TCM Exposé!

Stop looking at the legs and focus on the Leng Yong drinks!
(Source: http://christallehuang.blogspot.sg)

Patients always ask Dr Og about TCM, aiyah very pek chek lah. All I know about TCM is last time small I fever, my mother give me leng yong drink. End up I my fever never subsided for one week. Now I smart, just take panadol and pour whatever tonic my mother gives me. hahaha

But the most irritating thing about traditional medicine is this scenario:

Ah pek: "Lokun, why cannot recover one. You no good la"

Lokun: "Ah pek you got take your meds boh?"

Ah pek: "No leh, I am taking herbal medicine to adjust the Qi. The sinseh say my body too cool liao."

Lokun: "Alamak, just take both lah."

Ah pek: "Cannot! Take Chinese meds cannot take Western meds. Will cheong!"

(Disclaimer: no ah peks were ever hurt or injured in the making of this blog. Though sometimes there is an urge to knock their heads.)

In any case, Dr Og did some investigative journalism and here are some photos of Traditionl Chinese Medicine made the most traditional way. You decide if these are things you like to ingest, ok?

Wah, another innovative use of children's playground! Air dry TCM!

TCM medications processed and made the most traditional way. No western factories or industrial manufacturing! Just leave on the ground for extra ingredients!

A closer look. Just hanging around, hanging around...

Wow, pigeons all around the area. Mebbe they need to put up a scarecrow!

My humble thoughts on the SMRT Strike 2012

So now they officially call it a strike. And as you know, strikes are illegal in Singapore.

Nowadays COE so expensive, Dr Og also gotta take public transport. Compared to many countries, our transport system is very steady (bom bi bi) liao loh. In some countries, strikes are so common that they become a part of daily living. But usually, you have local people buay song their gahmen unlike in our case.

The Straits Times yesterday (not me hor) aptly pointed out  that Singapore is so reliant on foreign labour and talent even in healthcare sector.This to me is quite scary.

If strike how?

As we approach the ten years anniversary of SARs (Severe Acute Respiratory Syndrome - Singapore, 2003) and with news of a new strain of coronavirus (SARS-Like Virus Resurfaces And Infects A Family In Saudi Arabia) lurking, I can't help but wonder whether we can depend on any other than Singaporean healthcare workers should another pandemic erupt.

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!!!! 

Waste Time

So National Day came and went. This year Dr Og so busy, never even watch the fireworks. In hospital, always so many things to do; like change passwords, forget passwords and reset passwords for the various computer systems in the hospital. Plus if you also go to other hospitals to "visit" (means you kennah prostituted to other hospitals), you need to remember extra sets of passwords!

This is no easy feat especially when we get older and your digit span gets shorter! (BTW, digit span is not the length of your finger or any other parts of your body, so don't worry hor!) Now they more kiasu! Must have alphanumeric and capital letter! Uncle sometimes cannot even remember where I park my car you want me to remember so many difficult passwords?

Talking about car parks, the car parks in our hospital are the most jialat. One particular hospital the ramp into the car park so narrow sure scratch if you drive big car ok! Lucky uncle no money anyway so car small small. But the worst thing about the car parks are that there are no space. So if suay suay traffic jam or go out makan during lunch, come back sure no space. Now you know why your lokun always late for clinics huh!

But most times, we doctors always have to go to hospital very very early. Not to start ward round early, but to attend talks. Most times, the talks are irrelevant to your area of speciality but your Boss need to fulfil KPI for attendance. Its really funny to see Operations people working on their laptops in a clinical presentation. Talk about wasting time. Sometimes, the hospital hold talks during lunch and they tell us that's the only time doctors are free. But why they never provide lunch huh? Then when do we get to eat??? Then again, I must really count my blessings if its not one of those compulsory admin talk I have to attend coz unlike the Ops people, I cannot see my patients while listening to them sprout Greek. Mebbe next time Dr Og write blog during these talks! Anyway they are not during the official office hours. Ha!

Ok, I better get back to my work. Dr Og has cleverly written all his passwords on a piece of name card so that I will never get them wrong again.

Hahahahahahahaha!

Wait..... where did I put the name card huh?

Sometimes They Don't Survive

Statistics is very much part of our training in medicine. The graph above is known as a survival curve and every step signifies a death. Whilst a million death is a statistic, each death is to a doctor a powerful if not sometimes painful reflection.

For we may try our utmost and do whatever we can but sometimes, some will slip through our hands. With each death and with the bias of hindsight, there is always that nudging, albeit transient, feeling of guilt. The feeling that I could have perhaps done things better or that I could have done more, if I can do it all over again.

Or perhaps it is with the knowledge that with each death, we are ourselves one step closer, that is the origin for this wishful thinking of saving our patient's life, such that ours may one day be saved.

But alas, sometimes, and oftentimes, they don't survive.

The Avengers

Those who have not watched the Avengers must go and watch la! Especially lokuns. Not only was it very shiok to see Ironman fly here fly there, Hulk jumping around, Cap American cheonging aimlessly, the Avengers actually delivers a  very important message. Like in our Lokun Choo, Avengers is all about team work!

In a medical / surgical team, you always need the goodie two shoe like Captain America who does not care about pay or fame. A also stands for Altruism and he is always ready to throw the A card in your face. If you tio smack by him, its almost like kennah Cap's shield. Sure faint big time!

You will also always have the maverick like Ironman, narcissistic because his lao pek wu liu and he drives a Porsche to work. But no worries, Cap will keep him in check! Only problem is he will get all the girls la... (just accept it ok.... you drive Chery QQ, he drive Porsche...)

In every team, there will be a Hulk. Forever angry with everything and bashing around. You dunno why he is jumping in anger but he complains incessantly about everything including canteen food no good, weekend rounds too many, pay too low (which is true) and changes too many. Most of the time, Cap has to come in to damage control for him. Others may hate him but Cap will tell you he has a nice side to him known as Bruce Banner and is harmless la.

Thor is my fave character in the Avengers. Who don't like a pretty boy who thinks he is God? Unfortunately narcissism may cause conflicts in the team and Ironman will fight it out with Thor for that one chiobu nurse! Thor will lose as he is actually in love with himself (something only Gods can do) and is too busy playing with his own loin lock. Thor's greatest weakness is his hammer. It behaves like a boomerang; dunno how many times he tio whack by his own hammer liao!

Most teams will have a Hawkeye but some teams may have a lesser version, the Cockeye. Hawkeye is the most hated member of the team. Problem is that he likes to shoot arrows at people. If you tio his rapid fire, good luck. Cockeye abit better, coz he shoot arrows but everytime buay tio!

But hor, the most important member of the team is Black Widow! There must always be a sweet young thing in the team to make all the difficult blue letters to the hum sup senior doctors. Any unwarranted urgent radiology scans that your Consultant ask for, ask her to settle, sure can! However, she must be zhai enough like in the movie so that Ironman, Thor, Cap America and Hulk not matter how horny won't dare to touch her coz she is thorny.

It is important to remember that like the Avengers, we need to work together as a team to repel any possible Alien invasion. Good luck!

打点滴

Ok, if you guys are expecting daily updates, please don't. Just happen that I read this news I buay tahan must share my experience:

Patient: 医生，为什么不帮我打点滴！
Loctor: You have tension headache, iv drip will not help. Your blood counts are normal. No infection, no need for iv antibiotics.
Patient: 不行！我在国内每次头痛都打点滴！打了马上好！
Loctor: I'm telling you there is no indication. You are not dehydrated. No need iv.
Patient: 你是怎么當医生的呀! 我头痛就是要打点滴! 痛死了!
Loctor (in broken Mandarin ((I know, this loctor damn jialat, English Chinese all broken))): Tamade dian di ni de tou!! Chi wang yao ma shang hwei jia! (Google Translate: Madam, you can go home after having your pain killers.)

In some countries, strange as it may be, it is a cultural norm for patient to get an i/v drip for any condition or complaint. In Singapore, we like to do things for a rational reason. 不爽你又能怎样?

48 Men

The ongoing saga of the 48 men (and counting) reminds me of the times when we take a sexual history for our patients...

Loctor: Uncle, you got visit commercial sex worker or not?
Ah pek: Huh simi lai er?
Loctor: I mean prostitute la.
Ah pek: Huh? simi prostitute??
Loctor: Aiyah, chicken la...chicken...
Ah pek: Orrrhhh, Gwer! Got la. But tell you ar, I call chicken and then only talk la. I never do it...
Loctor (puzzled): Huh, talk only?? Never have sex??
Ah pek: Yah lah, no piak piak. But talk I also pay...

It is not uncommon (really) that (male) patients tell us that they have gone to CSWs but ended up only having conversations. The possibilities are:

a. Uncle cannot stand
b. Uncle forgot to take his Sildenafil (if you dunno what that is, click on the link, brand names not provided here as Dr Og is impartial!)
c. Uncle bought Sildenafil from JB and kennah counterfeit.
d. Uncle depressed, just need someone to talk to (unlikely because visiting a gahmen psychiatrist is cheaper and most Vietnamese don't speak local dialects)
e. Uncle tok cock (literally)

It is strange that not one of the 48 men brought up the defence of "I only talked to her niah!" in Court. Best still if the victims (48 men) can prove that they have some sort of erectile dysfunction or premature ejaculation and could not have penetrated the victim (under age CWS). Whatever the case, it will be impossible to prove that sexual intercourse actually took place though I am not sure if that has any legal impact. Maybe just having the intent and having made payment is bad enough to land you in jail.

So the next time you try to get a sexual history from uncles, don't forget to remind them to check the i/c or passport of the CSW. And if they really just need to talk, refer them to the appropriate people like counsellors, psychologists... (don't bother referring to psychiatrists, they don't generally talk to patients). Beats spending nine weeks at the wrong side of Changi!

5 Types of Medical Colleagues You Love to Hate

Dr Og tries to be positive but sometimes the serotonin receptors in the brain gets a little short circuited and you can't help but can't stand some of your fellow colleagues.

1. The Pseudo-Researcher

This dude was basically a chow mugger in school. When people were chasing skirts, he was chasing paper. So when he became a lokun and has gotten his name on as many degree as he can, he tries to get his names on journals. He does not care if he has any right to any database and will bulldoze his way to generating papers for journals even if he offended the rest of the world. Most of his papers would be case reports of no scientific value as he will not spend too much time doing good solid studies. After all he just gian to see his name on paper.

2. The Sneaky Bastard

Remember that JC classmate that told you he never finished studying for the exams and still topped the class? Remember the time he said he did really badly in the exams and ended up with an A when the results came out. That classmate of yours is probably a doctor now! Instead of being sneaky about his studies, he is now sneaky about his work. He doesn't share his notes for the MRC(Whatever) or M.Med Exams. He will borrow all of the senior's notes and tell you he lost it. He will chope exam leave before the posting even starts. He pretends to go for evening rounds but ends up assisting the HOD in the operation of the decade while you slough like hell in the ward. As he get more senior, he keeps news of research grants, training programmes, overseas conferences and any other opportunities to himself, even if he does not need them. He will suck up to the boss, get an A* for his TPM and tells you he got a B. He is sneaky because he is selfish. Just like back in JC days.

3. The Learned Colleague

Some say that learning is a lifelong process. But this people take it too literally (may be due to some frontal lobe lesions). They seem to be forever away for courses and training. However, they are never able to apply what they have learnt in real clinical practice in that few days you see them in the wards or the clinics. Your Boss may however be quite impressed with their insatiable quest for knowledge. Unbeknownst to him, these people will suck up the department training fund, make absolutely no contribution and bring their knowledge to their grave.

4. The BCC Char Bor

This is a bit of a sad case. Call it uglism but you cannot bin chow chow (face black black) if you are not bin swee swee (face pretty pretty). Typically, the BCC colleague is a female who just have to black face everyone. It may be that she steps on shit every morning or that she had some very traumatic experience during childhood. But whatever it is, she puts up that "you owe me money" kind of facies day in day out, to juniors, to peers and to seniors. The whole team cannot stand her but she does not seem to care. The only time she will smile at you is when she needs a really big favour from you. Sometimes, some idiot may defend her in the department and induce guilt in you by saying that if she is pretty, you would not be so upset with her. Do not feel guilty about it! This is real life, if you ain't pretty or handsome, then be nice. Prolonged PMS is not your birthright.

5. The Super Duper Bastard

Some people have it all! Its probably in the genes. Every decade or so, the stars align and the super duper bastard is spawned. He is the pseudo researcher who chases every paper qualification and writes stupid papers regardless of the scientific value (of which you sometimes have to review if he submits to the local journals). He is the sneaky bastard who uses rejected submissions to journal and sends them for overseas conferences as posters. He uses up all the department training fund to go for these overseas conferences and is thick skin enough to buay paiseh still go for lots of local courses. He may be a she and if back in the department for that few days annually from her long sponsored trips and courses,  she will show you her BCC!!

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