The Year That Was

Today, my medical internship (which lasted from May 1, 2005- April 30, 2006) was formally over. We had a rather lengthy (4 freakin' hours!!!) closing ceremony this afternoon. It was bearable for the most part, but judging from the many sleeping guests in the audience, I guess the program was rather boring to a non medical person. hehe.

Looking back, I would say it was not a very good internship program. For one thing, it was medical clerkship repeated for post graduate interns like myself. There was nothing new to learn theoretically. I guess the way the program was structured was necessary for UP interns--- after all, their medical clerkship is something like a "taste test" (I can't find the proper words to describe it) of clerkship. How else can you describe a clerkship program wherein they have summer vacation, christmas breaks, and holiday breaks? And in the hospital, they are often pulled out of the workforce, because of lectures, usually in the afternoon? And their rotations are mostly in the wards instead of going through the different sections of each department (i.e. in the case of pediatrics: nursery, emergency room, intensive care unit, out patient department). I guess they really can't rotate in each section because of their long vacations (how can you fit everything in less than 10 months?! they only rotate in OB-gyne for 2 weeks, which is supposed to be a major 2 MONTH rotation), thus the need to rotate in those sections in internship. So we can say that internship in PGH is like an extension or continuation (there, I found the proper terms!) of clerkship. It is the ideal program for UP interns because their clerkship would be severely lacking without it, but a highly inefficient program for post graduate interns like me. And here lies a huge gap in their training program.

In other hospitals, interns are like pre-residents already. Writing orders in charts, joining consultants during rounds of every single patient, adding insights to the management of each patient--- in addition to manual labor such as IV line insertions, pushing IV meds, creating a daily census etc. In PGH, clerks and interns are basically equal (except in IM wards wherein you act as a "real" intern during the last 2 weeks) because their duties are basically the same. Doing charts, carrying out orders, doing blood extractions (which is a job for med techs--- but since we have to cut costs in PGH, the job is given to clerks and interns... hey at least I'm now an expert in blood extractions. hehe), and gaaah!----- MONITORING! Checking the blood pressure, heart rate, respiratory rate, and temperature of each patient! In other hospitals, monitoring is a nurse's job, and in a teaching hospital, it is a clerk's job! Add that up to the list of PGH exclusives--- INTERNS WHO MONITOR. Thus seniority is seldom felt; rarely can an intern order--- or should I say, ASK a clerk to do something. So when can we experience true internship? Wouldn't it take huge adjustments when residency comes without such training?

The fact is, INTERNS are basically treated as STUDENTS in PGH. So blatantly, in fact, that the term used is "student-in-charge". I guess that's proper since most of the interns (150 out of 250 are from UP) haven't graduated yet. It's just that in other hospitals interns are treated as real doctors already. Heck, in PGH even the nurses see you as students only. They call you "SIR", "MA'AM", or sometimes "DOC" out of politeness only... you hear them talking behind your back and you'll realize they view you as mere students. Some patients even see you as students only. The "Dr." before our names on all our name plates are probably just there to appease post graduate interns since we already have medical degrees. In reality, we're not really treated as doctors yet.

Also, initially, I was under the impression that PGH is the ideal place for internship for the sole reason that it has the most varied cases, and cases are also numerous. Thus, there would be more learning on my part. That's not really the case though. Think of it as some sort of learning curve, wherein the optimal level is breached, thus learning starts to go down--- a lot of times, there are so many patients, you just want to get the job done, there's no more time for learning. Add the fact that residents are also so busy because of the sheer number of patients, they rarely have time to teach you what they know. I'm not generalizing though, there are some (mostly senior IM residents) who really find the time to teach you.

"Toxicity" (i.e. too much work, to the point of being er--- deadly, or poisonous. hehe) in PGH is also so over rated. Yeah, being the premiere government hospital in the country, you'd think it really is the most toxic, but that's not really the case. Ask around, the only people who would say this are those who haven't experienced training in other hospitals. For one thing, PGH receives the greatest subsidy from the government, while other state hospitals fight over the crumbs. If you say PGH is the most "low-tech", that PGH is the most toxic--- you haven't been to other government hospitals, wherein conditions are much much worse. Ever been to San Lazaro? Fabella? Jose Reyes? Sure, compared to interns in other hospitals, the work load is heavier because you're still basically a clerk, but there is such a huge gap with the workload of residents and interns. The residents absorb most of the work! Where else can you find medicine interns just sitting around the emergency room, while the residents rarely have time to rest? In other hospitals, since interns are like pseudo-residents, they take a huge burden away from the residents. The fact that the residents are also so nice takes a lot of toxicity away--- they're like your peers, unlike in some hospitals where you can really see the hierarchy between interns and residents. Also, in several rotations (in minors like ophtha, ENT), there are weekends off!--- completely unheard of where I took up clerkship! SO what's with all the complaining? Especially among clerks? They have a lot of vacations, they get pulled out from hospital duties (for lectures--- that's still REST nevertheless), and they do less of the dirty work! Where I took up clerkship, we take the urine output, we suction secretions, while in PGH the nurses do that. And where I took up clerkship, clerks are the ones who ambu-bag their patients, which can last for a full 24 hours without rest! In PGH, (here's another exclusive) it is the patient's guardian who ambu-bags. And in some instances, the patients ambu bag themselves. hehe. There may be more patients in PGH, but taking all factors into account, the work load for clerks is much much less.

Here's one glaring example. I remember how every UP intern was talking about how "toxic" the Ob-gyne rotation is, like it was some deadly fatal obstacle or something--- the ultimate in toxicity! And I almost believed them. For. Crying. out. loud. what exaggeration! Residents do most of the work! Interns only assist them most of the time! In Fabella, we do everything--- unless if the baby has an abnormal presentation, or when a CS is needed.. From labor up to the baby's birth, resuscitation of the baby, up to suturing lacerations, no matter the degree, we do all the work. Only if we really REALLY REALLY can't manage the patient will we refer to the resident. And it's like a baby factory in there--- LITERALLY, a baby is born every minute. The work is NON STOP. And what toxic paperworks? we have templates in PGH for crying out loud. During my clerkship, we had to do paperworks from scratch, and they had to undergo several revisions until the resident thinks it's PERFECT already, because it is an OFFICIAL hospital document and shouldn't be made haphazardly. And the dreaded morning endorsements? It's not like they'll shout at you or insult you or shame you if you can't answer their questions...unlike where I took up clerkship. Pushing stretchers on your own? been there, done that--- A lot of times, and with an oxygen tank to boot. Anyone who has a first hand experience of working in other government hospitals knows that he or she has no right to complain about the workload in PGH.

Do I regret taking up internship at PGH? It may seem like that, but I'm not. It's not all bad after all :) There are a lot of rare cases, cases you won't find anywhere else. It is up to each intern whether he or she finds the time to take each opportunity for learning. With the multitude of cases also, you'd be surprised that patients with myocardial infarction are so common that thay are monitored every 4 hours post MI instead of every hour. hehe. And in surgery, they let interns do minor operations--- and this includes not so minor ones such as removal of breast masses. hehe (though in other government hospitals wherein there are fewer residents, it's not uncommon for interns to do major operations such as appendectomy, but those are only in few institutions). And as I've said, the residents are so nice, demerits and sanctions are very rare, there are weekends off, that it's like a dream vacation! Okay, it's not really a dream vacation, but I felt like some caged animal who recently got free. hehe. You get used to the fact that there are no airconditioners in the wards and in some operating rooms, the heat's not so bad once you get used to it. The food is actually OK, including those freebies served in the mess hall. PGH may not be the best place for internship--- I may not take up internship there if given a second chance--- but it's still a good place for internship, at least when compared to most hospitals out there.


It's getting late and I have to wake up early... maybe tomorrow i'll post some pictures of those rare cases I've mentioned. :)