The Plight Of Housemanship Part 1

April 7, 2009 at 23:33 15 comments

I just read an article, from Wayang Party, consisting of an unnamed doctor’s reminiscences on his hellish houseman year. Boy did it bring back a ton of memories.

Housemanship year in Singapore is divided into three postings of four months each. Each posting is a different specialty, such as general medicine, general surgery, orthopedics, etc. Guided by rock-solid hearsay and nail-devouring anxiety, fresh grads choose their poison and then spend the last precious month of pre-work freedom performing various last acts.

Then hell begins.

“A typical day begins with daily ward rounds at 8am. The house officers usually arrive half a hour earlier to prepare the case notes, familiarize themselves with the new cases and to trace results from the previous night.

The ward round which is often intimidating, seldom ends before 11am and sometimes stretches pass 12 noon if the cases are complicated. Then begins a day’s mundane work of drawing blood, doing ECGs (there were no phlebotomists or ECG technicans in those days), typing discharge summaries, arranging for urgent CT scans, talking to patient’s family etc.”

Oh yeah.

“If one is lucky to have lunch, it usually means a quick bite at the caferia provided the nurses are kind enough not to interrupt you during the precious few minutes when the new admissions will start to come in at the same time.”

Oh yeah. The takeaway-coffee lady was always my best friend.

“We had six to eight night calls a month which start at around 6pm and end at 8am the next day after which you are still expected to work till 1pm before you can knock off if there is enough manpower.”

Oh yeah. Night calls, by the way, are in addition to the normal day’s work, so you start work at 0800 today and (in best-case scenario) knock off at 1230 tomorrow, then continue business as usual the day after.

When you’re on-call, you function as (very thin) cover for the assigned wards, in which admissions, blood-taking, reviewing, collapses, and sometimes death, go on happening. These things are no respecters of time.

I remember the days when I would be too busy to even pee till 10 p.m., and then for every minute I spent in the loo, my damn pager would go off at least once, each beep signalling something else to do in some other ward.

The average amount of rest per call I got that posting was maybe half to one hour. The on-call room in that hospital contained two single beds and I was the only girl that posting… but at 4 a.m., in a state of exhaustion, I never had the energy to feel discomfited at the presence of a snoring fella in the same pitch-black room.

At worst, there were 9 – 10 calls a month, so we spent the whole time being pre-call (= anxious), on-call (= hounded), post-call (= dead), pre-call, on-call…

“I still remembered the Head of Department telling us during the orientation that “post-call” is privilege, not a right. Very often we don’t get to leave early after a hectic night deprived of sleep or if we do, in the late afternoons around 3 to 4pm.

You have to experience it for yourself to know how it feels like to be without sleep for 36 to 48 hours. Your mind gets switched off, your eyelids go drooping all the time and you get irritated very easily. The body craves for sleep and yet you have to force it to be up and running. There was once I dozed off at the bedside of a patient while talking to him!”

That year, I had my hair chopped uncharacteristically short, for reasons I can’t even remember now. My weight fluctuated like today’s oil prices. I stopped wondering why there were so many reports of housemen having breakdowns and attempting suicide. There was the potassium chloride, and there were the syringes, lying oh-so-casually in every treatment room in every ward.

“A Singaporean medical graduate from Australia quitted only after one week in the ward. On her first night call, she was so overwhelmed that she locked herself in the call room and switched off her hospital handphone. She was expectedly haul up the very next day to face the music dished out by the Head of Department who obviously didn’t take kindly to her ”AWOL” . The last I heard of her is that she is now working in a hospital in Melbourne and has settled down there.”

As much as I would hate having a colleague like that in this warzone, part of me empathizes. I was very often on the brink of giving up myself, what more someone steeped in a foreign culture?

Unexpected disappearances still happen. About a year ago, there was a ‘junior consultant’ from India who decided to come and try things out. He wore a business jacket and seized every chance to spout high-falutin theories, which endeared him to nobody, but which at least looked like signs of capability. He returned to India after about two months.

My recent favourite is the German doctor who impressively managed to get enrolled in the local registry, instead of being relegated to the ‘non-traditional source’ pool. He snagged a position in one of the best departments, turned up for observation sessions, asked decent questions and tried to be helpful. During formal orientation, he was brought to the wards. The next day, he vamoosed back to Deutschland. No more Doktor for us.

Too bad. I’d heard he was cute.

To be continued… thank you for reading this! I’m not quite done yet. I need to go put my fingers in ice water and recharge before coming back with Part 2 tomorrow. Stay  tuned. :) 

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In Memorium: My Avatar The Plight Of Housemanship Part 2

15 Comments Add your own

  • […] Read about my own experiences in the field here. Possibly related posts: (automatically generated)Family of late Dr Allan Ooi questions […]

    Reply
  • 2. The Dead Doctor « Home of the Manx  |  April 8, 2009 at 00:35

    […] Read about my own experiences in the field here. Possibly related posts: (automatically generated)SINGAPORE ARMED FORCES DOCTOR DEAD IN MELBOURNEof […]

    Reply
  • 3. doktor77  |  April 8, 2009 at 14:26

    hey TheManx

    actually things are much better now:

    phlebothomists! OMG!

    ECG technicians!! wowow!!

    3 calls a month!!! LOL (i did 11 e.o.ds)

    MOs to take consent!

    =)

    Reply
    • 4. Katie  |  April 9, 2009 at 11:27

      Hi doktor77 – yar man! To my horror I find myself thinking thoughts that begin with “These youngsters nowadays arh…” and “During my time…”… SIGNS OF AGE!!! Hope you managed to get the full long weekend off. :)

      Reply
      • 5. doktor77  |  April 9, 2009 at 18:47

        haha katie,

        i escaped to the “darkside”… bwahaha…. 5.5day workweek, 2 nights only… couldn’t stand the hospital calls and stuff.

        and i indeed am having a full long weekend off! =)

        btw Great Blog! i truly learnt alot about perfumes haha
        rgds

      • 6. Katie  |  April 10, 2009 at 01:48

        I am jealous, doktor77… I am bound to the system for at least a couple more years. I will never be able to reconcile myself to night calls! On the other hand, I, too, am a free soul this weekend. Waha! Glad you liked reading about the perfumes. Cheers!

  • […] April 8, 2009 Thank you for coming back! Here’s Part 2 to yesterday’s post. […]

    Reply
  • 8. Caz  |  August 19, 2009 at 17:51

    Oh no… sounds more scary than i thought!
    i’m a year 3 medical student from Australia… i am kinda fond of going back to sg… but i’m really worried of the culture shock!

    can someone pls give me so advice? on anything! i’ll be really thankful!

    I can’t join the private sector immediately right? i’ll have to do the internship in public hospitals right?

    Reply
    • 9. Katie  |  August 19, 2009 at 21:34

      Hey Caz, didn’t mean to be so scary! Although I found housemanship an awful year, things got better as I became more senior. Housemanship in itself has also improved – there is a greater emphasis on welfare (some would call it human rights) now, and there are fewer calls, and more phlebotomists and ECG technicians.

      You are right to say that you cannot join the private sector immediately – your licence is provisional until you pass housemanship in a govt hospital, plus you should be a specialist first (otherwise cannot attract business right?). Family Med docs who go private tend to leave at a younger age (about 30), but other specialists need to build up experience and clientele, and usually don’t leave govt practice till they’re maybe about 40.

      Sounds like a damn long road, doesn’t it? That has its pros and cons.

      Few of us realize what we’re signing up for when we’re 18. The truth is, there’s probably gonna be culture shock in one way or another when you start out, regardless of what country you’re in. How many people have jobs in which they have to DO SOMETHING about the sick and dying in the first day, or maybe even the first hour, of starting? You won’t even have gotten used to people addressing you as ‘Doctor’ yet.

      If you ask me, it’s better to develop awareness early. Year 3 is a pretty good time. Attachments and electives are also opportunities to talk to your seniors, if you can grab them in a free moment. I was too shy to do that when I was a student, so I had to figure it out as I went along. Depends on how you like to do things. What’s for sure is that you’ll have many stories to tell about your working life in time to come. :)

      Would be happy to help if you have more questions. :)

      Reply
      • 10. Caz  |  August 20, 2009 at 13:52

        Hi Katie!!!
        thanks sooooooo much for the advise! true… i didn’t even think much b4 applying cos it seems like everyone is doing it. haha.
        i really learnt a lot from your blog. :)
        yeah. thanks. i’ve just arranged attachment at SGH & TTSH, to give me a better idea, as u said!

        if i’ll wish to go private in the end, how much difference does it make if i’m specialised or as MO ( to become Family med physician)? in terms of “finanical independence” and stuff…
        actually i’m quite interested to become GP, do u know the path? do i have to train a particular number of yrs in public? ( now the thought of public hospital starts to scare me…)
        i love teaching too ( i’m actually mentor to batches of med student from SG in my uni), but don’t think i can get to so senior in the public sector to do that… haha.

        many thanks again!!! i so appreciate your advise Katie! :)

      • 11. Katie  |  August 21, 2009 at 21:48

        No prob. I’m not on that particular path myself (i.e. disclaimer, hehe), but here’s what I know. Used to be that GPs were non-specialists (G stands for General after all yar?) and everyone else was. But times are changing and Family Med is now a recognized specialty. There are 2 ways to get it – MMed if you stay in govt institutions or GDFM if you’re in private (but those in govt have the option to take this too).

        But that is still some way ahead in your case. The current system here is this: after you pass MBBS, you still hafta pass 1y of housemanship and become a medical officer. Then you decide if you want to apply for traineeship in whatever specialty and get through the traineeship interview (easy-peasy in some specialties, long wait in others). Then you do the postings and exams, which are part of traineeship, and takes maybe 4 – 6y, until you exit as a specialist. Some specialties are undergoing a restructuring in their traineeship paths, but that’s still in the pipeline.

        I know several people who left govt practice as MOs, and not necessarily trainees in anything, to join or start a private GP practice. How much $ comes in then depends on how your business does. Everyone I know who did this left when they were roughly 4th-year MOs. In most cases, it was because they had to complete, or almost complete, their bond. The bond issue doesn’t apply in your case. But most people want to get a certain amount of experience and confidence b4 going private. Although work as a junior doc in public hospitals is scary, the positive side is that you are supervised and protected. Dunno what to do still can ask. Whereas if you’re a private doc, you are expected to be a fully-fledged medical professional, and you need to have thorough knowledge and people skills at your fingertips.

        It’s a good thing to love teaching in this line, and you can find someone to teach at any level. Passing it on helps keep you sane, and reminds you why you chose this work.

        Think it’s a great idea to do attachment in these hospitals. It will help you decide if this, here, is what you want to do. Who knows, maybe I’ll run into you sometime. :)

  • 12. sara  |  June 28, 2010 at 15:41

    can you guide a little about how to apply for houseman ship in singapore if ur an oversease med student???

    Reply
    • 13. Katie  |  September 30, 2010 at 16:50

      Sorry for the extremely delayed reply. Are you still a student? ^.^

      Reply
  • 14. MissyA  |  November 17, 2011 at 11:05

    Hi, Katie, had read about the housemanship u went through, unlike Singapore, it is 2 years here. During that time, we are treated as a cheap labour, low paid, high workload…. only RM 25 per night call, cheaper than those who are working at MacDonald. At one time, we need to do EOD call and sometimes back to back. No post-call in most of the postings, so we need to work from morning till ~6pm the next day, we can just fall asleep when we were writing. “U are nobody, mb just an amoeba”, ur status just lower than a nurse….

    I am a locum now, working office hours, which I think life is much more better compared to hospital-based, at one time was thinking to do master in psy, but after consideration, just give up, ‘cos it’s difficult to take care of my family, I have 2 kids by the way.

    I always tell those who want to be a doctor, think thousand times, ‘cos most regretted during 3rd year of medical school, and always because of “洗 湿 个 头 “, they just forced themselves to continue….

    Reply
    • 15. Katie  |  November 17, 2011 at 13:24

      MissyA, looks like we share more in common than bags! Maybe we might have met professionally if you’d decided to take up that specialty. You probably have figured out by now that I chose the other way round from you – specialized but kidless. There just isn’t a good way to have it all.

      I totally agree about thinking and re-thinking medical school. Do you know – up till now I can’t give a good reason why I signed up? All my reasons are really bad ones – my grades were good enough, my dad wanted me to, my boyfriend was interested in medicine… horrible, right? I can only say that it must have been a sort of divine direction into psych, which was all along the only specialty that I enjoyed.

      Might you have a blog too? I have a feeling that I’d enjoy reading it if it exists. :)

      Reply

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Welcome to my blog!


My blog-name is Katie but I will not respond if you call me that in real life because it's not my real name. Yes, I do practise virtual-world paranoia. No, I do not enjoy stalkers. But I do enjoy writing and having folks reading said writing, so welcome to my world. It's nice to meet you.

Playing in my head over and over again argh

I'll Have To Say I Love You In A Song (Jim Croce)

Book(s) of the moment

Hogfather (Terry Pratchett)

Books read in 2010 and 2011

Harry Potter & the Deathly Hallows (JK Rowling) - 'cos the movie's coming out!
Frankenstein: Lost Souls (Dean Koontz) - ah, bugger, it's part of a series! Now I hafta find all the books...
Dismantled (Jennifer McMahon) - oh, good one
Tigerlily's Orchids (Ruth Rendell)
Shutter Island (Dennis LeHane) - reminds me too much of work
Holy Fools (Joanne Harris) - it's official: I prefer her scary books
A Series of Unfortunate Events; The Unauthorized Autobiography; The Beatrice Letters (Lemony Snicket)
The Little Friend (Donna Tartt)
The main books - 11 so far - of the Southern Vampire series; the Aurora Teagarden series except for A Fool & His Honey - that makes it 7; Sweet & Deadly (Charlaine Harris)
The Woman in Black (Susan Hill)
Full Dark, No Stars (Stephen King)
Room: A Novel (Emma Donaghue)
Miss Peregrine's Home For Peculiar Children (Ransom Riggs)
The Bachman Books (Stephen King)
Men At Arms (Terry Pratchett)
Carpe Jugulum (Terry Pratchett)
The Fifth Elephant (Terry Pratchett)
Beauty (Robin McKinley)
The Sandman, Vol 1 (Neil Gaiman)
The Burden (Agatha Christie) - her crime novels are waaay better
Snuff (Terry Pratchett)

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