Sunday 30 April, 2006

Don’t let administration steal your unrostered overtime and ADOs

Posted in Emergency Dept., Michael Tam, Rants, Wards, Workplace at 20:39 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Catbert

“Catbert” the evil
Human Resources
Director

Administrators are not working for you. They are working for themselves primarily and secondarily for the “system”. From an administrator’s point of view, the “system” is working if they meet budgetary constraints, meet performance indicators like “length of stay”, and there are minimal complaints from members of the public. If medical administration can get this done by bullying the junior medical staff to work harder, longer, with less supervision and less pay, then they will, and they do.

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Form a strong JMO/RMO association

Posted in Michael Tam, Rants, Wards, Workplace at 20:09 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Strike!

We want our meal vouchers,
dammit!

Assuming that you work about 50 hours per week, you will be spending over a quarter of your life in and around hospital. If you are lucky and have good supervisors and mentors in the hospital, you may have people in the “system” that are both “on-the ground” and “proactive” in maintaining your interests.

The usual situation, however, is that you can be fairly certain that no one really cares about you. The only reason that your work hours are not excessively onerous, that you are paid rostered overtime, etc., is because of labour laws, your award and the guidelines as set by the PMC (Postgraduate Medical Council). Though these things offer a basic level of protection they are no good at providing any form of short or medium-term assistance with regards to industrial issues. The PMC, though a wonderful organisation, can really only act, “after the fact”.

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Protect yourself legally

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Wards at 19:47 by Michael Tam

Original article by: Michael Tam :: Printer friendly

you don't want it

The modern world is litigious

Whether you consider it a good thing or a bad thing is a matter of perspective, but the reality of the modern medical landscape is that it is a litigious world.

Although I do not believe that your medical practice should be focussed from a “defensive” point of view, one has to recognise that even though many threats of litigations from patients do not have merit from a “clinical negligence” standpoint, they often still have some sort of valid grievance that may have been handled better.

A special group of patients that will try to sue you are those who have a grievance with society in general. You will recognise them easily. They will complain about waiting in the Emergency Department, and typically refuse to commence the recommended treatment. Bad outcomes are not only more likely in these patients, but will always be viewed as “your fault”.

Being mindful of potential litigation is entirely compatible with good clinical practice.

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Get medical indemnity

Posted in Advice, Emergency Dept., Michael Tam, Wards at 18:22 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Protective gear

Don’t start work
without it

Although you don’t technically need private medical indemnity as long as you are working in the public hospital system and are on a training program (i.e., intern, RMO1 and accredited registrar positions), I highly recommend that you get it from day one of internship. The hospital does indemnify you and in general, this is sufficient. However, if there is a situation such that the hospital thinks that you alone are in the wrong, you may find that hospital administration will not support you legally. If you don’t have a medical defence organisation fighting for your interests, you may find that you have very few options bar hiring a solicitor. You do not ever want to be in such a situation.

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Recognise that you may hate some patients

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Wards at 17:42 by Michael Tam

Original article by: Michael Tam :: Printer friendly

I hate you...

Some patients will just
rub you up the wrong way

Most junior doctors have an upbeat and positive attitude when they start. However, before long you may discover that you dislike if not truly loathe some of the patients admitted under your care – no matter how much you try to “empathise” with their situation. Many doctors find this situation quite confronting and deal with it poorly. The most common response is denial and guilt; and though this may be “okay” for a patient in the Emergency Department who you will never have to see again, it is not a good framework for inpatients, especially if they are sicker or have chronic illnesses.

It is important to recognise to yourself when you don’t like someone as it is easy to fall into behaviours or conduct that is unprofessional, e.g., being rude or openly angry to the patient, minimising contact to such a degree that it impairs clinical judgement (i.e., taking a poor history or examination or giving inadequate information for a consent), or doing “punitive” blood tests or procedures.

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Never criticise a colleague in front of patients

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Rants, Wards at 17:24 by Michael Tam

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There will be times when a patient will relay you a history where you will think that another doctor’s management or clinical decision to be baffling, inexplicable or plain wrong.

Be aware that there are malicious people who view doctors as a soft target for litigation. Don’t let a careless comment ruin someone’s year.

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Beware of drug reps bearing gifts

Posted in General Practice, Michael Tam, Rants, Wards at 17:19 by Michael Tam

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Big pharma

“Big pharma” only loves your
prescribing power

“Big pharma” spends billions of dollars each year on advertisements to doctors, and they are not doing so out of charity. Every doctor you speak to will think that they are not influenced by the pharmaceutical industry and this is the great swindle of our profession. Drug advertisements are so pervasive that it is sometimes hard to know where they end and where real medical education and trial results begin.

Part of the problem is that drug representatives are invariable really nice people so it is almost impossible to turn them away. They develop good if not great rapport with most doctors and what they say always seems to make perfect sense. Never forget, however, that they are still working for a big multinational whose goal is to make money; and their way of making money is to convince you to prescribe their most expensive drugs to as many people as possible.

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Keep a broad holistic outlook

Posted in Advice, Michael Tam, Rants, Wards at 16:58 by Michael Tam

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Don't loose sight of the forest

Your patient is more than the sum of
their symptoms and signs

It is easy to loose perspective during a busy medical or surgical term. Patients become known by their illness or disease, and you may soon find yourself doing tests and asking for consultations on routine rather than for clinical indication. It is easy to be too heavily focussed on the “tree” and miss the “forest”. Many hospitals have set protocols and they are generally a good idea as it means that a clear clinical pathway is followed. However, a protocol is not a substitute for thinking and clinical decision making; context is important.

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Help each other

Posted in Advice, Michael Tam, Wards, Workplace at 13:34 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Help each other

Everyone can do with a little bit
of help sometimes

No one knows the difficulties of being a junior doctor better than your fellow junior doctors. You must as a group try to help each other out. If you are not in a particularly busy team and the general medical intern is struggling, offer to help with their ward work. If someone needs to swap out of an overtime shift, try to be accommodating.

If you look out for each other, hospital work will much more pleasant. By working together as a group, you will reduce the amount of “burn-out”. Everybody will have their rough patches and their “bad” weeks and terms. It’s part of the job. However, knowing that you can reliably fall back on someone to pick up or swap a shift when you’re just exhausted from your day job is very comforting.

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Remember that you are the doctor

Posted in Advice, Michael Tam, Rants, Wards at 13:21 by Michael Tam

Original article by: Michael Tam :: Printer friendly

As you work through the hospital system as a junior doctor, you will meet a special group of people. They are usually nurses or sometimes allied health professionals, who think that they are clinicians; and they definitely think that they know more than you.

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