The red cape
~Remember the unforgettable scene in Grey's Anatomy where George does open heart surgery in the lift? In reality, this situation would probably never, ever happen but it reflects the over-glorification and misplaced romanticization of the surgeon's capabilities.~
One of the worst jobs a training doctor could ever have in a tertiary hospital is the job of the medical registrar or better known as the Med Reg. The medical registrar is often regarded as the 'go to' person, not a highly desirable title in the hospital. When interns comment to their surgical registrars, "This lady is not quite right." - The orthopaedic registrar might reply, "Are her stitches out yet?" The general surgical registrar might attempt to check for post-operative complications and then concede by saying, "Ah make a referral to the Med Reg."
In the emergency department, emergency doctors are mostly concerned about dividing patients into the 'sick' and 'not sick' group. Once declared sick, they run through a mental list if the patient needs a CVC line or lumbar puncture or intubation, failing the need of an exciting medical prodecure, it is then time to refer to the medical registrar to sort out the real problem.
If the problem requires thinking - it is time to refer to the medical registrar.
It would not be uncommon during an emergency call up in the wards when a patient clinically deteriorates for whatever reason - the medical registrar is expected to be decisive and make the correct call. Even if the patient belonged to a surgical unit, one would be very surprised to see the surgical registrar attending. And during the few occasions that they do attend - their only concern would be for the surgical wound - has it burst open? Anything short of that - and they carry on to their next operation.
Surgeons, emergency physicians and obstetricians in particular get a lot of glory on television shows. I will give them their due - their hours are often long especially certain surgical specialities like cardiothoracics and neurosurgery. But the reason for this glory is sometimes misplaced. The recognition given implies an ownership of in-depth medical knowledge and science consequentially leading to the outcome of lives saved. This is not always true. In fact many surgical registrars and notoriously, orthopaedic registrars, have simply lost their basic clinical skills and can only be regarded as surgeons and not necessarily a 'doctor' in the traditional sense of the word. Harsh, I know.
Remember the unforgettable scene in Grey's Anatomy where George does open heart surgery in the lift? In reality, this situation would probably never, ever happen but it reflects the over-glorification and misplaced romanticization of the surgeon's capabilities.
Everyone wants a quick fix to their problem. My hip hurts when I walk. Bang! A new ball and screw is in. Glory to the orthopaedic surgeon. My tummy hurts doctor. Zaaap! And the appendix sits in a yellow-top jar.
Lives are saved, pain is history and all is right in the world again. All glory to the one that wields the scalpel.
But in life - not all the heroes are as dramatic and not all problems are as easily solved. And the medical registrar is one of the unsung heroes who are hardly given their due for the hours they put in and the many, many referrals they receive in a day for all kinds of reasons, some a reflection of other specialty registrars' lack of desire to think. The work of a physician is not seen as life-saving or as 'sexy' as their surgical counterparts. Nothing is sexy about a little old lady who lives at home alone, taking twenty different medications presenting with the vague symptom of fainting and vomiting who nobody has any clue what is going on. Or the post-operative patient who develops chest pain and shortness of breath. The interns page their surgical registrar who mumbles under his mask to the phone, "Page the Med Reg."
In a tertiary hospital where specialty units only take patients relevant to their expertise - everyone else who doesn't quite fit a specific problem gets turfed to the medical registrar. "Look we're not quite sure what's wrong with the patient. Gastro has said no as there are no signs of active bleeding and the surgical registrar has felt the abdomen and doesn't think the patient has a surgical abdomen. But he's not well enough to go home.....I think this patient needs to be admitted to the medical unit." The 'leftovers' are what the medical teams often have to deal with.
HOUSE was perhaps an initial attempt to give physicians their due but eventually even the physicians were seen doing surgical and radiological procedures that they would not otherwise do in real life. Ask the person on the street if they know what a physician is and they would have no clue. Ask them who a surgeon is or an ER doctor and you will get a different answer. Little do they know that when they become really sick and no one knows what to do - a page goes off to the medical registrar ( a training physician) to come and sort out their problem.
This is how medical registars get their reputations for being 'tough' and 'rude' and 'difficult'. Either be tough or get walked all over by other units. Be harsh or else you will get all the 'leftovers' in your unit. Demand that the residents perform relevant examinations and investigations before even thinking to speak to you and give them an earful if they had expected you to think for them.
At the end of each year - an award is given to the doctor who is considered 'toughest to refer to'. This award is voted by the junior doctors. It is not unusual for a medical registrar to win this award - a reflection of the many referrals they receive in their work.
I had the chance to work with a registrar who had won the award twice. I was intimidated to work with her initially. Many horror stories would circulate in the ressies about how some doctors have been known to cry after their referral to her was turned down harshly. One always thought twice before referring to her and made sure that all the relevant information were available. She had many nicknames, not all of them flattering. I had come to know the softer side of her through my work and would often defend her to my colleagues who thought I was crazy to do so. I had not seen her since that rotation and so was very touched when I received this in my inbox this morning which brought tears to my eyes.
Hey Mun,
Just thought I'd send you a quick message. I saw B last night and she mentioned that you had left Australia. I was really surprised as I thought you were a great resident (in fact one of the best we've had!) and I thought you would be a great med reg! B mentioned that there were some personal things you were dealing with and thats the other reason I wanted to get in touch.
First of all I want to assure you that I am not here to pry or gossip.......trust me, I know what that feels like. I just wanted to tell you that when times are tough, sometimes it's hard to see a way out. Take it from someone who knows....things will get better. I'm sure you heard about everything I went through. It was the most humiliating experience of my life...I was in a very dark place and I never want to go back there. I did turn a corner though. The pain never goes completely but you just learn to deal with it.
Obviously I don't know your situation, but try and stay positive. At least you now have your family around you. If there's anything you need Mun, even advice etc just give me a shout. All the best.
R
Empathy is a rare quality and to receive it from someone who many have regarded to be an unlikely candidate, it only goes to show that in the medical world but also in life - the heroes or heroines are not always the one wearing the flashy, red cape.
One of the worst jobs a training doctor could ever have in a tertiary hospital is the job of the medical registrar or better known as the Med Reg. The medical registrar is often regarded as the 'go to' person, not a highly desirable title in the hospital. When interns comment to their surgical registrars, "This lady is not quite right." - The orthopaedic registrar might reply, "Are her stitches out yet?" The general surgical registrar might attempt to check for post-operative complications and then concede by saying, "Ah make a referral to the Med Reg."
In the emergency department, emergency doctors are mostly concerned about dividing patients into the 'sick' and 'not sick' group. Once declared sick, they run through a mental list if the patient needs a CVC line or lumbar puncture or intubation, failing the need of an exciting medical prodecure, it is then time to refer to the medical registrar to sort out the real problem.
If the problem requires thinking - it is time to refer to the medical registrar.
It would not be uncommon during an emergency call up in the wards when a patient clinically deteriorates for whatever reason - the medical registrar is expected to be decisive and make the correct call. Even if the patient belonged to a surgical unit, one would be very surprised to see the surgical registrar attending. And during the few occasions that they do attend - their only concern would be for the surgical wound - has it burst open? Anything short of that - and they carry on to their next operation.
Surgeons, emergency physicians and obstetricians in particular get a lot of glory on television shows. I will give them their due - their hours are often long especially certain surgical specialities like cardiothoracics and neurosurgery. But the reason for this glory is sometimes misplaced. The recognition given implies an ownership of in-depth medical knowledge and science consequentially leading to the outcome of lives saved. This is not always true. In fact many surgical registrars and notoriously, orthopaedic registrars, have simply lost their basic clinical skills and can only be regarded as surgeons and not necessarily a 'doctor' in the traditional sense of the word. Harsh, I know.
Remember the unforgettable scene in Grey's Anatomy where George does open heart surgery in the lift? In reality, this situation would probably never, ever happen but it reflects the over-glorification and misplaced romanticization of the surgeon's capabilities.
Everyone wants a quick fix to their problem. My hip hurts when I walk. Bang! A new ball and screw is in. Glory to the orthopaedic surgeon. My tummy hurts doctor. Zaaap! And the appendix sits in a yellow-top jar.
Lives are saved, pain is history and all is right in the world again. All glory to the one that wields the scalpel.
But in life - not all the heroes are as dramatic and not all problems are as easily solved. And the medical registrar is one of the unsung heroes who are hardly given their due for the hours they put in and the many, many referrals they receive in a day for all kinds of reasons, some a reflection of other specialty registrars' lack of desire to think. The work of a physician is not seen as life-saving or as 'sexy' as their surgical counterparts. Nothing is sexy about a little old lady who lives at home alone, taking twenty different medications presenting with the vague symptom of fainting and vomiting who nobody has any clue what is going on. Or the post-operative patient who develops chest pain and shortness of breath. The interns page their surgical registrar who mumbles under his mask to the phone, "Page the Med Reg."
In a tertiary hospital where specialty units only take patients relevant to their expertise - everyone else who doesn't quite fit a specific problem gets turfed to the medical registrar. "Look we're not quite sure what's wrong with the patient. Gastro has said no as there are no signs of active bleeding and the surgical registrar has felt the abdomen and doesn't think the patient has a surgical abdomen. But he's not well enough to go home.....I think this patient needs to be admitted to the medical unit." The 'leftovers' are what the medical teams often have to deal with.
HOUSE was perhaps an initial attempt to give physicians their due but eventually even the physicians were seen doing surgical and radiological procedures that they would not otherwise do in real life. Ask the person on the street if they know what a physician is and they would have no clue. Ask them who a surgeon is or an ER doctor and you will get a different answer. Little do they know that when they become really sick and no one knows what to do - a page goes off to the medical registrar ( a training physician) to come and sort out their problem.
This is how medical registars get their reputations for being 'tough' and 'rude' and 'difficult'. Either be tough or get walked all over by other units. Be harsh or else you will get all the 'leftovers' in your unit. Demand that the residents perform relevant examinations and investigations before even thinking to speak to you and give them an earful if they had expected you to think for them.
At the end of each year - an award is given to the doctor who is considered 'toughest to refer to'. This award is voted by the junior doctors. It is not unusual for a medical registrar to win this award - a reflection of the many referrals they receive in their work.
I had the chance to work with a registrar who had won the award twice. I was intimidated to work with her initially. Many horror stories would circulate in the ressies about how some doctors have been known to cry after their referral to her was turned down harshly. One always thought twice before referring to her and made sure that all the relevant information were available. She had many nicknames, not all of them flattering. I had come to know the softer side of her through my work and would often defend her to my colleagues who thought I was crazy to do so. I had not seen her since that rotation and so was very touched when I received this in my inbox this morning which brought tears to my eyes.
Hey Mun,
Just thought I'd send you a quick message. I saw B last night and she mentioned that you had left Australia. I was really surprised as I thought you were a great resident (in fact one of the best we've had!) and I thought you would be a great med reg! B mentioned that there were some personal things you were dealing with and thats the other reason I wanted to get in touch.
First of all I want to assure you that I am not here to pry or gossip.......trust me, I know what that feels like. I just wanted to tell you that when times are tough, sometimes it's hard to see a way out. Take it from someone who knows....things will get better. I'm sure you heard about everything I went through. It was the most humiliating experience of my life...I was in a very dark place and I never want to go back there. I did turn a corner though. The pain never goes completely but you just learn to deal with it.
Obviously I don't know your situation, but try and stay positive. At least you now have your family around you. If there's anything you need Mun, even advice etc just give me a shout. All the best.
R
Empathy is a rare quality and to receive it from someone who many have regarded to be an unlikely candidate, it only goes to show that in the medical world but also in life - the heroes or heroines are not always the one wearing the flashy, red cape.
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