Saturday 6 May, 2006

Don’t give out your home telephone number

Posted in Advice, Michael Tam at 8:08 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Is it a patient?

For similar reasons of security as explained here, do not give out your home landline telephone number. There is no particular reason why anyone needs to know your home landline number and it is relatively trivial to convert a number back into a physical address.

If you do need to give out a telephone number, a mobile number is always preferable. In the worse case scenario, you can always just get a new mobile number. If you want to give your patients an avenue of contacting you, the practice telephone number or hospital ward telephone number should be sufficient. I once made the mistake of giving my mobile number to a patient’s mum (while I was at the Sydney Children’s Hospital) as she needed a way of contacting me on the weekend. This resulted in being called about 5 times over the weekend for trivial matters. Thankfully, apart from being somewhat anxious, she was otherwise settled so she never called me again.

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Friday 5 May, 2006

Get a post office box with mail redirection

Posted in Advice, Michael Tam at 23:36 by Michael Tam

Original article by: Michael Tam :: Printer friendly

I discovered this in my internship and it is something that you should definitely consider investing in.

There are many good reasons why you should get a personal “post office box”. The main reasons include security, safety, convenience and professionalism.

You will have to trust me on this one, but you do not ever want to be stalked by a patient, particularly a patient with a mental illness or one that has a grievance against you. Considering that over the course of your career (even as a JMO) you will meet literally thousands of patients, even having a very small proportion of “wacky” people being your patients, you will still potentially come to grief (and the proportion of “wacky” people out there isn’t that small). The best way of minimising the risk is:

Never give out your home address to anyone except your family and close friends.

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Sunday 30 April, 2006

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

Original article by: Michael Tam :: Printer friendly

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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Keep a broad holistic outlook

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

Original article by: Michael Tam :: Printer friendly

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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Get “on side” with the nurses

Posted in Advice, Emergency Dept., Michael Tam, Wards, Workplace at 13:11 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Nurse Ratchet

The infamous
Nurse Ratchet

The nursing staff is a buffer between you and every complaint imaginable to man that your patients may have. They can make your job easy or make your life hell so it is pretty important to make sure you develop a good working relationship with the nurses. That is not to say that you should do everything they ask of you, but a bit of courtesy and respect can go a long way. Often, if the nurses think that you are competent and reliable, they will stop pestering you for every minor thing.

A lot of the senior nurses are very experienced so you should consider their worries about patients seriously. You should take their ability to “triage” your patients with gratitude.

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