Now days we occasionally hear healthcare provider will say.. “be a team player... we are on the same team”... I personally, have heard this statements numerous time.
When someone did something wrong, I’ve heard people said... “You must work as a Team”.
When someone said something wrong,.... “We must work as a Team”
Honestly, I’ve been called “Not a Team Player” before. I was accused this when I shouted at a medical officer seing my patient in Emergency Department.
Am I really not a team player??. Sometimes I wonder and start to think back... What do we mean by the word “Team”.
“Team” in a simple words mean : Group of people working together for a specific goal.
On the other hand “Culprit” means: “The cause of a problem” or “person who is responsible for a crime.”
In healthcare, a Team should be a group of people that fight for a common goal... PATIENT’S CARE.
So, when someone shouted because the care provided to his patient was inadequate ... he is a team player not a culprit.
Went someone raise an important issue regarding patients care ... he is a team player. Opposing that is the Culprit.
Finally, as for me:
When a lay person did something great to the patient... He is a Team Player
When a Consultant/physician/surgeon/medical officer/etc did something lousy... He is a Culprit. Stop calling him a Team player.
Sunday, October 2, 2011
Wednesday, April 13, 2011
Excellent Emergency Physician
I’m sure most of us have heard this
An average surgeon knows how to cut,
A good surgeon knows when to cut and
A better surgeon knows when not to cut
I’ll like to adapt this to Emergency Physicians (EP)
An average EP knows how to detect emergency condition
A good EP knows when and how to treat
An excellent EP anticipate complication
An average surgeon knows how to cut,
A good surgeon knows when to cut and
A better surgeon knows when not to cut
I’ll like to adapt this to Emergency Physicians (EP)
An average EP knows how to detect emergency condition
A good EP knows when and how to treat
An excellent EP anticipate complication
Thursday, November 11, 2010
Blessing in disguise….
One morning, I just completed my night call and on my way to our CME room. We were having our weekly departmental CME and naturally the emergency physician would chair the session. I called one of the senior resident who worked with me that night and asked him to attend.
During the lecture, I noticed that he didn’t show up. So I sent him a text message…
“Sometime I wonder kenapa kau tak suka dtg CME. Dtg la. Belajar aje.” (Sometimes I wonder why you don’t like to attend our CME. Please come for the sake of learning).
For those who don’t understand Malay, it is consider a slap on the face if a student got this kind of message from a teacher/consultant.
I made a big mistake. Actually I did not notice that I mistakenly sent this message to my senior consultant.
He replied:”Tq for reminding…sya d Putrajaya” (Thanks for reminding, I’m in Putrajaya).
This text message when from a very junior emergency physician to a respectable senior consultant. The content should be considered as something rude.
The way he replied my message showed his maturity and why he is the “respectable senior consultant”.
I regretted I sent him the message, but I’m glad it happens. Without that incident I would have not learn a valuable lesson from him… To be humble.
It is a real blessing in disguise…
During the lecture, I noticed that he didn’t show up. So I sent him a text message…
“Sometime I wonder kenapa kau tak suka dtg CME. Dtg la. Belajar aje.” (Sometimes I wonder why you don’t like to attend our CME. Please come for the sake of learning).
For those who don’t understand Malay, it is consider a slap on the face if a student got this kind of message from a teacher/consultant.
I made a big mistake. Actually I did not notice that I mistakenly sent this message to my senior consultant.
He replied:”Tq for reminding…sya d Putrajaya” (Thanks for reminding, I’m in Putrajaya).
This text message when from a very junior emergency physician to a respectable senior consultant. The content should be considered as something rude.
The way he replied my message showed his maturity and why he is the “respectable senior consultant”.
I regretted I sent him the message, but I’m glad it happens. Without that incident I would have not learn a valuable lesson from him… To be humble.
It is a real blessing in disguise…
Tuesday, October 19, 2010
Dear Doctors – Are we guaranteed enough to be saved in our own grave??
We, Muslims believed that everything that we did during our lifetime will be questioned back, the moment we have been put in our own grave. All these while, it involves good deeds and of course the negative sides of our own mistakes that we have done.
In fact, we will receive punishment in our grave prior to the “judgement day” in which life in the hereafter.
Do bear in mind that all the things that we did will either help us or punish us. I don’t think I need to explain more regarding the duty on how to perform prayers, fasting, paying zakah as well as performing haj. These can be referred directly to our pillars and all Muslims will say that they knew about it.
Moving on to the next agenda on the matter of our duty as doctors? Well, let’s talk about what we did all these while. Believe it or not, we will definitely be asked in our grave and yet, Islam has always being the way of life as it practices equal judgement. Hence, I would like to highlight once again about what we do in our lifetime will be asked in later life.
The medications that we gave to our patients, various investigations that have been carried out and others will be taken into account. Thus, this is for sure that we will be asked either it has been justified or not.
So, let’s ask ourselves, “Have we caused harm to our patients?, Do we really care and allow our patient with peritonitis to just lay down on bed at 2am and plan to do laparotomy at 8am?, Can we say that all emergencies CT with contrast need a renal profile and let them wait?. Did we fight for our patient's right or simply keep our mouth shut letting things be?
Can we answer all these questions comfortably in our grave? Perhaps, almost all of us will say a big NO. All of us must have done something during our career timeline thus that will lead us to answer it as such. I would say that nobody’s perfect in this world and we all did mistakes. But then, mistakes can be very subjective based on different views of people. It can always be intentionally or unintentionally.
In this blog entry, let us focus on the “Big Intentional Mistakes”. Big Intentional mistakes may be seen and overlooked by some of us as it is small and perhaps some may be saying that it is not a mistake at all.
An example of this big intentional mistake will be a surgeon who is preaching everyone during lectures, seminars, and conferences regarding an urgent exploratory laparotomy in an unstable intra-peritoneal bleed. Surprisingly, in his own department, it has not been done. Patients will undergo CT Abdomen to rule out other things. When they have been asked whether this “other things” can change the management or not, they will keep their mouth shut. As a matter of fact, even a surgeon in training will answer in his examination that an urgent laparotomy is needed in an unstable intra-peritoneal bleeding. But then, in real life, he would waste valuable time ordering repeating ultrasound and CT abdomen prior to the procedure. This kind of person has no insight in answering and supporting his statement yet this is the person among some people who might have hard time in their grave answering all these questions.
But, do think twice. We are “The Doctors”, the one with high ethical value. We have been taught and trained well. I personally can’t remember the exact number of various ethics’ lectures that I’ve attended. But then, think again…. I’m not talking about coming late to work. I’m talking about the simple life saving procedure and simple way to ease patient’s burden.
So, here are some questions to be pondered about:
Why each time during examination, you answer exploratory laparotomy, but in practice you delay the definitive treatment with investigations…?
Patient with meningeal signs: Why for patient A you will do CT with contrast urgently but for patient B you let him wait for hours wanting to see the renal profile first?
So, What is our answer?. Are we guaranteed enough to be saved in our grave?
Perhaps, let us start correcting these “Big intentional mistakes” and then start focusing on the small ones.
In fact, we will receive punishment in our grave prior to the “judgement day” in which life in the hereafter.
Do bear in mind that all the things that we did will either help us or punish us. I don’t think I need to explain more regarding the duty on how to perform prayers, fasting, paying zakah as well as performing haj. These can be referred directly to our pillars and all Muslims will say that they knew about it.
Moving on to the next agenda on the matter of our duty as doctors? Well, let’s talk about what we did all these while. Believe it or not, we will definitely be asked in our grave and yet, Islam has always being the way of life as it practices equal judgement. Hence, I would like to highlight once again about what we do in our lifetime will be asked in later life.
The medications that we gave to our patients, various investigations that have been carried out and others will be taken into account. Thus, this is for sure that we will be asked either it has been justified or not.
So, let’s ask ourselves, “Have we caused harm to our patients?, Do we really care and allow our patient with peritonitis to just lay down on bed at 2am and plan to do laparotomy at 8am?, Can we say that all emergencies CT with contrast need a renal profile and let them wait?. Did we fight for our patient's right or simply keep our mouth shut letting things be?
Can we answer all these questions comfortably in our grave? Perhaps, almost all of us will say a big NO. All of us must have done something during our career timeline thus that will lead us to answer it as such. I would say that nobody’s perfect in this world and we all did mistakes. But then, mistakes can be very subjective based on different views of people. It can always be intentionally or unintentionally.
In this blog entry, let us focus on the “Big Intentional Mistakes”. Big Intentional mistakes may be seen and overlooked by some of us as it is small and perhaps some may be saying that it is not a mistake at all.
An example of this big intentional mistake will be a surgeon who is preaching everyone during lectures, seminars, and conferences regarding an urgent exploratory laparotomy in an unstable intra-peritoneal bleed. Surprisingly, in his own department, it has not been done. Patients will undergo CT Abdomen to rule out other things. When they have been asked whether this “other things” can change the management or not, they will keep their mouth shut. As a matter of fact, even a surgeon in training will answer in his examination that an urgent laparotomy is needed in an unstable intra-peritoneal bleeding. But then, in real life, he would waste valuable time ordering repeating ultrasound and CT abdomen prior to the procedure. This kind of person has no insight in answering and supporting his statement yet this is the person among some people who might have hard time in their grave answering all these questions.
But, do think twice. We are “The Doctors”, the one with high ethical value. We have been taught and trained well. I personally can’t remember the exact number of various ethics’ lectures that I’ve attended. But then, think again…. I’m not talking about coming late to work. I’m talking about the simple life saving procedure and simple way to ease patient’s burden.
So, here are some questions to be pondered about:
Why each time during examination, you answer exploratory laparotomy, but in practice you delay the definitive treatment with investigations…?
Patient with meningeal signs: Why for patient A you will do CT with contrast urgently but for patient B you let him wait for hours wanting to see the renal profile first?
So, What is our answer?. Are we guaranteed enough to be saved in our grave?
Perhaps, let us start correcting these “Big intentional mistakes” and then start focusing on the small ones.
Saturday, September 25, 2010
Spice-up “Impression” and/or Diagnosis
The Emergency Department is the place where most diagnoses are made.
Quite frequently, patients in the Emergency Department will be admitted without a firm diagnosis. Not being able to give an exact diagnosis is not in itself a failure of management. It is a matter of simply describing the patient’s current illnesses
I’ve always emphasized to myself and other medical officers to clearly state their diagnosis/impression. Lets face it, how often do you think doctors in the ward will read the whole documentation once patients have been admitted? Most of time they will just read our Impression: e.g., Acute Inferior MI.
By not reading the whole document, the team upstairs will not know some of the important things (why the diagnosis was made, findings, management and etc.) that happened in the Emergency Department.
Therefore during their morning rounds, the consultants will not be fully informed regarding the initial management and will assume most of the patients’ management has been done by their team rather than otherwise.
Once, I encountered a cardiologist that did not realize most patients with AMI in his center received their thrombolytic agent in the ED (without the presence of the cardiology team). In fact, patients’ complications will be fully managed in the ED as needed (central venous line, arterial line, inotropes, temporary pacemaker, etc.) and yet it is presumed that these things were done by the cardiology team.
So my suggestion is simple, we spice up the only thing that we are sure the receiving team will read, i.e., The Impression.
Here are some of the examples that I have started to write during my rounds.
Suggestion #1:
Imp: Acute Inferior MI
Change to
Imp: Acute Inferior MI with right ventricular involvement complicated by acute pulmonary edema (Killip II), reperfused post-Streptokinase
Suggestion #2:
Imp: Thyphoid
Change to
Imp: Clinical Thyphoid (Awaiting serology) in view of
1) Relative bradycardia
2) Constipation preceeding diarrhea
Suggestion #3:
Imp: Septic shock secondary to pneumonia
Change to
Imp:
1) Septic shock secondary to pneumonia (currently on single inotrope, SvO2 improving)
2) Intubated for respiratory distress with difficult airway (Comark Lehand III)
Suggestion #4:
Imp: AGE with severe dehydration
Change to
Imp:
1) AGE with severe dehydration - failed outpatient therapy
2) Hypokalemia secondary to 1 (K correction started)
3) Lactic acidosis secondary to 1 (improved after initial fluid bolus)
Suggestion #5:
Imp: MVA with left femur fracture
Change to
Imp:
1) Alleged MVA with close fracture of left femur
2) Complicated by Class II shock (Improve with fluid bolus and traction)
Quite frequently, patients in the Emergency Department will be admitted without a firm diagnosis. Not being able to give an exact diagnosis is not in itself a failure of management. It is a matter of simply describing the patient’s current illnesses
I’ve always emphasized to myself and other medical officers to clearly state their diagnosis/impression. Lets face it, how often do you think doctors in the ward will read the whole documentation once patients have been admitted? Most of time they will just read our Impression: e.g., Acute Inferior MI.
By not reading the whole document, the team upstairs will not know some of the important things (why the diagnosis was made, findings, management and etc.) that happened in the Emergency Department.
Therefore during their morning rounds, the consultants will not be fully informed regarding the initial management and will assume most of the patients’ management has been done by their team rather than otherwise.
Once, I encountered a cardiologist that did not realize most patients with AMI in his center received their thrombolytic agent in the ED (without the presence of the cardiology team). In fact, patients’ complications will be fully managed in the ED as needed (central venous line, arterial line, inotropes, temporary pacemaker, etc.) and yet it is presumed that these things were done by the cardiology team.
So my suggestion is simple, we spice up the only thing that we are sure the receiving team will read, i.e., The Impression.
Here are some of the examples that I have started to write during my rounds.
Suggestion #1:
Imp: Acute Inferior MI
Change to
Imp: Acute Inferior MI with right ventricular involvement complicated by acute pulmonary edema (Killip II), reperfused post-Streptokinase
Suggestion #2:
Imp: Thyphoid
Change to
Imp: Clinical Thyphoid (Awaiting serology) in view of
1) Relative bradycardia
2) Constipation preceeding diarrhea
Suggestion #3:
Imp: Septic shock secondary to pneumonia
Change to
Imp:
1) Septic shock secondary to pneumonia (currently on single inotrope, SvO2 improving)
2) Intubated for respiratory distress with difficult airway (Comark Lehand III)
Suggestion #4:
Imp: AGE with severe dehydration
Change to
Imp:
1) AGE with severe dehydration - failed outpatient therapy
2) Hypokalemia secondary to 1 (K correction started)
3) Lactic acidosis secondary to 1 (improved after initial fluid bolus)
Suggestion #5:
Imp: MVA with left femur fracture
Change to
Imp:
1) Alleged MVA with close fracture of left femur
2) Complicated by Class II shock (Improve with fluid bolus and traction)
Saturday, September 11, 2010
My first Eid Ul-Fitri as an Emergency Physician
Recently me and my family celebrated Eid Ul-Fitri. This is my first Eid as an Emergency Physician (EP). Here are some of the remarks I got regarding my profession (most of them translated of course…)
Aunt #1: So you can treat anything and everything???...
Me: No Aunt, just anything to do with emergency situation.. including finding a taxi and a coffin..
Cousin #1: You are an EP now, so when are going to be a specialist???
Me: … (Stunted)….
Cousin #2: So (since you are a specialist now) you are not seeing patients anymore.
Me: I’m responsible for hundred off them perday, review a handful of them, fought for some of them, conducting procedures and sadly pronounced death for a small fraction of them.
Cousin #3: Now that you have become a specialist, Life will be easier for us. Recently I was found to have an enlarged uterus for more than 6 months. I’m currently under gynecologist follow-up. May be you can help out….
Me: Please continue the follow up. In emergency department, we take care of acute illnesses. We will refer this kind of cases to the same person that you have seen.
Aunt #2: So you are specialized in Emergency Medicine… I just get to know about it recently.
Me: Thank God…Finally.
I’m not surprise with some of the remarks. “Emergency Medicine” and EP’s are still young in Medical Field. We still have a long way to go.
Selamat Hari Raya to all
Aunt #1: So you can treat anything and everything???...
Me: No Aunt, just anything to do with emergency situation.. including finding a taxi and a coffin..
Cousin #1: You are an EP now, so when are going to be a specialist???
Me: … (Stunted)….
Cousin #2: So (since you are a specialist now) you are not seeing patients anymore.
Me: I’m responsible for hundred off them perday, review a handful of them, fought for some of them, conducting procedures and sadly pronounced death for a small fraction of them.
Cousin #3: Now that you have become a specialist, Life will be easier for us. Recently I was found to have an enlarged uterus for more than 6 months. I’m currently under gynecologist follow-up. May be you can help out….
Me: Please continue the follow up. In emergency department, we take care of acute illnesses. We will refer this kind of cases to the same person that you have seen.
Aunt #2: So you are specialized in Emergency Medicine… I just get to know about it recently.
Me: Thank God…Finally.
I’m not surprise with some of the remarks. “Emergency Medicine” and EP’s are still young in Medical Field. We still have a long way to go.
Selamat Hari Raya to all
Tuesday, August 17, 2010
Treating patients as parents…. Should we???
We all have heard remarks that doctors should treat patients as their parents. Some of us accepted this view as it’s provided a firm practices of medicine.
I personally think this notion should be alter.
When my parent was admitted, I was able to stay up more than 36 hours, running from department to department, stand-sit-kneel and all of others. I managed to do this for one patient. We managed numerous patients per day and it is impossible if we would have to do the same.
Plus, when we managed our parents, we tend not to be objectified. First, we would think the worst possible diagnosis and doing unnecessary investigations. Second, some of us would even go to the other extreme as thinking there is nothing terribly wrong with our parent and asking them to sit tight in the house.
Belief me when I say I’ve seen doctors that wrongly treated their parents. Most of them regretted what they have done.
The best way is to get a second opinion. This not only shows the doctor’s maturity, it would directly give the best treatment to our parents.
So when you ask
“Should you treat your patients as you are treating your parents?”.. I’ll answer NO and alter to..
“We should treat our patients as we would like other doctors to treat our parents”
Does it sound fair???
I personally think this notion should be alter.
When my parent was admitted, I was able to stay up more than 36 hours, running from department to department, stand-sit-kneel and all of others. I managed to do this for one patient. We managed numerous patients per day and it is impossible if we would have to do the same.
Plus, when we managed our parents, we tend not to be objectified. First, we would think the worst possible diagnosis and doing unnecessary investigations. Second, some of us would even go to the other extreme as thinking there is nothing terribly wrong with our parent and asking them to sit tight in the house.
Belief me when I say I’ve seen doctors that wrongly treated their parents. Most of them regretted what they have done.
The best way is to get a second opinion. This not only shows the doctor’s maturity, it would directly give the best treatment to our parents.
So when you ask
“Should you treat your patients as you are treating your parents?”.. I’ll answer NO and alter to..
“We should treat our patients as we would like other doctors to treat our parents”
Does it sound fair???
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