Pretenders

That's Dr. Nick Riviera from The Simpsons. It's funny seeing his antics on TV, but when you see such incompetent doctors in real life, it's not funny at all. I started this other job last week, as an emergency medicine physician at a government hospital near the private hospital where I'm currently employed since January. I'm not required to report to that hospital everyday, so I though I might as well find something else to do during those days when I don't have work. So when I was offered this job, I accepted it. I figured i could use the extra money. And the pay IS good. Plus, since I'd be working in a government hospital again, i'd feel right at home. Only it wasn't really a government hospital, in the sense that services rendered weren't for free. They had fees for everything! Expenses were only cheaper compared to most private hospitals... a lot of patients can't even buy the medicines needed, and they expect them to pay for miscellaneous hospital fees and professional fees? You'd expect that there would be some free stuff, but NO. everything has a price. It's even more frustrating that there are no actual licensed surgeons on duty, so we have to send even critical patients away and advise them to transfer to other hospitals. And we also have to send patients away due to overcrowding--- a problem common to all government hospitals. With the number of patients we have to turn away, I can't help but think that it was a somewhat useless hospital. I mean, what purpose does it serve if it can't cater to the needs of the less fortunate constituents in the city? The city would've been fine if it wasn't built at all.

The first day of duty was relatively benign. Sure, I didn't get to sleep at all, but the patient load wasn't really much... at least it's not much compared to the number of patients I had to attend to where I used to work. Patients appeared constantly, but at least they do not come in droves. I got to eat on time, and the work load wasn't that physically taxing. But I had a big problem. I was in unfamiliar territory. For the past year, I've handled nothing but surgical cases. As a result, it seemed that I've become unfamiliar with medical cases. That's a huge problem because in the emergency room in that hospital, patients aren't distributed per department. That means I get to handle every patient that walks in--- be it surgical, medical, gynecological, pediatric, obstetric... when one pregnant patient came in, I did an internal exam, but I wasn't sure anymore about what I was palpating. On my last duty, three geriatric patients came in with chest pain. I gave the initial medications and I immediately ordered ECGs done... but I wasn't sure about what I should do next. When the ECG tracings were handed to me, it seemed Greek to me. Crap! It's been two years since I've read an ECG tracing, I could barely read one now! I've been used to referring such patients to the medical department immediately, so now I can't seem to manage such patients on my own! I asked the consultant on duty that night, but he wasn't much help. He didn't finish training as an emergency physician nor as an internist... his residency training program was surgery, so he was also not used to handling medical cases! I ran towards the callroom and quickly scanned some medical books. Then I ordered this and that medication, not really sure of what i was doing. It must have been dumb luck because the patients seemed to have stabilized. It was so embarrassing. And i pity the patients coming in for help, expecting expert advise from such inept novices. It's even more pitiful when one realizes that such scenarios are pretty commonplace. When i receive referrals from other hospitals, i can see a lot of doctors improperly managing their patients. As a physician on duty in the emergency room, I see myself as inept. But a lot of these other physicians are even more inept than me. What does that say about the health care system in the country? Emergency situations call for competence, and yet many physicians on duty in emergency rooms aren't competent enough. They say it's difficult to properly screen employees since a lot of physicians are leaving the country. Strict screening procedures would drive the few interested applicants away. Resignation isn't really the best option, knowing that they can really use my help. I guess until proper screening procedures are implemented, going back to my medical books to refresh my knowledge is the most responsible choice. Without sufficient knowledge, I wouldn't be able to help even if I wanted to--- I could even be doing more harm than good, even though my intentions remain pure. Pure intentions aren't enough. A little knowledge can go a long way. Hopefully when I return there next week, I can already make the right decisions, i can treat my patients properly. Hopefully, I can manage each patient because I know how, not because I'm pretending to know how.