Will the real slackers please stand up?

My previous post regarding my internship in PGH made me think about other things. When I mentioned how toxicity is so overrated in PGH, I remembered how the issue of "slackers" (the lazy people, those who don't work, those who are often absent, those who don't help around, those who just sit around) always seems to come up. And whenever it comes up, it tends to create this great divide between UP interns and Post graduate interns. I'm glad in our group this seldom becomes an issue, but it is a cause for many arguments in other groups. Knowing how worse conditions were for us as clerks in USTH, I doubt if any of my 13 schoolmates can be accused as being a slacker--- okay, except for one, but as his close friend, I know he has a valid reason. hehe. Okay, and except for another one, but she's been known as a slacker since her first year in med school. How she got accepted in PGH for internship, I'll never figure out.

*shrugs shoulders but with a knowing smile*

anyway, the rest of my schoolmates think life in PGH is like a paid vacation. That's why we often wonder what's with all the complaining, and what's the deal with reshuffling schedules so everyone would have equal toxic and benign shedules, equal holidays, half days, and weekend duties in the end (they never really equalize anyway)? And knowing how those post graduate interns from UE had worse experiences during their clerkship compared to ours, i doubt if they'll be the ones "slacking" around. Stories from PGIs (from now on post graduate intern = PGI, it's getting tedious typing those 3 words)from De La Salle also seem to show that they're having a less toxic time in PGH. That's why I'm always defensive when PGIs are accused of being lazy, when they are called slackers. I agree it's possible for them to slack, we can't generalize after all. Maybe one PGI had suffered from burnout during clerkship, and now chooses to be lazy... or maybe there's a med school where they had an easier time during clerkship compared to their internship in PGH. But I've worked with many PGIs, and I can say I haven't seen any of those so called PGI slackers. if there are any, I can't think of any other explanation for their behavior, besides those two reasons I've stated above--- unless, perhaps, they are lazy to begin with. Their laziness could be an inherent trait, which has nothing to do with being a PGI.

So who has the tendency to slack, then? I hate it when UP interns seem to have this predilection to endorse to those students in lower years that some PGIs have a tendency to be slackers, as if it was some word of caution. For crying out loud, who has the tendency to slack, anyway? Those who have a less toxic time during clerkship compared to internship! And most of them are UP interns! They may take offense, those who feel so superior and intelligent just because they are UP medicine students (I'm not generalizing, but there are a number of them). FYI: Just because one is intelligent, that doesn't mean that person can't be lazy. And based from my personal experience, I have not encountered a slacker PGI. The slackers I've encountered--- those who are often absent, those who don't do much work, those who avoid work, those who rarely help, those who keep on disappearing are--- surprise, surprise!--- UP interns! Again, I'm not saying they are the slackers. Majority of them are very hardworking. And I'm sure there are lazy PGIs out there, I just haven't worked with them. I'm saying we shouldn't generalize. I really hate it when some of UP interns point to PGIs as slackers. Before they do the finger pointing, they should look at their own group first, because based on my experiences during internship, there are more slackers there.

I remember a few weeks after internship started (this was June 2005 if I remember correctly), the PGH administration had a meeting with all interns. When the hospital director asked if there are any complaints, most PGIs were quiet. The UP interns were the ones doing all the complaining! Like this girl with dyed hair, complaining that a resident scolded her. She asked if what actions she can take in retaliation. I looked at the reactions of the PGIs and all were smiling at each other. I know what they were thinking, because i had the same thoughts. We suffered much much worse during our encounters with residents and consultants during clerkship, so what was she complaining about? Residents in PGH are really nice compared to those in some other hospitals. And even if they weren't nice, shouldn't you just accept the scolding, being one of the lowest creatures in the medical hierarchy? If she's feeling all superior, that she can't be scolded, then she's in the wrong profession! Such attitude has no place in a profession based on service. Besides, I don't think a PGH resident would just scold an intern or any student if he or she has no valid reason.

Then another guy, an obnoxious, annoying, attention seeking gay UP intern complained that residents ask interns to follow up labs, he'd rather spend the time observing patients, learning about patients, blah, blah, blah. yadda yadda yadda. What does he think he is, anyway, some paying spectator? An audience in a medical play? An intern is part of the hospital work force, and being one of the lowest in the hierarchy, often the most menial labor is given to them. Learning while doing all those work is his or her own responsibility. He or she should find the time to broaden his or her knowledge. The director's response was a classic. "Even at my old age, I still follow up the laboratory results of my patients. I still monitor them. How can you complain about those things so early in your medical career?". Again I looked at my fellow PGIs. Everyone was shaking their heads in disbelief. These interns studied in UP for crying out loud, they should exude humility, not pride, arrogance, and superiority. And most PGIs looked up to them during the start of internship. How can they behave like spoiled brats?

But you know what sucks the most? It's bad enough that the slacker image is branded on PGIs by some UP interns. It's worse when hospital administrators do this as well. A day after his meeting with all the interns, the hospital director met with the previous president of all interns. The hospital director told him, "The PGIs this year are too much! they do nothing but complain!"

Apparently the hospital director, who happens to be a UP Medicine Alumni, is blinded to the fact that there are a lot of slackers in his own brood.

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. :)