What does it mean when a doctor is said to be oncall? Watch ER or Scrubs and the first thing that comes into mind is that the doctor is working overtime in the hospital...and perhaps also over the night. Right? Well perhaps but not entirely true.
The doctors seen mainly working over the nights in most public hospitals (in Malaysia) are newly graduated house officers and their counterparts the medical officers, or sometimes registrars. So, what about specialists then? From my experience (and please do not quote me), the higher your status the less work it seems when you are oncall. Meaning? Put it this way, in medical field, specialist works from home and can be consulted via their mobile phones. Medical officers can be contacted via pagers/bleeps but they are on site and if needed will come to review. And finally the front man, house officers see most patients admitting or presented to the hospital. I wouldn't even want to mention consultants...as i believe you would get the idea now.
Having said that, this is not entirely true for some fields though, for example surgical/orthopaedics where surgeons are almost always around for theatre times.
So what you may say? It basically mean that the most junior and inexperience person is treating majority of the patients. Surprised? You bet! It may have changed over time but seriously this is definitely very true. Getting the seniors involved therefor depends on the insight of house officers, whether to refer or not to refer. Many a times, fear of disturbing a "specialist's sleep" (so called, but remember they are still oncall and being paid) or even the medical officer delays such decision till the early hours of the morning rounds. Patient would then suffer as a consequence.
Would senior supervision throughout the night help? Definitely. Would night rounds with the seniors be helpful? Definitely. Should there be fear of referring to the seniors? Definitely not! Should seniors be vicious, mean, inconsiderate, nasty to the juniors when they are so called 'disturbed'? Never.
Perhaps we take it for granted that litigation is not as rampant compared to the western world and take the risk of allowing the current practice to carry on. Perhaps we are short of doctors, but we are sure having lots of colleges producing new doctors. Perhaps we have been in such situation (as house officers) and hence felt that the new doctors should go through such 'so called' experience of working but wouldn't it then be a vicious cycle?
This is merely how i feel, what i experienced and it may not be similar to where or what others practice, but hey this is my blog and i think i can voice out my thoughts... hehehe.
Well, what are your thoughts?
2 comments:
YL, I'm doing specialist call already and nothing has changed! I still stay in, albeit with the small luxury of driving home for a quick shower and dinner unlike my HOs and MOs who are virtually confined to the hospital when they are on call.But other than that I'm back in the wards pretty soon to begin night rounds that usually stretch on till close to midnight.
I agree with you that no doctor should ever be irritated when they are consulted at funny hours of the night - after all they are paid to be on call! But I don't totally agree that phone consultation is wrong. It really depends on the nature of the consultation.
fibrate: absolutely and totally agree with you that nature of consultation is important. Wow.. i thought it would be sometime before the change but appears to me it has already happened. But i am sure you would feel better after seeing those necessary cases during the night rounds and ensuring things are running and managed smoothly right? I wonder whether there are other places like yours too??
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