Spread the word – Nurses passing report / giving medications should not be disturbed

Doctors gripe about nurses and patients. Nurses gripe about doctors and patients. Patients and their family gripe about nurses and doctors. At the end of the day, the healthcare professionals hunker down and do their jobs as they feel they have a responsibility to, and the patients still need to seek medical care.

 Yes, we complain that patients nowadays have a sense of entitlement and enjoy the sick role, treating the overworked nursing staff like their maids. How often do you see or hear of patients who complain that the nurse is within sight, within earshot but refuses to stop what she’s doing to help a young man admitted for pneumonia get a cup of milo… just because she’s wearing a bright-coloured vest that says “SERVING MEDICATION”.

Doctors too are guilty of the same, grumbling that the nursing staff are so busy “passing report” that they cannot answer queries / spare the case files / serve the patient whose family is complaining loudly about the lack of milo.

 You would think that we would know by now that allowing the nurses to pass report and give medications uninterrupted is shown to decrease errors. Yet people routinely complain about the nurses doing something that is shown to help them (the doctors by knowing the patients better, the patients by not giving them medication that can trigger anaphylaxis and lead them to die)

Perhaps what we need is better information giving.

For instance, the ward should have a poster of a nurse in the serving medication vest “Please let me focus on serving you the right medicine.” or something to that effect.

The medical officer room should have one targeted at the doctors that says “Please let us pass report. Proper handing over lets us help you with your patient.”

Think it’ll help? Maybe it’s a start. 

 

The Roster Monster

The roster monster… um… manger is an important figure. He (or she, you politically correct folks) holds the ultimate power of leave, call and ward/team allocation. The roster monster is usually nominated because it is a thankless job that nobody generally wants as inevitably he (or she, damn you PC folks) becomes the most unpopular chap around. Except for the rubbish house officer. However, because the roster monster holds such influence over the quality of life of everyone, the most responsibile, hardworking person is usually chosen.

So it was with J.’s surgical rotation, when everyone targeted BB (a pseudonym, if you haven’t figured that out) to be the house officer. After that, though, JustKidding stood up and said, “Actually I don’t mind being the roster monster.” Given that it’s a thankless job that no one volunteers for, who would deny him? So it was that we nominated both of them as co-rostermonsters.

Cynical fact #5: few people who volunteer for a thankless job do it out of the goodness of their heart. So it was that JustKidding (JK for short) has turned out to be, well, very much less-than-ideal.

Confidentiality in the Workplace

It helps if you’re able to keep secrets.

Information:
There’s a certain professional image that healthcare workers are obliged to keep, and this image is actually essential to the job we do. It takes a huge measure of trust on the part of the patients to entrust their personal information, to be subjected to invasive and uncomfortable examinations/procedures, to put their very lives in our hands. And we are in return obliged to do the very best we can and to keep the information entrusted to us in secret.

Recently in the news, there was news of One-Eye Dragon’s execution and his wish to donate his kidneys… in his own way returning something to society. Speculation was rife in the local papers that one of the recipients was the ex-CK Tangs CEO Mr Tang Wee Sung. At the same time, another patient in SGH received a deceased donor renal transplant (deceased donors have 2 kidneys, right?). Possibly from One-Eye Dragon? Maybe, maybe not. We’ll never tell, not even to our families.

Pictures:
With the advent of Facebook, it seems that people are increasingly more comfortable with their lack of privacy, putting photographs and personal information on the web with little privacy control (though such features are in place).

Personally, I’m okay with pictures taken with colleagues in the medical offices, at events, at teachings. What I do not support, however, are pictures taken in the wards – in the inadvertent case that some patient confidentiality is compromised in the background. Furthermore, it reeks of a lack of professionalism to be taking photos in the ward. But that’s just me.

Sometimes when we’re so tired with work piling up and patients’ families demanding for updates in the background we really don’t give a rat’s ass any more… but maybe in the back of our minds we should realise that by maintaining our professionalism, it helps make everyone’s work a little better in the future.

Biostatistics for Research

J. attended the Biostatistics for Research (Advanced) Course held by the SGH PGMI (Post-Graduate Medical Institute) and it was good. He’s had a little bit of experience playing with SPSS on the basic-intermediate scale and thought it would be useful to understand the statistics of medical research a little better.

Maybe it goes a little too far, but possibly, just possibly, all clinicians should attend a course in medical research + biostatistics so as to better understand how the evidence that we rely on on a regular basis comes about. For instance, how tedious it is to come up with a scoring system (e.g. for cirrhosis) that has good clinical correlation.

It was a useful course, though the course prices ($700) was somewhat exorbitant and wiped out a good percentage of J.’s HO training fund. Ah well.

Less Than Ideal Timing

Hanging around at 5.50pm one day, J. saw the HO on call (let’s call him HO5) for his ward come in. (people renamed, bed numbers renumbered, etc. for the purpose of anonymization)

“Hey man, I’ve just got one case to hand over. He’s in bed 72. Patient with myelodysplastic syndrome, sepsis with DIC (disseminated intravascular coagulation). But he’s alert, we’ve been checking bloods everyday and it’s all improving. TW downward trend, coagulation profile looks good. Can’t quite wean down the oxygen yet though. Just to keep an eye on him. I think he’s stable for now, shouldn’t give you any problems on call.”

5 seconds later:
-ring ring- “Hello doctor HO5 are you the HO on call for ward 93? Patient in 72 stopped breathing please come now,” says the nurse on the phone standing behind J. to the HO on the phone in front of J. Via the phone.

Hmmm… 72? That sounds familiar…

Anyway, J. went to run the resus since it was his patient anyway. Despite aggressive CPR, atropine, epinephrine, ventilation… resuscitation unsuccessful and stopped after 30min on grounds of likely futility. Damn.

Great Book: No Country For Old Men

Aye, this is the book that was made into a major motion picture made especially memorable by a particular atrocious haircut sported by Javier Bardem (creepy!).

No Country For Old Men by Cormac McCarth is a fantastic book with fantastic characters and a gripping plot that made J. [speed-]read it all the way through in one sitting. He’s going to go through it again to make sure he didn’t miss out much the first time round.

Now all that’s left to do is the watch the film version.

The Brevity of Life

[Post-dated Entry]

The hospital grapevine is an amazing thing. News spreads like wildfire. So it came to J.’s notice from pathology folks some time back that a junior (name unknown) had suddenly passed on. And that struck a nerve like no patient he’s ever had did. Here was an apparently hale and healthy man/woman who had out of the blue crossed the border between life and death, cause unknown. While he can detach himself from the elderly patient with ischaemic heart disease passing on, this is another matter entirely.

The news had come because supposedly CG-mates/friends of said person, J. quotes, “boycotted” the posting because they didn’t wish to see the body of a good friend undergo the knife. That’s a very reasonable thing to do, and J. didn’t think the use of the word “boycotted” was appropriate at all. After all, an autopsy consists of elegance in brutality, with the search for truth being advanced at the cost of the human body.

Anyhow, J. doubts that the autopsy (it being a coroner’s case) will throw up much answers. Was it Brugada Syndrome?

And it was only recently that J. finally realised who fate’s victim was. A cheerful, warm-hearted man. J. can only imagine the terrible time his family and close friends have gone through.

To said person, wish you were still here.

On Call

What does it mean to be on call?

“Call” runs on the principle that people fall sick at all times, not just during the 5 day work week, and that things need to be done for patients at all times, not just during office hours but it’s difficult to have the full hospital running as per a normal day. As such, “call” is to allow the hospital to continue functioning with a skeleton crew until the full cast of characters returns the next day/ on Monday.

It’s not a great time to fall sick, as you can imagine.

It’s also a tiring experience for the doctors involved. As a house officer, J. can only comment on the experience of a HO on call.

Nepal Trip Day 15: Rest Day in Pokhara

Ahh… a leisurely day. Woke up when we felt like it. Eventually, we had brunch at the entrance of Sacred Valley Inn (attached is Monsoon Cafe) which was good… but had no scones to satisfy my craving! Later on, however, H & I shared a scone from Pumpernickel Cafe that was somewhat ordinary. Ah well.

After a coffee, we went shopping and bought presents for family, then rested until 6pm when we went to the Love Shack for a briefing on the next day’s whitewater rafting. Met a fellow Singaporean who rented a sleeping bag with us. We ate dinner at Everest Steak House. Unfortunately, the beer had gone to my gut an I was unable to eat much. Dang! Nothing much done this day.

Nepal Trek Day 12 (Trip Day 14): Birethanti – Nayapul – Pokhara

It was an easy, comfortable day. Waking up in the snuggly comfort of blankets at 0630hrs, we packed slowly, shaved (parts depending on person in question, cough cough ahem), washed up an had a leisurely breakfast, finally leaving at 0930hrs for a short but brisk walk to and then through the touristy streets of Nayapul.

We arrived at the road at 1000hrs, where we had to bit a sorrowful adieu to our walking sticks, first obtained from the porters before we set off from Pothana. A nice van came by to take us back to Pokhara in about 2 hours.

And that marked the end of our trek. Tips of 2 days pay to each of the porters, boots finally retired, sleeping bags returned, and had lunch at purportedly the best view/food in Pokhara – Mike’s Restaurant. The view was great, the food decidedly less so, with the flies and birdshit spoiling the meal somewhat.

The rain came so K and JW went back to take in the laundry first while I paid. We sat around the girls’ room on the 3rd floor of Sacred Valley Inn, counted our money and talked, waiting for the rain to stop. When it diminished, we set off unperturbe by the rolling thunder, only to be punished barely 3min out by a downpour. We quickly sought shelter in the comfortable environs of Moondance. The place was nice, the food wasn’t. Nonetheless, I had a bottle of Everest Beer (the other local beer besides Gorkha). Oh, the desserts weren’t bad (apple crumble, Macchpucchre something)

Afterwards, JW went to make a Skype call while we moved on, looking for sunblock for rafting and presents.