House Officer Teaching

Dear beloved House Officers,
There will be teaching tomorrow at 5.30pm, Thursday the 27th of March, 2014. We will be covering on some clerking and basic management of common problems in the ward. Thank you.

Know you generics

When a House Officer write a prescription he or she must follow the following format:
[dosage form] [generic name of drug] ([brand name]) [dosage] [frequency]
For example:
IV ceftriaxone (Rocephine) 2g bd
IV piperacillin-tazobactam (Tazocin) 4.5g qid
In order to do this one must know your generics and hopefully this document will help.

There is no one size fit all

Should we go back to the on-call system? The modified on-call system with pm off? With am off? 75-hours shift? 65-hours shift? 3 shifts per day ala Accident and Emergency? There are so many variations but at the end of the day there is no one-size-fit-all. Each hospital in the country has different staffing, facilities, training, equipment and circumstances. We have to make the best that we could with what we have and not what we hope or wish for. However there is one thing I am confident about that the best person to make such decisions is not some administrator sequestered in an air-conditioned office but the people on the ground reacting to changing situations by the minute. I believe that the best person is the people on the ground as represented by the head of department. Each department will have its own staffing needs in even the same hospital. I believe the Honourable Minister of Health and the Director-General should give the Heads of Departments the discretion to decide which system will be best suited for their department currently with the available resources. They should trust the Heads of Departments being the leaders in the field to be able to make the wisest and best decisions.

Probational release

Have you ever had a House Officer that was so terrible that you are in a dilemma? The said person is not good enough to be released and releasing him would be unfair to the next department and the public at large. However if you don't release said person but extend the person in your department it will rile up all the senior people, create havoc in the rostering and basically slow down the whole department. Since medical gets 80% of the first-posters, you can't really expect medical to keep and train all the weak ones. What should you do then? Either action is destructive. I believe we should be given a third option which I will call the probational release.
        With probational release, instead of immediately serving the extension the House Officer is given an opportunity to go to other departments to pick up more skills and experience before coming back to medical to serve his extension. Thus the other departments share in the training of weaker ones.
         For the House Officer they are given the opportunity to pass with their friends thus avoiding stigmatisation, they are also given release from the current batch of senior doctors so that by the time they return they are less likely to be with senior people who are victimising them (if that be the case) and thus with additional skills and experience, they will be able to give a better impression to a different batch of senior doctors.
        For the senior doctors in medical this will be a breather and given time we will have forgiven and forgotten the crazy things that got the House Officer extended in the first place thus making it easier to give said person a chance to prove his or herself. And of course all the other departments will have an opportunity to have input into this person's training. Looks like a win-win-win situation for me.

History-taking, summarising and presenting

History taking:

1. Pre-morbids (D2FMC3):
1. Duration
2. Diagnosis
3. follow-up
4. Medication
5. Compliance
6. Control
7. Complications
2. Presenting complaints:
1. Open questioning
2. Closed questioning: relevant negatives

Summarising:

1. How was the diagnosis made?
2. What was done and why.
3. What you doing and why.
4. What you will be doing and why.

Presenting:

1. History:
1. Presenting symptoms improving or not?
2. Side-effects of your treatment.
3. Basic functions:
1. Eat
2. Drink
3. Sleep
4. Pass motion
5. Pass water
2. Vital signs and observations.
3. Examination.
4. Investigations results.
5. Plan.

Management guide

This is the draft version of the management guide for House Officers. In the old days we used to produce our own management guide but nowadays House Officers rarely do this so I produced this PDF file as a guide to them.

In addition to that it is time to bump up the older stuff I did. These will be the nucleus of Hospital Klang House Officer guide:

The clerking manual

The procedure guide

The medication guide

All these are still in draft version but I hope it still will be helpful. Do contact me regarding mistakes in the comments section so I can correct them.

Teaching tomorrow

Dear beloved house officers,
Tomorrow, Wednesday at 5.30pm the 19th of March, 2014 there will be teaching for house officers. I will compering some basic things to do in the ward. Such as the basics of clerking, how to summarise and present a case.