The Plight Of Housemanship Part 2

April 8, 2009 at 21:20 10 comments

Thank you for coming back! Here’s Part 2 to yesterday’s post.

Still quoting from yesterday’s article from Wayang Party:

“There is a “macho” culture pervading the local medical fraternity that because medicine is a noble profession, all doctors are expected to put up with sacrifices and hardships which the job entails even at the expense of their own personal well-being.”

I can’t disagree with that. On bad days I fantasize about poker-faced administrators trying to pass a bill to limit the hours that doctors spend eating and sleeping, so as to increase productivity for the institution. Perhaps one day they will no longer pay wages to doctors, but instead make them reimburse the system for the gracious privilege of working for them.

<Laughs madly>

I do apologize, but the trauma of those days has permanently exacerbated my tendency toward self-centred whinging. Now and then it demands to be leached from my system.

To be fair, life did not remain as bad after that terrible year (if it had, the ward sisters would be wondering where all the potassium chloride had gone). Depending on the specialty you choose, ward rounds and night calls can, and usually do, become less lethal. More importantly, as you rise in seniority, you begin to see the purpose and meaning of the work you do, and that makes all the difference.

The sad and sinister bit is this: in order for senior doctors to ‘graduate’ from the cesspool of stooge labour, the labour has to remain in the stooge level. Which means that housemen will remain screwed until they get promoted, and the next batch of unfortunates takes over. Having escaped from hell, the survivors have no wish to turn back and re-immerse themselves in the pits. Which means that things are unlikely to change from that direction.

Things, however, are slowly changing. Initial changes included increasing the number of medical students and limiting the number of night calls housemen are allowed to do (I believe the current number stands at five or six per month). Hospitals also began employing peripheral staff to help draw blood and do ECGs. Right now, some departments are trying out a shift system, to reduce the number of hours that doctors are on active duty.

The most resistant item, I suspect, will be the mindset of doctors themselves. Strange and ironic, but true. Why? Because doctors still see housemanship as a trial by fire. If you’ve survived a gruelling housemanship, I can safely assume that you have a minimum standard of resilience and probably intelligence. But if your housemanship was all cushy, then you might be a soft spoilt brat from the new generation of whiny losers. Any Tom, Dick or Harry could be a doctor. What is the world coming to?

I can see this train of thought in my own mind, Judas that I am.

Still. I cannot forget how those dark days made me hate – really hate – everyone, from patients, seniors, fellow housemen, non-doctor friends, and most of all, myself. Anyone, who for any reason, deprived me of one minute of sleep, or detained me in hospital for one extra second, deserved to rot in hell. Anyone who was having a good time, or who patronizingly condoled me on my busy job, was a piece of shit. Patients were gloating enemies. Seniors were selfish sadists.

Tell me – how could any of that have made me a good doctor?

I tell you – it did not.

I think it made me a bad person.

Now I say that it was the grace of God that pulled me through that year and put me on the track to being a normal human being again. I married a wonderful man, got a suitable posting and found new friends who unknowingly preserved my sanity. Bless them. Given time to rest, read, love and laugh, I was able to remember the bits of me that housemanship took away. Still, it took years to undo the damage. Even now, I can still hear echoes of that long-ago rage.

Some of my colleagues never found God or someone to love. I don’t know how they kept going. I can think of several who are still full of hatred toward humanity. I think they are frightening, and keep my distance from them.

There’s no pat solution to this mess. In Ireland, where a law was passed in 2004 to reduce junior doctors’ working hours, 36-hour shifts still happen as a matter of course. It’s not so easy as passing a new law and assuming that things will fall into place. Issues like medical manpower, auxiliary healthcare and traditional mindsets still need to be addressed. Beyond those are abstract concepts like individual faith, character, resilience and support.

As for me, I take it as part of my work to be kind and reasonable to junior staff. Ditto for medical students when I teach them. Poor kids, for having Apollyon still lying in wait for them. Things may not be quite as bad now, but they can’t be a bed of roses either. Will I have a hand in creating a better place? I don’t know. Only time will tell.

This I do know: If I ever have children, I don’t think that I could, in good conscience, encourage them to become doctors.  

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The Plight Of Housemanship Part 1 Blessed Good Friday

10 Comments Add your own

  • 1. Syz  |  April 9, 2009 at 18:17

    As a junior Dr who was a houseman just a few years ago, I came in with a heavy burden on my shoulders and I somehow survived – yes, calls were less than before, usually 4-8 calls a month compared to the 8-10 last time.
    I meticulously arranged for post call cover as lack of sleep was a great enemy of mine.
    Clerking 30+ patients and doing countless bloods were second nature if painful.
    The batch after us was slightly more lucky, but still worked very hard.
    The batch after them, now. Due to higher powers (white horse syndrome again?), they enjoyed privileges close to those of medical students. They were known to refuse to do work, asking MOs to do their work for them, and went post call without arranging for post call cover.
    Privately I have hard them complaining about how hard they worked.
    Tsk.
    I’m torn knowing a part of me envies them, and the other despises them.
    Sigh.

    Reply
    • 2. Katie  |  April 10, 2009 at 01:42

      I know EXACTLY what you mean, Syz. I have had HOs like that… on the other hand, there were good folks with principles like yours too. You know, I suspect it never ends. MOs bitch about HOs, Rs bitch about MOs, and I’m sure Cs bitch about Rs and HOs bitch about everyone. Sometimes just have to stand back and laugh at the ridiculousness of the situation. This is the first time I’ve actually written out my feelings on the topic and it gives me a surprising amount of relief. Thank you for sharing your experience! I hope work is going well and that you get to have a break this weekend.

      Reply
  • 3. anonymous  |  June 5, 2009 at 16:13

    I can understand the plights. Even as a MO or registrar, things don’t seem to get better in some of the departments. I am very tired of this system. In fact, can anyone tell me how to quit the government sector and join the private practise? I have completed my bond.

    Reply
    • 4. Katie  |  June 6, 2009 at 01:03

      Yar… to be honest, sometimes I still wonder why I chose this profession. I guess the feasibility of going private depends on what your specialty is and whether you have lobang, or failing that, plain old $$$. Heh. At least you have completed your bond! I am still very very stuck…

      Reply
  • 5. Miao  |  December 20, 2010 at 18:25

    hi there,

    i accidentally found ur blog and its amazing… the literature is beautiful…

    i suppose, ur housemanship period is more fantastic and “enjoyable” compare to housemanship in ur neighbouring county where there status is just “medical student with payment”… even medical students are high class then them where at least they are not scolded so damn bad…… pity them too… btw, doctor here are not respected at all, not even by the nurses…

    yeah, btw, may i know how to apply housemanship in SG? my med school is recognized by SG (haha, forgot to introduce, i am still a medical student, going to grad very very very soon…)? if i managed to past housemanship in SG, can i cont my master there… confirm seat? i mean directly without wasting any more years like: must becoming a medical officer for 2 years then u re qualify to do master? so curious about it…

    thanks… nice days…will wait for ur reply patiently… :)

    Reply
    • 6. Katie  |  December 21, 2010 at 12:02

      Hello Miao, thank you for visiting and for your very kind comment!

      Congratulations on your upcoming graduation – it represents a culmination of years of study! It also means a period of consideration regarding where to plant the roots of your career, doesn’t it? Have you visited the Singapore Medical Council website ? My journey was different from yours in that I was trained in Singapore, so I got to simply follow the crowd in terms of submitting applications and other admin matters, so please pardon me for any errors in this.

      It’s good that your med school is recognized here, but I would strongly recommend that you check with SMC about whether this means you can do your housemanship here, or if you need to complete it on home ground first. In either case, I believe you need to apply for provisional registration here after obtaining a job/training position in one of our public hospitals (NUH, TTSH, SGH, KKH, CGH, JGH/AH, KTPH). Once you obtain full registration, your path should be similar to the local grads’. However, specializing is still a lengthy process and everyone has to fulfill a certain number of years as a trainee… or, as the case is now – a resident.

      This process is, at the current moment, very much complicated by the introduction of the medical residency program, like how the US does it. I’m not sure if you’re familiar with this concept – essentially, junior docs are now residents instead of HOs and MOs, and straight out of med school, they sign up for specialty training and are sent through a predetermined course of clinical postings which take a shorter time (five years or thereabouts) to complete compared with the current system (at least seven years).

      This sounds really good in theory. However, there are drawbacks that may apply to your situation. First, med students are pressured to select their specialty with no benefit of experience (yikes). Second, while the residents receive their protected training periods and take their time with a single-digit patient list, someone has to do the actual work of clearing the thousands of patients that roll through the public hospitals each day – i.e. the local and foreign folks who have not applied for residency (ouch).

      Therefore, to summarize, I suggest that you obtain SMC’s advice on your housemanship and have a good think about how you would like to fit into the new residency program. I hope this helps you in your career decisions. :)

      Reply
      • 7. Miao  |  December 21, 2010 at 18:32

        thank you very much for ur advise… :)

        ya… my uni is the one out of two that recognize by SG… thank God!

        will consider about it…

        good luck to u … :)

        regards…

      • 8. Katie  |  December 22, 2010 at 14:52

        Welcome and good luck!

  • 9. T Guy  |  April 20, 2011 at 00:31

    Hi Katie, I do not know if you still check this comment but I am a Malaysian Medical Graduate who has decided to do housemanship in Singapore and perhaps the residency program there.
    Is there anything bad about the decision I made? I mean, in terms of a Singaporean point of view. How do you see foreign houseman working in Singapore?

    Reply
    • 10. Katie  |  November 14, 2011 at 14:26

      Hi T Guy, I’m sorry about this super-late reply! I took a hiatus from blogging and only looked at this today. Perhaps you are already in the program by this time and have formed an opinion of the system. In the event that you are not, here’s my two cents.

      The first thing is, of course, to ensure that you are logistically allowed to do HOship here, in terms of accredited qualifications. Then you have to think about your long-term plans, especially if you’re aiming for residency, because you’ll essentially have to put all your eggs into one specialty basket from the word go (and I can’t imagine being in those shoes; it was already hard enough for me to decide to sign up for my traineeship interview as an MO).

      This is important because, in this day and age, your contemporaries (or competitors, if you choose to see it that way) comprise not just the usual NUS grads; right now you have Yong Loo Lin graduates AND the Duke-NUS postgrad residents eating the same pie. Therefore, if you’re not able to commit to and fight for a particular specialty from fairly early on, the other option is to work in the capacity of a resident physician (i.e. stable and often decent-paying worklife but without career advancement).

      What I’m saying is to look beyond your HO year, with its invariable trials and tribulations, in order to make your decision. If you have a specific goal in mind, then that will be invaluable in helping you get through what most docs consider to be the worst year of their working lives.

      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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Disclaimers: 1) I cannot help but bitch about work sometimes, but everything here comes under the realm of personal remarks, and nothing here is said in my professional capacity. Nor does anything here reflect the opinion of the institutions that employ me. This is just me shooting off. 2) Most identities have been anonymized, particularly those of folks I know on a personal basis. Same goes for my workplaces. However, commercial and public places and figures remain named. Otherwise some things just wouldn't make sense. 3) Links and sources have been provided where appropriate and possible. They are not meant to challenge anyone's ownership. If this causes any discomfort or offence, please let me know.

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