Wednesday, May 03, 2006

Why I love working here

It's going to be difficult if/when I decide to go home to practice, seeing the difference in how medicine is practiced. Especially after training and working here for 8 years.
And I'm not even talking about the huge salary difference.
I thought about this yet again when I saw a patient with a pituitary macroadenoma. The pace at which things move here can be dizzying.
Day 1: I see the patient, order lab tests and MRI. Visual field testing.
Day 2: Results show this is nonfunctional. Consult neurosurgery.
Day 4: Neurosurgical consult. Agree to proceed to surgery.
Day 5: Transphenoidal resection of pituitary tumour.
Day 6: Discharged from hospital.
Or, something else I see frequently, primary hyperparathyroidism:
Day 1: See patient for chief complaint of hypercalcemia and high PTH. Order other tests and parathyroid sestamibi.
Day 2: Results suggest an adenoma. Make a surgical referral.
Day 4: Surgeons agree to take patient to surgery.
Day 5: Surgery. Discharged on same day.
Same applies for other fields in medicine. Take an MI (heart attack) for instance. I thought about this when I read about 2 prominent Malaysians who died of 'heart attacks' in the last 2 weeks, and wonder if those could have been saved had those hospitals had the resources:
0 minute: Patient experiences chest pain.
23 minutes: Brought to ER. EKG shows ST segment elevation. Stat labs show elevated cardiac enzymes.
24 minutes: Patient codes from ventricular tachycardia.
24 minutes 15 seconds: Chest pads applied. 200 joules given. Returns to sinus rhythm.
24 minutes 21 seconds: Patient is back from the dead.
31 minutes: Goes to emergency cardiac catheterization.
44 minutes: Coronary stent deployed.
5 days: Patient walks out of the hospital, alive.
I catch myself wondering if I'll be able to switch gears and get used to the system back home. Here, I feel like I'm making a difference, and am truly helping patients. I'm not sure how much I'll be able to do back home. Or, if I'm going to be able to change things for the better.
After all, we physicians do get so spoilt here. Order a chest CT, and within 4 hours I'm seeing the report and the images on the computer.
I know doctors back home do the best they can, and often patients do receive excellent care. But I do wish there was more funding for public healthcare.


Blogger titoki said...

Yes, it's frustrated to work with people who don't share the same working ethics and values with you.

Yes, it's frustrated to work in a Third-World where everything is S.L.O.W unless you have $$$ to speed up things.

And yes, Malaysia sux in many ways but it's home and home is where the heart is. :)

2:55 AM  
Blogger WMD: Wife, Mother, Daughter said...

I sure hope that when the times come, you will decide to come back. We need doctors like you. It may seem that it will be an uphill struggle working in a underfunded and chaotic system but if everyone were to shy away...when will the healthcare system improve. It would be in such circumstances that every little that you do will make a HUGE difference.

9:10 AM  
Blogger Thoughts on my Journey said...

Reminded me of my frustrations a few years back/even at times now - when I returned to M'sia, fresh after my PhD, full of enthusiasm. In fact, that is how most my colleagues felt. Nevertheless, deep inside I believe, our return and letting our voices heard, even within the department-far far from the top decision makers, we can slowly help make a change. It may not happen overnight but enough to cause some ripples.

9:20 AM  
Anonymous sabrina said...

somehow i would not encourage you to go back. it is home, and if you miss home, you can fly back. ( yes i know the time difference and the long flight)
but, believe me, it is a lot more worse if you stay there permanently.
adapting to the inequalities in every aspect ( i won't be explicit, but you know what i mean)
dealing with the frustration of government bureaucracy, dealing with the different work ethics and values of everyone around you..
people do not share the same views with you anymore.
i am not sure about you, but i definitely do not have the same values as most of our fellow countrymen these days.
i say this because i wouldn't want you to end up hating your job in a non-conducive environment..

4:07 PM  
Anonymous Anonymous said...

Unless work is the only source u derive satisfaction n pleasure from, being near to family n friends would be another deciding factor whether to stay put or come home.
We can never expect M'sia to have the similar level of healthcare system as US, after all, we are only a developing country. No doubt there's too much govt bureaucracy, lackadaisical attitude at work and inadequate funding that hamper our progress, but me being in the system before, I reassure u, it's not that bad actually.
We need more ppl like u to help improve our healthcare system. Play ur role as a patriotic M'sian. Ask what u can do for ur country, not what the country can do for u.
Even if u find this not ur cup of tea at the end of the day, u can still opt for private practice or fly back to US. At least, u can hold ur head high n tell the world, that u've played ur part as a citizen or tried ur best to help make a difference. Just my two cents' worth...


9:01 AM  
Blogger suanie said...

marry me and move me to USA la. i will make u a very happy man... malaysia, what's that? hehehhehe :P :P

9:14 AM  
Blogger vagus said...

but, but, suanie, you didn't even wanna meet up in february? :((

9:39 AM  
Blogger Greenapple said...

honestly after so many years, it will be tough to return home.

but whatever your decision is, I wish you best of luck. I am sure you'll make big impacts regardless.

2:17 PM  
Anonymous RonT said...

hey doc, hope you wouldnt expect similar kind of working procedure and efficiency you are getting where you are now, if you move back to'd just as foolish and naive as those 1st year med student like yourself 10 years ago. its sad but its true.

1:05 AM  
Blogger Liv said...

Nope not Malaysian...thanks for stopping by though! =]

I always wanted to be a doctor... I just wanted to have fun more so I changed my major in college. lol... I have mixed feelings now about my career path.

I have many relatives and friends who practice medicine here in the states that are eliminating bits and pieces of what they do because of insurance issues... I see the paperwork interfere with the caring aspect of medicine. I feel lucky sometimes that I have an 'in' with certain doctors or some of my care might be skipped due to conservative insurance coverage... not wanting to do testing etc...

Anyway nice blog and thanks for sharing!

3:16 PM  
Blogger febe said...

It is very difficult to adapt and definitely NOT rewarding no matter what everyone else might tell ya!I had to send a patient of mine for MRI at a centre almost 2 hours away(as the 'district' centre i worked for only had CT scan machines...) and in the time that it took to do a bloody MRI, the patient collapsed (she had a brain tumour) and had to be ventilated!It's very, very, VERY F-R-U-S-T-R-A-T-I-N-G!
Whatever decision you make though in the end, NEVER regret!

11:10 PM  
Anonymous Anonymous said...

are you on a J1 or H1 visa in US?

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