Housemanship: Should I stay in Malaysia? Or should I go abroad?

Interestingly, I have received several messages the past few weeks from final year medical students who were already thinking about their housemanship. Should I do my housemanship (or internship) in Malaysia or continue abroad?

Most of these messages came from students who were already abroad and were hesitant in starting their housemanship in Malaysia due to many factors, but mostly concerning the work culture. I suppose the healthcare scene in Malaysia is notoriously known for the workplace culture, i.e bosses bullying house officers, asking them to get their GRAB food and not say thank you (whatever), bosses who aren’t thoughtful, considerate or helpful. Well, it is true there are some bosses who are notoriously known for their attitude, particularly prevalent in a certain department than others, there are however exceptions to superiors who are helpful, nice and very approachable.

Workplace culture differs from teams to teams, departments to departments and hospitals to hospitals. I suppose researching the hospital departments should aid in your decision-making process before applying for housemanship. Never apply to a hospital for logistic reasons. Housemanship is a difficult time period, choosing the right hospital is important and necessary to safeguard your wellbeing for the next 2 years.

While a lot of talk is about the workplace culture, housemanship in Malaysia generally gives you a lot of practical experience compared to overseas. I mean, how can you not do more? You literally mend the whole cubicle with 10-12 patients every day, and sometimes you are put alone in the ward with 28 patients, so how can you not learn to work strategically? But bear in mind, learning in these conditions are not always optimum and your learning may not always be right, seeing as how you need to manage all 28 patients quick and fast, otherwise, you’ll never be able to finish working and be able to leave on time. So even though you’d learn how to work fast, it may not always be using the right methods. Your hands may not always be as sterile as it should be.

And of course, on top of that heavy workload, your superiors may expect you to know all the cases, be able to manage everything a house officer is expected to do. Malaysia still has a lot of these unreasonable settings due to a lack of manpower, inefficient/ineffective hospital admins and lack of helpful/thoughtful colleagues. Nice people can be hard to come by.

Culture, skills and workload, when you add all of these up, it’s left with time management. You will almost always never leave on time. How can you? When you have to manage the whole cubicle/ward, on top of all the IV cannulas that aren’t working, and all the additional morning bloods you have to take, the requests and referrals you have to make, the AM, PM reviews you have to write, the lunch you have to pick up from the main entrance that your superior never got for you (sorry, sarcasm), how could you ever finish your work? And there isn’t a culture of passing over such to the oncall house officers either, so all you could do is finish up your morning plans before you go back, otherwise it’d be deemed “passing over shit”.

Malaysian housemanship is a lot to handle. It’s less enjoyable, but you see a whole different side of a dysfunctional healthcare system made up of bones that are trying to hold it together. Sometimes, it cracks a little, but it will stay and it won’t fall. The amount of learning depends on the individual. Some people learn a lot, some just don’t. Personally, it’s hard to learn when your every day is stressful. So learning, depends.

Given the recent announcement of more permanent positions and the eligibility of contract doctors to pursue masters, specialising isn’t really a huge problem in Malaysia. There is still a strong bottleneck for only those elite + those with connections can enter a master’s program. Given my time in Australia, training over there seems to be better, more tolerable, more research-oriented, more independent, more goal-oriented, but harder to level up. Hence, it might take years and years before you could become a consultant. But training in Australia is generally better (and the pay is great).

Should I do my housemanship in Malaysia or abroad?

There’s a few things to consider. Remember, Malaysia’s housemanship is brutal. 2 years of service makes you a competent MO. Internship training abroad unfortunately doesn’t give you that level of experience as it is here. Hence, most internships aren’t recognised in Malaysia. So if you were to do your internship abroad, coming back might mean you will have to restart your housemanship.

The other option is completing your housemanship here, then going overseas. There’s always this glimmer of hope that perhaps being a doctor in Malaysia is not that bad, if that’s the case, try starting your career with being a house officer in Malaysia then decide from there onwards. At least you’d be able to get your license at the end of it.

But of course midway through your housemanship, if you feel strongly about the need to quit because of bad mental health, bad work ethics, bad work culture, bad superiors, then tender your resignation. Your own personal morale should take precedence. Proceed with your plan abroad.

Can I return after my internship abroad?

You can return anytime but be prepared to restart your housemanship. There’s this saying whereby if you were ever to return, always return as a specialist. It’s just easier that way than to come back just to restart the process of being a doctor.

My main concern is my family, what should I do?

An honest discussion with your family should allow you to decide on what’s next. If you can’t go abroad, then your best option is to pick a hospital that’s good for you. Alternatively, an MBBS degree doesn’t always mean being a doctor. Lots of people end up in other successful careers, they earn better too.

I hope this helps.

Regards,
Darien

Housemanship Guide: AM Reviews

This is for all the fresh graduates who just entered the workforce. Welcome to 2 years of hell. Seniors used to tell me it will get better, but did it really? In some ways it did, but for the most parts, it’s just the same shit, different things every day. But anyway, I guess one of the key lessons that nobody teaches you in medical school is reviewing patients. Sure, taking history and examining a patient is one key aspect, but when it comes to reviewing patients, asking relevant questions on a day to day basis, is a whole other continuum that nobody teaches you. It is as much common sense as it is practical experience that is to be gained throughout your internship. Before I lay out a format, here are some pointers.

Writing reviews are easy, it just takes a couple of practices, with familiarity and repetition, you’d do it like a robot (legit, same shit every day). But writing reviews aren’t as important as seeing your patient, assessing them and making sure they are making progress every day.

In Malaysia, as you know, we go to work on average 5AM everyday. In some departments you start taking blood before writing reviews. That may mean you’d actually have to come much earlier just so that you are able to finish taking all the bloods and completing all your reviews before your MO comes. My trick is (if I already know the patient) is to assess the patient as and when I’m taking their blood. A simple “how are you doing today?” is a good way to start. If you know this is a patient that came in for some cardiac issue, important questions to ask would be “any shortness of breath or chest pain?”. These questions become important when you document in your review later. The same applies to other organ systems.

A quick and simple assessment of your patient is CCTVR:

  • skin colour (C),
  • capillary refill time (normal <2 seconds) (C),
  • cold/ warm extremities (T),
  • pulse volume (V) and
  • rate (R).

Whenever you start writing your review, it goes in this order:

  • patient details/demographics
  • underlying conditions
  • issues
    • and relevant information
  • progress/current state
  • examination
  • impression (if a new issue pops up)
  • plan

Here is an example:

Ali
69 years old gentleman

Underlying
1. T2DM
2. Hypertension
3. Dyslipidemia

Issue:
1. NSTEMI
– Trop I (on admission) 4590 -> 3000 -> 2500
– Started DAPT (Tab cardiprin I/I OD and Tab clopidogrel 75mg OD)
– on S/C Clexane 60mg OD Day 3
– Planned for angiogram

2. Uncontrolled Diabetes
– HbA1C (2/2/2022) – 9.5%
– on S/C Insulatard 20units ON and SC Actrapid 14 units TDS

Currently,
Comfortable under room air
Tolerating orally well
No chest pain/SOB
BOx1 yesterday

On Examination,
Alert, conscious, CRT<2s, warm peripheries, good pulse volume, pulse is regular
JVP not raised.
Lungs: Clear
CVS: DRNM
PA: soft, non tender, not distended. No hepatomegaly

Plan:
1. Continue insulin regimen.
2. DXT QID, inform if DXT>12.
3. For cardio to review.
4. Inform if chest pain/SOB.
5. Continue DAPT.
6. Continue S/C Clexane.
An example of an AM review.

My example is of course an oversimplified version. A good and detailed version should entail home medications (prior to admission), years of illness, location of follow up under the underlying conditions. Your issues could probably be elaborated further, e.g initial presentation, progress in ward etc. And of course, your examination should be more comprehensive.

If this is your first time reviewing a patient, it is good to include the initial HOPI prior to your issues. This makes it easier to present your case later. It sets as a good reminder (assuming you’d be able to flip open your case notes for some pointers, which may not always be the case).

In an ideal world where admission clerking is perfectly done, your daily AM reviews need not be as detailed, but rather include information that constitutes the patient’s progress. This allows you to write a comprehensive discharge summary later on. I’ll probably write about this at some point later. I hope this helps all you juniors!

Cheers,
Darien

What you need to know about the Malaysian doctors’ culture

“One HO come to OT now.”

“HO, one patient admitting today, please do the necessities.”

“HO, please postpone all elective list patients.”

The reality of healthcare, for us all at the bottom of the hierarchy is this: we don’t have names. The last I checked, our mothers gave us all names, yet we’re subjected to two letters H-O, not even the entirety of it – house officers, as if our ranks have just been degraded to a mere two letters. Let me be clear, they know who we are and they know who is working for the day. I am sure because I introduced myself to everyone. So why not call us by our name?

“Darien, would you mind postponing all the patients coming in next Tuesday?”

Now, wouldn’t this be a better more polite approach?

Even if they don’t know who’s working today, then…

“Hey, who’s working today? I just need someone to help me with something.”

How’s that?

There is a strong patriarchy culture amongst Malaysian doctors, nobody else matters but you. So far, out of two postings, I have only met two doctors who are so down to earth that they would be willing to do all the discharges while you do all the bloods and all the other pending ward works. This doctor once said “Darien, let’s focus on doing all the discharges.” That day, I was so swamped, I was the only house officer taking care of the whole ward with 14 to 16 patients, 5 discharges and 5 admissions. At some point, I think I teared a little before he eventually came to the rescue. It was a blessed day to have received help. Also, thank you to all my colleagues for lending a helping hand when I needed it.

Once, there was a registrar whom I’ve worked with the past 4 weeks, who would say “What matters is not you or me, what matters is the patient. Your sorry won’t help anyone. So don’t apologise.” It was also a bad day, everybody was stressed. One thing went wrong and all hell broke loose.

What are the odds of working with superiors who don’t consider the type of work, so long as the patient is well and gets discharged, then it really does not matter who does the work. It is awfully rare to be working with people like that. If you are reading this, you know who you are, thank you. I had the opportunity to work with true doctors who didn’t consider the work of a house officer any different than that as a registrar, all work, equally important.

But truthfully, I have only been in two departments.

As I recall, there were days where it was busy and as a house officer, we have to be prepared to handle multiple discharges and admissions coming in, not forgetting active plans, referring and requests. With 15 patients, all with active plans, there comes a minute where you just don’t know where to start or how to even begin. If you work with doctors who would be willing to help you, then you would know, no matter how busy the day gets, you will survive. But a bad day is when you receive no help and you are left to fend for yourself. That happens, and it sucks.

By the way, there is absolutely nothing wrong in asking for help.

But why are MOs and Regs the way that they are?

Depending on the department and the hospital, I suppose, most MOs working for the team for that day, will be juggling both ward and the ED referrals. So it’s not surprising for them to be constantly busy, on their phone, on their feet, moving back and forth. Registrars are mostly only seen during rounds, in our eyes, if not, they are likely either in clinic, OT, ED, teaching or some meetings. So literally, we live up to our titles “house officers”, we take care of the house, i.e the ward.

Sometimes, for the benefit of the doubt, it’s not that our superiors don’t want to help us, it’s just that they are way too busy handling their own work.

But I have also met numerous other bosses who would simply not give a damn about the work. They merely expect you to do what you have been hired to do (slavery).

Just to illustrate a point, on many occasions back in orthopaedics, I had to request for “urgent” MRIs and CTs. The very first time I requested, I was obviously unfit to make any requests (I was day 1 of life). Nobody had helped me. In fact, my MO said “did you say this? you gotta say this -“, then he said “try again”. He hung up the phone and I was left to fend for myself against the very angry, annoyed and intelligent radiologist who would, of course, know better of the indications. I, on the other hand, who just started, would of course, know nothing about making request, or how to even begin. Interestingly that day, I was taught of the word “goreng“.

“Darien, you need to learn how to goreng.”

“Darien, you must goreng goreng so that you can get the request accepted.”

I supposed the most intriguing bit of this entire conversation was that, there was a need to ram up the issue, make it so severe that it must have warranted an MRI. That day, I was not taught of the indications, instead I was taught that I needed to do better, to “goreng” better. Truth is, it does not matter how sick your patient is, so long as your boss wants it, you got to get it. Most people don’t think, but if you try too hard, you might just land yourself in trouble. To the radiologist if you are reading this, this is the sad unfortunate truth that happens everyday. Your time and energy is wasted because these people exist to take up your time and energy for non-emergent cases, that are already occupying bed spaces, of which patients who really need them, aren’t getting it. Sorry for the time you have wasted. And to the world, the reality is we are understaffed, under-resourced and we simply don’t have the capacity to treat the population coming to us, we are simply overloaded with patients.

Day 1 of life, the most important lesson, apparently I needed to know was “how to goreng 101″. It wasn’t about writing reviews or managing chest pains or SOBs, but instead it was how to have your request granted urgently.

That’s the culture of it all. Truth is, sometimes, bosses don’t care. As long as you get the job done, then they are happy with you. That is, also unfortunately the sad truth. Because this also translates to nobody really cares about your learning and whether you are on track, what matters is you get the job done.

The jist of it all is when you have very busy superiors, they tend to treat you less. When you have superiors who are more free and able to help, they would if they wanted to.

But of course, I have heard worst in other hospitals. Literally, one house officer to 20 patients? Lack of MOs and registrars in other hospitals.

Then the questions remains – can we blame our superior for being mean, annoyed and angry all the time? Are they simply just tired and fed up of the system that they can’t be bother dealing with us? I think there’s always two sides of a coin and therefore two sides of a story.

Our system is overloaded with patient, coupled with inefficiency in the way the healthcare system is managed. Lack of resources and lack of manpower does not help at all, unfortunately, if at all, it exponentially makes everything worse. Say if I had 20 patients to juggle today, and suddenly my colleague decided to take a leave, I would be alone managing everyone. Imagine the time I have to be there before my registrar is, imagine the amount of patients I have to review in that morning, and the active plans I have to carry out throughout the day, all alone. As a house officer, we can only pray that the world doesn’t hit us hard, on a daily basis, and that it comes at a pace, at a rate that we can handle. To our superiors, we hope that they treat us well and we in turn can learn and do our work better.

So, the Malaysian doctors’ culture is this

  1. Depending on your hospital and your department, there will inevitably be some superiors who are arrogant, selfish, difficult to work with, vulgar, intentionally make your life difficult, lazy, unreliable and undependable.
  2. Lazy is a common aspect where superiors may simply rely on your finding and come up with a management plan. ALWAYS get them to double check unless you are confident.
  3. The “apa-apa sahaja”, “sesuka hati kau”, “do whatever you want” culture certainly exist. Remember if this was your father or your mother, you wouldn’t do whatever you want. But believe me, cultures like this exist. As house officers, all the more reason to be stern and professional and do the needful for your patient’s sake.
  4. Mean doctors are everywhere but never let them get the better of you. Somebody once told me that even mean doctors have something to teach us. They teach us to be better than them. But just because we have experienced such culture, doesn’t mean we can go boomer about it to our juniors in the future. “Last time ah.. we used to…” (You know what I mean.”
  5. Harassment. Big big issue, hardly ever address. But it exist. Sexual harassment exist. And I would say report them, you won’t lose your job, so no worries. Why would you lose your job after getting molested by your superior? It simply does not make any sense. But if at all, remember our generation have the willpower as strong as social media. That’s our strength, utilise it, go all out. Nobody will judge you, only the perpetrators will be judged. Doctors are notoriously known to protect their reputation, so what better than tarnish them altogether? My point is harassment is a big deal, and if doctors cannot understand that, they don’t deserve to have a spot at service.

The culture exists in many form. Some good, some bad. It takes one bad apple to rot the entire department’s reputation, e.g O&G. But for the most parts, I am optimistic that most doctors remain good, and true to their work and passion.

Even though in the last decade, the image the doctors have portrayed hasn’t been all good, most doctors I have worked with are still kind at heart. Keep an open mind, dear juniors.

P.S I hope not to offend anyone with this article. Merely stating my experience and offering a perspective most might not have heard. To the doctors who may be reading this, I hope this provides an insight you wouldn’t have imagined/known.

Cheers,
Darien Liew

Housemanship: Just about my week in urology

Behind every cloud is another cloud.” – Judy Garland

It has been a terrible week.

Sorry, I could not think of how else to define/describe the past 7 days I put myself through, or rather what I have gone through.

First off, 15 house officers left the surgical department to the next, with only 2 entering the department. Only about 10 house officers working each day since the start of this week. There are seven working teams: Hepatobiliary, Colorectal, Vascular, Upper GI (or MIS), Urology, Neurology, and Endocrine & Breast, with the former three being a major team. This week, I have been allocated into the Urology team and likely to remain for the coming week or so. It has been one hell of a week. I alone covered the entire urology ward with an average of 13-14 patients per day, an average of 4 discharges per day and 4 admissions per day. Not to mention patients who come in specifically for trial of void (TOV) where they too are considered admissions. Speak of more work! So yes, it has been a very tiring week.

Literally my schedule every day now looks like this:

DayScheduleSupposed Working HourActual Working HourHours Spent in the Hospital
MondayAM7AM – 5PM5.30AM – 9PM15.5
TuesdayAMX7AM – 9PM5.30AM – 10PM16.5
WednesdayAM7AM – 5PM5.30AM – 9PM15.5
ThursdayAMX7AM – 9PM5.30AM – 10PM16.5
FridayOncall8PM – 12AM6PM – 12AM6
SaturdayPostcall12AM – 9AM12AM – 9AM9
SundayOffNone

Officially worked 79 hours in my first week of urology!

In spite of the terrible working hours, the specialists and the MOs were very nice and supportive. I supposed that makes the working environment all the less hectic, considering they too played a working role in the ward. For example, there was a day where I had concurrent admissions and discharges to do, I did all my admissions but only managed to start doing the discharges at 6PM, my MO literally sat down and told me “look Darien, no worries, we are going to focus on doing all the discharges now”. I looked at him with a sign of relief and I felt my shoulders relaxed a little.

I supposed one must wonder why this had to be pointed out. Typically, MOs in the urology department take on the lead to see peri patients and ED patients, so they too are held up with a lot of work. Other surgical departments may play a similar role, but not as busy. So in spite of my MOs being super busy, they were able to spend some time in the ward to help finish up pending tasks, and that everyone, deserves an applaud. Because you cannot imagine one house officer juggling 14 patients, with multiple requests, referrals, blood taking, admissions and discharges all going on at the same time. It’s just an impossible workload made possible, nevertheless.

Suffice to say, the department has been very hectic but it has been very enabling at the same time. And that is what makes it possible to work in. Thankful for the team.

Steep learning curve, but it has made me learnt to work efficiently and effectively.

Starting Out: Housemanship

I think it’s hard. I think it’s been incredibly hard to work as a house officer. This is the harsh truth.

Just today, I made a mistake and it hit me that what really bugs me the most is the constant anxiety that something can go wrong, anything, everything, any time, any day, whenever. It happened today and I felt absolutely helpless, regretful and can only hope that all will be well. It is time like this you would wish that someone will tell you “it’s alright, we all made mistakes”. But the reality is this, you are not allowed to make mistakes, they bring dire consequences, and you know it. I supposed this is the job we all signed up for as doctors.

Happy days, unknowingly entering the reality of medicine.

11 weeks and counting. That is how far I have survived through housemanship. In all honesty, I think the work is doable. I think it can all be managed as long as you are resilient enough to push through the day, with your mental health in the right state of mind, and your mindset and attitude in the right places. I think for the most parts, housemanship is survivable. But who am I to say that when I’ve only completed half of my first posting?

I’ve known friends in other hospitals, unfortunately in a less ideal workplace environment (and culture). The work is undoubtedly demanding. Bosses are demanding. Superiors are demanding. Some days, there is so much work that you you just cannot help but feel like the whole damn world demands from you. That makes it all so difficult. But for the most part, it’s still doable, I think.

I spent the first 4 weeks, in fact even now, still familiarising with the system. It was frustrating at first, when you are expected to function like every other individual, yet when you are so unfamiliar with how everything works. It was hard, really hard at first. By the fifth week, you’d think you’d get a hang of it. But every day continues to be a challenge. One day you would be ask to get a neuroconduction study, and you would be like “How do I do that? Do I need to refer neuromed?”. Other days, you’d be asked to request an ECHO, and the same thing goes “How do I do that? Who do I call? Where do I go? Do I need to refer cardio?”. But this isn’t the best part. When you finally get a date, say for an ECHO, your bosses will tell you to get an earlier date. Say that these bosses round at 4PM in the afternoon. You’d now be stuck in a daze and be like “What do I do? Who do I go to? Where do I go?”.

It’s challenging when it’s demanding.

It’s challenging when there’s so many plans.

It’s most challenging when you know so little of the system and you are just not equipped to handle the workload.

I think when you are a first poster, naturally everything would be difficult. You would literally wake up every day and think that the job is hard, and you would just rather give up. Truthfully, the challenges every day and the things people put you through, the way the environment and culture pushes you through, every day it gets an inch closer to the threshold where you can no longer tolerate. After all, why put yourself through such lengths?

Naturally, every job has its own difficulties. No doubt. As healthcare professionals, your job is to prevent death for as long as you can. Some deaths are inevitable, i.e natural death, patients with really poor prognosis etc. But little do you know, every little plan you carry out every day has its risks of causing death. One tiny mistake can ripple out in so many ways. Say, terrible handwriting, you may have mistaken a 100 for a 10 for medications. Too much or too little, patients can die from it. Sometimes you get so tired you may miss things out. Some things that cannot be missed out, inevitably gets missed out. Some days are just terrible days, and it happens.

But I supposed when we get into this career, we all know what we signed up for. Or do we not?

Once a student, I think I do know some of it. But I never knew the reality of working through it. It is so much harder.

Now, actually working through it, I understand the complexity and the true nature of the job. The nature of the job? It demands so much from you, and yet so little comes back to you.

Once with hopes and dreams, great ambitions and desire to achieve so much, now you are just so tired everyday that you would want to do the bare minimum and survive through it. That is all you can think and do. That is simply because the work is demanding, and you are just exhausted every day.

Let me now venture into passion. Undoubtedly 80% of the individuals, today, entering medical school would probably say ‘born out of passion’. Yeah I would agree, passion gets us started. Passion puts us through 5 long years of education. Passion drives us to do better, pass our exams, shine in front of our peers, and in fact gratify our innate need to succeed. Passion gives us that.

Passion is the ultimate driving force for one to study medicine, and to graduate with a Bachelor of Medicine, Bachelor of Surgery, or the equivalent of it.

Passion puts us through all that.

But passion does not equip us enough for the demanding workload that you never realise existed. Passion now no longer exist. Passion now dies because everyday is about securing your mental health, getting yourself through and pulling yourself together, for the next day.

Remember, passion gets you through 5 years. But the 5 years after? You are ultimately on your own to fend for yourself. You are now an independent worker, you now have a need to earn for a living, a need to survive through a harsh (sometimes) toxic environment and a need to support your family and yourself. Passion for learning is not the same any more now that you are working.

Learning back then, working right now, is far different in terms of gratification, satisfaction and expectation. Simply, less gratified, less satisfied and unfair expectations.

Putting all together. You would now probably notice the contradictions within my article. I started of by saying it’s hard. Then I say it’s doable. Then I say it’s challenging and demanding. So, what is it? Which is it?

Here’s the truth, there are days where it’s incredibly difficult, and days where it felt okay. Some days are chill days. Some days are busy days. Some days you get bullied, some days you don’t. Some days your bosses are nice, some days they are not. Every day is a different day. In spite of all the challenges, we still wake up every day going to work. Because how can you not? Remember, you now need to earn for a living, you now need to live your own life. It is a constant juggle between maintaining your mental health and the need to sustain a living. The best you could do is just pray for a no nonsense day, and that every day is a good day.

For those who struggle in housemanship, especially if you are starting out, I feel you, and I know how challenging it is. I cannot help but wonder, would it be the same 10 weeks later, 20 weeks later, when you are a bit more familiar with the system and experienced with the work? After all, in practice, medicine is rather repetitive. Could it be extra challenging for us now, just because we just started? I mean look at the 4th and 5th posters. They seem to be doing fine? I think.

11 weeks and counting. I personally have an innate desire to complete my housemanship, it is the lingering thought that I will not be able to, that bothers me everyday. We still try to be positive every day, anyway. After all, what else can we do?

Perspectives: Working in Australia

It was a sunny Monday. I remember the very first day working in Monash Medical Centre. It was orientation for all the newcomers. Being absolutely foreign to the land, I was intrigued by how they communicated with each other, so polite, and so diplomatic. The way they have portrayed themselves, absolute diplomats. Walking into a hospital full of Whites with a good mix of Asian was a new landscape for me. Having grown up watching Grey’s anatomy, this is very relatable.

Thrown into the Endocrinology specialist clinic on day one, not knowing anyone or how the clinic works, and only the head of the department, I was told to sit in and follow through the clinic and later attend to various meetings. In the clinic, I was really impressed by their consultation and their culture of communicating with patients. I realise the time they have taken to see a patient has by far gone pass any clinic sessions I ever had. The patience the doctor has, the politeness and the invitation to the patient to provide input for their treatment, now, this is new. Being a Monash student, I now believe that in this setting, it befits what I was taught in school.

I realised at an instant – this is a new culture. A culture I was not exposed before.

I had first hand visualisation of a specialist dictating his consultation to the GP regarding the patient’s case, so as to update the GP on the progress and the management plan. Electronic records have never been so enlightening to me.

12.00PM and it was lunch time. I was told that there will be food in the meeting. It was Grand Round and they talk about current research, issues and management. It was intriguing to see how all the bright minds debated about the issue. While research continues to drive every day medicine into new management and new procedures, the outcomes of research has never been more appreciated than what I have experienced in this setting – the Australian setting.

After having gone through 18 weeks, 6 weeks in each posting, 3 postings in total, the learning culture here is far different. At any corner with any doctor, it is a matter of want to learn or go back home early. Every health professional provides an opportunity to learn, be it the doctor, the nurse or the pharmacist. They will invite you, ask you and query your opinions. They will invite you to be part of their team. They will ask you questions pertaining to the case. They will query why you would suggest that. As a member of the team, you are part of the system and you are part of the patient’s case. Being included in the case means that you effectively become part of the managing team. Now, this is the career I signed up for.

I feel many a times the culture in Malaysia hasn’t been the most enabling and supportive. Sure, doctors are busy, nurses are busy, and everyone’s busy. In Australia, they acknowledge that they are busy but they take the time to return to you and actually invites you into their discussion. It is a culture that enables an individual to participate and learn.

Truthfully, this is an article drafted many months ago. I have yet to stop thinking about the work culture and how to potentially bring about this culture forward in the Malaysian setting. I have had numerous discussions over the last 10 months, and in every healthcare-related conversations, I have never failed to mention “you know, in Australia…. this is just how it is.” Truthfully, this is a setting Malaysia will probably never have.

Now, having experienced both the Malaysian and the Australian system, I have never been more enlightened, and inspired to do more, be better. It’s the culture and the amount of professionalism in the hospital, between doctors, doctors and patients, the team, and with the nurses, physiotherapist and all the allied health professionals. The amount of respect given to every member of the hospital is unprecedented.

Are you happy to do this?

It is encouraging and motivating, and it is interesting to see that at every corner I turn, whenever I looked lost, someone will inevitably ask me if I’m okay. I like that the culture and the atmosphere is so uplifting, so supportive. And of course, at every turn, there’s always coffee.

Here’s a typical breakdown of daily work life in a Endocrinology setting:

  • Be there at 0750
  • 0800 Ward rounds. AM Registrars would have already received the handover.
  • If we’re lucky 1000 we finish ward rounds and we go for coffee.
  • On days where there’s clinic, the registrars will all go for clinic.
  • On days where there isn’t clinic, the registrars and the residents will see all the patients from referrals, placed at other wards. On good days, we finish by 1500. Otherwise it’d be 1700. Nobody ever stays after 1700. Work is always finished before that. Registrars will do handover with the night registrars.
  • Patients directly under the Endocrine unit is usually not many, at most I’ve seen is 7. While referral will usually have at least 60.

In the Neonatal setting where I was working in NICU with Monash Children’s Hospital, this is how it goes:

  • A typical day starts with Handover in a meeting room at 0800.
  • By 0830 we start ward round. There are 4 teams, Special Care and the NICU team. Each team will have no more than 20 babies under their care.
  • Ward rounds will usually finish by 1100 and coffee will be bought by one of the consultants for the ENTIRE unit. They will literally call each team and ask who’s on and who isn’t and they’ll note down the orders, properly label each coffee, and deliver to the pantry.
  • Lunch will follow and there will either be tutorials/meetings, otherwise ward work continues, e.g fluid chartings (which I really enjoy doing).
  • Occasionally in the afternoon, you’ll get emergency cases where NICU will attend to. I once got to see a TGA baby, it was amazing.

12.26 AM and I never ceased to just imagine that one day, I hope to be working in this culture – the supportive and enabling culture.

Dear Boomers (in Healthcare)

There was one who thought he was above me, and he was above me until he had that thought.

Elbert Hubbard

Dear Boomers,

I have had an interesting 5 years dealing with doctors in healthcare, both in Malaysia and Australia (a short period). While I think no doctors will have any ill-intent, the method of communication has certainly felt otherwise. In this generation of leaders where the millennials will soon dominate, as you have in your time, I feel it is deeply important to understand how millennials work and communicate. In the context of my writing, I will also want to factor in many considerations, which you will soon realise, if you have not before.

Unfortunately Boomers, in all my dealings with you guys, there have never been a time where it was easy. I often feel the arguments all stem from just pure miscommunication and the lack of consideration and understanding given. I feel that a lot of presumptions and biased perception, experience of the past have led you, Boomers, to judge a person. Let me tell you why this is a bad mentality. Dear Boomers, we, millennials now live in a time of uncertainties. We live in a time where we have to deal with our mental health, the lack of understanding from third parties, the biased opinions where we are not good enough (because everyone thinks they are better), the amount of competition because let’s face it, you win or you lose, nobody will care about your mere existence and certainly the judgements we receive from you, Boomers. While I do think the society has not changed, I still think it is the same. But remember, how millennials were raised, we are far different from how our parents were raised. In a time of hardship, poverty, war and going through a period of massive achievements, Boomers can become very proud of what they can accomplish and therefore look down on everyone else who could not. They are not only prejudiced but they put the comparison above anything else, because Boomers think that if they can, everyone can. But it really is not the case. Do not be confused, this entire thought process only invites conflict and competitions.

Dear Boomers, understand this, all of you may have lived through a time of hardship, we did not. We acknowledge and we sympathise that you did; we are glad you did, without you, there isn’t an us in this picture. Your achievements have brought you joy, pride and prosperity. You’ve shared all that with us, leaving hardships behind us and ensuring a comfortable life for your children. Most parents would not let their children suffer, and therefore there is a saying where we are all born with silver-spoon, stuck-up brats and unappreciative bastards. But hey, you made it that way, own up to your plates! There will always be a conversation between millennials where we feel our Boomer parents or our Boomer superiors are absolutely condescending. That is because, they are! I feel that Boomers say a lot, but they don’t actually preach them. Do you expect an exemplary role to follow through with us? I bet you, not.

We, millennials face all different kinds of hardship. We are glad that poverty or war isn’t on our plates, but we now face more personal dangers like bullying, harassment etc. Remember this, our society has now progressed and advanced, we no longer expect an impending war to come whatsoever. We have now surpassed that period of time and therefore it will be unwise to think how weakly a millennial is now compared to their parents and their grandparents. This is a time where competitions is above everything, and it is a competition where we fight for name, glory and money. It is a time where if you’re no good at this, you’re no good at anything. At least, this is the mentality our Asian parents have imparted on us. Because if not, why do Asian parents send their kids for art classes, music classes, boxing classes, and all the tuitions because Asian parents fear their kids aren’t good enough, or that they think their kids are terrible at it. Sure your child may be bad at maths, but if you haven’t given the right motivation and encouragement, don’t blame the kid for doing it all wrong. Address your parenting and then address the needs of your child. Certainly, none of the Western kids have got Mandarin, Bahasa, English, Math, Science, History and Geography tuitions, all laid out within 5 nights a week. Weekends are perhaps reserved for classes like art and music. And don’t blame kids for not spending more time with you people! You put us all through these busy schedule.

Dear Boomers, we live in a time where our parents put us through all this because they want us to be better and that the lack of achievement is probably a shame to the family. We probably understand, maybe. But what is more surprising is probably the amount of wows and talks about your children’s achievement during a CNY gathering or during a coffee meet-up. You glorify your kids all for your own personal pride and personal intent. When your kid isn’t doing well, envy takes over and you torture your child.

Dear Boomers, we live in a time where I think most millennials will eventually learn of the importance of managing expectation. This is probably because our parents have imposed unjustifiable restrictions, unexplainable rules and unreachable goals. Millennials at this day and age have come to realise about time management and organisational management and all of which can only be managed if the expectation is properly dealt with.

Dear Boomers, while you think your word is gold, we think that everything needs to be justified and reasoned. We don’t believe in authoritarian. We believe in forging meaningful partnerships and collaboration. We believe that this is the time where working together makes a better impact. This is why in healthcare and in education, more and more learning spaces are coming up. We also now have a tremendous amount of co-working spaces that are available. That is because it isn’t just us millennials that believe in them, it’s also the Generation X and maybe the Boomers (to a certain extent), who also believe that no companies, societies or organisations can survive this world without friends and supporters. All the more reason why it makes it so difficult for millennials to survive. Not only do we now have to face competitions, we have to balance that with forging alliances with people who are themselves struggling. But we know that there is a vision that is long term and that if we work hard enough, we can all achieve that vision. And remember, above all that competition, our parents still think we haven’t spent enough time with them, tell me where have my time went, and tell me, did you not just tell us to do better?

So Boomers, you may have come from a time of hardship, we are now in a time of balancing our lives. Because when millennials function in the society, we tend to overwork ourselves (either this or our Boomer employers put all of our lives at risk), because we want to see an outcome that is satisfactory and appreciable. We are constantly being seen as inferior and we strive to work harder, to do better. While Boomers, you may have either fought the war or you ran for your life, we stayed to fight our own wars. We push ourselves to “deal with it”, because in reality, adulting is confronting, and that, for all millennials, is probably the hardest. Clouded by social media frenzies and the amount of mental health issues in our young population, the struggle is inevitably harder, not by your standards, but by each and everyone’s own standards. We are indeed living in a very lonely society, filled with competitions, judged by others, looked down, bullies; and yet we still try to survive in our own ways.

There is absolutely no shame in prioritising our mental health, mind you.

To all the Boomers in healthcare, thank you for your hardships. We understanding the bureaucracy and the hierarchical mishaps you have to go through, but we now need not live in that era. Change starts when you decide when it starts. But so long as you Boomers are in power, you know that no one can say otherwise. But remember, millennials have a very collected voice, very vocal and extremely powerful when come together. This is where I feel, our achievements are at its best when we all work together for a common vision.

To all the Boomers in healthcare, it is okay to not see or realise our vision, but here is my piece of advice, Look for a new perspective, actually learn and appreciate how things are done overseas. Then come back and tell me how things can be better here. It isn’t always the case where you are right, and we are wrong and that you know better, and we know nothing. Because all the millennials today can tell you that there will always be a better way. Here is the better way: gain a new perspective, have empathy and hear us out, and treat us with respect.

To all the doctors who once called us medical students: anencephaly, dumb or useless medical students, I challenge you to instead think of a better word to encourage and motivate us.

Cheers.

P.S. This probably should not represent all the millennials, but herewith my thoughts. I hope to not inflict any offence to anyone and that the concept of Boomers should not reflect everyone within that era.