Thursday, August 6, 2009

stressful docs

Doktor disaran jalani latihan urus tekanan
Oleh Sazarina

Stres punca ramai mahu tinggalkan bidang perubatan

KUALA LUMPUR: Doktor perlu diberi latihan pengendalian stres secara berterusan kerana kerjaya itu adalah antara bidang yang mempunyai tekanan kerja paling tinggi. Presiden Persekutuan Psikiatri dan Kesihatan Mental Asean (AFPMH), Prof Dr Mohamad Hussain Habil, berkata jika golongan itu tidak diberikan rawatan segera, ia boleh memudaratkan bukan saja doktor terbabit malah pesakit yang dirawat mereka.

Beliau berkata, berdasarkan kajian antarabangsa, doktor adalah antara kerjaya yang mempunyai tekanan kerja tinggi selain juruterbang, Perdana Menteri dan Ketua Pegawai Eksekutif. Justeru, beliau mencadangkan Kementerian Kesihatan mengadakan program latihan pengendalian tekanan secara berterusan kepada golongan doktor ini supaya mereka dapat mengendalikan tekanan secara baik. "Tugas sebagai doktor memang memberi tekanan yang hebat dengan waktu kerja yang tidak menentu, ditambah dengan bebanan kerja sehingga mereka langsung tidak mempunyai masa untuk aktiviti peribadi.

"Program pengendalian tekanan selalunya dilakukan oleh syarikat besar untuk kakitangan mereka dan sudah tiba masanya doktor juga diberikan program seperti itu," katanya ketika dihubungi di sini, semalam. Kelmarin, Ketua Pengarah Kesihatan, Tan Sri Dr Ismail Merican, mendedahkan 21.8 peratus doktor pelatih di seluruh negara memerlukan kaunseling dan 5.8 peratus pula memerlukan rawatan khusus.

Statistik itu berdasarkan satu kajian terbaru di 28 buah hospital besar yang menunjukkan 67.8 peratus doktor pelatih mendapati latihan mereka adalah terlalu stres dan 53 peratus kadang-kadang memikirkan untuk meninggalkan bidang itu kerana tidak tahan dengan tekanan.

Kajian itu juga menunjukkan stres paling tinggi ialah berkaitan dengan waktu kerja serta bebanan kerja dan 30 peratus hingga 40 peratus daripada mereka tidak mempunyai masa untuk aktiviti sosial dan rekreasi.

Acute respiratory distress

Being in medical line can make you really lose your sense of compassion and sympathy towards others.
Especially when you are in posted in medical ward.
Sometimes we even get irritated with patients. what more if the patients are those who would not comply with the treatment and medications given. And they persistently ask to go to back home as soon as possible.

What more when those are the people who keep being admitted to the ward because of the same problems...

Currently there are a lot of chaos regarding the H1N1 thingy..or ILI or SARI..

There are a lot of changes in the ward because of the event.

The ward which was previously saved for the dengue patients are now being filled up with patients suspected of respiratory problems

throughout my oncalls-- there have been quite a number of suspected cases

the things's sort of cumbersome to actually have to don the spacesuit...

and the N95's really hard to breathe in those stuff..

and then you have to do the throat swab..and the notification..
but the thing is..respiratory distress is a very life threatening event..and a very acute one , that is.
one of my patient had collapsed this morning just before the morning rounds. She had aspirated earlier after taking her breakfast.
Thus we had proceeded with Intubation in which i had failed for the first time. due to the difficult intubation, we had referred to anaest.
during the procedure, the pulse had become absent and quickly we commenced to CPR. alhamdulillah, she had revived and proceeded with bagging until further admission to ICU.
What a day to start with.. the afternoon, another unstable patient arrived. It was a life threatening asthma.. it had also threatened the staff as well,mind you..
She became unstable, and had progressed quickly to distress.
She was then electively intubated due to her worsening condition...
What a day...what a day...

Saturday, August 1, 2009

I'm so stressed out...

Tiredness can make you lose your balance..your control and ultimately the common sense..

For the past 3 weeks, I felt so much overworked...especially since having so many oncalls in such short oncalls have been every other day...which means that my life is solely confined to the hospital. it's either you're oncall or you're post calls. Alhamdulillah the specialist has been such wonderful sport about it..i mean in regards that i'm not performing that well currently.

What i'm worried is that the patients are at risk when we're not in our optimum shape..

This is all about taking care of patient..making sure that they get the best treatment that they should...

But the thing is..doctors are very much human and very gullible for errors. What more if they are under pressure and stress...

I personally do not mind getting up early for ward and preparing for the patients.. but i cannot perform my best when i have just finished my oncall that morning and directly start the next day of job..if the calls were in fact not so eventful, then it is understandable..

Working under enormous pressure and stress is daunting...especially when you are very much tired.

I had actually cracked during the ward round after so many Every other day calls..

Throughout this 2 weeks, there have been so many poisoning cases , whereby the patients had intentionally drank weedkillers, paracetamol overdose, and many more.

These patients are mostly under stress and many of them did take the medications intentionally with the intentions to either to relieve the stress or had suicidal ideation.

It worries me that what length that people are able to do to relieve their problems..this does not concern only the patients, mind you...

a whole lot of doctors are also under pressure and stress...and many of them manifest by way of quitting the job or not appearing for work.

And that does sit inside the minds of so many houseman...including myself...

sometimes, it feels that it is not worth it to suffer through all this whereby we have other choices..


Ya Allah, aku berlindung kepadaMu dari kebingunan dan kedukacitaan, Aku berlindung kepadaMu dari sifat lemah dan malas. Aku berlindung kepada Mu dari sifat penakut dan bakhil. Aku berlindung kepada Mu dari beban hutang dan penindasan orang....


Paracetamol poisoning ( Panadol)

- Paracetamol is converted to a toxic metabolite. N-acetyl-p - benzoquinonimmine, which is normally inactivated by conjugation with reduced gluthathione. After a large overdose, glutathione is depleted and the toxic metabolite bind to liver cell membranes causing necrosis.

What they present with:

symptoms over the first 24 hour include anorexia, vomiting, and diaphoresis, but the patient is fully conscious.

Hepatic enzymes begin to rise 48 hours after ingestion and peak at 72 - 96 hours. REcovery starts after approximately 4 days unless hepatic failure develops.

Symptoms at this stage : Right upper quadrant pain, jaundice, confusion,somnolence and coma.

Organophosphate poisoning;

organophosphosphorus insecticides include malathion, parathion, dichlorvos, and diazinon.

what they present with:

wide spread muscarinic and nicotinic effects:

- muscarinic: nausea, vomiting, miosis, abdominal cramps, urinary and fecal incontinence, bronchorrhea, diaphoresis, salivation, lacrimation, cough and dyspnea

nicotinic effects:

twitching, fasciculations, weakness, cramps, and hypoventilation with respiratory failure.