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Thursday, October 06, 2016

Forensic Medicine: Are they Real Medicine?

I have written a few post before this as a series of story on doctors in Malaysia. Everyone can view the post here:

  • How to Become Doctor in Malaysia

  • Are you Still A doctor?

  • House Officer : Are they Real Doctor?

  •  Direct Selling Doctor In Malaysia

  • I have talk in details regarding a pathway for a doctor after becoming a medical officer. In my previous post, I also talk regarding Aesthetic medicine which I find it to be an unreal medicine. I still think it that way. I believe most doctor will agree on that except aesthetic doctor themselves.

    Also in my previous rant I mention about forensic medicine. I have been thinking a lot of forensic medicine. Are they real medicine because from what I know and from my experience, Forensic Medicine is very special. It's like a special branch in medicine. They does not do what other doctors do everyday. They deal with dead people....

    Forensic Medicine: A Cycle completer

    I do not need to talk about different branches of medicine, it is broad. Everyone should realised by now that medicine can be divided into a limitless speciality as long as they are new thing found, medicine can be branching as that new thing. For example, no one knows about nuclear medicine perhaps 100-200 years ago. Now, nuclear medicine in common. Molecular medicine, genetic medicine, as times goes by, many new branches of medicine will follow.

    To generalize it, I like to think medicine in this way. A real medicine is when someone find a diagnosis and treat them. Everyday, this is what doctors do. Our work and life are dedicated in finding a diagnosis and solved it. That is medicine in general. Thus, if you are thinking of making a new branch of medicine, then start doing something that follow this rules. If what you do does not relate in anything in diagnosing or treating a disease, then you are not doing real medicine.

    Nuclear medicine, molecular medicine, sport medicine, combat medicine (does this thing exist?), all deal in trying to help in any way of making a diagnosis and eventually will lead to a treatment and a better life for a patient. Medicine also need a patient to be called medicine. If you are treating a healthy person who want to be pretty or not satisfy with God's creation, then that is not considered as patient. Patient is someone who are ill. Patient does not equal to a customer. Thus, there are no such thing as patients are always right. I am being sarcastic again towards aesthetic, I am being unfair here.

    Never mind, let us look at the other branch of medicine that is quite interesting, but does not interest me, Forensic Medicine. They are those doctor who deal with dead people. I know, perhaps someone who are reading this post is a forensic pathologist, and he or she must said that Forensic does not only deal with dead people. People that are still alive also sometimes need forensic opinion, maybe. However, I am being naive here, the main core of business for Forensic is dealing with dead people. Full stop. KFC might be rich in selling other product such as that expensive carbonated drinks or cheezy wedges, or maybe the burger...but their main core business is fried chicken. So, we do not want to go in details on what a forensic pathologist do.

    Forensic medicine itself is a wide area to be covered. But if you encountered someone who said he  or she is a forensic doctor in Malaysia, 95% confident level they are Forensic Pathologist. What they do? As you know, cut that people to find the cause of death @ post mortem @ autopsy. What they do is pretty interesting and horrifying (for me). They cut dead people..really cut it. Remove the organs, cut the skull, remove the brain... If that body they cut still alive when they started, the body must be 100% dead after they finished. It look cruel, gruesome, nauseating.. I, too, also have to join their autopsy as I am taking pathology as my master study now so I know. There were nothing beautiful happen in that post mortem area.

    People must be afraid to be post mortem now. Why they? They will be dead by the time someone order a post mortem. Nothing to be afraid of. I am just joking, but seriously, a lot of people refused post mortem because of the nature of the post mortem that really..not that beautiful as I said. I am not trying to scared the public, but this is reality. Sometimes I wonder, why do you need to cut that dead body like a fish if you already know that the deceased died because of gunshot to the head. I am feeling very lucky not choosing forensic as my master study. I really do not like it.

    Unfortunately, no one can refuse post mortem. Post mortem was done not because that doctor love to cut dead people (some of them do), but it was done because of the law. Post mortem can only be done under police authorisation. We used to call it P61. It was actually a form that will be released by police (numbered P61), and given to the hospital and then the respective doctors will do their work. If the doctor themselves simply cut all dead people, they will be no different from any other character in that horror movie everyone should remember.

    So, why the law order for post mortem or autopsy. Simple, to determine the cause of death. This cause of death can be presented in the court, and if not, the cause of death is very important in world health statistic. I give an example, hundred people died in a village in 1 month. If you bury the dead, without post mortem, how will you know the causes of their sudden death in 1 month period. Are they killed? Are infectious disease cause the death? Or maybe some factory leaked a poisonous material into their water source? It's important to know, for our record, for our statistic so that later, when another village affected, we will know the causes of that happening. We have prevented a horror movie to be made based on what happen in that village... unless they were killed by some demons or something. Get back to my point, post mortem is necessary. No one can refused it no matter how hard it will be, especially if it happen to our family member.

    Enough talking about what forensic do and so on. I want to get back to my ultimate question. Is forensic a real medicine. If we come back to my simple rule of medicine, diagnose and treat, these group of people in forensic sure involved in diagnosis. No doctors can see what they can see. It was very hard for us doctor during operation even on a simple task like finding an appendix, but for forensic people, they take out the whole guts out. Then search for whatever they want. So now, forensic is doing half medicine job? Diagnosis. Do they treat the dead people. No. No medicine can cure dead people. None. So this forensic does not follow the rule of medicine (I invented). So, can we classify them with aesthetic doctor?

    No. They are real doctor, they are doing real medicine. How so? Do you think I am just being biased? I said it, medicine must diagnose and treat. So how do I get to say Forensic is real medicine.

    I've been thinking this for few weeks before I wrote this. I always think of this. Trying to find an answer on how to explain why forensic medicine is real medicine. I know they are real but I can't explain it. Until today, when I discussed with one of my colleague. I love how she solved the problem until I want to named it after her. She is taking forensic pathology as her master study and I believe she will be a forensic pathologist in few years time. I will named this after her as a credit. Her name was Dr. Nadiawati but I don't like that name (nothing personal), but we called her Nadot thus I will name this Nadot's Cycle of medicine.

    Nadot's Cycle of Medicine

    In medicine, my rules are diagnose and treat. You find any branch of medicine out there, they must be related to this two thing. This is our world, this is like a religion to us doctors. The day we stop this two thing is the day when we were out or quit of being a doctor. So, medicine does not work as a single unit but multiple cooperating unit that will eventually end up with diagnosis and treatment. We, pathologist will not be able to give diagnosis to clinician if the clinician never interviewed that patient, never examined and never knew what to diagnose. 80% of diagnosis will be made clinically, and the other 20% will be supported by pathological investigation, radiology, nuclear medicine, molecular, or whatever there are in medicine. The treatment will be given by clinician, the surgeon, or anyone who involved based on the correct diagnosis that has been made earlier. So medicine, is a group of people who try to diagnose and treat a patient.

    However, before an illness become an illness, they are a group of doctor who will be out there to stop them. No, not aesthetic doctor. I am talking about public health doctor. Those doctor in public health area will be involved in the prevention of the disease. Prevention is better than cure, so as these group of people who diagnose and treat find out that perhaps they should be one step ahead of the disease, public health branch eventually developed. Public health is very important because they are like someone who negotiate before a war happen. They are the front liner. Those who cannot be saved by them will end up in hospital for another group to handle. Public health eventually will ask for help from these hospital group of doctors. For example, they may ask a cardiologist to give a talk in the public, or consult physician in the hospital if they have doubt in preventing the disease. Pathology will help in term of their screening test. All those normal blood sample will be sent to the lab and if it is proven to be not normal, they can act as early as possible. Radiology also will help. Have you ever had a chest x-ray during medical check up. That's radiology part. In developed countries, even molecular medicine people also will help in genetic screening and so on.

    It is very dynamic and involved a lot of team work. So this public health is the first thing that will happen in the cycle of medicine. The prevention part. Once prevention has failed, here comes the doctors in hospital to come and try to diagnose what has happen. No need to talk about this, everyone know how it goes. Diagnosis, lab test, radiology, diagnosis, treatment. Everyone must have their experienced admitted to hospital or maybe their relatives. This is where you can see real medicine happen. What you did not realise is the war is also out there. These group of people in war are considered as sweeper. The one who goes out there early as a scout is those public health people.

    So after the prevention, the diagnosis and treatment, where does this cycle goes? Bingo, forensic medicine. If prevention failed, the treatment failed, there are only one place you might end up. Not hell, not heaven. Its forensic department. Here, what they do is to again find the diagnosis, the real diagnosis. Someone might died because of a motor vehicle accident. Not many realised that that person maybe die because of heart attack then causing the motor vehicle accident. Only forensic will know it. Someone might died because of assaulted by the authority, but forensic know that the person is dead because of rhabdomyolysis or fatty liver disease before he was assaulted. Did I go to far? I think I did.

    Let us go back. Once the diagnosis has been made by those forensic people, now they know that this thing can be prevented. For example, if someone died because of heart attack, but during autopsy they find out that the person might be having a myocarditis, or pulmonary infarction. Thus, this crucial information will be relay back to the clinician and clinician will be aware better in the next cases that came with the similar presentation. If you recall my story about a village where 100 people suddenly died in one month time, this is where forensic play their most important part. They will determine what causes the death, then after they found out they will relay this information to the public health / prevention group of people. If that 100 people die because of an infectious disease or contaminated water, thus the public health doctor will be aware of it and they will act accordingly to prevent another village from ending up the same way.

    Here we can see that forensic medicine is the end of the journey in the medicine and they were also a connection where the cycle will return itself back to the prevention team.

    The cycle will look like this

    Public health --> Medicine (this include clinical and non clinical doctor) --> Forensic --> Public health.

    In circle it will look like this:

    Obviously it is not as simple as this. But I think it's a good explanation to make common people understand that Forensic is involved in the real medicine. For that, I call it Nadot's Cycle of Medicine. Perhaps we can add more branch later to make this cycle more specific but as for now for explaining my point, that would be enough. So, if you are interested in Forensic, you can apply it under master in pathology. Without them, the cycle will not be completed. 

    Foe every birth in this world, there will also be death

    Sunday, October 02, 2016

    Doctors in Malaysia: Direct Selling Doctor?

    I will continue with another topic for my series of post regarding medical doctor in Malaysia. Please go through my previous post on this series:

    The purpose of my writing on this series are due to my urge to inform to those who want to become a doctor and for those who do not, to understand on how a life a doctor really is. There are thousand of article, blog post, even books out there showing the painful life of a doctor, how noble the job is, everything seems to be talking on one side of the fence. I want to talk on both side of the territory. The ugly side, and also the pretty side of medicine. A soldier won't admit their work just doing nothing waiting for enemy to attack. A teacher won't admit that their job is less stressful than those soldier. Same for doctor, always picturing themselves as the only person lifting the whole world. I want to talk on what really is medical life. Using example for soldier and teacher, I would say that a soldier won't admit his work is less stressful, teacher also won't admit that, even doctors won't admit. 

    If a person who work under the hot sun, lifting load of concrete and iron, compare to those three people, they should be thankful for their job. 

    This is my intention. I want people to understand that life as a doctor is a bless, same for soldier and teacher or whatever you do. Everything have their pros and cons. We should not be always bias towards each other. Everyone need everyone as a unit to keep this country running. With that, I should salute all those who are working today, no matter what you do. Without further ado, I would like to talk on the ugly side of the doctor... when doctor is doing business. 

    Patient is customer - Customer means money. Here comes the money

    (That was an awkward title..I may need to change it later)

    So, as all those house officer now fully trained, confident, full with skills and knowledge, they will received a certificate of full registration. Now, they can do whatever they want. Basically, they are now can work anywhere they want. Does not matter it is a government hospital, private hospital, private clinic, company, or they can just sit at home doing nothing. Just to make sure that they are not bonded with JPA or government scholarship. Perhaps I will talk more on that bond later in the future. 

    So most of the doctors will continue working in government. The pay was enough, not much, but enough. They have their own house officer to help them now. Nurses have more respect towards them, specialist now feel more like a friend compare to before, life is good. So they stay. Some of them (however now seems that more doctor are choosing this pathway) left government and start working in private sector. Life there is much better, less patient so they can practice medicine with more passion, the pay is superb, and everything else was the same as in the government hospital. One cannot denied that the pay is the major factor to be involved in private sector. Another group will join private clinic as a general practitioner. The pay is higher, and they now can just run a clinic treating common cold, simple cases, and chronic cases which are stable, the rest of cases will be referred to hospital. Life is good here, and this group of doctor engage more to society compare to those in Hospital. 

    Another atypical place to work is a company. A lot of company are hiring medical officer to look after sick worker in their facilities. Pay is good but this company usually want some credential along with that doctor they are hiring. You need to have some speciality, an extra credit in your CV before you can join a company. I heard that an oil company (I do not want to mention which one), are hiring medical officer with just ALS certified (Advance life support). That ALS can be obtain in a 3-4 days (if not one week) course then you got your job there. No need to become specialist. But some company like to hire a doctor with specialty, for example Occupational Health Specialist. My friend keep trying to pass this entrance exam to enter Master Program in Occupational Health (OSHA they call it). He never pass. It was difficult compare to ALS. Anyone want to work in private and thinking of a specialty, OSHA could be a good choice. 

    More atypical doctor will join Aesthetic.. a beauty clinic they say. This is an 'easy' way to become some kind of expert. You need to enter a short program, or diploma, or master program (I doubt people will take it), and become a aesthetition. I do not know how to pronounce or spell that. Let just call it aesthetic doctor. A lot of people confused on this kind of doctor. Are they specialist? Are they dermatologist? Are they plastic surgeon? I also sometime confused. But my question would be where do they get their certification? Do not get me wrong, Aesthetic doctor is a real doctor, they are medical officer who took some courses and work as an aesthetic doctor. They are not dermatologist. They are not plastic surgeon. They are just medical officer who are interested on that field. It is an area of interest. 

    Aesthetic is a part of dermatologist master program. So a dermatologist, can be an aesthetic doctor by default. Their counterpart is plastic surgeon which are doctors who take master in surgery and specialise in plastic surgery. To become dermatologist and plastic surgeon, is hard way to do it. Becoming an aesthetic is much easier. I am very sorry to say, but I don't think aesthetic is real expertise. Some of my friend who are doing aesthetic now would be so mad and angry, they would challenge me to become aesthetic to try how hard their life is.... As I mentioned in my introduction, no one going to admit their job is the least to be having a headache and no one going to admit they defeat. It's a natural human reaction. 

    Put that aside, for me medicine is a about treating diseases. I took pathology because I love medicine. I want to study on the disease. I want to help clinician to make a correct diagnosis thus supplying a correct medication. This is real medicine for me. As medicine developed, we start to think that maybe prevention is the best cure. So, with that another branch of medicine developed. A public health medicine, community medicine, family medicine... this group of medicine focus on targeting healthy individuals to prevent them from falling sick. Pathology do have a role here as we understand that diseases does not happen in one day, so we need to tackle it before it become a diseases. This is a beautiful way of medicine. 

    Aesthetic by the way, is doing something out of this. They are in the line in between prevention, treating, and I do not know what. I am not saying they are fake doctor, they are real one. But their patient will be consist of those who are pretty who want to be prettier, or those who want to grow hair, and those who want to shape their stomach by not doing exercise, or those who want to make their skin more fair...and it goes on. It give me a headache. This is not a real disease. There are no pathology on that. Some of you will argue saying that hair loss is a disease and we all should focus our energy to solve them. I would say, those the hair loss have the potential to turn into a cancer? Or is it a predisposing factor for hypertension? It may be a sign of diseases, and if it is, then you will refer them to rheumatologist, dermatologist, immunologist... the real doctor. 

    So sorry guys, I still not believing aesthetic until maybe one day later, when you step out from that grey line. 

    So what is the deal on becoming aesthetic? Why lot and lot of doctors want to be come aesthetic. Read the topic above.... here comes the money. There are now aesthetic department in a government hospital, if there is one, usually it will be under dermatology. Aesthetic will always ask payment from their customer. The treatment won't be subsidised by government, I too will not subsidised them if I am the government. Those customer they treat are those who have nothing better to do with their money. They should be called only as customer, not patient. Do not get me wrong here, I don't blame people who go to spa and medispa and whatever you call it to become thin, beautiful or white, it's their choices. But I do think that a doctor is actually not necessary to be there too. Give that place to a beautician, does not make any different. Doctors is infiltrating anywhere like leeches, to suck money from everywhere they could.. 

    I am too harsh here. It could lead to misunderstanding. Let me get this straight, I am partly wrong in my last statement, doctor is needed there. Why? Because only this people has the licensed to give certain type of medication and procedure. To make sure it is safe. That's their job. Anyway, they can become a business person to, selling product to their customer. It's a double edge sword and I do not like it. 

    Worse than that is when a doctor still working in a REAL MEDICINE field but start selling products. 

    Let me quote:

    "The practitioner is the trustee for the patient and accordingly must avoid any situation in which there is a conflict of interest with the patient." 

    A general ethical principle is that a practitioner should not associate himself with commerce in such a way as to let it influence, or appear to influence, his attitude towards the treatment of his patients.

     The association of a practitioner with any commercial enterprise engaged in the manufacture or sale of any substance which is claimed to be of value in the prevention or treatment of disease but is unproven or of an undisclosed nature or composition will be considered as infamous conduct in a professional respect.

    A practitioner has a duty to declare an interest before participating in discussion which could lead to the purchase by a public authority of goods or services in which he, or a member of his immediate family, has a direct or indirect pecuniary interest. Non-disclosure of such information may, under certain circumstances, amount to infamous conduct in a professional respect.

    Where the practitioner has a financial interest in any facility to which he refers patients for diagnostics tests, for procedures or for inpatient care, it is ethically necessary for him to disclose his interest in the institution to the patient." 
                                 - 3.4: The practitioner and Commercial Undertakings. Taken from Malaysian Medical council Code of Professional Conduct

    End quote. 

    Lawyer know this. Doctor

    I do not need to elaborate more here. As stated in that code of conduct, any doctor who sell stuff that claimed to be in the value of prevention of treatment of disease but is unproven or of an undisclosed nature or composition will be considered as infamous conduct in a professional respect... I am just repeating what it ways. Doctor's cannot sell product that can cause conflict of interest. 

    To make it easy, I will choose a chef for an example of this situation. A chef, highly regarded for his master skill and cuisine, work in a top restaurant. His dishes were all good. You can't deny it. You go and ask him why is that his dishes were so good. He then will say, because he is using a good ingredients and he is cooking it with the amount of spices until its perfect. You were amazed. You went home and try what he told you, it turn out that he is right. That is his secret. 

    Another satisfied customer came and ask the same question, but then now the chef said, its because I am using this $100 pan. The customer bought that pan from him, went home and use a good ingredients and spices to cook and it turn out the chef was right. 

    And another customer came asking the same question. The chef became greedy and sell another $100 pan. The customer went home and cook with cheap ingredients and wrong spices. It turn out bad. The customer said the chef is lying. He went back to the chef asking for refund, the chef said that the second customer testimony saying that he was right. The third customer must be wrong. He did not get his refund. 

    Now, is that chef a good person or not? Do not say he is a good businessman, or he still a good chef. I want you give me honest opinion, is he is a trustworthy? Certainly not. 

    Same as doctor, who sold all this kind of product. You take his or her words thinking that this doctor must be real because he is a doctor (like the chef working in top restaurant and the food is good). This doctor must not be wrong, if not he must be in jailed. You will take this doctor word as it is. You are wrong, this doctor is business person first and not doctor first. It is very unfair for patient. 

    I have met a lot of this type of doctor. I always call them "apostatic" doctor. Medicine is kind of religion for me. So those who did not follow the real medicine would be apostate. Some of them who I met selling Vitamin C injection. Rm100+ for one injection. As you all know, Vitamin C will be excreted into your urine no matter how much you take it. It's a micronutrient. Eating one lemon perweek will prevent you from vitamin C deficiency. Why in heaven you need to take thousand upon thousand of miligrams into your body? Thinking that it will prevent viral infection - a theory not proven. Thinking that it will cause your skin to be beautiful - it may but you need a microgram dose a day for that and it does not directly connected to beautiful skin. have you ever heard of people with vitamin deficiency in our country? Unless they have a syndrome..or diseases, or vegetarian (in case of vitamin B12). Some doctor I met selling virgin coconut oil. Telling that this oil is good in preventing 101 diseases. Common, coconut oil? Its a good food sources but do you need to sell that in your clinic? Was it supposed to be in supermarket or grocery store? 

    See, if that oil sell in grocery store, with that kind of price (expensive), people won't buy it. If you put it inside your clinic, along with all those antihypertensive medication, diabetic medication, antibiotic, and other real medication, then there will be something going on there. People will believe this coconut oil will have the same effect like those antihypertensive medication and so on... They will buy it. They will be cheated. The doctors will smile and - here comes the money...

    I do not say doctor cannot become a businessman. Well, many doctor successfully do so. They can. Unfortunately, they have to choose. Like the aesthetic doctor I mentioned before, they have to choose which pathway they want to take. Why I respect my aesthetic doctor friends is because they did not shy and they are proudly claimed themselves aesthetic doctor. They choose to do that and they are targeting customer based on their area of interest. Although, most of the aesthetic doctor is the one selling product like this. sigh. 

    The worst is those who still work in real medicine but sell product like they are some kind of aesthetic doctor or something (oops, sorry). As I said, they have to choose. The recommendation for a doctor that want to sell health related product it to quit their practice and start focusing in their product. They can use their title-whatever- as long as they did not practice clinical medicine anymore. It's very confusing when a robber also work as police officer at the same time right? Thus choose one. 

    Some people will start attacking me for saying this. They will say that we all will grow old and broke if we did not start doing some kind of business nowadays. Well, you have to understand here, I am saying about those who sell health related products. Those doctor who sell headscarf, cake, nasi lemak, gold, stock market, cars, houses, and any other thing, they are not doing anything wrong. They can do that. What they should not sell is those coconut oil, vitamin c, supplements... because all of this are conflicting with their current job. I mean they have to treat, yet they want to prevent by selling stuff. Why don't give that stuff for free if it really preventing diseases? They must answer, because they will not have any income from that then. Now you realise, those doctor selling product put money first, patient later. No matter how they say it, their interest is conflicting. 

    So, everytime you went to see a doctor and he start promoting you product.. quote those code of conduct I just shared above. You might give that doctor a chill a bit. ;)

    Don't sue them by the way, yes you can do that. Just tell them the truth if you really love that doctor or maybe you a good person. You can report them to MMC and they license will be taken and maybe they will become a full time salesman or salesgirl. 

    I would really like to remind all my doctors friends on this law...but, they hate me for that. It does not matter how much people hate it, its the truth. 

    Truth is like poetry, and most people hate poetry. 
                        (From the movie :The Big Short [2015])

    Monday, September 26, 2016

    House Officer in Malaysia: Are they real doctors?

    Does house officer job really tough? I have written about this in my blog before. It may be already lost somewhere in the internet. One of the most memorable time of your life after becoming a doctor is house officer time. The time where you find your true self, your weakness and your strength. It was also the time when you have to decide, whether you need to continue such life, or just leave it and find other job. To tell you the truth, a lot of my friend who dropped out from house officer program are successful nowadays in other field. So what is it like to be a house officer? This will be a part of my chronology of 'Becoming a doctor in Malaysia' post. You can check out the previous post here:

    House Officer: Have they eaten their breakfast?

    I will start my story here by highlighting that many member of the public, and even some doctor themselves doubt about house officer credibility and competency. That is a normal thing no matter where you work. Does someone become an expert immediately at the first day of work? If they do, that must be  a Godly miracle. People are so afraid of the house officer until they think they will die just by seeing one of them. That's a bit too much, but seriously, a lot of people really afraid of house officer. 

    A nurse for example, will always look around for medical officer or specialist to prescribe their child or themselves medication for flu. They afraid that if a house officer prescribe it, they will die of the side effect..of paracetamol... ? They were so afraid to consult house officer, as much as they could, they will keep bothering the busy medical officer and specialist to consult them. 

    Not just the nurse, the other staff, all are afraid of house officer. Don't get me started with patient. Patient will feel anxious and nervous when a house officer start interviewing them. It's like a bad luck just step into their cubicle, or something like that. 

    The reality is, a house officer is a doctor. A person who learn medicine for 5 years, knows the pathophysiological aspect of a disease, and know the treatment for it. If not, they should not have been graduated from medical school in the first place. What lacking inside a house officer is experience. That experience will be gained through out 2 years house officer program. They will be guided by their senior, medical officer, specialist, consultant, to become a safe doctor in the end. 

    Are they not safe in the first place? They should. Any mistake done by a house officer is punishable either via extension of their course or by terminating their career. A lot of house officer who get disciplinary action and warning letter, are given option to resign. Technically, in government sector, option to resign equals to termination. It just a nicer way to fire someone. House officer is safe and a responsible. They were not like kids running around doing anything they want. They do their job according to the standard operating procedure, guidelines and any evidence based medical knowledge available. 

    A house officer also will not be put in a hospital without specialist. All house officer will only be assigned to an accredited teaching hospital. This means that every aspect of patient safety is being taken care of not only by that house officer, but the medical officer, specialist, consultant, up to hospital director. What house officer did, is basically applying what have been discussed on a higher level, and deliver them to patient. It is not like they did something just by themselves. 

    This is why you can see rounds are being done in a regular basis in a teaching hospital or hospital with house officer. Rounds are basically a meeting, consist of the highest person in the ward (Consultant) down to the lowest person in that ward (house officer?). I do not like to think that house officer is the lowest ranking person there, but let this stereotype thinking be there for a reason. We should not label someone the lowest person, yet we need to assigned someone to be the lowest one. Thus, House officer with proudly took that place. Imagine having a meeting two if not three times daily everyday, 7 days per week. I put one of you in a meeting once a month, you will be already complaining that you have too much meeting. Yes, rounds are meeting. A patient case will be presented to the highest person in the rank, then that highest person will gave order to the lower person below him or her, then down-down-down, to a house officer... WRONG!

    That is what you think, but that is not the reality. A medical round is actually a place where everyone will discussed the case. As discussion of this cases is strictly confidential, it is better to discuss it in font of the patient themselves so that they can be involved in the discussion. It's not for the highest person in the rank to make a decision, he is there for other reason which is approving the decision. This is where it get interesting... A house officer is the person that usually present the case to all the members of the meeting, thus if a patient too scared and skeptic about a house officer, think what will be presented there. A lack of information could lead to a disaster. Refusing to answer that stupid question from a house officer could cost you a life. The information then will be digested and circulated around so that everyone will try to chip in and 'vomit' an idea on how to solve patient problem. Someone will suggest doing surgery, another one will suggest to wait and start antibiotic, the pharmacist will suggest the dosage and which antibiotic is better compare to the first suggestion, the nurse will suggest to use other antibiotic as not enough nurse to deliver to frequent dosage, the consultant will nod, give his or her own suggestion, everyone agree...then done. 

    I really love the way this meeting happen. At the same time, they will ask the patient whether the patient agree or not. It's very interactive. Medical round is the most interactive meeting I ever seen in my entire career. The rest of other meeting was just for tea, coffee, people bashing each other, and no conclusion in the end. The meeting in a medical round will only lasted about 5-10 minutes, but the outcome is always fruitful and the action will be rapid. 

    The round will be done usually in the morning, and in the afternoon. Another round will also be done at night but usually consist of those who are on call only. The decision making for a patient, thus, is not simply like a boss ordering something and everyone must follow. Its always a group decision. What will happen if some rogue doctor want to be a hero for himself or herself? You will always see them crying later getting scolded in front of everybody. No..I remember when I was a housemen, my senior told me, don't be a hero. You can save someone's life by not being  a hero... 

    So what if in a situation where decision making has to be done quickly. We call them life saving situation. Life and death in the hand of that one doctor that was around? Will then he or she be a hero (or heroin)? 

    This is where basic life support or BLS, Advance life support (ALS) or whatever LS, come in. People might think that doctor act like a hero or heroin. Looking at a doctor trying to save a person with cardiac arrest always look dramatic, full of action. If it was a rap music, it must be sound like Busta Rhyme or Tupac Shakur ( oh I am old). It was flowing like that doctor brain is a computer with the latest intel processor installed. Yes, it was cool. I also find it cool to see a doctor trying to revive someone's heart who has stopped. I've have my share of experience as well. 

    To tell you the truth, everything done in that life saving situation is already planned. A doctor was 'acting' like they were reading the script. They have to memorised the script, of course, before they can act it. This is what I mentioned above. All the 'LS' that we have. It is basically simple, a normal person can learn that (in fact they did teach to public, but no one bothers). Everything was already being written down, which one to do first, which to do next. Just follow the procedure/ the flow chart, we might end up saving someone's life. House officers are compulsory to attend and get certified on that course..the BLS. They will have their certificate in their filed at home or wherever they keep it. That certification is valid for a certain period of time...3 years..5 years. (I forgot. It has been sometimes since I left clinical work.)

    The nurse will also have to attend this course, in fact all hospital staff need to attend. It was one criteria to be fulfilled to get that accreditation or MS ISO certified. So, if you work in hospital, there will always be that one person, likely your superior, that keep nagging you to join that course. You will feel lazy to attend it as there will be exams at the end of the course. It is compulsory nevertheless. An organised chaos.... this is what they call it. Organised chaos as everything will look chaotic and full of drama..but it was actually organised.. Every action was structured long way before it happen. 

    Thus, you are pretty much safe now in your stay in a hospital. What else can mess your life up? Certainly not the house officer. Certainly not that nurse you scolded just now. Certainly not that consultant or specialist. Certainly not the medical officer... It must be a bad luck if you mess up in the end. 

    No, seriously. Everyone make mistake. Sometimes, a bad decision by a doctor can end up hurting you more. Doctors are human too. No matter how good cops are, there will still crimes on the street. No matter how good teachers are, there will still be a student who failed. No matter how good pilots are, there will still airplane accident in the news. Everywhere, there will be something out of bad luck will happen. This happen because God let it happen. It's beyond our human power. 

    So there will still be patient who will end up having more complication from that surgery, or from that medication given.... Medical error can still happen even if you ask a robot to do medicine. We, doctors, are human, and human makes error. However, to minimised the error is what every doctor will be doing everyday. Do no harm. That's our ultimate motto as a doctor. We can't fixed that lungs that someone have been smoked for 10 years that end up with lung cancer. We can't stop that bacterial infection that started since 2 weeks ago, and patient just came to hospital yesterday. We can't stop someone's liver to stop functioning because of those alcohol he drank since he was teenager. We can't. What we do is to minimised the damage and the error. That's what we do. So, if you are in a hospital, you can't put a 100% chances that you will be cured by doctors. But you certainly can rest assure, that all the doctors are trying their best to control the damage of the disease...and save you along the way. 

    House officer, is a doctor themselves. They will think like what I have been described. Patient safety will be their utmost priority. I once a house officer myself. Those years in that program teach me the most important lesson in my life. I would never kill anything in this world. Our job is to save life and not to end it. Give that House officer a chance to interview you, be cooperative, and sometime, ask them...

    'Have they eaten their breakfast?' ( or lunch)