Archive for September, 2008

TTSH vs SGH: Medicine Call Coverage

Uhoh… here we wander into dangerous territory. Because rare is the person who’s done medicine postings in both TTSH and SGH. And it’s obviously unfair to compare Ortho in one hospital with Internal Medicine in the other… because it’ll be completely different even within the same hospital!

With his incredible powers of projection, empathy, and plain guesswork, J. tries to look at calls between… dum dum dum… SGH Internal Medicine and TTSH General Medicine calls.

This is a short match slated for 3 5-min rounds… here we go!

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TTSH vs SGH: Bloods and Plugs

Aye, one of the drone work that house officers do (though it is a very important skill) is that of phlebotomy and gaining of intravenous access. Intravenous (IV) cannulation is a vital skill that determines whether a patient can get IV fluids, inotropic support and antibiotics, all potentially life-saving.

Of course, teams take a myriad of bloods on a regular basis. Full blood count (FBC, aka complete blood count), urea-electrolytes-creatinine (U/E/Cr), liver function tests, anemia workup, calcium-magnesium-phosphate (Ca/Mg/PO), brain natriuretic peptide, coagulation profiles, the list is endless. And let’s not forget the doctor-only bloods: blood aerobic/anaerobic cultures/sensitivities (blood c/s) and arterial blood gases (ABG).

So let’s see… which hospital wins? This is a difficult one, so we’re going to break it down into bloods and plugs.

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TTSH vs SGH: Computerised Patient Management Systems

Welcome to round 2 of SGH vs TTSH, the controversial face-off in which the only loser is J. for having the cajones to put this onto the interweb. It is politically incorrect, so to speak. However, since this information is widely known and reflects the views of fellow HOs but not necessarily J. himself, it seems to be fair, wouldn’t you think?

Yesterday in the field of radiological investigations, TTSH had SGH beat down so bad it seemed like the fight was over. Not so, however, because today the round is on patient management computer systems! Hurrah for the IT age! So you think…

And the winner is… Bum bum bum bum!

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TTSH vs SGH: Radiology

Hurhurhur… because J. likes to stir up trouble, possibly including for himself, he’s going to voice out the general consensus of house officers who have had the advantage of working in both places. As such, there’s going to be multiple rounds between the two healthcare heavyweights: TTSH and SGH… going toe-to-toe over various parts of daily work as a house officer.

Today, we focus on radiology.

And the round goes to… dum dum dum…

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The Feeling Of Entitlement

It is a sad truth that the appreciative patient is a dying breed. In its place, we have the more apparently-educated, demanding patient (and family!). Since when was public healthcare industry a service industry?

Everyone has a right to the best clinical practice possible within the realms of material constraints.

What people don’t have a right to… is a demand for an update on their family member at 10pm from the on-call doctor at a time he’s trying to set IV lines for sick patients who need IV antibiotics, expecting him to drop everything to cater to their whims. Persistently. Incessantly. Such that he’s getting 2-3 calls from the nurses in the course of trying to look for a vein (renal failure patient, y’see).

A patient’s right to know and his right to proper healthcare doesn’t mean he gets to demand additional service at the cost of depriving other patients.

Next, some patients behave as though their allowing us to draw blood from them is a bestowment.

Yes, uncle, if you would keep your O2 mask on, take your medications and stop smoking in the toilet with your pneumoina + COPD exacerbation, maybe we can stop going “wtf look at these horrendous ABG results… increase the O2 and recheck ABG”.

The doctor doesn’t enjoy taking bloods. Well, some do, it’s a bit cathartic at times, but for the most part it’s just brainless extra work.

So please, the spoiled patients out there, the doctor-patient relationship is not just a consumer-provider relationship, so stop acting like you own the hospital just because you pay a modicum of money (J. works in a C-class ward).

P.S. Insulting your blood taking person (doctor/nurse/phlebotomist) by commenting on their inexperience/lousy skills can be painful.