Friday, August 12, 2011

The Tagging Experience

Salam.

It's been a hectic and strenuous two weeks of tagging as a first poster at the Medical Department, HoSHAS. As a tagger, I was required to work double shifts - come in at 7am and check out at 12am (but usually I finish work later than that).

Welcome to HoSHAS quarters, Block E.

The routine begins with morning HO review of patients. On the first day, I was given only one patient to clerk - AEBA secondary to UTI. I was scolded by the MO because I didn't put in any clinical plans - senior HOs were supposed to teach me the works but they were occupied that day.

Then, comes the MO review rounds. These are just refinement of HO management plans. It's during this time that I learn the most. I get to see how the MO's think and argue, and then manage.

The specialist review rounds comes later that morning. Specialist discussions are usually too deep to follow during the initial days of tagging, but slowly I caught on and asked questions.

Medical rounds usually last until lunch, stopped awhile for visiting hours, then continued in the evening.

 Hospital Information System (HIS) - berebut laptop dengan nurses untuk buat morning review.

After the rounds, it's time to work the clerical skills - writing discharge notes, calling clinics for appointments, writing referrals, tracing old notes.. stuff that will work itself out by trial-and-error over time. Here's the tricky part - all of these have to be done according to priority, some must be done before the end of the office hours.

Life in the Medical Department is a hectic one, compared to other departments. On an active day, admissions can go up to 25, ballooning up the ward, warranting transfer of old, stable cases to other wards.

My energy drink.

Here's a very brief summary of my tagging life:

On day 2, I was entrusted to cover one cubicle of 4-6 patients.

On day 3, I did CPR on 3 different patients.

On day 5, my post-HD patient developed ACS and died.

On day 8, I was reviewing 8 patients per day. Still slow.

On day 13, I pronounced the death of a patient. "Makcik, pakcik dah takde."

Death consists of five forms to be filled in.

On day 14, my newly diagnosed PTB patient absconded.

TB registry.

GETTING SCOLDED

I've been scolded a few times for my lack of sense of priority but it's an understandable fault - first timers usually don't have the same awareness, sense of urgency or responsibility.

I've been scolded for not reviewing fast enough.

"Tunggul kayu ke? Pegi la clerk new case tu."

I've also been scolded not being aware of the events in the ward, especially the acute beds.

 Items to prepare for femoral catheter insertion.

Everyone gets depressed after a scolding, especially if it's not your fault to begin with. But bouncing back is key. And also, saying sorry if you're wrong, saying sorry even if you're right.

 
Accompanying a patient's transfer to HTAA.

PROCEDURES

Things that were previously awkward to do are now staple.

"Doktor Yusoff, bed 6 cabut branula dia."

"Doktor, bed 18 tak pasang CBD lagi."

"Doktor, anaes call, cakap bed 26 tak repeat ABG lagi."

Gotta memorize what each tube is for by the end of the first week.

What hand hygiene?

But the most routine-disturbing phrase has got to be this:

"Doktor, bed 24 collapse!"

OFF TAG

Alhamdulillah, now that I'm finally off tagging, I have plenty of time to settle my unfinished business e.g. doing the laundry, stocking new supplies of food for sahur, Tarawih prayers, writing this blog, and recreational stuff.

It's a relief but a lot of responsibility at the same time. Some times, the night shift HO will be alone to take care of the whole ward. By merely hoping for the uneventful is wishful thinking; one has to prepare for medical emergencies. That's when you have to decide whether it's necessary to disturb the on-call MO.

If an ACS patient complains of chest pain, you take his vitals, do an ECG stat, give him sublingual GTN, compare the latest ECG with the old ones, review the latest blood investigations, then you decide whether to call the MO or not. If you're not sure, you can just inform him/her while giving her the important info.

That's just ACS. There's SpO2 dropping, hypoglycaemia, hypotension, fitting, etc.

But this level of clinical acumen will only improve by time. Until that time, you'll get scolded over and over again for not being able to prioritize or manage simple events.

 Blood culture company giving a talk, then freebies.

Oh, one more thing - night shift HOs have to take blood from the whole ward at 6am in the morning. If one starts at 5am, he/she will probably finish around 7-8am.

So medical students, do come and help, yes?

4 comments:

Faiz Ezanee said...

Thanks bro Ucop for sharing your experiences. InsyaAllah juniors will help you taking the blood, provided you teach them again the correct way to take blood. They (4th year) are coming next week. :)

Najmee said...

Arghh. Finally. Updated.

Been waiting for so long to know about the experience of all USIM's 1st batch docs.

Anyway, it seems like off all I've
read, you're the one that get the
least scolding. Naissee.

Do update more eh. Gotta be ready from now.

(One more thing, are there plenty of those pre-clinical things that you have to apply? Or is it mostly things that you'd practice during
the clinical years?).

[Word verification: extless.
Sounds like exitless. Once you're
a doctor, there's no exit door?]

Dd4 said...

Assalamualaikum. Emm by looking at the quality of your photos, i knew your life is really hectic.. Hope u survive well.. Make us proud.!!

Sop said...

faiz & dd4 - you guys are next. we may set a good lead, we may not. either way, you're still in our shadows after all this time..huhu

najmee - least scolding? not really. often i treat the scoldings as friendly reminders, turning those negative aura into positive vibes. because ultimately they scold you not because they're assholes, but because they care for the wellbeing of the patient, and don't want you to mess up too.
when you think like that, then nothing will stab you in the heart except for the need to buck up :-)