Medical - the STAT department !!!

When I was a medical student, there are Internal Medicine Dept, Cardiology Dept, Neurology Dept & Respiratory Dept, had to spend one to two months in each department....
Never crossed in my naive mind that in Malaysia, all 4 departments are combined into one, which is MEDICAL !!!

 

My specialist once said, "All patients presented to Emergency Department (ED) is a medical patient, until proven otherwise".. (in my head, i was like, walao wei !!!)

This explains why in every government hospital in Malaysia, medical has MORE wards compared to other departments !!!

This is why in the beginning, i always say, medical is the busiest department of all !!

So as a houseman, especially if you're given medical as your 1st posting, what should you do??

 I can't teach you everything you need to know in this short post, if its possible, why the heck we spent years in medical school, right?? What i can teach you is, how to become a successful houseman in this department.

Learn How To Do Houseman's Job

With all the knowledge we gained from medical school, it will be useless if you don't know how to use it in real life. When i was tagging in this department, they gave me a list of things i need to master in order to get off-tag (start oncall/shift schedule). So basically, they were telling me, "Aidil, if you know all these stuff, i am confident to let you work night shift alone, because you know what should you do, in case anything happened while the MO is not around"

• Basic Life Support : Medical Officer (MO) will be busy as well, they can't stay in one ward, ED will always bother them, not to mention, referrals from other department. So if a ill patient suddenly stop breathing, your job as a houseman is try to keep the patient ALIVE while waiting for your MO to arrive !!! Thats it bro..!! Btw, Know the case (read the patient's file briefly), because you need to inform your MO mostly via phone call.
• Branula : Most of medical patient will need intravenous line, HO need to insert them by hook or by crook.
• Blood Taking : Medical is a department where they rely on blood too much (sry to say that). There are too many diseases and blood investigation is very vital for diagnosis and treatment evaluation as well. Taking blood from the vein is easy, in medical you need to learn how to take arterial blood, its very common in this department, compared to other.
• ECG : You need to know how to perform the test and do your own interpretation of the ECG. I will teach you on how to read ECG later. This is expected of you as a HO, as heart attack is the number #1 killer in Malaysia.
• ABG : Arterial blood gas, yes you need to know how to take them, and do your interpretation as well !! Of course, you need to know weather the blood is artery, vein or mixed. If its not arterial blood, you have to repeat it!! (Poke the patient until you get it right).
• Glasgow Coma Scale : All HO must know and memorize them. If a patient GCS suddenly drop, your MO will ask about the GCS, because they need to know if the patient need emergency attention (eg:intubation) or not.
• Basic Treatment : What will you do if the blood (buse/creat) you took, came back as hypokalemia or hyperkalemia? The ABG you took showed poor oxygenation or metabolic acidosis? ECG you perform showed myocardial ischemia? Patient develop hypoglycemia?? Your decision can save a patient life or prevent their condition from worsening. Learn, ask your senior HO, and ask your MO. Better be safe than be sorry. Trust me, you don't want to get extended in this department, its damn tiring dude !!!
• Learn to prioritize your workload : Nurse will inform you everything, from high blood pressure, low glucose level, patient has shortness of breath, to patient request paracetamol !! Because they don't want to take the responsibility if anything happened.

At times you will wonder, if you had chosen the right path...


Nothing is impossible, the word itself says, “I’m possible!”
–Audrey Hepburn

Believe you can and you’re halfway there. –Theodore Roosevelt