Paperwork, signatures & ink stamps

I've just finished my second week as the house officer of the Surgical Admissions ward. Already I'm starting to feel a bit despondent about being a doctor.

I don't mind working the long hours associated with being a doctor. In fact I rather crave working, since there is nothing for me to do when I return to my room in the intern quarters. My laptop cannot play DVDs for some reason despite having the capability to do so, there's no internet connection so I cannot surf for porn and I can only take so much reading of "Pride and Prejudice" each night. Most of the time I'm just too tired to do anything active and I just fall asleep at ten o'clock at night after having a shower and brushing my teeth.

I don't mind being at the whim of the nurses either. There are a lot of tasks nurses can perform but legally cannot since they are not qualified to do so. They cannot write prescriptions or order CT scans despite knowing what it is entailed. That is where my signature and my ink stamp comes in. I accept there is much I can learn from experienced nurses about the running of a ward and what protocols and procedures need to be followed.

I don't mind my superior either. Most of the consultants & senior medical officers are nice. It's some of the residents I cannot stand. There are two resident surgeons who are obnoxious, condescending twats but I'll leave that to another blog entry, just like how I like to comment how female radiologists are such bitches.

What really gets me is the amount of hospital bureaucracy and CYOA (cover your own arse) medicine that is being practised. There are a few examples I like to share with any readers out there:

1. Whenever somebody is admitted to the Surgical Admissions ward, the interns have to fill out a sheet pertaining to which specialty the patient has to be under. If the patient has probably peeing, he/she goes under the urology team. Unfortunately these forms are really constrictive with little space to elaborate on the patient's condition. Also we still have to fill out these forms even if the medical officer has taken a history already. It's a stupid practise that seems only to happen in surgery to the best of my knowledge. Sometimes I can't be bothered to ask the patient a second time how's his poo is and just fill out the form based on the medical officer's notes.
2. Whenever a patient has a condition, there are some investigations we have to order despite the chances of them occurring are non-existent. For every person who comes in with chest pain, we have to order cardiac enzymes & CK-MB to rule out a heart attack. Anybody who comes in with tummy pain has to have his/her amylase checked to exclude acute pancreatitis. Even if the person banged his head a few days ago and comes in complaining of just dizziness the interns have to go down to the CT room and order a brain CT just to exclude any bleeding, despite having examined the person thoroughly. When did we rely so much on tests and not on our clinical judgement having asked a complete history and performed a thorough clinical examination?
3. Medical officers send us to order urgent CT scans despite knowing the chances of succeeding are remote. Why? Because they are scared of their seniors asking why they didn't TRY to book those urgent CT scans if they don't. Nobody wants to take responsibility for the patient. When nurses inform house officers of a change in the patient's condition, they don't really care about the patient's condition. They just want the responsiblity of the change in the patient's condition off their hands and into the doctors. They just want you to say the phrase, "I will check on him/her."
4. Everything has to be documented. Whenever you see the patient, look at his/her investgation results or do anything to the patient, you have to write it down, put your signature next to it and then put your ink stamp next to it just to make sure. Even if the patient has a perfectly normal chest X-ray which for no apparent reason was order, I still have to write down, "CXR: NAD" in the patient's progress notes.

All this paperwork gives me no time to practise real medicine, the one that you aspire to be and what they teach in medical school. I just wish this bureaucracy will stop.

Stupid patients

I'm rather glad the Olympics are over. It has been a very good Olympic Games, with Michael Phelps & Usain Bolt being the top stars. I just hope the changes that have been made for the Beijing Games will keep - the sporting venues are used instead of being left abandoned to disuse & the pollution levels are kept low. I also hope the local channels beef up their coverage next time, with presenters who actually know what they are talking about instead of pretty faces who have only two brain cells.

********

Even during my first week in the Surgical Admission ward, you get to see the most absurd of admissions coming in. When the Typhoon Nuri hit Hong Kong on Friday, there was this elderly lady who was blown over and suffer multiple abrasions including a knock to the head. The police didn't know who she was since she didn't have any identification on her and she was so confused she couldn't say her name. Eventually when her condition had settled she could say her name and her husband could be bought over to properly identify her. When I was setting her drip, all she was saying was, "I got hit on the head... how did that happen?" to which I replied, "There's a typhoon out there and you were blown over." I couldn't actually say what I was really thinking which was "You silly cow! Why did you go out in a typhoon?" Thankfully her condition was stable and she was mentioned in the news.

Even more absurd is the elderly man who scratches his butthole with a toothpick and then is surprised to find his bleeding out of his arse. Or what about the woman who dislocates her jaw for the second time but waits twelve hours to go to hospital despite being in considerable pain?

Really I think there is evidence for creationists to prove that evolution doesn't exist.

Working through the storm.

I'm currently at work today as intern in the Surgical Admissions Ward, even though I'm not supposed to be. Since there is a typhoon heading straight towards Hong Kong, only on-call doctors are required to be on duty. This means the on-call doctors have a lot more work to do, since there will be people admitted today despite the weather. This is a ridiculous rule that applies to house officers, since us interns are living right next to the hospital, barely 50 metres away. There might be a slight threat of us being blown over but I still think it is negligible.

I came into work because I know somebody will be swamped with work and I'm too nice a guy to allow that to happen. I know it is a huge character flaw in Hong Kong that will be exploited. My admissions ward partner didn't come in today, despite living next to me in the quarters. He has an exam in October, so he needs to study and he was on-call the last time a typhoon nearly hit Hong Kong. So I can forgive him for not coming in today. However the intern who is supposed to be on-call for the Admissions ward today says he's not coming in until 18:00. That means the on-call medical officer for admissions is being swamped.

Also many of the nurses were surprised that I was in. Most of them were grateful I was in but there were a few who said I shouldn't be there since I'm not covered by the hospital. That is really the attitude of most hospital staff - to not hold responsiblity for any actions. Everybody doesn't want to work on the day of a typhoon. Nobody wants to hold responsibilty so nurses tell house officers when a patient's condition changed. I really don't like that attitude and in the era of litigation & claims & insurance, it really prevents good medicine from being practised.

Even more Olympic criticism

So far this Olympics hasn't been marred by too much controversy. The Chinese government has effectively suppressed any demonstrations or protests by limiting them to certain areas and putting up so much bureaucracy in the way that it is virtually impossible to successful apply for a permit to protest.

There haven't been many doping offences either. Only one major doping offence that concerned a medal has appeared. So far it has been a relatively clean Olympics and I hope it stays that way. Let's hope we don't get another Marion Jones or Ben Johnson incident.

I'm still hating my local TV station's biased towards the Chinese during the Olympics. As I said before the media should be unbiased and impartial during coverage of any news, whether it is news, sports, business or entertainment they cannot put their opinions in. I say this after Liu Xiang pulled out of the 110 metres hurdles. The channel treated it like somebody important has died.

Another thing I don't like about the Olympics is how some participants swap countries just to compete in the Olympics. I just think it is wrong. You should be proud to represent your country at the Olympics. Even though I think patriotism is blind and irrational, there are times when it is warranted. Lots of Chinese athletes who couldn't get into their national team go to your countries to compete for them, including Hong Kong. There should be a rule, just like in football, that you can only represent one country during your lifetime (apart from when countries break apart like the former Yugoslavia and USSR) and you should have lived in your adopted country for at least seven years.

I'm just glad the Olympics are coming to end soon - I don't think I can stand any more Chinese propaganda at the moment.

The off-season: West Bromwich Albion

I finally made it to the last team and I was only on day over my limit. Assisting in my analysis of the last team West Bromwich Albion is the fact I haven't seen them play, not even yesterday against my team Arsenal.

Out of the three promoted teams, WBA are the most likely to stay up. They have the attacking power to score enough goals whilst they have consolidated their defence during the summer. Hopefully Tony Mowbray can do the job.

GK: Dean Kiely, Scott Carson, Michael Danek

Getting Carson was a real coup for WBA. An England international with Premiership experience under his belt and still relatively young, West Brom can have two good goalkeepers hopefully keeping the goals out.

RB: Carl Hoefkens, Gianni Zuiverloon

Really I have no idea about these two players. At least Mowbray has two players for this area.

LB: Paul Robinson, Marek Cech

Probably a better area for West Brom. Robinson has Premiership experience and was courted by other Premier League clubs during the summer. In the first game against Arsenal, Cech was pushed into left midfield, maybe indicating he may be there for the rest of the season.

CB: Leon Barnett, Neil Clement, Shelton Martis, Abdoulaye Méïté, Pele

Recruiting Meite was vital - none of the other players bar Clement has played in the top flight. This is where Mowbray may have to recruit more players than he needs and fast.

WG: Chris Brunt, Graham Dorrans

A lack of wingers could lead West Brom to play a defence style of 4-5-1. Chris Brunt is the most likely to shine in this area.

CM: Robert Koren, Jonathan Greening, Kim Do-Heon, Filipe Teixeira, James Morrison

With Greening, Koren and Morrison in the centre, the middle of the park is a solid area for Mowbray. We still have to look out for Kim whilst Teixeira might leave.

FW: Roman Bednar, Ishmael Miller, Craig Beattie, Sherjill MacDonald, Luke Moore, Bartosz Ślusarski

Probably the most crowded area for West Brown. Only Bednar, Miller and Moore could take on the Premiership whilst the rest are just too bad or unknown to me. Most like they will play 4-5-1 or 4-4-2 with Bednar partner the other young striker.

Summary

In: Winger x 2, Forward x 2
Out: Martis, Beattie, MacDonald, Ślusarski

Olympic burnout & overexposure

Unless you have been living on Mars for the past few years, the Olympics are being held in Beijing for the next two weeks. Already I'm sick and tired of the Games.

I'm not usually a great fan of the Olympics. There are a number of things wrong with the whole Olympic movement. I hate that the Olympics have to sell themselves out to companies like Coca Cola and McDonalds just to make themselves viable. The whole Olympic ideal is to be "stronger, faster, higher" and I don't think you will be doing that consuming soft drinks and burgers.

I also don't like the way the Olympics are treat by viewers. Everybody uses the Olympics for blatant country bashing; to say one country is better than another. Let's face it, you can't watch an event if there isn't anybody from your country competing. We all great when our country wins but try to make excuses when our country loses - we can never applaud the fact that our country's athletes were beaten by better athletes. In the modern age when war has been phased out (almost), the Olympics is our substitute for war.

Taking this idea that "our country is great" is the host nation itself, China. Politics and sports are not supposed to mix but China are just doing that with the Olympic Games. They are using the who event to show the world just how great they are, just glossing over the act that they have a poor human rights record, they only could just manage to hold the Games by shutting down all the factories & taking away half the vehicles off the road and they don't do much in the world politics such as matters dealing with Sudan, Burma and Zimbabwe. Why am I not surprised that they used a little girl in their little propaganda? Just read this article from BBC News and you know what I'm write about. I just hope Great Britain don't go down the same road with London 2012.

What is much worse than China using the Olympics Games as a propaganda tool is the local media coverage of the Olympic Games. Most of the Olympic Games is being broadcasted on TVB Jade, a local Chinese TV channel. Unfortunately the word "unbiased" is not what I would describe their coverage to be. I understand you will broadcast all the events China and Hong Kong are taking part. However to hear in the commentary "this just shows how great China is" or "Come on China!" is not what I want to hear. The media is supposed to be impartial, non-partisan and professional, not some crazed sports fan who has the microphone. They are not supposed to impose their own views on the event. I have heard BBC commentary on sports when England are playing. I was in USA when the Atlanta Games were on. I have never heard any of the commentators going throughout the whole coverage saying how great the nation is.

I remember eight years ago in the Sydney Olympics when one Hong Kong female TV 'reporter' (I use the word 'reporter' lightly when in essence she is a TV 'personality') when one Chinese athlete won (I think it was in the swimming events). I could hear was her screaming in delight that a Chinese swimmer one and I don't think she got a question in because she was so excited. That's when I started hating TVB's coverage of the Olympics and wished for more professionalism. If I was in Britain, at least I would be listening to seasoned sports commentators or ex-professionals who can string a sentence together. Unfortunately I'm in Hong Kong and I get TV 'personalities' and actors commentating on the Olympics. I'm sure they could find some former athletes who could commentate on the events instead of getting Dodo Cheng or Hakken Lee (yes, those are their real names).

I was going to go on about how competitors would rather compete in the Olympics than represent their own country but we still got two weeks left of the Olympics. I can rant and rave later about that.

The off-season: Stoke City

Like Hull City, Stoke will be struggling to stay up this coming season. They were hard to beat in the Championship with the impregnable defence but in the Premier League they will need more than that to stay up. I really don’t think they will be able to stay up if they continue with the squad they currently have.

GK: Steve Simonsen, Thomas Sorensen

Getting Sorensen will help bring some solidarity in between the posts. This is a goalkeeper who has experience with Aston Villa, Sunderland and Denmark. Simonsen may have been given a chance but I think Sorensen will start in goal at the beginning of the campaign.

RB: Andy Griffin, Lewis Buxton

Griffin might be an experienced right-back with Newcastle United, Portsmouth and Derby but I don’t think he has the capability to be a Premier League right-back. Clearly Tony Pulis will need recruiting in the upcoming weeks.

LB: Carl Dickinson

I have never heard of Dickinson which doesn’t say much about his playing ability. Even if Dickinson is an unfound treasure playing in the lower leagues, Stoke will still require a back-up left defender in Dickinson falls foul to any injuries.

CB: Leon Cort, Ryan Shawcross, Andy Wilkinson

In Cort and Shawcross, Stoke have two up and coming centre backs. They maybe have fantastic ability but experience is still wanting. Tony Pulls will need to bring in another centre-back, preferably somebody with experience.

WG: Liam Lawrence, Danny Pugh

Not a great line-up - a Manchester United reject and somebody who couldn’t make the grade with Sunderland. I actually think Lawrence is underrated and shouldn’t have been booted out of the Stadium of Light by Roy Keane. I still think Pulis needs to recruit a natural winger.

CM: Glenn Whelan, Salif Diao, Rory Delap, Seyi Olofinjana

Probably Stoke’s strongest area with Premier League experience with Diao & Delap plus natural flair in Olofinjana and Whelan. I don’t think Stoke will require buying players in this area.

FW: Richard Cresswell, Ricardo Fuller, Dave Kitson, Vincent Pericard, Jon Parkin

Probably not the most impressive line-up in the Premier League. None of the players actually lit up the Premier League or are twenty goals per season strikers. Fuller is chronically injured whilst Kitson was not prolific in the two seasons when he was playing in the Premier League. It will require more goals to keep Stoke City up. Even Pericard, who has played for Juventus and Portsmouth, is not in the frame.

Summary

In: 1 x Right-back, 1 x Left-back, 2 x Centre-back, 2 x Wingers, 1 x Forward
Out: Buxton, Phillips, Parkin, Pericard

The off-season: Hull City

Hull City will be in the top flight for the first time in its history, which stretches back more than a hundred years. So forgive me if I state I know nothing about how the team play or what kind of players they have. Phil Brown, who used to be Sam Allardyce's number two at Bolton before going off to Derby and failing there, will have a hard time keeping them up. In the back of his mind he knows the team won't stay up. He will have to wait out this season, pick up the parachute payments and try again the season afterwards to consolidate themselves in the Premier League.

With that said, he does seem to be attempting to stay in the Premier League from some of his summer signings...

GK: Boaz Myhill, Tony Warner, Matt Duke

Bringing in Warner gives Hull City some Premier League experience between the sticks. Although Myhill is a keeper with international experience with Wales, he's still relatively inexperienced and will be facing top strikers every week. Don't be surprised if Warner starts to be in the goal during the middle of the campaign.

RB: Nathan Doyle, Bernard Mendy, Sam Ricketts

It will be a straight fight between Ricketts & Mendy for the number two position. Doyle may move on but he's still young.

LB: Andy Dawson

Dawson still is the only left back on the squad, so it won't be a surprise if Brown recruits a more experienced left-sided defender to back-up or even displace Dawson.

CB: Michael Turner, Anthony Gardner, Wayne Brown

Hull needed to bring in a defender with Premier League experience, so bringing in Gardner on loan was a good find. They still need to bring in another central defender.

WG: Ryan France, Richard Garcia, Nick Barmby, Craig Fagan, Peter Halmosi

This is where Hull have an abundance of wealth. With Nick Barmby being the experience they need, it will alow the likes of Garcia, Fagan & Halmosi to attack without fear. France is most likely to leave though.

CM: Ian Ashbee, Geovanni, Bryan Hughes, John Welsh, George Boateng

Brown has got the best idea of bringing two veterans in the likes of Geovanni & Boateng to be the centre of midfield. It looks like club veteran Ashbee will have to take a back seat whilst Welsh needs to rediscover the form he had at Liverpool.

FW: Caleb Folan, Dean Windass

If Brown doesn't recruit now, he won't be in the job come Christmas. Goals keep you up and he doesn't have any strikers of worth. It's difficult seeing where the goals will come from for Hull City at the moment. Folan didn't exactly light the Premier League up with his previous club Wigan Athletic whilst Windass will be used sparingly due to his age. Phil Brown will have to invest in a striker with Frazier Campbell, last season's top striker for the Tigers, staying at Manchester United for the immediate future.

Summary

In: 1 x Left-back, 1 x Centre-back, 2 x Forwards
Out: Doyle, France, Welsh

Running around like Mike the Headless Chicken

I'm really thank I have been posted to my current convalescence hospital. Compared to other hospitals, the workload is lighter. I don't have to admit many emergency patients which would require asking a proper history and performing a thorough clinical examination. Most of the patients I admit are transferred from the main hospital for convalescent care or are having elective surgery. Therefore most of their details are already on our electronic database and only requires a cut & paste approach. Of course for each patient I do ask how they are doing and assess their condition but it is much easier.

Most of the blood taking is performed by the nurses but I am proficient in taking blood, since I need to do it if the nurses can't, for example if they can't find a peripheral vein, for cross matching blood and when a blood culture is required. Most of the other stuff the nurses can do but usually require the house officers' signature. Interns do get ridiculous calls from nurses just to say what the blood results were and they require the interns to do nothing, just so that they are informed. Basically the nurses are covering their arses and shelving responsibility to the interns, in case something goes wrong.

Since I'm based around four floors in the current hospital, most of the time I'm running around like a headless chicken try to do all my tasks. One manages to sort out which is necessary and what can be left to a later time but I do manage to get off work at a reasonable hour, if you call six o'clock a reasonable hour. If fact I don't mind working to late. I don't have nothing much to do in the evenings. I'm just thankful I don't HAVE to revise or study when I get back in the evenings. Eventually I will have to study, since I can't remember how to read an ECG or what to do in particular situations but that will come later. Most of the evenings I'm bored to death now. Initially I had videos to watch on my notebook. Now I've run out of videos to watch and can't download any on the hospital internet networks. So I'll have to wait until I get back home to retrieve my videos. I can't be bothered to go out since that requires money and I can't watch a movie every day. So far I have resorted to buying some books and now am engaged in the fierce rivalry between Mr. Darcy and Elizabeth Bennett (prize to the first person who knows which novel that comes from).

At times I'm grateful I am busy and at other times I wish I had something to do... like now.