Service Quality

Dr Og is still a bit sore over the fake 20% pay rise saga. You see, in a recent wedding I went to, a IT friend exclaimed loudly, "Wah! 20 % pay rise ar!!"

I took great pains to explain that "no lah", its at best 5% per annum, lest the bride and groom expect a corresponding increase in the ang bow!

Another issue that arise during the recent saga was the introduction of the Service Quality Komponent. Lets just say Dr Og is a great proponent of solid service. Some doctors don't seem to realise or they die die don't want to believe that medicine is basically just a service industry. Yes, doctors (of all grades) tend to have a messiah complex and think that they are doing what they are doing to save lives. But honestly, even saving lives is a form of service, is it not?

And it is not only the patients we are serving. We also serve our Bosses. These days things may have changed with Residency but when I was a Houseman, I was the biggest service provider since I served all the patients and was at the beck and call of everyone else in the team from the Medical Officer to the Senior Consultant. We had to buy coffee, run errants and play flower pot during meal times with Senior Cons who needed his ego soothed with a big entourage. More often than not, we also tio raped and kennah bwat guyou on our gluteus region by our seniors. At times, we had to go karaoke and it is rumoured that some female HOs also provide extra service. Hahaha...

You wouldn't blame me if I were to tell you that I felt like a prostitute as a HO, the similarity in that we had to service anyone and everyone, being the lowest life form in the hospital food chain. And when I became more senior, I often had to use this analogy to correct the attitude of some yaya papaya HOs or interns.

But on deliberation with one of my senior doctor one day, he concluded that the term prostitute may not be most appropriate for obvious reasons. He reckoned, "I think we are more like...... Geishas!"

卖 艺 不卖身！What wisdom :)

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

How Long Should We Wait?

I was waiting to see my Lokun the other day (yes, Dr Og IS ah pek and need to see dr also lah) and I had to wait one hour! The lady in front of me cow peh cow boo for being seen 15 minutes late, "Aiyoh, like that hor I tell you I might as well come late. Also get seen at the same time WHAT!!"


But then when it was her turn, she stayed in the consult room long long, refuse to leave and thereby contributed to my long waiting time!

Dr Og usually don't complain when I have to wait because my medical colleagues always waive professional charges for me la. Even at A and E, I also don't cut queue and most of the time I don't declare I am a doctor because I paiseh...

I know its quite a hassle to see a lokun because of the long wait. Its like tennis, you wait for the player to wayang abit, bounce the ball, swing the bat and suddenly everything is over in a split second! Still ok if its a sweet young thing tennis player but otherwise what a boring sport.

Waiting for doctor is the same thing. You wait and wait and when you enter the consult room its like kennah hypnotise, cannot remember what you wanted to ask and then the consult over liao!

But how long should we wait?

I'm not talking about how long patients should wait but instead how long should doctors wait for their patients? I can safely say that at least 75% of my patients don't come on time. The range of lateness can be from 5 minutes to anything like a few hours. But because the clinic staff don't want to offend the patients and always got something against doctors, the late patients still get registered and have to be seen.

If I had my way, I will not see any patients that is late. If you are five minutes late, its 50% of a ten minutes consult. Its neither fair to you as a patient to be seen in a rush nor to the doctor who needs to decide on your management.

Patients have many reasons for being late:

1) "Loctor, hospital boh parking one". This one quite true. They build hospital never build car park space one. Expect patients to take helicopter isit?

2) "Raining leh, din bring umbrellllllla". Singapore weather suka suka rain and Dr Og also don't like to take umbrella out, so can understand!

3) "I forgot got appointment until last minute than I rush out!". Aiyah, forgot then forgot all the way can or not?

4) "I was looking for my appointment card..." Alamak, the last time and the last last time already tell you no appointment card also can register...

5) "I come early also must wait!" Ok, you continue waiting.

6) "I was abducted by aliens on my way here!" Boh jiat yok!

7) "Loctor, I have to finish watching 爱 first."Courtesy of anon@1123AM

Sometimes, patients may be late because we cock up on our side too. For eg, they give patients a cardio appointment before the respi appointment and the cardio appointment got delayed.

And sometimes, doctors can be late themselves causing delays in the consult.

But in all honesty, patients being late is the number one cause of why you are not seen on time! The appointment time just keep getting shifted backwards and the ones who are slotted towards the end just gets seen later and later.

So I will like to make an appeal for all those who read this (you must be really bored) to go for your appointments with your doctors early. Simply because the reason why you are not seen on time is because you are late yourself. Have pity on doctors, they are humans and need to have their lunch. They also got family to go back to after work.

And surely you don't want to be the one waiting for one hour behind some kpkb woman.

Green Creatures

As a young kid, I was often fascinated with mythical creatures such as the Yeti and Loch Nest Monster. It was even more fascinating when I visited Scotland that I did not see any monsters (unless you include those ang moh char bor who are double my size with more facial hair than my pelvic region)  but instead found out that a whole tourist industry can be generated from these creatures of unknown origin.

But actually hor, there is also such a mythical monster that has been frequently sighted in our hospitals. In Singapore, we are unable conjure names like The Abdominal Abominable Snowman as its too hard to spell and cannot pronounce in Singlish. So we call this creature, AnAssF (pronounced N-S-F).

The AnAssF is green in colour (mostly)  and was first sighted in the eighties. The sightings have become more frequent as our little island become more urbanized and congested (it will however be wrong to assume causality as con founders such as over pampering mothers need to be ruled out).

Possible areas for sightings include the A and E particularly in the middle of the night. He will appear out of nowhere with the chief complaint of "Can have MC for today boh?" If he manages to get a MC for today, he will routinely try his luck and ask for MC for the entire week. When asked what physical ailment he actually suffers from, he may have anything from anal itch / headache / eye pain / earache / sore throat / chest pain / armpit pain /  leg pain / faint when exposed to sun. Over the years he has learnt not to complain of abdominal pain and/or diarrhoea as that will automatically earn him a PR which is generally unpleasant unless you meet one that enjoys prostatic massages.

Physical examination will invariably yield NAD ("No Abnormalities Detected" /  or sometimes "Not Actually Done") but the kind doctors will always give him the benefit of the doubt. However, the real diagnosis will be revealed when you see the re-entry chop to Zouk on his wrist and it is Thursday wee hours.

Sometimes, the AnAssF may get admitted by some sotong amateur A and E locum, especially if the doting mother (another legendary mythical creature) is accompanying. In the ward, the AnAssF continues to have strange and unexplainable symptoms but no actual signs (except for the washout Zouk re-entry chop) can be detected.

It will not take long for junior doctors to know that the cure all for these green creatures is Atten-C (MC lah).

PS: That said, many NSFs have genuine symptoms. Some are also genuinely very stressed up since their maids are not there to help them do everything. Boy boy needs time to adjust lah!