‘rights’ was demonstrated to me by a student who stood at the head of the table observing an operation last week. It was a difficult case – I was digging through scar tissue to access some very fine blood vessels without clobbering any of them and causing a blood bath. There was concentrated silence in the theatre for 2 hours. During which time, I was trying not to get too annoyed with his continuous fidgeting, coughing and sighing. When we finally negotiated through the difficult part of the operation, and I was able to relax (i.e. multi-task), I asked the student if he saw what we were trying to do. He shrugged and said that he didn’t really understand because I didn’t talk to him. I held onto my patience and pointed out all the blood vessels I have dissected out and asked him if he recognised them.

‘No, I have never seen them before. I wouldn’t know what they are. You are supposed to teach me today, but i haven’t learnt anything. I have just stood here for two hours. I don’t think we learn very much watching operations, when are you giving us a tutorial? We have a right to proper teaching.’

Time paused. I could see myself pointing to the door, and yelling ‘Get the F%$#& out of my theatre and don’t ever let me see your #$@% face ever again!’

Instead, I said, ‘If you go home and read about the anatomy of this area, you can give me a tutorial tomorrow on it, and I will tell you whether I could have done that dissection better.’

3. Your opinions are important

Trust me when I say, No, Your opinions are best kept to yourself. In regards to opinions, I have two rules I live by: One, your opinions are only worth mentioning if you are either as old as the person you are giving the opinion to, or you have at least half the experience of the subject as the person you are talking to. Two, some opinions are best left unsaid even if it is a good one.

So if you have had no experience in surgery, you need to shut up, watch and learn. I asked a medical student on her first day once, about what she think Plastic Surgery was about. She said that she knew it was all about reconstruction after removal of cancer and injuries, but ‘in my opinion, it is not really essential, so I think they should cut it out of the public health budget.’

Hmm. Let’s imagine the scenario of Miss Smartass getting run over by a car, then carted into my theatre with crushed legs. There I was, standing over her, waving my amputation saw, as she is drifting off to sleep under anaesthetic,  ‘so who think plastic surgery is not essential now?! Mwahahahaha.’

My pet hate is the student who watches me do an operation and tries to tell me how they would do it and why. Ah huh, and sorry if I sound rude, but how many of these have you done? I had to laugh once when a student actually replied, ‘Oh, I haven’t done any, but I have seen quite a few.’ My dear boy, this is not a football game, everyone is an expert because they have watched the game for years. Trust me, if you put any one of those loud, opinionated, beer-drinking, fat bastards who are always yelling obscenities from the couch, onto the football field to play, do you think they can score?! You think they’d win the game? Why don’t you just finish off this operation while I go for my tea break.

4. Medicine can be mastered with ‘Problem Based Learning’ (PBL)

I don’t think I have ever hated a mnemonic more than PBL. Don’t get me wrong, I understand the basis behind PBL, but I think PBL should be taught at the level of training registrars and residents. Teaching PBL to medical students, is like teaching a 17-year-old how to drive without him/her having passed the traffic rule-book written test. You cannot solve the problem, without rote-learning the basics. Yep. Rote-learning, reading, studying and memorising. No shortcuts or ‘I will be able to work it out.’ If you don’t have the knowledge, you won’t be able to ‘wing-it’. And trust me, when someone is bleeding to death on the operating table, they wouldn’t want you to ‘wing-it’ either. Medical school is all about garnering the basic knowledge required to make decisions, and clinical experience during internship and residency is about using that knowledge to perfect the art of clinical judgement. I am still doing problem based learning every single day I am at work. It is something I believe I will continue to do until the day I retire.

Back in the days when I was a medical student (here she goes again *eye-rolls*), we had structured learning of all sciences. It was boring, it was tough, and the amount we had to know seemed irrelevant and insurmountable. But man, was it all so useful when I started surgical training. I am a firm believer that my role as a clinical teacher is to demonstrate to my students the importance and relevance of the basic sciences. I am not trying to teach them how to do an operation, diagnose a disease or to predict prognosis. That is something I teach my surgical trainees. For the medical students, all I am trying to do, is to show them that if they know their sciences well, there will be a whole new world for them to explore with the knowledge they have.

5. There is no such thing as a Stupid Question

WRONG. There is such a thing as a stupid question. Like, ‘What sort of surgery do you do?’ Ok, let me get this right. You have been assigned to my team for 6 weeks and you have no idea what specialty we are in?

If you are thinking of asking a stupid questions, it is better that you say nothing at all. There is nothing more annoying than silly questions from medical students which reflect their complete lack of preparation. Not to mention the polite but pathetic inane questions that accentuate their complete disinterest, absence of comprehension and desire to be somewhere else. Just give me the goddamn attendance form, I will sign it so that you can get your irritating bored ass out of my theatre.

I do like questions when I operate. I like intelligent questions from my students. When a student asks me a question which showed that they have actually done some background reading, I am in seventh heaven. I would take them on a tour of every detail, every aspect and every possible outcome of the surgery we are doing. It is almost orgasmic when my diatribe generates more intelligent questions, showing that they understood what I have been trying to show them, and their interest in what I do. To me, that is like the ultimate ego-stroke.

Sometimes the students are very quiet in my theatre. I suspect it is because they don’t want me to know that they have NFI (No F%$#&ing Idea).

6. Participate in ‘Active Learning’ – speak up and question your clinical teacher

This is like a fast train wreck combining both number 3 and 5.  This is an example of ‘active learning’ from a 3rd year medical student I had last year.

Expert Medical Student: Why are you removing the rib like that?

Me: Because it is a safe way of doing it and it is how I normally do it.

EMS: I don’t think you are doing it right.

Me: Why do you say that?

EMS: I have seen Dr X and Dr Y do this operation last week and that’s not how they did it.

Me: There is usually more than one way of doing an operation, we all have our own preferences.

EMS: But I think their way is better.

Me: Because?

EMS: They are older and much more experienced, so I think you should do it like them.

I wondered if I would get reported if I picked up my sharps dish and bitch-slapped his face with it.

Me: Why don’t you just watch the way I do it and see if it achieves the same result.

EMS: I wasn’t trying to be rude or anything, it’s just that we are told to question everything so that we can learn why you do what you do.

Me: Ask me why then.

EMS: Why what?

Deep breath.

Me: Forget it.

I love my students. Really. I do. I am just very selective whom I show my love to. I love them by teaching them, and I only teach the ones that put in the effort, show respect for their teachers, don’t take our time for granted and don’t make unnecessary noises. I am too old to waste my time and effort on the others.

I sound like an old, arrogant and cranky surgeon. In actual fact, I am afraid to say that my rant reminds me of the Professor of Surgery I had when I was a medical student. Oh God, I really am ancient. I will know I am archaic when I find my portrait next to his in the hallway of the department of surgery.

 

The Doctor’s Handwriting

doctors-handwritingECG

Once upon a time, I used to have very neat writing, but medical school, surgical training, and the endless beauraucratic paperwork has beaten it out of me by the time I have become a fully qualified specialist.

My writing got so bad – that this week, when I left my husband a shopping list of things I needed urgently, I got a surprise in return. The list was:

  1. face wash
  2. moisturiser
  3. coffee beans
  4. shampoo
  5. conditioner

When I got home, I asked him whether he got the stuff I needed, and he said it was in the kitchen. I found the shopping bag sitting on the bench, I looked inside. And I found, face wash, moisturiser, coffee beans, shampoo and not one but two boxes of condoms. He must have thought all his birthdays and Christmases have come at the same time when he saw that on my list.

It is a good thing that most medical records are converted into electronic files, and doctors are no longer required to write, other than scribbling their signatures on printed reports, scripts and request forms. I was told once that the secret in writing doctor’s handwriting is to look at the first letter, and then the last letter. Look at the length of the line in between these two, and the brain should fill in the rest. To me, it’s a bit like deciphering an ECG (and for a surgeon, that is no small feat, as it is often the physicians who actually has the ability to read the subliminal messages in the wavy lines of an ECG). I would have a look at the squiggles, and see if at least one of the lines is recognisable. One can often decipher the overall meaning of an ECG (and a letter for that matter) once a something in the middle makes sense.

Even though now it is considered to be negligent if the writing in medical charts or communications is not decipherable, this has not stopped some hilarious misunderstandings due to bad hand-writing.

I was reviewing an inpatient with facial burns, whilst covering for a colleague. The patient asked me if he had to keep using the ointment my colleague prescribed him. I asked if he was getting a rash or reaction from the ointment. He said no, but he was getting bad diarrhoea and going to the toilet at least 4 times a day, usually after he has used the ointment. I looked at the notes to see what my colleague has written, and he wrote “Paraffin, top, prn” which basically means, vaseline topically to the burn wound, pro re nata (as required). I then looked at the medication chart, it was transcribed by the pharmacist into his medication chart as “Paraffin, 10g, PR” which means, 10g paraffin per rectum. Poor man was probably wondering why the nurses kept shovelling vaseline up his bottom when his burn is on the face.

Once, during a consultation, my patient handed me his referral letter from his doctor. He told me that he came to see me about his skin cancer. I nodded and read the short brief scribbled note.

“Dear Dr T, thank you for seeing this 46 year old man with a biopsy proven basal cell carcinoma over his right scrotal area.”

I stilled for a moment. Silently, I cursed my colleague, and wished he had sent this patient to a male surgeon. But I gave a mental shrug and got over it very quickly. I tried to make the patient feel comfortable by having a chat with him about his medical history, medications etc. Then I told him that if the cancer was small, I should be able to excise it under local anaeasthetic only, a bit like a vasectomy. I ignored his strange look. Finally, when I ran out of things to say, I asked if it was ok for me to call a chaperone so that I can examine him properly. He gave me another look, but shrugged ‘whatever you want, doc.’ I asked him to step behind the curtain, get undressed and lie on the bed.  He looked distressed, then said, ‘but doc, I just need to roll up my sleeve, it’s here.’ He stuck his right wrist under my nose. Over his scaphoid area, was a small skin cancer. (For the non medics – scaphoid refers to the area at the back of the hand, near the base of the thumb.) Yep. I was walking a close line to being reported to the medical board for inappropriate sexual harrassment behaviour.

Once I received a letter from a doctor working in the country, who has been dressing my patient’s wound at home. Mrs M was a 50 year old lady who had very bad ulcers on her legs, and her doctor felt that they have deterioated, so sent her back to my office. I got her onto the bed, and opened the handwritten letter while my nurse was undressing her wound.

“…..I would be grateful for your input in her wound management, as I feel it is worse. The woman is pregnant, so I have tried to use some topical antibacterial dressings. If you feel that she requires oral antibiotics……..”

I looked up at Mrs M and frowned. ‘Is there something you would like to tell me?’ I asked her. She smiled sheepishly and admitted that she’s put on too much weight since she last saw me. I thought, well there are women who are having babies in their fifties, so I said ‘Congratulations, so how many weeks are you?’ Mrs M looked up with a start, then started laughing so hard she couldn’t get her words out, but I eventually worked out she was denying her pregnancy. I told her that’s what her doctor wrote. She insisted on reading the letter, after which, she started on another fit of laughter, with tears running down her face. My nurse snatched the letter out of Mrs M’s hands, and squinted her eyes as she read it several times. Then she pointed to the sentence ‘The woman is pregnant’ and said, ‘I think this says, the wound is pungent?’ Yep. The wound did stink out my office when the bandages came off. Mrs M needed to be readmitted to hospital, for antibiotics and dressing on the surgical ward. Not the maternity ward.

When I was working in general surgery, I once received a patient  with questionable bowel obstruction transferred from another hospital. They were particularly concerned about him because he has not been able to tolerate any fluids orally. I was not convinced he had a true obstruction, but reluctantly accepted him despite the fact I was up for my second night on call in a row. He arrived through emergency with a hand written letter.

“….Mr XX has had ongoing retching for 24 hours, he last opened his bowels 3 days ago, and has farted since 6am this morning……”

I was livid. If Mr XX has passed wind, it meant he wasn’t really obstructed. He probably just needed to have a good enema. I couldn’t believe that I got woken up at 2am in the morning to see someone with constipation. I rang up the referring doctor and ripped through him (fuelled by lack of sleep) about unable to diagnose and treat constipation. When the poor man on the other end of the line got his chance to say something (because I stopped to take a breath), he said that Mr XX hasn’t passed wind for 3 days. I put on my self-righteous tone and referred to his letter. ‘No, no, no!’ the young doctor cried, ‘I wrote he has fasted since 6am’. Let’s just say, humble pie was not easy to eat at 2am after 48 hours of no sleep.

The best one arrived via fax. It was another handwritten referral letter I received from a local family doctor. Luckily, I was reading this before the patient came to her appointment. (Warning: I apologise in advance for the foul language you are about to encounter).

“Thank you for seeing Mrs Z, her cunt has been worrying her. she has tried many self-remedies to treat it  she has applied several different herbal salves, soaked it in methylated spirits, pricked it with a needle, and tried to level it with sandpaper. She’s so fed up with it, she would like to see you about having it cut out…..

Ouch. Ouch. OUCH?!?!

Nah, I thought. I must have misread something. So I re-read the letter again and again. I scruitinised the offending word. But it was as if I was hypnotised, once the word ‘cunt’ was in my head, I couldn’t possibly see another word within that particular scribble. The harder I tried, the more blinded I was to any other possibilty. There was a curve like a ‘c’, and an end that is definitely a ‘t’. I took the letter to my secretary and asked her to read it. She started, ‘Dear Dr T, thank you for seeing Mrs Z, her…’ she stopped suddenly. Go on, I urged her. She looked at me with pleading eyes and told me she couldn’t bring herself to say the word. I gave it to my nurse, she raised her eyebrows at me. I thought about ringing the doctor and get him to send her to a gynaecologist. But my curiosity got the better of me. When she came into my room, I asked her to show me her problem. She smiled, bent over in her seat, and took her shoe off.

Under her big toe, was a plantar wart.

I have to admit, I have always struggled with hand-written letters from my colleagus, and I hang my head in shame on behalf of my profession. But personally, I have a valid excuse. After all, English is my second language and I failed spelling when I was in primary school, so I am pretty much illiterate when it comes to reading letters anyway.

An Impossible Letter to the Health Minister

This is an open email distributed by the doctors working in the public health system of Queensland Australia.
The Queensland state government has presented new contracts consisting of ‘improved’ work conditions for its doctors.
These conditions include:
1. If a doctor resigns, 6 months’ notice is required, or paymentf 6 months salary to the hospital is required for leaving
2. On dismissal, there is no process for appeal
3. Doctors can be rostered to do any shift, with no specification on having available junior staff support
4. Work conditions (pay, allowances etc) can be changed without notice by adminstrators
5. Work hours, duties, locations can be changed by discussion, not agreement
 
It is a contract which several independent industrial lawyers have advised against signing.
It s a contract where the government will own the doctors’ livelihood. Doctors will be held hostage by their contracts, which may come in conflict with patient care, as they may have to make decisions to appease the administrators, rather than what’s best for the patient.
 
*Please note, I didn’t write this email, but I wish I did.
 
 
Date: 7 March 2014 10:48:17 PM AEST
 
Subject: Nothing here is impossible Mr Springborg

Dear Minister Springborg and Premier Newman,

We have been told that your legislative changes are irreversible, and the train carrying these individual contracts has already pulled out of the station, and cannot be stopped.

We sincerely hope that your talks with the SMO representatives around the concerning issues in the contracts result in a successful outcome for all.

If SMOs are not convinced that our ability to continue to practice public health medicine with safety is secured, then the state will be in grave danger of losing its’ brightest and best.

Please listen:    We say to you that nothing in your legislation, and the individual contracts, is irreversible. This train wreck can most certainly be stopped.

You are dealing with a group of people who understand what is truly irreversible and impossible, as they have stood in the face of death and tried to stare death down, bargained against time with their knowledge, skills, equipment and courage, and sometimes failed, and often times not.

When you have to tell parents that their child has autism and intellectual impairment and that their lives will forever be filled with difficulty and challenge, and watch their grief unfold – that is irreversible.

When you watch a child bleed to death before your eyes as you pump blood in their arm only to see it pour out of the gaping hole in their skull, where it has been sheared off from a motor vehicle accident – that is irreversible.

When you tell parents that their baby has cerebral palsy and will never walk or talk, or even eat independently, because their brain is malformed or damaged beyond repair   –  that is irreversible.

Nothing here with your individual contract legislation is impossible to change – we’ll tell you what is impossible.

When parents beg you to save a child’s life after a second failed bone marrow transplant for leukaemia, as you’re watching them die from an infection they have no white blood cells left to fight  –  that is impossible.

When you’re trying to bring back a heart beat in a child who has been pulled from the bottom of a pool, an hour after its heart beat stopped  –  that is impossible.

Don’t you dare sit there and tell us that this legislation is irreversible and that stopping this contract roll out is impossible. Because we know that all it takes is a show of hands in a parliamentary room, and the swipe of a pen across a piece of paper.

No fancy machines, no million dollar drugs, no transplanted tissues, no 12 hour operations, and no miracles of fate.

Just understanding and good will from your colleagues and yourselves. And if you’re up all night to achieve that, then welcome to our lives.

We have each others’ backs, us medicos  –  we always have and always will.

Because we have all stood there with the sick and the dying, and we know how lonely that journey is without colleagues at our shoulders, and support and resources at our backs.

So we will stand together, even if we have to walk away, together  – until you listen, and pull on the brakes, and stop this train wreck from playing out to its end.

Please enter the discussions with good will, and open minds and hearts, and leave your egos on the coat rack outside.

The health of the state is in your hands – please don’t throw it away.

Sincerely, Senior Medical Officers of Queensland Health.