It is often too easy to work like one of those clichéd musical box ornaments – At the turn of a knob, the miniature dancer dances on her pedestal lifelessly, accented by her frozen, painted porcelain smile. It has no mind, no life nor soul – it dances and twirls, until the gear turns out;, ending its transient burst of life to stagnation, then returning to rest its little musical coffin.
The B clinic in IMH is strongly reminiscent of internal medicine outpatient clinics or government polyclinics. The patient load is terribly high, leaving medical and nursing staff to go without lunch in order to finish the load. Sometimes doctors have to overrun clinics – morning sessions nibbling into the afternoon slots, leaving the last of the morning patients tired and frustrated, and the early afternoon patients anticipating in anxiety.
The typical experience of a consult room is one of heightened anxiety, an emotional climate that can be easily felt once the consultation commences. In 5 to 10 minutes, there is much to be done. Hello uncle how are you? Did you take your medication? Any side effects? How much medication do you need? How is your mood? Depressed? Are you hearing voices? Can I see you in 3 weeks time? Often, the junior doctors see patients who are relatively stable, thus requiring minimal intervention besides maintenance on the therapeutic regimen that works for them. Therefore, if one’s luck is good enough not to encounter any acutely unwell patients, the consultation sessions work like a factory production line – concise, precise and goal-directed, to the benefit of the outpatient system that keeps the clinic running effectively.
This then brings us to the topic of the lifeless porcelain dancer in the musical box.
The system that helps to establish order and stability in healthcare is also the breeding ground for clockwork production. If a doctor works long enough in this system, soon a template will develop and fall into place – a brood of questions to ask, a schema of patterns to recognize, the development of an accurate guesstimate of how much time it takes to finish seeing a patient. Our good doctor then becomes the dancer in the musical box – the marionette of hospital protocol; tugged by the strings of which hospital resources, public expectations and administrative policies are attached to.
Indeed, it is not easy being a doctor in a government institution; there are often more bouquets than brickbats, there are unseen and unspoken hurdles to be crossed. In a country that has expectations that our healthcare be reminiscent of those in Western countries, local culture, attitudes and beliefs on healthcare is still anchored by our Asian backgrounds.
Yet above all, despite the challenges, credit must be given to the doctors who break the porcelain face of the lifeless dancer – making that extra effort to offer personalized care and recognize the human factor in providing healthcare. Doctors who refuse to see their patients as, say that schizophrenic who is on risperidone 2mg ON, but as a father of 2 who lost his job 6 months ago, the one whose daughter is sitting for major exams this year, the one who was at the cafeteria this morning and had wanton noodles for breakfast, the one who is about to start a new job as a deliveryman next week. Doctors who always ask ‘what’s next?’ for their patients, never content with ‘as long as he’s stable on haloperidol and doesn’t hear voices’, an advocate of empowerment and the rights to quality of life.
We must thus never forget to acknowledge these good colleagues – those who strive to be a tool of the system, instead of allowing it to be a noose that limits what they can do as healthcare professionals. They are a constant reminder to the rest of us that we have a choice – that we don’t have to be that lifeless porcelain dancer in the musical box.
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