Wednesday, December 09, 2009

Keeping secrets

I don't try to hide the fact I have depression, which lead to two repeated years plus two deferred years when I was studying medicine. I don't feel ashamed I took longer than everybody else to get a medical degree. I knew I had problems and it wasn't entirely my fault.

Yet there are times I "bend" the truth. I don't exactly lie but the entire truth is not exactly revealed. The best example is when asked about my background. Due to my deep accent, I'm always asked my fellow staff about my upbringing. I always say I was born in Hong Kong but grew up in England. So there is nothing wrong there.

Yet there is always questions about duration and such. I'm always asked how long I have been back in Hong Kong. The real answer is ten years - five years of my medical degree plus the extra four years entailed plus my intern year. What most people expect the answer to be is six years - five years for the medical studies plus one year internship. So I never ever say an exact number. I always state I have been back for my university studies and have been so ever since. Not exactly the whole truth but not exactly a fib either.

So why do I "bend" the truth? Why don't I just admit to the fact I spent more time than anybody else to get a medical degree, just because of my depression? The fact is I got sick of explaining my life story every time this possibility crops up. Me explaining my life and my depression becomes like that game "Twenty Questions" when people try to narrow down the truth. At the end of the day I just want to simplify matters.

Occasionally I do have to get a sick leave when I go for my follow-up appointments. Then some parts of the truth do creep out. I'm always asked where have I been when I go to my psychiatrist. I usually say I just have to follow-up with my doctor and hope the questioning ends there but it never does. This leads to the inevitable question, "What are you being followed-up for?" which leads to me say, "Depression" and the barrage of questions afterwards.

I understand some people who keep secrets. It makes life a little more simple. Now I have some kind of understanding what schizophrenics and homosexuals go through. I would never say my predicament is exactly as does who are persecuted like gays and lesbian but some people expect you to conform the normal standards and if you have a deviance, you are most likely to keep it in check even if most people are willing to accept it.

Thursday, December 03, 2009

Increasing levels of bureaucracy

Having requested my holiday leave* at the end of my rotation, I have finally finished surgery and will be going on to accident and emergency next month.

* I can never call my holiday leave "annual leave" as I get the leave four times a year. It can only be called annual leave if I can bunch up all my leave into one massive holiday, where I probably go back to England.


I've only just left a surgery department where they recently opened another ward. This means another twenty six beds available and more opportunities for patients to receive treatment and surgery. This maybe good for the nearby population but does not bode well for junior doctors. We do not receive an increase in manpower, meaning an increase workload. I'm not complaining, having already left the department already.

This is just one of several examples of the increase level of bureaucracy in hospital work. It has been steadily creeping into the workplace. It comes with the organization you work with. The larger the organization, the more paperwork and guidelines you must follow and there is no bigger organization than a government installation. In recent months I have noticed how anal some people who set out these guidelines really are.

The first example I encountered was writing management orders for intravenous fluids. In the past I could just write what intravenous fluids I want for my patients in the management orders sheet. If the intravenous fluids contained potassium, I would have to write it on the drug sheet, which is fair enough since overdosing on potassium is very dangerous. For some reason, this policy was changed so I have to write ALL intravenous fluids into the drug sheet, whether or not it contained potassium or not. Also I have to write the frequency more explicitly. In the past I could write "2D1S Q8H" which means "two units of dextrose 5% and one unit of sodium chloride 0.9% every eight hours". Now I have to write "2D1S Q8H per unit/pint*" which means a few more seconds. If you are writing this for every week for every patient, the amount of time spent doing this starts to build up.

*Whoever writes "per pint" for intravenous fluids or even blood products is wrong. A pint is 565 ml, whilst an unit of intravenous fluids is always 500 ml, whilst for blood products it is usually 330 ml. Just being pedantic.

Another example of bureaucracy I have just encountered is blood taking. In the past we had to use a barcode system to print labels for blood specimens if we want to type and screen a patient. For those of you who don't know what that means, it basically means knowing a patient's blood group so we can give blood just in case. We had to use an electronic device to make sure the patient's identity was correct. It's quite similar to the mobile phone 2D barcode system you see. It would be fine if it was just for blood typing but now we have to use it for EVERY specimen, whether it is blood, sputum or urine. It is so annoying and so cumbersome and so time-wasting! At the end of the day, we want to avoid mixing up the patient's identity with somebody else but the specimen taking is still being done by a human and the placing of the label is still done by a human, which means it is prone to error. Putting another level of checking may reduce this type of human error but at what cost?

Bureaucracy is fine but there is a limit as far it can go.