Monday, June 14, 2010

Surviving Housemanship

I remember the feeling of apprehension on the first day of housemanship, or internship as they call it in Ireland, where I first trained. When I was a medical student, almost finishing up my final year, I could not wait to graduate. It was not so much of impatience to start working, it was more of the thought of finally free from exams!

However, on day one of life as an intern, as I walked into the hospital where I was about to be part of, what came to my mind was "Am I ready to practise in the real world? What if I can't remember what I learn? What if the specialists hate me? " It's probably normal to feel that way no matter how hard we try to convince ourselves that we are now ready to become doctors! ( I am sure the patients would fear more knowing new interns are coming in )

Looking back, the apprehension never really dies as each day passed by, but it became less each day as confidence grew. My 6 months in the county hospital was wonderfully challenging and... to put it simply, educating. And to me that is what housemanship/internship should all be about.

I learned a lot as an intern, not just in treating patients, in managing cases and in becoming a good doctor.I also learned good interpersonal and communication skills... with colleagues and patients alike. I lovingly recall the wonderful people I worked with, the helpful nurses and ward clerks, my registrars and senior house officers that keep encouraging us and teaching us new things all the time, and of course the specialists, the bosses that despite their vast knowledge and experience still treated us interns as part of the team. Teamwork -that was what I gained most as an intern there.

After 6 months working overseas, I decided to return home. Initially I dreaded the thought of completing my housemanship in Malaysia. It was probably because of the 'horror' stories I've heard about the hardship of working as a houseman home. But to my surprise, it wasn't as bad as I thought it would be. Maybe because I pictured worse. Or maybe it was because I managed to complete my housemanship in a university hospital which I heard is less busy than a general hospital. Of course, life is not a bed of roses. There are times of hardship, ups and downs, as in everything in life would be, but it is never the end of life.

Of course I can recall moments of pressure, especially coming from individuals, although I am grateful that this was rare. Maybe it was due to the fact that my first 6 months experience as a newly graduated intern was relatively more pleasant - in the sense that I was working in a peripheral hospital or district hospital , which was smaller in size with less number of patients. Nevertheless, the conducive environment and the motivating staff were the two key factors that help me to develop my working attitude and mould me to become the doctor I am today.

However I need to stress here that I am not undermining the working environment back home. I have nothing but respect to all the housemen that manage to complete their housemanship here. Is is tougher being a houseman in Malaysia compared to being an intern in Ireland. This is just my personal opinion based on my short experience working as both. What I found most different is the number of critically ill patients being treated in the general ward. When working in Ireland, most of the critically ill were managed in the intensive care unit or the high dependency ward. But this is a challenge in Malaysia as there are less intensive beds to accomodate the vast numbers of critically ill patients. That is why I am amazed at the skill and confidence of a fellow houseman managing an emergency case in the general ward, being the first person to attend such cases, not an anaesthetist medical officer as it would be in the ICU or HDU.

Unfortunately, the downside is, as a houseman, hungry for knowledge and experience, you will have to be careful in enquiring the right facts and learning new skills. Sometimes, the burden of work will force a houseman to learn from another, which can be disastrous if the 'teacher' himself/herself is not well-trained. I suppose due to the increasing awareness and the numbers of medicolegal cases in the western world, they are very careful at allowing an intern to perform a difficult procedure without supervision. However, in a crammed hospital with sometimes extension beds, this is probably a luxury. A houseman sometimes finds him or herself in a difficult place to manage on his/her own not because of lack of support, but because the senior officers also have their hands full managing cases. That is why I can understand why a fellow medical officer can easily loose his/her cool when a houseman makes a mistake. We do not expect housemen to be perfect but at the same time we want to protect them and ourselves from making mistakes that could cause a loss of life...

All in all, what I can summarize is that housemanship or internship is an oppurtunity for each new doctor to prepare him/herself in becoming a good medical practitoner and a team player. You have to be strong in and out and be positive always in facing the challenges of the medical world. You might be yelled at whether justified or not... but just remember, being scolded for a mistake is better that being regretful when a patient dies because of something that we do or do not do. And of course, at the end of it all, you become a better doctor each day if you learn from your mistake and try your best to do better.

Just remember why we became doctors in the first place. For muslims, doing your best is an act of faith and sincereley treating your patients and their relatives, and working together as a unit, all has a reward, if not in this life, in the hereafter...insyaAllah.