IT sibei Ho!

Recently my friend who was in charge of the IT implementation of his department told me that the new electronic medical record system is sibei solid.

Well, Dr Og suay suay kennah do IT systems in hospital many years. All I can say is that my youth was wasted (sob sob...) and the time spent evaluating IT systems for the hospital could have been better spent surfing the net for boh liao things (at least that would have brought me some joy tio boh?).

Anyway, since we good friends, I entertain him and ask him why so solid leh?

"You know ar, this time the system hospital want to buy is very customisable. Last time all the systems have to input this input that but this one no need! Means ar the old old lokuns who only want to write a few words in the electronic notes can be easily done. So the lao lokun can just type 'NAD' for notes can liao wor!"

Apparently, this current system costs a few million bucks unlike the cheap cheap ones we evaluated in the past. Understandably, it is more time consuming to be typing notes rather than writing them on paper when seeing patients.

Hmmmm, but to pay few millions so that we can over ride the system to type less...

Hmmmm, nothing that can't be done with simple paper and pen...

IT sibei ho ar!

I rest my case.

Never Learn

Some nice reader left a comment that I must be busy as I have not been blogging recently. To be honest Dr Og had been quite boh eng... this game called Candy Crush has been really sucking up all my time.
Since I kennah stuck at some stupid stage now, I thought take a break.

In between games, Dr Og somemore got to go queue up at MacDonalds... at first for Hello Kitty then the Minions. Really sibei boh eng ar...

The worst thing was when queueing up for Hello Kitty some more got haze! It was really terrible queueing up in the N95 mask and having flashbacks of SARs days.

So while I queue here and queue there, a good friend who works in hospital admin called me.

"Eh brother, you got N95 masks or not?"He ask me.

"Yah la, still got some."Dr Og is a hoarder and I still have those 10 year old N95 masks from SARS days.

"Ooi, don't mind pass me some can?"He pleaded.

"But I thought you work in public hospital, how come no mask ar?" I was puzzled.

"Yah la, the hospital short and now cannot sell to staff...." He replied angrily.

"Wah liao!"

In the end I gave away all my N95s and had to use my recycled nuar nuar (rotten) one.

So it seems, always like that loh. Masks no enough, don't take care of own people and panic only when things happen.... what is new.

5 Steps to Becoming a Truly Patient-Centred Public Hospital

See Ma! Got carps and cigarette butts!

Hospital admins are always talking about missions and visions and senior management is always harping about patient centred care. But honestly, when you go to a hospital, do you feel like the hospital is meant for you the patient? When you want to get admitted, sure tell you not enough beds and kennah stuck in A and E. In fact, you may not even be able to find a car park space for your Mercedes in the first place! 

No scared. Dr Og reveals the 5 secret steps to becoming a truly patient-centred public hospital!!

Step One - Have a Lottery Store
Buying Toto and 4D are undoubtedly the favourite past times of Singaporeans. How can miss buying your lucky numbers just because you are admitted to hospital right? If you miss, the number sure come out one! 

Hospitals should have a lottery store right in 7-11 or Cheers like our HDB estates la. To make things easier, let the ah mahs (cleaners) in the ward help patients collect bets and earn some tips for themselves. In OT last minute before the anaesthesia sets in can also put last order. Its win-win for everyone!

Step Two - Have More Yellow Boxes
Ok, Dr Og knows this is controversial. Yah lah, smoking is no good. But isn't it cruel to make the ah pek with COPD (panting) crawl all the way out of the hospital boundary to smoke? Have a heart, condone off more yellow boxes in the hospital for them to smoke. 

But have our medical social workers station there to provide counselling and nag at all of them about smoking. This will also increase the work scope of our MSWs and stop them from complaining about "everyday only do financial assessments niah..."

Win-win again!

Step Three - Treat Your Doctors Better
Look. The simple fact is that patients go to a hospital to see doctors and to get treatments. You can have the most friendly counter staff around but all the patients really care about are the 15-minute consults where they get to interact with the doctors.

Du Lan (angry) Doctors (DLDs) are not going to be very nice to patients are they? DLDs will spend every waking moment in angst and in opposition to the hospital administration. All there are in their minds are how to siam the next admin meeting / hospital lecture on anything but patient care and how they will really like to trip the CEO as he walks out of his office before giving him a good piece of their mind. 

Yup, DLDs are not effective doctors. Is it really that difficult to make doctors happy? See my next post lah!

Wah Waterfall. Well done CEO!

Step Four - Kill the Water Features
I can understand why all CEOs want a pond or a fountain in their hospital. The official story is that the kois and sound of running water are soothing to our patients. In reality, the CEOs are probably comparing "is your pond bigger than my pond" during MOH meetings! Honestly, how many patients you ever see going to enjoy the water features? They are becoming places for people to throw rubbish and their unwanted neon tetras. Also poses a danger for drowning (don't look down on shallow waters ok)!!! Water features are useless, waste water and waste money. Get rid of them, make better use of the space (like 4D shops, yellow boxes or maybe extra hospital beds) and show that you are committed to patient care.

Otherwise, get rid of the CEO.

Step Five - Change Hospital Name Can??
Last time very easy. Hospital in Changi called Changi Hospital. Or named after Singapore. Or at the very least named after a great historical pioneer and philanthropist. Now suddenly named after people Dr Og has never heard before one. Must google then "ohhhh is the ancestor of some rich family." 

You really think our ah peks and ah mahs can remember all these names?? Now you ask them where they are when you do orientation, they all tell you they are in Tan Tock Seng coz thats the only hospital with a human name that they know.

So change the name back to like Yishun General, Jurong General before even the taxi drivers get confused. 

Especially when its impossible these days to drive to a hospital (even new ones) as there are no carpark one!!!! 

Gostun!

Gostun is the Singlay (Singapore Malay) word for reversing.

Eg. Lai. Gar Gar (dare dare) gostun your car!

Gostun can also be used metaphorically to mean a reversal of any kind. Today, Apple made a super gostun! Just as everyone anticipated a iPad 3 or iPad HD, Apple song song released the new iPad as "iPad". Aiyoh, how can???

While analyst confirm that this will not affect the sales of the new iPad, it does pose a serious problem. Imagine this scenerio.
HO: wah Boss, new iPad ar?
Consultant: Are you asking if this is a brand new original version of iPad or a new new version of iPad?

Evidently, when nomenclature kennah gostun, communications can become a problem and our ward rounds shall never end. Of course the only reason why the Consultant bought the new iPad is because he believed he was going to get a pay raise. But as the saying goes, do not count your eggs before they are hatched. In the land of ever changing constitution, it should be "do not count your eggs until the chicken grows up".

Firstly, the lokuns struggling in lokun chu were told they could expect a 10-30% per raise in their basic pay in April this year. Then as announced here, they say and I quote:

"The new framework will be implemented in phases and doctors will, on average, see an increase in total compensation of around 20 per cent by 2014.

Phase One will commence next month, and doctors will start to receive their pay raise according to their job levels.

Associate consultants in hospitals will get an increase equivalent to 20 per cent of their base salary, while consultant family physicians in polyclinics will get a 10 per cent raise.

Doctors will receive further increases when the framework is fully implemented in 2014.

Dentists' pay will also be adjusted."

 Dr Og always readily admit that my England no powderful but I would assume that the passage means that in April, ACs will get a 20 percent increase to their base salary, etc. Dentist of course we don't care la. There are so few in public sector and they are not even real doctors :P

But for those who have been briefed by the men in black from the ministry next to a lokun chu, our pay raise also kennah gostun liao! Apparently, in April, we will only get some funny component which the above said people refuse to commit to. Wah biang, whats this? Early April fool joke ar?

Wei! Don't like that can or not? My lao pek, lao bu, wife and kids all read in newspaper big big that I will get 20% pay raise. But actually boh leh. How I explain to them? Wait my wife think I keep mistress and never bring the dough home how? Wait I really already keep mistress and cannot upkeep her how? Wait I preorder the iPad, engrave name, cannot even sell in eBay liao, how?

医生们，有没有被骗的感觉？

Bodies

When we talk about bodies, as lokuns, we automatically think about the dead cold ones we send to the mortuary.

But these days, the buzz is really about what hospital administrators like to call "warm bodies".

Sorry la, Dr Og dunno what  warm bodies are... simi lai eh? Are warm bodies those not yet cold but will eventually turn rigor mortis? Or do warm bodies belong to hot girls who have somehow gain 10kg after marriage and child birth?

And how often has it been that we hear our bosses and senior management talk about getting warm bodies for the department. We need warm bodies here, warm bodies there, warm bodies no enough. A warm body is better than no body.

When I did a literature search (on Google of course), the following definition turned up:
 n.
just anyone who can be counted on to stay alive. : See if you can get a couple of warm bodies to stand at the door and hand out programs.(1)

When I look around the office, I see a horde of warm bodies prevented from decomposition by air-conditioning set at a ridiculously low temperature; set to be turned off by these very warm bodies after they have left work while the rest of us continue to slough and suffocate to death. They don't do any real work. Some may pretend to press on the keyboard, some may be blatantly watching youtube and most are just making nonsensical updates on their facebook status .

So gahmen say they will flush healthcare with hard cold cash and so all the hospitals die die gotta employ or deal with losing funding later on. But lemme tell you, warm bodies will do more harm than good (unless they belong to the hot girls before childbearing!):

1) They are space occupying lesions. Warm bodies take up space. Even if they have nothing to do, you gotta give them a place to sit, or at least stand right?

2) They will kill morale. Soon everyone, even the good guys, will want to be a warm body coz there is nothing to do and you can still draw pay.

3) Membership is for life. In healthcare no one ever gets fired. When u ever see anyone dismissed tio boh? Once inside, the warm bodies will stay there forever.

4) Warm bodies have NO insight. They think they are the best workers around. They believe that they should get an 'A' grade for deceptively looking busy and getting in the way of those who are doing real work.

5) Warm bodies cannot be trained. Its a fallacy that warm bodies can be trained to do work. If they can do work, you will realize it during the job interview or at least on the first day of work (and therefore they will not be labelled warm bodies).

So don't just hire for the sake of hiring. Especially in healthcare where its a matter of life and death. If they don't deserve to be a specialist, fail them during residency. If they don't perform up to standard, send them back where they came from. Don't let our healthcare system become diabetic; hyperglycaemic but you can't digest the sugar.


Wah got Reference Sia!
(1) http://dictionary.reference.com/idioms/warm+body

A Corn Job?

Suddenly, in Dr Og's FB, alot of status say going Fire Drill. Seems like in recent weeks, there have been a spike in the number of drills performed all across the hospitals of our little island! If only I can bring my dog to work, he would be very excited!

Well, there are no dogs in hospitals but there are DOCS. The everyday challenges of life and death are seriously insufficient to occupy the great minds of doctors. In between saving lives, docs are also expected to be involved in operational and administrative duties.

Jay in his corn field

The holy grail for the admin is of course Jay-See-I (pronounced as JCI). Jay is a Bee Kok Kia (from US) and every few years, he will come visit us in the hospital and See (actually more like scrutinize) how I am doing. He will issue you with a certificate if he thinks you are doing things right.

But I think Jay is a con corn man, peer jiat one! Does he know anything other than corn to tell us what to do? No, no, no... In true Americano Bee Kok style, he gets you to produce books and books of standards, protocols and policies and then audit you based on the standards you created. Like that very sinang mah, Jay just make you do the work and collect his million dollars fee after he tells you how terok you are!

Actually like that also is very simple for us, as long as we make the policies easy for ourselves! But how can right? We kiasu, kiasi! We need to SM ourselves with the highest standards. If Jay tells us to jump 5 metres, we die die jump 10 metres!

In the ward...

Medical Officer: Why I cannot use blue pen???
Sister: Bee-coz hor, Jay won't like it.
Medical Officer: But other wards can what!
Sister: You see you see, I photocopy blue ink not clear! Wait sure fail Jay-See-I! And you also cannot use fountain pen bee coz will fade. And you cannot use gel pen because will smudge. And...

Somewhere else...

Staff Nurse (SN): Doooctooor, harder! Yes, deeper! 
Senior Consultant (SC): I cannot tahan liao! (panting) How many more thrust???
SN: Oh Dooctooor, almost there! almost there!

The SC is of course performing chest compression on a mannequin at the Basic Cardio Life Support (BCLS) Course with the trainer who is the SN. Never mind that he is all 70 years old and might collapse anytime himself. Also never mind that he has 40 years of experience in Anaesthesia and the number of resuscitations he has done are too many to be counted. Even more never mind that his trainer has never resus anyone other than a plastic mannequin (and if the SC collapse the SN would fail in resuscitating him).

Why liddat? Because Jay-See-I...

Again, this is all very solid if we can maintain high standards we saboed ourselves with. But oh no... being Singaporeans, we only mug when the exam is round the corner, right? So in the half year prior to Jay's arrival, we suddenly gotta chop our names, write the date and time, use black ink (but no fountain pen), get accreditated for BCLS and of course, there's always the fake fire to learn how to run away from.

Interesting Fact: Fire was a discotheque popular in the 70s. The patrons were all bengs and lians chanting "Fire fire in the sky..."

Tags: Fun, JCI, Medical, Quality

Hospital Hierarchy

Houseman Survivor Guide
I. Introduction
II. Hospital Hierarchy
III. A Typical Day
IV. Painkillers
V. Meet The F*ckers

I have been asked to explain the hierarchy in the hospital. I guess that is pretty reasonable though I am quite disappointed....... haven't you all been taking careful notes of my posts!!!??? And by now shouldn't you already know the answers??!!!

I guess not and here goes (from the lowest rank to the highest):

1) The houseman a.k.a house officer, a.k.a HO also known as intern in America
Experience points needed: 0, just need to pass MBBS (Monkey REpublic)

The lowest life form in the hospital. Looked down by everyone and despised even by the amahs. Despite the fact that they do the bulk of the dirty work, do not even think of appreciation. A HO's duties include getting to work before his bosses and preparing for the ward round before the team comes. He is in charge of all the ward duties and orders given by the team (we call them changes). He has to take blood, do discharge summaries, speak to full of nonsense relatives that no other team members wish to entertain, take some more blood and occasionally suck his bosses' asses. Do not despair coz each sucky low down brainless job gives you 1 experience point and in no time (actually in one year) you will gain enough EP to raise level.
A successful HO is best described as a prositute, providing the best service to everyone including the MOs, Registrars, Consultants........

2) The medical officer a.k.a MO
Experience points needed: 10,000

After swimming around the wards as an amoebic creature, a HO after one year develops into a more decent life-form (like tamagochi like tat lah) : the MO. A 1st year MO is known as a baby MO. The MO's job is quite different from his amoebic past. For one, he can acutally argue back with the nurses. If things really get out of hand, he can also complain to the nursing officer ("MO also o-hui-cer, NO also o-hui-cer, who scared who). But bare in mind that the nurses always win (unless you no scared make girls cry).

A baby MO with new found power (and dignity) often acts irrationally and rashly. He will not hesitate to show off his knowledge or correct the senior doctors especially if he not been properly baptised into medical practice during the HO year (not tekan-ed enuff).

He will learn that you don't do stupid things like quarrel with nurses and argue with your bosses when he gets a "C" grading for his posting and consequently gets only paltry pay increment and bonuses.

When the MO manages to pass an interview and is successfully accepted into speciality traineeship, he becomes a trainee or MOT. It is something like a promotion in that you are now accorded slightly higher status and more responsibilities are expected of you..... No! You don't get a pay raise, instead you have to PAY for the traineeship!!!! Yes you pay to do more..... its like SM, come on give it to the MOT!

There is another MO entity..... Lurking in some corner of the hospital is the chronic MO. These are doctors who fell off the system but somehow never made it to GP pratice. They are chronic as they do not specialise and they will forever remain MOs. You can easily recognise them from their BCC (臉臭臭) facies and their preoccupation with some other side lines. Chronic MOs are the nautral nemesis of nurses as these are people who can be of equal seniority to the ancient matrons and like them still have not moved on.

Specialist and the Senior ranks
HOs and MOs are not specialist. A MO can transiently become a MO-specialist (MOS) if he passes all the exams but there is not specialist slot for him.

Registrar a.k.a Reg a.k.a 'R'
Experience points: 100,000

Usually when a MO gains enough EP from performing countless procedures, therapies and politics over coffee, he is ready to attain Advanced Specialty Training and raise level to a Reg. The Reg now can independantly make decisions and lead the team. He is a specialist but still need approval and guidance from the Consultant for difficult cases. Otherwise he can afford to come later than the MO for the ward round.

Associate Consultant a.k.a AC
Experience points: 200,000

Having served his time as a Reg, he gains level quickly to become an AC after completing his exit exam. This is the same as the previous Senior Registrar rank. They just change the name to make some hanta kaki senior reg happy. This is usually a transient rank as the AC will soon depart for foreign land to learn this ancient art from a different race.

Consultant
Experience points: 500,000

A consultant is a full fledged specialist. He is now the boss of his own team. Everyone in the team kow tow to him. Other than clinical responsibilities, he has to wrestle with administrative irritations. He has to approve the bloody leave of that stupid MO who decided to get married when the rest are busy preparing for exams.

Senior Consultant
Experience points: 1,000,000

Having grown roots in the department, the senior consultant is a god-like figure. He appears to save the day when less experienced doctors botch the job. He makes the final enlightening comment during the grand ward rounds and he will soon be forced by admin to either semi-retire or go private as he is too expensive to keep around despite the gem that he is.


The Private Doctor
Experience points: 0 or 1,000,000,000,000

Sometimes, doctors fed up with public hospital and will go private! Most times this is an upgrade and the experience points goes up! But at times, some lokun experience points become zero after going private.

Of Diseases and Administrators

Ever since our gahmen's pro-creation policy was announced, many departments had started on five days work week. But as my boss correctly put it, "Diseases do not respect office hours". So most doctors are still rostered to come back on weekends to see patients. And yes, you guessed it (if you didn't, you haven't been reading enough of my blog, press Alt-F4), we don't get paid for the hours spent doing these morning rounds.

You can claim for transportation though it has come to my notice that despite the steep hike in petrol prices, our mileage claim had remained the same for the past donkey years.

And to compensate for the Saturdays off, our working hours have been increased by half hour per day during week days (you do the maths). As you see, while diseases don't respect office hours, administrators most definitely do......

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