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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)

Friday, September 23, 2016

Becoming a medical officer in Malaysia: Are you still a real doctor?

To recap from my previous post, a person must completed 5-6 years study in medical school, pass their professional exam, enter 2 years house officer training program, pass their exam and completed their logbooks, then a person can now be called a fully registered Medical Officer / Medical Doctor.

A Journey of a Junior Medical Officer

After 7 or 8 years experience, a house officer will be given a full registration under Malaysian Medical Council. This registration process is a lengthy process which takes up months before it will be completed. Most doctors will apply for full registration 4 months before they finish their house officer training program. The registration will be processed only if all the criteria has been fulfilled by the house officer which includes log book, review by a board of specialist, no disciplinary action recorded, and other paper work stuff that need to be settled. A full registration means that the doctor now can practice as a doctor independently. They can work in government, they can open up a clinic, they can join private hospital or clinic, whatever they wanted to be. Thus, all private practitioner (medical officer) in the clinic you saw when you had a common cold, was not only completed medical school, but they also have their named fully registered after completed their 2 years training.

The registration is public, you can look up in Malaysian Medical Council official web page for any doctor you have in doubt to be a real doctor. If his or her name turn up in MMC database, they are real. Other than that, report him or her to the nearest police station available ( I am just kidding but I am serious).

All the doctors that has been given full registration (to contradict my previous statement) can not practice in private sector yet. At this point, they will be referred to as a Junior Medical Officer. After given full registration, a medical officer need to serve a 1 year compulsory services in government hospital before they can go to private sector or open up their own clinic. This 1 year compulsory service is necessary to make sure that a medical officer is truly safe to practice. Anything happen within this 1 year period will affect their career forever. No mistake can be done within this monitoring period. However, at this moment, a medical officer is fully responsible for his or her own action.

During house officer training, any mistake done will be answered by the specialist or medical officer in charge of that house officer. After becoming a medical officer, that doctor need to answered to any problem by himself or herself. If they wrongly given wrong medication to any patient, they will be sacked from their job, they can be sued in court, they need to answer to Health Department Director themselves. Basically, they are responsible for whatever they do. Commonly, during my time, a house officer will be sent to district hospital to practice. This will make sure that they brush up all their clinical skills and acquired more experience without having specialist to take care of them all the way.

However, some medical officer now have the luxury to directly enter a specialist hospital or directly enter their department of interest. I do not agree partially on this as for me, experienced is important. However, by doing that, a medical officer can progress towards another step of their career to become specialist quicker than the others. It is a matter or opportunity. For a medical officer that have not decided on which area to specialise, they will serve the community until they decided.

I will continue on this story on the perspective of a medical officer that was sent to district hospital, which I did. In the way, I will also tell a brief story on the other perspective where a medical officer directly enter their area of interest. In district hospital, depending on how big that hospital are, a medical officer need to be in charged of all discipline. This include obstetric and gynaecology, medical, surgical, orthopaedic, paediatric, psychiatric and perhaps whatever disease are there out there in the community. A hospital in district setting was never designated to receive only one kind of patient. Unless a tertiary hospital such as Women and Children Hospital or National heart institure, almost all hospital received all kind of patient. Some district hospital have their own small unit to handle a particular cases, eg; paediatric and labour room, but the doctor handling all this unit usually is the same doctor. The doctor you met in emergency department in a district hospital, might be the same doctor that will treat you when you are admitted in the ward.

Yes it was very busy working in district, not like what people always say " district doctors shaking their leg only everyday, no patient what..". Not when you offer free healthcare, all sort of people will always like to go to hospital, plus the people in a very district area will only come to hospital when they were severe enough. A severe patient will take hours to be taken care of compare to a simple common cold patient that only started a day before.

All the experienced acquired during house officer training will be very valuable now. The logbook they asked to complete during house officer time now feel relevant. In district, you will insert your own chest tube, you will do your own caesarian section, you will intubate and resuscitate on your own, everything is on you. If you cheat your way during housemen time, then it will be a perfect time to cry and quit. Life not getting better after house officer. A medical officer in district, work harder than the house officer.

Nevertheless, any cases in district setting which need specialist consultation need to be discuss with a specialist in tertiary or referral hospital first. So it will be a mistake if you think a medical officer is doing that surgery for his own fun, or giving you medication simply without giving a thought. Most of the work of a medical officer in district setting is recording all their observation and finding, and talking on the phone with specialist. Discussing a patient with a specialist is necessary to make sure the right treatment is given and this will also protect the medical officer from any medico-legal action in the future. For example, a pregnant lady who came with a fetal bradycardia which mean the baby in the womb heart rate is slowing down. The baby maybe in distress, as so the medical officer attending that. The baby need to be taken out immediately. An emergency caesarian section need to be done. As you observed the nurse running here and there preparing the patient to be sent to operating room, you will see the doctor sitting on the table like he or she never give a damn about anything. Plus you can see him or her looking at their smartphone and sometime texting. You feel mad. You post in social media that this doctor is useless. Pause for awhile, you might be wrong. At that precise moment (I recall from my experience), the doctor is sitting on the table recording whatever finding he found on that pregnant mother, the heart rate, any medical illness, allergy, indication for surgery and such. He then will call the specialist in tertiary hospital relaying the information he has. The cases will then be discussed intensively and in a very details manner. It will not take more than 10 minutes to do that as the baby in the womb is suffocating, however the details on that discussion must be very structured and clear. (This is what they taught in medical school, on how to present a case to the examiner).

The specialist will then give it a go or a no. If it is a go, the medical officer will then run to the operating theatre to do the operation.

Not just during emergency operation like this, most of the time, all the cases other than simple common cold and a few other simple cases, will be discussed in details with a specialist before any further action taken. This two layer system will make sure that patients safety are not compromised. Whatever treatment you get in the district hospital, will be equals to what you get in a big tertiary hospital. If the treatment is not available, then usually a patient will be transferred to a tertiary hospital.

Other than treating sick patient, medical officer also need to prepare medical report for insurance claim, or medical check up, giving continuous medical education to hospital staff, attend meeting, sometime went out to public to give health education. Medical officer also need to complete their logbook of procedure. The logbook will be assessed by hospital credentialing and privileging committee which usually include hospital director and a visiting specialist. This means that medical doctor are still need to be performed certain amount of procedures to be certified competent.

Medical officer also required to attend courses to make sure that their yearly license can be renew every year. A full registration is one useless paper that usually be kept in a dusty file or box and only to be taken out if necessary. What is more important for a medical officer is that yearly license to practice. It is called Annual Practice Certificate (APC)

A doctor can boast anywhere about them being a doctor, have that medical degree and completed their 2 years house officer training, but without APC, he is useless like a driver without a driving license. When a driver without driving license hit a cow that cross a road without looking, do you blame the cow? No. You blame that driver. If that driver has a license and hit that cow, you will then consider that the cow maybe the cause of the problem. Same goes to doctors without APC.

So when you meet a doctor, instead of asking for his medical school degree certificate, you can just ask for his or her APC. Unable to show their APC is a serious offence and can cause that doctor to be taken disciplinary action. I am serious on this. That is why, when there are bureaucratic problem causing our APC to be unavailable for that year, we will not touch a patient at all. We will rather sit and write a medical report or just hanging around doing nothing. It was rare. APC usually will be available after a doctor applied for it. Just to make sure that doctor attended courses, and not getting any disciplinary action, APC usually will not be a problem. Medical officers usually renew their APC a year before it expired. So usually will not be a problem on obtaining that. This means, a doctor that do not have APC, that doctor is either fake doctor, or a doctor with disciplinary problem...(or bureaucratic problem, not to forget this as my friend had his time hanging around unable to practice because someone lost his APC application).

For those who directly enter their field of interest or work directly into a specialist hospital without going to district, they will have better opportunity to get a shot to become a younger specialist. However, the work load is the same. As working in district cause you headache because no one is there to help, working in tertiary hospital also have their own headache. With a lot of patient, proper guidance from specialist, and ability to perform procedure that only available in hospital with specialist, these group of doctor will get their experience in their own way. District is like working in a small restaurant with thousand customers to be feed, and tertiary hospital is like a fancy restaurant with michelin star working under a famous chef. Both restaurant will serve good food to their customers.

After a year of serving as medical officer, a doctor then can now choose whether to stay in the government or go out to private practice which offer better salary than government.

Stay or not Stay

This will be the first big decision for a medical officer. Stay or not in the government. They have serve for at least 3 years in the government ( 2 years training + 1 year medical officer), so now it is all about building up their future.

They will be pro and cons and either decision is not wrong. It depend on the individuals. The pro of staying in the government is you can get your grade up easily by serving for another 2 more years. A medical officer will be graded UD44 and after 5 years serving in government they will be UD48. The monthly salary will go up of course but not as much as a private sector can offer. The importance of getting your grade up is to make sure that you gain enough experience, of course, and also to make sure you will not stuck forever in your UD44 grade. If you went out to private sector, you will not be graded like what they have in government, you will only be known as medical officer and perhaps you will be registrar after years and years applying to your boss. And I doubt someone will be rank up to registrar simply by applying.

Staying in government means cheaper salary, and years and years of labour and services. A friend of mine who work in private can already buy a house if not two house while I am still struggling to pay the loan of my medical study. Sometimes, grade is not important as what you think. Although, I stay in government for one reason, this is important...the ability to continue further study to become specialist.

As a government doctor, you have the opportunity to further your study and sponsored by the government. I will not talk much on this as I already dedicated a few post in my blog regarding how to apply for a master program sponsored by ministry of health. You can check it here.

So let us proceed. As I mentioned above, you will be promoted to UD48 after 3 years serving as a medical officer ( total 5 years serving in government. 2 years house officer, 3 years medical officer). By getting that grade, you will be known officially as a senior medical officer. A senior medical officer have a higher price in the market compare to junior medical officer (UD44). Even private clinic usually like to higher junior medical officer because their starting price will be lower. Do not confused the grade with skills and experienced. A medical officer grade UD44 can be as good as UD48 and UD48 can only be good as UD44. Grade is only a matter of how long have you serve in government. As I describe in length, a medical officer you find in a private clinic has serve his or her term for 3 years intensively in government hospital. They are not a low class doctor as you like to think. They were survivor. They only choose different pathway because in life, in a direct way to success, sometime you need to change your direction to be successful.

Up until this point, we have covered all the way of a journey of becoming a doctor. From Medical student, to house officer, to junior medical officer, to senior medical officer. I can go a little further but talking about what beyond UD48, I shall reserved to when I already reach that point myself. I hope that people will understand, if you see a doctor in front of you with their APC, they are almost certainly experienced and went through what I have discussed in my post here and before this. 

Medical doctor is a noble profession. It was not easy to achieved that status (I only discussed here until the point someone become a senior medical officer). If we talk more on the journey to become a specialist, you know how hard someone to get that title. The experience, the knowledge, the time spend on work, the family that left behind, everything is what make a doctor a real doctor. I am hurt if someone self proclaimed himself or herself a doctor but never experienced what I have discussed in length here. We can't stop these self proclaimed, bogus doctor, but we can educate the public on how to recognise them. 

Salute to those who have reach this point of becoming a real doctor.

Continue to next chapter on House officer.

Monday, September 19, 2016

How to be A Doctor in Malaysia: Are you a real doctor?

When we talk about doctor, not many knew about how someone eventually can hold that title. For most people, to be a medical doctor, you need to enter medical school and miraculously be a doctor 5-6 years later.

I was called to write on the career pathway of a doctor. As any other professional career, I can assure you that it is not easy to be a doctor, a real doctor. You can be a bogus one but what's the point on that? This will be a multiple post entry, and for the first part of my story of a doctor's journey, I will call it: 

On The Beginning Of A Young Doctor

Everyone is correct, to be a doctor, the first step is to step into a medical school. To be accepted into a medical school, a person or a student must excel in his or her A-level exam, matriculation, or anything similar to that. In Malaysia, there are quite a lot of medical school however we need to understand that not all medical school were acknowledge or accredited to teach real medicine. Most public University in Malaysia are safe as all have gone through a strict quality assessment and accreditation process before they can produce a medical graduates. Some private college however, does not comply with the standard, thus choosing a medical school is an important step to do. One must not simply enter any medical school and be a doctor. 

I will not discussed on details on how a medical school being assessed in its quality, although all medical school that are acknowledge usually will have enough teacher, facilities, and a well structured programmed to learn medicine. 

Medical school usually offered 5 or 6 years program consist of theory and practical aspect of medicine. During this 5 years of study, student will be 'forced' to memorised all the anatomy of a human body (dissect a cadaver while doing that), understand the physiology of human body, the chemical aspect of of bodily function, pathology of disease and pharmacology. Practical aspect usually comes during third year and onwards and usually were called clinical years of study. During this three years of clinical years, student will be exposed to real patient in the ward, practice simple procedure and brush up their interviewing skills. From what I remember, medical school study is all about interviewing a patient to get the diagnosis and after that discussed on how to treat that diagnosis. 

This is why, medical student need to be in a hospital most of the time. I heard that some medical student graduated without going to the ward and meet up with patient, I do not know whether that can be counted as a medical graduates or not. During my years of study, my job everyday was to 'hunt' patient to get as many diagnosis as I can (not just for the case write up / case report that need to be sent). That's why some patient complain in social media that medical student irritate them and annoyed them. Some patient even refuse and rudely ask medical student to stay away from them. They did not understand that medical student is actually trying their best to learn from experience and if they look not that professional, yes, they are medical student for god sake! Professionalism does not happen at birth. It is acquired to knowledge and experience. 

Student also will be taught on soft skill, how to approach and talk nicely to patient, medical ethics, how to do a good clinical research, and even sent to district to study villagers aspect of health. I still remember my district posting where my group was chased by villagers' dogs as we enter the village. Some even suspect us on selling them some products so we were not welcome all the time. 

After an intensive 5 years of study, medical student need to undergo professional exams. This is the final exam to determine whether you are capable to be called a doctor or not. Professional exam will consist of theory paper on everything we have learn during that 5 years course, and clinical exam where each student will be given 1 patient to be interviewed and then the examiner will ask all sort of question regarding the diagnosis and how to treat them. There will also be a short case where each student need to examine around 10 patient (10 minutes for each patient) and come up with a diagnosis and treatment. As you can imagine, for long cases, plus short cases, there will be around 11 patient on that exams, and a student need to study 100 if not thousands diseases to prepare for that. The cases will be totally random, to be safe is to study the common one, but do not hope too much for a common cases. I get Friedreich's ataxia in one of my short cases, and my long case was Varicose Veins. I was memorizing all the hypertension, diabetes, heart disease, and all the disease in the wards, and one of them came out..varicose veins. 

After medical school, a medical graduates will receive the approval and a piece of paper called degree, and from that moment, he or she can called himself or herself a doctor. I will call them medical graduates as for now because to be a doctor is not merely to get that degree. That degree will not allowed a medical graduates to open up clinic or simply treat people. The degree is not the license to do what doctors do even though most our our lecturer said it is. It was not. 

House officer in the House

I will be honest here. After medical school, me myself felt that I am already a doctor. I can put that title in front of my name and I have a license to practice what I learn. Unfortunately, it does not goes like that. 

Medical graduates have to enter a 2 years program called housemenship. Officially and to make it sound less sexist, it was called House Officer Training Program. Some called it HO-ship. This program is the nightmare for every medical graduates. Half of medical graduates will be fallen during this 2 years period. I, myself feel like I will not be through during my HO-ship but I kept telling myself that I already spend 5 years in medical school, 2 more years would not be so bad. It was horrible. 

During this 2 years program, all this doctor or they call it trainee doctors, will be forced to apply whatever they learn during medical school to a real life saving situation. They will be pushed to the limit, and they will be stressed, they will be depressed. This was necessary to make sure that every young doctors can cope with that stress. There are no such thing as stress free environment when you are dealing with life and death decision. You are basically trying to fight the death angel, you are challenging the death sentences that are already given to a patient by God. You must be over the limit to do that. 

You will have only a few hours sleep every night for the next 2 years in the program and even if you have more than 3 hours of sleep, you will be haunted with a nightmare. You will dream of your patient, your job, your boss, and every other staff in the hospital. I may exaggerated a bit but this is what you will feel. 

Nobody respect a house officer, that is the reality. Life is a bit confusing during house officer training as all these doctors are still not yet a real doctors, thus everyone will try to step them on the head. Nurses, sisters, matrons, PPK, janitor, patients, medical officer, specialist, and so on will never respect this human being bearing the title of house officer. This is why many drop out and left this program to pursuit something else. Most of them could not cope with such life. 

Put the dark story aside, a house officer is not that inferior after all. Try removing this group of people from the hospital, all patients will be dead for sure. These house officer is trained for 5-6 years in medicine (in case you forgot, duh!). They can make life saving decision, and if they don't, they'll be screwed by everyone mentioned above. So, it was a mistake to label these young doctors as inexperienced, no brain, tidak pandai, stupid, or whatver. They have passed their professional exams so they are knowledgeable, more than any other person who never went to medical school. 

House officer, not just a tool to write (a writer) in a case note. They are not robot who are programmed to only do work without thinking. Most of patient and the public misunderstand the role of house officer. They are not simply following orders, they are actually capable of making a decision. Most of the cases that are admitted to hospital will be clerked or interviewed by this house officer, they make diagnosis, they plan the treatment, and they wait for the medical officer or specialist approval whether to proceed with that decision or not. In a life saving situation, house officer can even administered life saving drugs and medication without waiting for specialist or medical officer to come and give the order. 

For example,in a case of symptomatic hypoglycaemia, a house officer will not wait to call his or her boss to ask on what to do, they will immediately order intravenous dextrose and keep on monitoring blood sugar level even without the knowledge or their superior. Same goes during any other life saving procedure, where basic life support need to be started. 

House officer are not called house officer for fun, they were in house doctors who keep their eyes 24 hours inside the ward. They will be the first one to noticed if someone having problem in the ward. Its like having a maid taking care of your house, would you hire a maid that only do what you asked them to do? You will prefer a maid that know what need to be done without you around. 

House officer  will be rotated every 4 months. They will cover medicine, surgery, obstetric, gynaecology, paediatrics, emergency medicine, and orthopaedics. Some of them will go to anaesthetic medicine instead of emergency. Now I heard that there are a few additional rotation that they need to do such as psychiatric and district posting. Each rotation will have its own assessment and logbook to be completed. Logbook is necessary to make sure that all house officers completed all the procedure to make sure they have enough experience on doing that procedure. 

After a harsh 2 years of training, young doctors will be called senior house officer and eventually, if they passed their assessment and completed their log books, become a medical officer. 

Only those who are tough enough to went to through that 2 years period of intensive training, will be crowned as a medical officers. Those who did not complete 2 years house officer training, can be a bogus doctor, or claimed themselves as a doctors and sell health products using that name. 

I am very sorry to say that, as many of my friend also did not completed their house officer training, some be a good citizen, some become teacher, some become a good businessmen and businesswomen, and some using their name to sell health related products, but I have to give the honour to those who completed the program. They eventually become a real doctors after that. 

From that moment of finishing housemen-ship, a doctors can claimed proudly themselves as a doctor. A real one. Trust me, most of them will not announced themselves loudly as doctors in public. Not because of they ashamed, not because of they were humble, but because the experienced given during that 2 years of house officer training will make them realised how heavy the responsibility of becoming a doctors. Becoming a doctors is not just simply calling yourselves a doctors but the responsibility that are given to you. Life of someone you barely knew will be put upon your shoulder, and you are capable of 'creating' a life, reviving the death, or even kill someone. 

For me, all doctors that have that full registration as a medical officer are damaged. Somehow, you can see in their face, they have been through a painful pathway of life. Salute to them, they are the real doctors, they deserved to have that Dr title in front of their name.

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