Malaysian Housemanship

Well, you signed up for it and after 5 years of endless studying, you finally have gotten your placement. You are now doctor so and so, day 1 of tagging in this ward. What does it take to survive?

First of all, most of the pre-housemanship courses or talks in the market will not "prepare" you for HOship. I have attended one during my long wait into HOship and I must say nothing prepares you for it except for the last 5 years of medical school. The time you spent, the effort you made (learning skills and procedures) and the discussions you had with your lecturers, tutors and mentors are what builds the foundation for HOship. A two or three day course will never cut it. 

That being said, if you still feel anxious for what is about to come, all is not lost. The purpose of HOship is to consolidate your skills and expose yourself to more clinical management, ie, things that doctors do (in real life) to cure, treat or minimise an individual's risk for complications. Here's what you need to do.

1. Do it, don't dream about it!

You can say all the right things, plan the right stuff but if nothing is being carried out, the patient dies anyway. Those who pass exams are skilled at giving succinct descriptions about the patient, form accurate diagnoses and drafting hypothetical plans. In real life, bloods have to be taken and run, results have to be traced and updated. Procedures have to be documented. Medications have to be served. Orders have to be carried out. Nobody will be in the right mood to teach when they find out that nothing has been done for a bleeding patient since morning until the afternoon. 

2. Attitude, Commitment and Sacrifice.

Be willing to LEARN from everyone and everything, like a sponge. Absorb the good and bad lessons and practice what is right. Be there to learn when someone is doing a procedure. ASK when you don't know or you are not sure. Be open to criticism and ADMIT your mistakes. Most importantly, be responsible for your patients. Every single individual is someone else's parents or sibling. They are not there to make our lives miserable. We are there to make them better so that we can all carry on with our lives. 

Most of the time, you may feel that whatever you do leads to a dead end. The endless cycle of wake up early and going back late just because a patient collapsed or you got stuck with new admission. During the bad times, I like to read back letters I wrote to myself during the good times to remind me of my purpose and my commitment to this profession. It will only be 2 years, MO life will be a huge upgrade from HO life in terms of working hours. 

3. He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. 

Your patients ARE your books and your books should stay at home. Patients ARE the endpoint of everything you have been studying towards in your career. If you are not always learning and finding ways to solve their problems, I believe you have defeated your own purpose of doing medicine. Leave the thick notebooks at home and learn the basics of human touch. That being said, you shouldn't go to the wards empty-brained. Learn basic resuscitations (BLS, Shock, Sepsis 6) and how to pick up when things are about to go downhill (National Early Warning Score - by NHS). Do not be an overly qualified porter who just sends and trace blood results. 

4. Discuss and practice (what you preach!) 

When you have a thought or opinion in the patient's best interest, you should discuss them with forthcoming colleagues. The more you discuss, the more you will find out that there are actually many different ways to solve a problem. Some solutions could even save the patient a lot of money! 

The next time you encounter a similar problem (which you likely will), test out these solutions, I am sure your patient will thank you a thousand times over.

Add-on: One of the often-overlooked topic (especially during this pandemic) is handwashing. Practice yourself by going through the 6 steps (or 7 steps, depending on whether you are doing a procedure or not) before and after handling food. It doesn't take long and it saves lives! 

5. You are not a one-man-army. 

No matter how many prizes you've won, how skilled you are, you cannot do things alone. You cannot resuscitate a patient alone. You cannot perform surgery alone. In fact the more complicated it is, the larger your team grows! That goes the same for everything else in life. An example are the pharmacists. You will be surprised about how important their input is during the ward rounds.  Learn to share, LISTEN and work together. Even if you are the best, everyone is replaceable in the end. So stay HUMBLE.

Lastly, stay focused. These are challenging times ahead. Be wise about the type of burden you take on. Be responsible for your own learning. Your welfare and career are urgent. The others should take a backseat. 

Useful apps in the wards (not sponsored)

- Steth-o-cope

- QuickMedicine

- Touch Surgery

- UpToDate (reference & drug-drug interactions)

MMC Manual for Housemanship in Malaysia - Here