1. I learn to identify ill patient that need to be attend first, and those relatively well patient who can wait. To put it in a simpler way, I learn how to prioritise. To put it in a more professional way, I learn how to triage patients.
2. I learn how to manage different cases, from simple case like soft tissue injury, to severe case like those arrive with GCS 3.
3. I learn Total Quality Management from Dato Abu Hassan. Syndromic interpretation, activation of senses, package of management.
4. I learn how to order necessary investigations that will help in diagnosis or change in management, instead of ordering every single investigation under the sun. This explained why in US they called it "diagnostics" instead of "investigations".
5. I learn about team work in ER. ER is not a stage for one man show. You cannot run the ER yourself. You need your colleagues, your staff nurses, your medical assistants, your seniors, your specialists. There is no hierachy gap between superior and inferior, but at the same time we respect one another, and seek for expert consultation when needed.
6. In ER or even in pre-hospital setting, we specialised in emergency airway management, we intubate patient in ground zero, with possible on-going CPR. We learn crush intubation.
7. I learn not to be a diagnostic chaser, even though diagnosis is important. I learn to identify the problems, the syndromes, and carry out investigations and treatments even without a proper diagnosis, this is what Dato Abu Hassan called as "package of management".
8. I learn not to practise bedside medicine. I don't ask one thousand questions and wait for all the possible investigations from the lab before starting the treatment. I don't want to get the right diagnosis but lose the patient.
9. I was given opportunities in hands-on. Bedside ultrasound, neck line, chest tube, RSI, intubation, CPR, TCP.
10. In ER I can forget about visiting the radiologist of the day (ROTD) and beg for a CT scan or ultrasound scan appointment. I scan the patient myself. IVC, FAST, ECHO, lung scan, 2-points-compression test.
11. We are not jack of all trades but master of none. Emergency medicine is a specialisation by itself, which connects all other specialties in a horizontal sense, under the roof of emergency conditions.
12. EDHKL provides teaching opportunities through CME, grand rounds, course (BLS, ACLS, TLS, TQM, airway, FAST).
13. Emergency medicine is not limited to ER or ED with four walls. Emergency medicine covers pre-hospital care (PHC), disasters, retrieving medicine, relieving works.
14. I am learn how to answer some weird questions asked by your relatives, although I might still not be able to arrive to a proper diagnosis or explanation.
15. I can forget about "jaga wad" and do the endless ward round. In the ward, houseman did round x1, then medical officer did round x2, then specialist did round x3, then consultant did round x4. AM round, PM round, oncall round, midnight round. Morning OD blood taking, BD, TDS, QID. When patients going to have a rest in ward?
16. I learn how to take history from patient, and start creating case note from scratch from a piece of paper. I can forget about flipping through the thick case note and read through other people's clerking, and stop reading "case and progress noted" and "continue as planned".
17. I can come to work on time, though I might not be able to go back on time. I don't have to come very early at 5am to review patients in ward, who are sleeping at that odd hour.
18. A senior told me that you can't learn medicine in one day. In a similar way, I learn the fact we can't be staying in the hospital and "jaga" the patient. I learn to passover patient's care to other people, because I am not a robot that can work 24/7. ER is a place where some one will continue the work after your shift or during your off day.
19. In certain environment in the hospital eg. ward, ICU, OT, oncall system might works better than shift system. I also have great respect to those doing 36-hours oncall. But the fact that we work shift and not oncall doesn't mean that we work lesser. We work in a shorter duration of time, but in greater intensity, with patients flowing in non-stop to the ER, regardless whether you still have beds or even chairs for them. Shift system recognises the fact that doctors are humans, and they need rest because they can get exhausted too.
20. I learn how to compromise to improvise, rather than being OCD. I learn how to work in an enviroment with limited resources. I learn how to do ECG without the bulb that connect the lead/wire end to the chest and limbs.
21. I learn to know my limits, when to call for help, when to refer. To put in a more professional way, I learn when to "seek for expert consultation".
22. I learn that effective high quality CPR can actually revive someone.
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Something that I wrote after I finished my posting in emergency as houseman, basically is a list of quotes from emergency physicians and medical officers.
Invaluable lessons from a department that never stop amaze you, from your superiors, from your colleagues, from your staffs, and even from your patients.
"Whether you came to emergency by choice or by force, you came to the right place." - Dr Faisal Salikin
"Don't try to treat the patient alone, we treat the patient together, and share the burden and responsibility together." - Dr Faizal
"It is okay for not knowing, but it is a sin for not learning." - Dr Mawar Ayub
"Triage is an art. The secret is, instead of asking 'which one is right?', you should ask 'which is better for the patient?' " - Dr Alzamani Idrose
"Concordant is bad, discordant is good, but too good is bad." - Dr Umul Khair
"We don't practise bedside medicine. We don't take history for an hour, then examine patient, then take an long list of blood investigations and X-ray, then only start treatment. We start treating before we have an exact diagnosis, this is what we called package of management." - Dato Seri Abu Hassan Asaari
"Patient comes to you will fall into two categories: classic or typical, and atypical presentation. As you see more patients in your practice, more patients with atypical presentation will fall into category of classic presentation. This is what you call experience." - Dato Seri Abu Hassan Asaari
"Learn from the water. They are very humble. They take the shape of the vessel that they are in. They conform to the situation they are in. Even if they lie on the floor, if they want to fly, they can evaporate and become cloud in the sky. If they want to be strong, they can become iceberg and sink a ship. Each of us may be a droplet of water, but if we are united, we can become ocean." - Dr Alzamani Idrose
"Individually, we are a drop of water. Together, we are an ocean." - Dr Alzamani Idrose
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Something that I wrote after I listened to a presentation by Prof Terrence Mulligan in International Clinical Conference on Emergency Medicine (ICCEM) October 2015.
A breathtaking presentation by Prof Terrence Mulligan. He brought us through the rocket science of Ptolemaic geocentrism vs. Corpenican heliocentrism, Newtonian physics & quantum physics, and finally brought us back to emergency medicine.
The explanation of apparent retrograde motion of the planet can be explained in a simpler way after change of perspective.
Many misconceptions of emergency medicine by others is largely due to the lack of understanding the fact that there is a paradigm shift in medicine.
To think that emergency medicine is a jack of all trades but master of none means they have ignored the fact that emergency medicine is a specialty in itself, not in a vertical sense but in a horizontal sense.
