Category Post-SPM

A young girl working alongside medical staff: the little obstacles Part 1

Rachel Tan HX 1 Comment

Previously, I had written about my experiences working at the Covid 19 frontlines earlier this year, and a detailed list of my job scopes as a Patient Care Assistant at a small Malaysian hospital. However, I have never told you about the various events of sakit kepala (meaning “headaches” in the Malay language) I get from working there.

However, these little mishaps and frustrating events are now only in my fond memories, as they are great insight into what the healthcare system is really like, and remind me that there will always be things to worry about when it comes to the health of the people. It also dawns on me that running a hospital is not easy, and there are bound to be disagreements and inefficiencies in the system, even if everyone truly does tries their best to provide the best care for their patients. If I were to become a doctor in the future, I must not become one of the strawberry generation (in Chinese, a strawberry is said to “bruise easily”, symbolizing our new generation that cannot take little failures and hardships). Therefore, a little hardship is good for training the spirit.

Of course, when I am writing about this, I am aware I have to tread lightly.

The first headache that comes to mind is this particular time we tried to do something as simple as registering a patient, that needed to be seen outside the hospital due to observed possible symptoms of Covid 19. I was sitting behind the counter of the emergency unit, doing admin work (handling of registering of the patients, writing in the case log book, opening certain bills, preparing lab forms etc). I was already juggling more than three things in my mind when a doctor from the specialist center walked up to me and said: “I want to see my patient outside the hospital. Register her under the emergency unit.”

I was confused. This was a patient of a specialist doctor. She should be registered under the specialist clinic, not under emergency. What should I do?

I asked the nurses this question. “Hey, dia patient specialist centre!” called the nurse, voicing my concerns exactly. “Bagilah specialist department register patient sendiri.” (Let the specialist department register their own patient.)

I then brought this patient’s personal details form to the specialist center. I explained to them that a doctor under their department wanted to see a patient outside, and instructed me to register her under the emergency unit. “Jika doctor nak tengok kat A&E, registerlah kat A&E. Bukankah doctor sendiri dah suruh register A&E?” (If the doctor wants to see the patient at the emergency unit, register them there. Did the doctor not request for the patient to be registered there?)

That did make sense, so I left and walked back to the emergency unit, but I was getting more and more perplexed now. So, the question is, should patients be registered under their doctors’ department, or should they be registered at the location there were being treated? Yes, that is precisely the question. I did not know the answer to that, but I knew that there was probably no answer. Perhaps no one has even thought of it before, since it is the first time we have had COVID 19 come attacking the people and and our already overloaded hospital system.

Knowing that doctors usually have the final say in everything (and perhaps rightly so), I expressed this issue to that doctor. “Is it possible or not, to register her here? If it’s possible, I want her registered here. Just register her here.” He demanded, pointing down at our registration computer. I nodded and he bustled off.

“Um,” I said clearly, hoping my colleagues (nurses at emergency department) had noticed, so that they wouldn’t demand yet again why I was registering a specialist doctor’s patient under our unit. “Dr X said to register them here. So I must register them here.” A nurse next to me had heard and agreed.

I tried to register the patient, but… I can’t remember at this point what exactly happened, as it has already been a few months since I stopped working at the hospital, and all this studying at university has probably displaced all my prior knowledge of the details of working! I do recall something about this patient having just visited the specialist center yesterday or something of the sort, which meant that her medical record folder had not been sent back up to the medical record department (known for short as MRD) yet and was still in the depths of the cupboards at the specialist center. So the patient’s details had to be brought to the specialist center yet again, but this time the nurse next to me said she would handle it, storming off with the patient’s details. Just like that, I was no longer involved in this issue.

For your information, dear reader, this is not uncommon. When working at the hospital, I face problems with tracing medical record folders all the time. Hence, for my medical interview to enter foundation leading to MBBS at my university, in the essay we had to write on the spot on our ideas for improving the healthcare system, I suggested that a electronic medical record (EMR) system should be imposed widely throughout the country. My interviewers praised me for being well read, but actually, I still have a lot to learn, haha! It’s just that when you had worked for two months at a hospital facing exactly that kind of problem, with folders missing, hidden in the cupboards or I-don’t-know-if-it’s-at-Emergency-or-Specialist-Centre-or-MRD-or-could-it-have-accidentally-gone-into-the-trash, it’s difficult not to wonder about a solution to this issue yourself.

There are two things I have learnt from this event alone. One, the importance of implementing a electronic medical record system on all medical premises, but of course that takes time and perseverance on the part of the government. Two, I have also discovered that doctors make most of the primary decisions, and as a doctor in the future, I may not be as lucky as I now am to be able to bombard my colleagues with questions or push duties to my fellow nurses if I’m not sure about anything. If I were to become a doctor, my nurses may be the ones to look to me for answers and although doctors are human, too, you just cannot always be saying: “Sorry, but I’m not sure.” Along the way as I am taking in medical education, I must also ensure that I am well read and updated, and find ways to help myself become smarter and be able to think on my feet. That is what is required of a doctor.

Although I have faced many predicaments during my short time as a patient care assistant, I now remember them all fondly and I know they have all helped me in some way!

The truth is – I have managed many things efficiently, juggled five things in my head to do at once, taken orders from two people talking at the same time, run from the first floor to the third floor, and performed at my best on many days. However, I have also made tons of mistakes, been ordered about and scolded often, and faced many frustrating issues while working; but when I think about everyone’s higher purpose here – providing the best care for the patients, it is easy to take every problem with a pinch of salt. It really is. I think it is healthy, it is a blessing, to have a higher purpose. That is what I hope my medical career will be like in the future, since I am sure problems like these, or even much worse, cannot be evaded. I am going to work very hard to attain good results so that I may earn my place along those who own this higher purpose together.

Stay tuned for other obstacles I’ve faced while working at the hospital, during the Covid-19 crisis! I will make the links available here once I have written Part 2 and Part 3 of the little problems I’ve overcome while working. Bye for now 🙂

I have JUST found a sliver of extra memories from my job at the hospital.

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Only just yesterday night, or rather, at 1am this very morning, I was telling you that being human has already started to erode away at the memory of my priceless experiences working at a hospital. And in that same blogpost, I had said the one thing I wanted most was probably to remember what I’d heard.

Until now, I probably only remember what I’d seen. The problem with remembering what you see is that eventually, you end up only being able to picture the layout of the emergency unit, but you can’t remember many specific scenes at all. All you remember is how the counter looked like, how the lift smelled like, how cold it was in the wards etc. Because when you’re in the same small space for long hours and for two months straight, all the scenes merge together to form a blurred image. Unless you had moved around much more, then you may be able to recall more specific scenes. In fact, I have read about this somewhere before, and that is how the human brain works. This is called “spatial recognition“.

(Spatial recognition is not to be confused with “spatial recollection“, which is another important concept I will be sharing with you in the not-so-near future. But, if you’re curious, I’ll include their meanings down below. I have even simplified it for your understanding!)

Actually? I’m here to tell you that I’d found some recorded moments, knowing that I would want to remember.

Just now, I sat on my bed and listened to the recordings on my phone. There was a lot of background noise in each one, but that’s what you get with low quality phone recorders. There was one recording of my high school classmates collective laughter. There were two of my retail colleagues promoting our travel products to our friendly customers.

And there were about six at the hospital, of my colleagues chatting and laughing. In one, I heard a baby crying in the background. It was probably receiving an injection or an IV insertion…. haha. Doctors spoke on the phone and nurses bustled around the registration counter. I could only make out their voices and no words at all, but truly that itself is all I am looking for.

Six short recordings is hardly anything compared to the two full months I’d experienced. Yet it is certainly still something. I’m happy to have found these memories.

Spatial recognition: Here, space (spatial) literally means empty space. Remembering and recognizing things by being able to picture precisely where those events took place. That’s how the human brain works.

Spatial recollection: Here, space (spatial) refers to time. Remembering things by spaced out re-reading of material, to slowly commit something to memory. If you want to remember something, you usually read it once tomorrow, once in a couple of days, then once next week, then next month. That’s how the human memory works.

Just got my university online lecture notes!

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Just checked our university’s e-learning website and some of the notes (all of them are in powerpoint presentation form) are ALREADY UP! I am not sure whether these are our main notes, or just for casual reading, but it is something, for sure.

Update on 28th of January 2021: Those were not our main notes, they were old notes just for our reference.

I have printed some out to start studying already. MBBS (Bachelor of Medicine and Bachelor of Surgery) is one of the most rigorous courses, and to achieve AND maintain a CGPA of 3.5 in foundation leading to the degree course, the minimum requirement to enter our institution’s MBBS degree course, I absolutely have to get going!

I would like to repeat again that although this blog is meant for everyone, its main purpose is to be a guide, or simply a companion, for my peer and future-generation friends who are looking to pursue medicine as a career. Through this blog, I also hope to connect with you and would love to be friends. You can find me at Instagram (@racheltan_hx).

As of now, our e-learning environment has put up lecture notes in the form of presentation slides, along with some videos for certain chapters, and quizzes to test our knowledge. It has a very simple user interface (layout and design). However, I still find exploring the student portal, e-learning platform etc interesting.

I must remind you that I have only just attended my e-orientation, and the commencement date for the foundation programs is later in June; however fret not! I have signed up for some online talks, hosted by my university as a welcoming for new university students. Still, there has been no instructions to read the notes in the student portal, and there have been no lectures at all yet.

I am currently still unsure how we will be informed when there will be a online lecture; but I will cross the bridge when I come to it 😉

For now, I shall check some of the notes out. There is already a lot of content on the e-learning platform. Cell Biology, here I come!

~Rachel Tan, Blog author, 16 May 2020.

My Job As A Hospital Patient Care Assistant

Rachel Tan HX
Credits: Blog author, Rachel Tan HX, 18

Disclaimer: This blogpost is specifically targeted to help or inform students who are considering or are studying medicine, and is less tailored toward healthcare professionals or the public. This blogpost is NOT written to garner followers or to be made viral, which is why this blog will not be intentionally publicized.

As some of you already know, I spent the past two months working at a hospital as a patient care assistant. Being hospital staff, I have learnt so much just through observation and listening. Today, I would like to share with you what is required of my job as a PCA.

First of all is admin work. Contrary to what the position “Patient Care” Assistant suggests, most of the work of a PCA is actually done sitting behind the counter. The admin is known as the person who handles the computer and does all the paperwork. My job is to register patients in the system, trace their old medical records, bill patients, make sure all their details along with their diagnosis, attending doctor, and time visited are recorded into a large patient log book. The paperwork consists of various types of hospital forms, including the prescription form for medicine, x-ray form, lab form, insurance forms, Covid 19 test form, and the various charge forms (billing) for nursing procedures, disposable items, doctor consultation fees and usage of medical equipment. Then there are the phone calls, which could be internal (coming from the cashier next door, general ward, x-ray, lab, HR, marketing or any department within the hospital) or external (from patients, doctors from other hospitals, etc). You have to remember all of the extension numbers from the various departments, so that with one glance you know where the call is coming from before you even pick up the phone. When a patient comes with health insurance or a medical card, we have to call up the insurance company to check if there is coverage, then request for a guarantee letter(GL), which can take from 10 minutes up to 2 hours, by which time we would have to call up yet again to enquire about the GL status.

You might groan in boredom when you listen to all the work I have described, but there’s so much to absorb all at once, you have absolutely no time to be bored. Try it, and you will wonder how admin work can be so difficult to keep up with, especially during your first few weeks!

Secondly, a PCAs job is to do despatch work. If today I am assigned morning shift, I must make the beds or change any bedsheets or pillow cases which are dirty and send them up in a laundry bag. I must record the number of soiled linen sent up and request for new ones. Once in a while, I will also be called up to collect items from purchasing, such as gloves, face masks, small tubes for collecting blood or urine; or to send or collect medical equipment to or from CSSD (Central Sterile Services Department). I also must collect lab and x-ray reports when they are ready.

Thirdly, in light of Covid 19, more demands have been placed on healthcare personnel, namely triaging and assisting the doctor during covid screening. As an unlicensed person, I can only triage. Triaging is, in simple terms, deciding on the order of which patients should be attended to, based on the seriousness of their condition. I will ask every person that wants to enter the hospital a list of questions that checks for Covid 19 symptoms or possible contact, while wearing my complete PPE (Personal Protective Equipment).

A fourth requirement is not specific to PCAs, but rather for all staff working in the emergency unit, and that is having 3 shifts. For instance, PCAs working for the specialist clinic work office hours, but I happen to be given a job as a PCA under the emergency unit, so every day I can either be doing morning, evening or night shift, depending on a duty roster that is updated weekly. Once in a while, I will also be asked to do a double shift for 14 hours straight.

Finally, we reach the part you have been waiting for: patient care! I have transfered patients with leg injuries onto a wheelchair, wheeling them from their car into the emergency unit at 2am. I have pushed patients on wheelchairs to get their x-ray done, or on beds to do a supine x-ray (lying face up), both often connected to saline drips. I have lifted a boy’s leg with a hornet sting to place a tenapad underneath; held a crying, struggling little girl’s head as the doctor did stitches on her chin; brought water for an alcoholic suffering from SOB (shortness of breath); made friendly conversation with anxious senior patients; and translated entire doctor consultations as best as I could to many mandarin-spreaking patients (I struggled to translate all the medical jargon to Mandarin, though).

I have also dealt with two particularly serious cases that I will refrain from mentioning from the time being, as those will be left to another post where I must ensure patient confidentiality, while at the same time bringing the story to you.

Those are the main five duties I have as a Patient Care Assistant! If you are a teenager and have tried working in a hospital, or even have any sort of work experience, I would be delighted to hear from you.

After all, I set up this blog for one main reason: to write the informative, or healthcare-related blogposts, from a Malaysian medical student’s perspective starting from her teenage years, that I have always wanted to read but could never find on the Internet. So I went on and did it myself! Now, I hope to bring forth the stories to you. 🙂

Small note: Although this blog is meant for everyone, my main intended audience is for my peers and next generations who are thinking of, planning to or are currently pursuing a career in healthcare, therefore much of my content will be tailored to our understanding.

My First Day At Work (Hospital)

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Here’s what all of you have been waiting for: the first tip of the iceberg of my experiences (a Malaysian teenager’s experiences) in the healthcare sector!

For those who are new to my blog, I am actually still a post-SPM teenager, to join foundation in science in May this year. After my time as a sales and retails assistant with a small local company ended, I proceeded to seek a job at a hospital for relevant experience with what I’m planning to study. I am currently still working there and I am immensely grateful for the enriching experience, as much as I enjoyed that of my previous job. See previous post: My First Day At Work (Retail).

My first day at work as a Patient Care Assistant (PCA) at the Emergency Unit was an unbelievably hectic one. Someone from the human resource (HR) department helped me set my thumbprint in the hospital system, which I would use everyday for clocking in and out. Then I was brought to the Emergency Unit, where she gave quick instructions to the staff to add me to the duty roster and show me around. The Emergency Unit is very small and easy to navigate. It mainly comprises of a registration counter, the medical officer’s consultation room, a small ward with three beds and a treatment room.

After that, I was given my pre-employment hepatits B jab by the same nurse who showed me around, who would in the coming weeks become my colleague and friend. Then I walked, uncertainly, to the registration counter and sat at the computer.

This was how the working environment at the counter had looked like to me on my first day: raised voices of the staff, hospital forms being thrown about, furious typing on the computer keyboard, patients walking in and out. Already this was a small hospital, and the Emergency area that I was working at looked more like a small clinic than a hospital; yet I could hardly process anything that was going on. I knew one thing for sure, though: this is what behind the scenes looks like. This is a real hospital. Just like facing out of the shop booth to promote the products instead of facing in to make a purchase, I was standing behind a counter I only ever stood in front of. It was a change in perspective, an intriguing shock to my system, and I was eager to learn more.

So I sat at the counter and let a nurse tell me what to do. “Click sini. Click sana. Tekan ini. Type nama dia.” I understood that there was no time yet to explain the why and how of everything that was happening, and diligently did as she said, even though my mind was spilling with questions. I would later realise that in this fast-paced working world where customers (first job: retail) or patients (second job: hospital) had to be attended to quickly, learning should be based less on endless questions and more through observation and practice. You really learn a whole lot better that way.

But you must dare to observe and dare to practice. You truly must. You must let your desire to learn override your fears, and then nothing can stop you from absorbing all that the world has to offer.

To the nurse that stood next to me on my first day, ordering me to do this do that, let’s call her Free (named changed to protect identity): I will remember you for some time to come. For every small thing that I did right in the coming weeks you would say “cantik” or “dah pandai”; you also knew how to breakdown certain things so that I would understand, and for that I am very grateful.

You could say that on my first day, all I ended up learning was only how the counter looked like. I still could not grasp anything properly, not even the basic registration of patients, because everything was happening so fast; but regardless, with my first glimpse behind the scenes, I was already learning.

Most of what I learnt on my first day was the physical layout, and the working atmosphere, and I do think that was already a good lesson for a beginner like me!

~Rachel Tan