Saturday, August 30, 2008

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.

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