Monday, April 28, 2008

House Officers: A Rose By Any Other Name....

We can call these medical graduates housemen, interns or by the acronym H.O. One lady surgeon even calls them slaves. The fact is, house officers are indispensable in Malaysian healthcare.

The day house officers in government hospitals go on strike is the day Malaysian healthcare collapses and comes to a total halt.

There is...a dire need for a system that places an emphasis on accountability and meritocracy. The lying house officer must be brought to book, the incompetent house officer sent back to his books, and the outstanding house officer written in the good books.

House Officers: The Backbone of Malaysian Health

Hypocalcemia in Pregnancy

It was 3am in the morning. A lady at 32-weeks of pregnancy came to the hospital complaining of numbness and very mild weakness over her right hand that was limited to a few fingers. The first house officer who attended to her, Dr. Gua, had no definite diagnosis in mind. She took the routine blood investigations anyhow which included a calcium level. Her calcium level came back as 1.9 which was low. Alarmed and concerned, Dr Gua referred the patient to her obstetric medical officer who was similarly troubled. She too had no inkling of the underlying cause and in turn referred the patient to a fellow medical officer from the department of internal medicine. The trainee physician arrived dutifully in a short while, attended to the patient, asked a few questions and ordered a truckload of blood investigations. The barrage of blood tests included a thyroid function test, liver function test, serum phosphate, serum magnesium, renal function test, serum and urine cortisol amongst others. She was worried over the unexplained severely low calcium level and decided to admit the patient for intravenous calcium gluconate.

Once in the ward, a second house officer reviewed the patient. Dr. Ahmad read through the notes and asked some basic questions. He too, was increasingly worried, but for different reasons.

Here’s why.

The initial blood was taken with a tourniquet that was applied for a pretty long time. Such a method of blood sampling may result in an artificially low calcium level due to physiological changes around the area where the tourniquet was applied. In other words, the pregnant mother did not have low calcium to begin with. Intravenous calcium gluconate is dangerous and could have killed her instantly.

The story does not end here though.

Dr. Ahmad repeated the blood sampling without a tourniquet. The result of the second calcium level was 2.2, which was acceptable in pregnancy due to physiological changes in the blood constituents. His medical officer however, did not think so and again referred to the medical team for further advice. It was decided that the plan to give intravenous calcium gluconate should go on. The mother was started on calcium tablets thereafter. Dr. Ahmad remained unconvinced and suspicious of his superiors’ management throughout. He complied nevertheless.

In retrospect, the pregnant mother presented with symptoms very typical of carpal tunnel syndrome. It was the right timing at 3am, the exact symptoms and in the ideal patient. There was no need for any blood investigations or any possibilities of an impending stroke whatsoever.

House officers and the Quality of Malaysian Healthcare

The public healthcare of Malaysia will rise and fall with the services of the house officers. I do not know about the rest of the world but this is fact for Malaysia.

The first personnel to attend to a newly admitted patient in the ward is usually the house officer. The ill patient who suddenly takes a turn for the worse is usually referred to the house officer on-call. Blood investigations, applications for radiological procedures, referral letters and discharges, and basic clinical procedures are all carried out by the house officers.

Without house officers, much work will not be carried out or would have to fall upon the shoulders of the medical officers.

We can call these medical graduates housemen, interns or by the acronym H.O. One lady surgeon even calls them slaves. The fact is, house officers are indispensable in Malaysian healthcare.

The day house officers in government hospitals go on strike is the day Malaysian healthcare collapses and comes to a total halt.

The Malaysian Medical Association (MMA), when they are not boozing away in the MMA house, has been fighting for the rights and welfare of house officers for decades now. I say aye to more rights and welfare and renumeration for house officers, yet I also know pretty well that we have a very variable and colorful population of house officers in the civil service. Not all of them deserve their basic salary of RM 2137.70 much less their much acclaimed right to greater benefits, higher allowances, more oncall claims and automatic promotion to a U44 grade officer.

I only have the experience to compare Malaysian graduates from local universities to Malaysians who graduated from foreign institutions.

Truth be told, despite all that they say about the low standards of our medical schools, the majority of our local medical graduates fit in fairly well into the local healthcare system. Fitting in is not synonymous with competency and excellence but most of our local graduates nonetheless are able to function in a system they are familiar with.

Granted a chance to work with foreign graduates in a foreign land, I just might be singing a very different tune. However, I am not even for a moment under the delusion that other nations naturally produce more ethical and more knowledgeable medical graduates.

I do know however that in most developed nations, there is a prevailing sense of responsibility and a emphasis on a culture of accountability.

That is something that is sorely lacking in our healthcare services.

The ‘Don’t Know’ House Officer

All doctors do not know something to certain extent. In fact, all doctors will not know anything about something if you prod them hard enough. Personally, I studied pharmacology rigorously like a mad man in medical school and naturally, I take pride in knowing something about drugs and toxins. If someone asked me something about the histological variants of ovarian tumors however, I will reply with nothing less than a stupid blank stare and declare with no shame that gynaecology is not my forte.

There are many house officers who however, seem to know nothing about all things. It’s really anyone’s guess whether this has always been the trend even in the good old days of Tanah Melayu or whether such a dunno tak tau culture is the result of half a century of race-based intake into local medical schools. The NEP policies have given rise to a complacent lifestyle among both Malay and non-Malays students. Why study hard when one has been having things served on a silver platter one’s whole life? Why study hard when one can pass an exam because the marking standards have been lowered to cater to the ‘special children’ with special rights?

House officers from foreign universities are not naturally better though.

The most reasonable and objective statement is to evaluate each house officer as an individual and not from the university one graduates from. We have a great number of lousy, undeserving students entering local universities both public and private institutions and they are not restricted to any particular race. We also have an abundance of mentally-challenged personalities graduating from India, Ukraine, Ireland, Indonesia and China. No doctor should be identified or stigmatized by the university one graduated from. The final competency of any medical student is really all about the person’s own initiative.

Unlike graduates from computer science and social arts and food technology, medical graduates upon completion of their studies are never ready to get up and work. A ‘don’t know anything’ house officer is terrible, but not beyond help. A conducive training environment made up of willing teachers, understanding superiors, supportive nurses and adequate facilities will make a world of a difference.

The ‘Don’t Know, Don’t Care’ House Officer

A forty-something man was admitted for hemorrhagic stroke. After a few days in the ward, he developed pneumonia and required mechanical ventilation. The house officer on-call whom I’ll just name Dr. Chong was entrusted with the task of sampling the patient’s arterial blood gases. He did so, but did not know how to interpret the results. Even so, he did not seek help. At 8 a.m six hours later, the patient died. Postmortem, the notes were reviewed and the results of the blood gases taken before the patient’s death were nothing less than shocking. It showed severe combined respiratory and metabolic acidosis.

Dr Chong is the kind of house officer I categorize as the ‘don’t know, don’t care’ type. These are characters that never fail to baffle me. I wonder what these clowns are doing in the profession of medicine in the first place.

They don’t know, not because they have cerebral palsy or severe mental retardation.

They don’t care, not because it’s not their business, but because they are callous, indifferent or simply uninterested. They appear to hold firm to the belief that ignorance is bliss. No matter what is happening, what instructions were given and how these house officers are reprimanded, their response is always along the policies of ‘don’t know, don’t care’.

“Doctor, patient is in pain…” – Don’t know, don’t care.

“Doctor, patient’s potassium is only 2.6…” – Don’t know, don’t care.

“Doctor, how is my surgery going to be like tomorrow?” – Don’t know, don’t care.

“Doctor, I am having a cough and a fever…” – Don’t know, don’t care.

These house officers are beyond help. As the person battling at the frontline, they do not seem to realize that the things they do and do not do at a certain time can make a big difference to a patient’s outcome. Perhaps they are not truly beyond salvation. Perhaps when one of their own family members die or fall ill, they might turn over a new leave and change for the better.

The ‘Don’t Know, Don’t Care, Bullshit Non-stop’ House Officer

These are the most dangerous and perhaps the most difficult to see through. Some people are born to talk, and then there are those that are born to bullshit. They are not necessarily smart. In fact, those who knew them well and long enough might even suspect them of having mild dyslexia. They are not caring, far from it in fact.

They are however very capable of putting up a face as though they are sweet, empathic and all that’s noble in a doctor’s holy heart.

They slither out of troubles and crises, and I use the word ‘slither’ because these doctors are serpents. Deceitful and cunning, eloquent and loud, these doctors will do anything to save themselves from trouble.

Outright lies, dubious documentation and clinical sandiwara are their practice of the day.

I’m reminded of someone I’ll call Dr. Marvin each time I come across such deceitful doctors.

Dr. Marvin was a graduate from a local private university in Melaka. He’d disappear for hours to have his cigarette session. When confronted about his disappearance from the ward, he would feigned that wide-eyed innocent look, stare you back in the eye like Shrek’s Puss in Boots and exclaimed regretfully that he came across some frail old osteoporotic lady on his way back from the busy clinic who required his assistance climbing the stairs to the second floor. When he failed to turn up for work or oncalls, he would swear on his mother’s grave that his father had a heart attack at home at 6 am in the morning. His father must be a very blessed person, because the senior Marlin has had twelve supposed heart attacks in the preceding two weeks and is still mysteriously alive with no symptoms of heart failure.

Unsurprisingly, these are the house officers most liked and favored by their superiors.

Unlike the don’t know, don’t care house officer, the ‘don’t know, don’t care, bullshit non-stop’ house officer are truly beyond redemption.

The ‘Know Something, Can’t Do Anything’ House Officer

House officers have for far too long been erroneously labeled as being a homogenous group. They might be the lowest in the hierarchy of the administration but they are never all equal and same. Similarly, just because one is a medical officer, specialist or consultant does not mean that the person possesses greater knowledge and more astute clinical acumen.

A young lady at 18 weeks of pregnancy was admitted to the High Dependency Unit for “UTI sepsis”. She was experiencing high fever with shortness of breath. Urine tests showed an ongoing urinary tract infection (UTI). She was treated with antibiotics and hydrated vigorously. Upon completion of the antibiotics, she was swollen all over the body. Her feet were both so puffed up that she couldn’t even wear her own sandals. Fluids were accumulating in her lungs, her abdominal cavity and even around her genitalia.

The consultant obstetrician came and ordered for a full workout to exclude tuberculosis and HIV.

The specialist in turn thought the source of the infection was from her genitalia. The so-called specialist refused to listen to the house officer’s objection and ordered an emergency surgery to incise and drain the ‘labia majora abscess’.

The medical officer complied.

The patient complied too and went under the knife.

There was no abscess.

In the midst of all this stupidity and narrow-mindedness was a house officer name Dr. Mel. Unknown to and unlike the consultant and his team of esteemed specialists and honorable residents, Dr. Mel had sat down and taken a full medical history and performed a complete and thorough physical examination. Dr. Mel had done something none of the obstetricians did. He listened to the young mother’s heart and detected a murmur. Dr. Mel put it all together and opined that the patient’s fever was because of infective endocarditis that had set upon a heart that was defective to begin with. The ongoing generalised edema was the result of heart failure.

He was sure that the obstetricians were wrong. He was sure that the patient had no supposed ‘labia majora abscess’. He was sure that sending the patient for surgery was a dumb and lousy idea. His hands were tight though. In a feudalistic system however, who will listen to a lowly house officer?

His conscience got the better of him in the end. Dr. Mel secretly arranged an echocardiogram for the patient. It showed a mitral valve prolapse with calcified valve leaflets. He restricted the patient’s fluid intake to 500 cc per day. Within a week, the patient was fit to go home. The last I heard, both mother and child were safe.


No doctors can fully rid themselves of the humbling title of house officer.

At best, every doctor is an ex-house officer whether one is now a consultant, a specialist or a private practitioner. Not all competent house officer ends up as a specialist and similarly, not all specialist was once a competent house office.

The specialist of one discipline may very well be as competent and knowledgeable as a house officer in another discipline. The obstetrician will fumble around when faced with an orthopaedic patient.

Thus, there is no need for arrogance and unnecessary show-off.

There is however, a dire need for a system that places an emphasis on accountability and meritocracy. The lying house officer must be brought to book, the incompetent house officer sent back to his books, and the outstanding house officer written in the good books.

This article was about house officers – their quality and qualities, their ethics regardless of ethnicity.

The contents of this article can easily be extrapolated to medical officers and specialists and consultants in fact.

After all, the consultants of today were the house officers of yesteryears.

For example, the ‘don’t know, don’t care, bullshit non-stop’ HO of 1980 is a neurosurgeon today.



robleong said...

Don't patients or patients' relatives sue in Malaysia if treatment administered is incorrect? This happens in the West which is one (unfortunate) way of ensuring that house officers do the right thing, or if they do not know, they should seek the advice of their superiors.

House officers should also be given sufficient time for continuing medical education and sufficient time to rest and sleep. I remember when I was a house officer doing a one-in-two first-on-call for six months, that was hell on earth so much so that one couldn't think properly anymore due to lack of sleep!

Anonymous said...

I've enjoyed your post. It's just not happening in MOH...step into any Ministry, it's the same scenario, over and over again.

Dr. Bhargava. {} said...

"Unlike graduates from computer science and social arts and food technology, medical graduates upon completion of their studies are never ready to get up and work."

I think this line points to the root of the problem.

Is it not terribly inefficient to train a student for 5 to 6 years, only to find that even the best among them are not ready to 'get up and work' on day one ?

Sadly, it is the same case in India.

Anonymous said...

great stories. Keep them coming.

Med dude in Melbourne

Anonymous said...

I am truly impressed with what you have written here POTS! This article is very true about the quality of our houseman nowadays. Not just houseman, but doctors in general.

I have just met 3 senior housemans today whom mistook unasyn for ceftriaxone, tramadol for brufen, and even insisted diclofenac is NOT NSAIDS. I am so embarrassed. I dont know what to call them. Stupid or plain stupid. I wonder what did they study in their medical schools. I wonder how many lives they have continually endangered.

I totally agreed with you about the specialist too, although they were briefly written about in this article. Allow me to share.

I still remember clearly about one incident, and i was unable to do anything because i was just a mere houseman. (Nobody will listen to houseman in this particular department, even the nurses will roll their eyes on houseman). I was doing on call in gyne ward and was summon to help out in resuscitating one cancer lady. To my horror, i saw one well-known arrogant specialist, doing CPR to that poor lady, at a rate of 5:2 chest compression:ventilation. In the end? The patient died. I still blame her for the patient's death. Had it been my mother on that very table, i would have screwed her ass in court! The specialist got lucky on that night, one is because the patient died, second is because the patient's family is not very well educated. They were the natives who resides deep in the interior part of sabah.

Now when i look and think back, probably that very arrogant specialist, never had any proper trainings in resuscitation when she was a houseman before. Or rather she was never interested to learn resuscitation because was too busy pursuing her master program. How sad. She is now a specialist.

You were right POTS. Every word.

You know who i pity the most? The lives of the sick, uneducated and poor sabahans...

Anonymous said...

heh heh... how i wish i am a lawyer in sabah.. heh heh....

Alan said...

You have accurately highlighted the plague that has overwhelmed the health system of Malaysia - don't know, don't care attitude. I must say that the majority of doctors today do not even measure up to half the quality of the doctors of yesterday. And when I say quality, I don't just mean the knowledge in medical science, but also the attitude towards the profession.

It's terrible enough to have good knowledge but the wrong attitude. To those who lack good knowledge and have rotten attitude, you ought to have a millstone tied around your neck and thrown into the depths of the sea.

Where is empathy for our patients? Where is compassion? Where is passion for our profession? Where is pride in our work? Where is honour? Where is responsibility? These are the fundamentals of being a doctor, without which we are merely gambling with the lives of our patients. If your conscience is right, very well continue to be ignorant and treat your patients like dirt.

The rotten attitude that's permeating through this once noble profession is the attitude brought on by a cohort of scumbags trained in certain medical schools (one particular one is in Malacca - >50% final year students fail every year, not considering the fact that their exams are way easier than the local university's).

Throw a stone and you'll hit a smoker/alcoholic/ignorant/irresponsible graduate from these institutions. Who ever taught these fools that the medical fraternity should be made up of people of these lifestyles?

In my analysis, perhaps this has to do with a certain ethnicity much more than a certain medical school. Perhaps, the government once made a good move in restricting the number of medical students in the local university from this particular ethnicity? I may sound prejudiced/racist, but if you know me personally, I'm not. This is my personal experience with "doctors" from this particular ethnicity. Of course not all of them carry this plague, but a majority of them do.

Anonymous said...

Quote "I have just met 3 senior housemans today whom mistook unasyn for ceftriaxone, tramadol for brufen, and even insisted diclofenac is NOT NSAIDS. I am so embarrassed. I dont know what to call them. Stupid or plain stupid. I wonder what did they study in their medical schools. I wonder how many lives they have continually endangered."

The more reason why there should be check and balance. Give the pharmacist their dispensing right would be a good start.

siang said...

I think there should be some screening process to assess whether a person is suitable to be come house officer or not.

Just recently, 2 of my house officer request to take some personal time off from the head of department because they are unable to cope with the stress. They have only work for 1 month!

Just think. After 5 or 6 years of studying and to find out you are not suitable to be come a doctor. Well there goes our tax payer's money. Personally I think too many parents are forcing their children to do medicine thinking that they will lead a glamarous life later on. Now they will have to see their children suffer for their ignorance.

Product of the System said...

I don't think anything in medical school will prepare the medical graduate to face a doctor's life.

The student has a set syllabus with a fixed daily schedule. The student gets the weekends off and read about the great things that can be done for a patient with a frontal meningioma.

He or she watches Grey's Anatomy, House, Chicago Hope, Scrubs and ER and aspires to do the apparently great things these TV characters are doing. They enter medical school thinkning they can cure cancer, conquer systemic sclerosis and bring relief to the soul with schizophrenia.

They end up facing a daily serving of blood, bile, diarheal stools and stinking urine in a patient debilitated by stroke.

The current practice of JPA is to have 2 week attachments for aspiring medical students in selected hospital departments.

Dumb,i say - Star Wars kind of dumb!

What can they see in two weeks?

CK Tan said...

POTS, 2 weeks is just enough to get chummy-chummy with all the superiors and chit-chat with good looking nurses and doctors then say bye bye.

again, POTS, enjoy ur post very much. the dire state of the system as a whole is really screwing us up, ALL of us.

Kong said...

Dumb or was it indifferent on the part of those who has the power to do something?

IMO, 2 weeks attachments is better than nothing. And it’s all luck as to what they get to see. If one of you doctor happens to come across them, you can dictate what they see. You have the opportunities to let them see how stressful a good doctor’s work is. If they don't get to see those, whose fault it is then? Certainly not the students'.

My son wanted to do medicine and I neither encourage nor discourage him. All I wanted is for him to be sure of what he's getting himself into, especially the hard work and stress etc. My son & his friends had written to the local hospital director asking to be allowed to be attached to the hospital to find out more. But the answer was "no". But eventually got to attend the JPA arranged attachment. So no, those attachments aren't a dumb idea as you put it. And if you agreeable to take my son and his friends for longer period of attachment, they would welcome it.

Kong said...

On a side note. In that 2 weeks attachment arranged by JPA for potential sponsorship, he did saw something and put it down in his personal statement. May be that has something to do with him getting offers from 3 UK universities to study medicine. Unfortunately, he didn't get the JPA because he only got 10A and not 12 or 15As which the education minister said are pointless. I suspect the minister will say one thing but JPA does another by looking for more than 10As.

Alan said...


If you think your son is smart enough, make sure he doesn't do medicine.

If he insists on going ahead with medicine, don't let him beg for a scholarship from JPA if he wasn't offered one from the start.

A lot of people fail to understand that a scholarship is just a privilege, not a right. I was once so sore over the fact that I wasn't accorded one but as I grew older, I began to see things in a more enlightened manner - if it's not yours, don't fall so lowly to beg for it.

Anonymous said...

This is directed to a comment left by alan...

">50% fail final year in this private medical college in melaka"

well sir i think you are so behind the times...well it may have been true in the first few batches, this institution now boast of over 90% pass rate. Why ? 1.the weak candidate is detained and not allowed to sit for the exam until he is up to the mark 2. the qualification now needed to enter is much much tougher than it was in the early years.. 3.the quality in training has increased many many times over...
I will concede that the first few batches were treated with kiddy gloves and there were a lot of teething problems i.e lack of teachers, lack of cooperation btw hospital consultants and college, lack of patients...
However now these problems have all been solved...and full acredition awarded by LAN. if it were so substandard why would LAN endorse and JPA continue to send its scholars here ? the entrance requirement to this institution is just as hard as any public university.

And no the exams arent easier...infact they are getting harder each year.

Just because of a few bad apples , please dont paint all the rest associated with this institution with the same brush. Not all of us who graduate from this institution are alcho's/smokers/indignant .... From every institution in any sector there will always be bad apples and there will always be a few outstanding ones...the truth is sir, for the most part most of us will fall under median of the bell curve...and the standard to be judge is the performance of those who fall beneath it...and i dare say graduates from this institution can hold thier own against grads from other colleges.

thank u!
Selamat Berkhidmat !

Anonymous said...

I personally think this ‘don’t know, don’t care’ attitude is very common not only among house officers but also all healthcare staff (maybe all government servants).
I hated O+G posting the most during my housemanship but unfortunately was sent to a pathetic town as a KKIA MO. As my O+G knowledge is limited, I read manual of diagnostic ultrasound before started working and searched relevant latest guidelines from WHO, NICE etc websites to avoid mismanagement. I noticed misuse of intramuscular iron dextran in this district and thus asked few senior MOs and even specialist on indications of the medication. They answered me that it depends (on individual cases) without further elaborations. I finally got the answer myself after searching all guidelines from internet.
Once I referred an obese elderly grandmultipara who presented with blood pressure of >140/90 at least 7 readings (but not at the same day) to senior medical officers in the hospital and they insisted the lady had no gestational hypertension with the reason being no two readings of BP >140/90 recorded in the same day with 6-hour apart. Again, they didn’t realize that the latest guideline says one reading is sufficient to diagnose gestational hypertension.
My staff nurses started combined oral contraceptive pill (as progestin-only pill is out of stock) in a mother who just gave birth 1 week ago!! So not surprising the mother brought in the baby to the clinic with neonatal jaundice needed phototherapy (as mother had little milk to feed the baby). They also failed to pick up few children with developmental delay as they didn’t perform the Denver development test properly. One senior JM didn’t know how to check for headlag in infants and she has been in the service for at least 7 years!
The medical assistants prescribed salbutamol tablet to all asthmatic patients instead of inhaler and they intubated patients with saturation of 50% or even 0% first instead of bagging to maintain saturation. And all patients with URTI would get erythromycin for their viral infection.
How about when their own family members got sick? I always see two extreme reactions. One is being overreacting and requesting the best treatment for their family members even for simple URTI(but they themselves treat patients poorly). The other extreme is total indifference, again! My clinic Sister’s mother has on and off bilateral knees pain and swelling for past 10 years and needed multiple steroid injections but she was not even sure the exact diagnosis and she thought it was GOUT!
I guess I was the only one in the clinic who actually read medical materials after office hours and I’m definitely not proud of that. How can anyone of them go to sleep in peace if they do not know what they do for the patients?
I believe ignorance is difficult to be rooted out in adults. Maybe by sharing our limited medical knowledge with them bit by bit, we can make a difference? I don't know…

Alan said...

In response to the comment directed to me by one Anonymous:

Why the LAN and JPA endorse this particular medical school in Malacca despite my allegations?

You must be ignorant if you claim not to know.

Shucks! Political reasons of course, silly!!

Dare you tell me that all the foreign medical schools endorsed by the JPA is up to acceptable standards? If your answer is yes, I'll rest my case.

Just take a look at the number of Indonesian institutions recognized by them. Have you ever been to one and assess their standard for yourself? I can proudly say that I have and it's deplorable. Yet, guess what? They are stil recognized by our beloved JPA.

If you stil don't see my point, then just be blinded by your beliefs and self-satisfaction.

P.S. - I did not paint ALL the rest associated with this institution with the same brush. Read my last sentence carefully before you act on your emotions. (Quote: Of course NOT ALL of them carry this plague, but a majority of them do). SIGH!!!

Anonymous said...

"Is it not terribly inefficient to train a student for 5 to 6 years, only to find that even the best among them are not ready to 'get up and work' on day one ?"

I guess the tough part about housemanship is learning the system as well - if they are sufficiently conscientous and well prepared, most HOs on the first day can clerk a new admission, order relevant invgx, take the blds, set the plug, start the abx/drip and call the MO to review the case. But on D1, this would probably take 40 minutes. During which, they would have had 6 calls for "patient has pain", "hypocount is 14, doctor", "relatives want update", "clerk the next 2 arrivals", "give first dose of antibiotics", "patient unable to pass urine" etc etc.. The curve is in learning how to prioritize and handle all the responsibilities that are thrown at you, knowing who you must see NOW and who can wait for a bit, learning to set plugs and take bloods asap, dealing with difficult relatives, grumpy colleagues, irritable superiors.. and although attachment and internships help ; the first few months will alway be in-over-your-head and out-of-your-depth. I guess maybe the genius types take to it like a duck to water, but the rest of us slog thru.

It's like one of the profs told us in final year, "A house officer is half a doctor." Haha.. Man, there's so much to learn.


Eng said...

Nice post!

Urology Surgery India said...

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