Training the Houseman

8:22 AM

Since leaving the Emergency Department, I haven't had a chance to mingle with housemen. It might be a blessing in disguise though as I might pengsan having to handle HOs. Despite 'love' letters being sent to the media telling the world about how big a BULLY some MOs are, there are still quite a few MOs who love teaching HOs the real meaning of being a doctor. A dear friend of mine, Dr Aimir Ma'rof recently posted this advice for budding future doctors. I think this is worth sharing for the betterment of the medical fraternity. 

There are currently 56 HOs in my department. 36 of them are attached to General Surgery while the rest are in the sub-speciality department on rotation basis. Out of that 36, 16 are placed in Male Ward and another 16 in the Female Ward.
People may argue in spite of the increase in personnel, the workload nowadays has actually increased. More forms to fill, more things to write, more notes to document. But what I do remember is the size of the ward still remain the same and the maximum number of patients it can accommodate in one particular setting is also the same. So I still think 16 HOs in one ward is a luxury.

In my ward now, there are 12 MOs. Now imagine, 12 MOs + 16 HOs in one morning ward round! These MOs need to impress the specialists, so by default they will present the cases. Worse, when the specialists actually demand the MOs to present every morning. So what happen to the 16 HOs?
One will write the typical "S/B.." and "plan", but have no idea why the plan is given in such a way. One will hold the TPR chart without knowing what to see. One will hold the medication chart, just for the sake of holding. The other 13?
Is it their fault? Partly yes, because I remember fighting with my MO to present case because I know more about certain patients and I wanted correct and detail information being relayed to the specialists.
But what happen nowadays is HOs are feeling complacent of doing a clerk job, since the main bulk of the doctor job is being carried out by their MOs. Morning review is being done for the sake of doing, not to take ownership of patient management. And some times, we as seniors, are also expecting them to only do a clerk job!
It has been a norm for certain HOs to struggle presenting cases without flipping case notes. It is common for HOs to remain silent when a question about patients was being asked. You can see them doing the morning review with all the thorough written documentation, but ask them to present.. you will feel like punching the wall!
HOs in my ward are divided into cubicles. Yesterday, there was a team of 5 HOs taking care of 3 cubicles, with total of 12 patients to review in the morning (it was actually 18 but 6 patients are under sub-speciality department with own HOs). I forced them to do morning round with me at 6.15am without opening case notes. Not surprisingly, they managed to do it well.
Today, I forced the same group to present the cases that they "did not" review. Meaning, they have to do handover or present cases between them before I come. Not surprisingly again, all of them can remember all 12 patients and present well without case notes!
Yes, it can be done. You only need the will to do it and good teamwork/colleagues. This is where you learn about friendship, about selfishness, about lackadaisical, about attitude, about working life, and about being a doctor!
Take ownership of patients, and see to it that they are managed well until they are discharged. You will only have that feeling if you remember your patients well. You will feel that you are actually a big part of the management team and not just an office boy/girl carrying out a clerk job.
There will be among you who keep on complaining that there are too many MOs, that your chances to learn are limited. There are also among you who took advantage of it by being complacent, that the main bulk of jobs and responsibilities lie with MOs.
Only few among you who just do not care and continue doing what is expected of a doctor. Few good one who just wants to see their own patients are in a good hand.
Which one are you? You choose and decide...

Dr Aimir Ma'rof, Surgical MO

Do share this with your HO colleagues, friends or families. Be a good doctor. Train well


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  1. nice advice...i will try insyallah
    -final yr medstudent-

  2. huhu sometimes if the mo is nice. its more easier toremember the case. but klo malignant mo semua benda dh merapuuu huhu sorry -mediocre ho-

  3. huhu sometimes if the mo is nice. its more easier toremember the case. but klo malignant mo semua benda dh merapuuu huhu sorry -mediocre ho-

  4. To the house officers who whine too much

    No excuse for H.O. either you learn or you get out of the ward. read up on cases you have seen in the ward at home or the procedures you've observed. the next time your m.o. is doing a procedure you can offer to assist and after a few times you can ask your m.o. to supervise you to perform one. you will learn so much more this way. you are a doctor for goodness sake not a clerk. start acting like one.

  5. Nice article, which you have described very well about the doctor job. Your article is very useful for those who are looking to doctor job. thanks for sharing. locum doctor jobs manchester


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