THE LOST COURTESY

Today I was so upset and greatly reminded of the World of Courtesy ranking, produced by Reader's Digest four years ago. According to the ranking, which might not be accurate at all, Kuala Lumpur i.e. Malaysia is ranked the third least courteous country out of 35 cities of different countries included in the RD's global courtesy test.



A sudden regret fulfilled me for a while - I am not sure whether it was a regret of being a Malaysian, or being surrounded by majority of non courteous people where you cannot make a difference. Or a regret of not staying and work in the UK , and not even applied for a job there. Whatever it is, I feel guilty for having this regret, but it surely does bring back nice memories and life back in the UK, where everything seemed so easy and approachable. And the courtesy was at its most. I have been to most of the European countries and I think UK is still the best at courtesy.

Let me go through and see the differences:

In buildings with doors

UK
I was walking 5-10 steps behind someone before reaching to a double door, and that someone I never knew would turn back to see if anyone was at the back, smile and keep the door opened until I reached the door, that sometimes I had to walk really fast to not make them wait for too long.

Here
I was walking just behind someone's bum, even worse someone that I know who realised I was right behind them, and we were just about to enter a door with him/her right in front of me, and then....'bamm'. The door shut. Right in front of my face.


When you are in need a favour

UK
People would ask politely, with the nice "Do you mind....." or "can you help me with....." at the start and the magic word PLEASE at the end. Even when the favour asker was a specialist asking for some help from a medical student. And help is at your tip of finger, especially if the favour you are asking is totally the responsibility of the person you are asking the favour from.

Here
If you ask for a favour nicely, there is the slightest chance of you being entertained quickly and nicely. Even if sometimes it is supposed to be their job. Most of the time you have to ask them three times then either do it yourself or start shouting and complaining (then people will complain about you to the boss). Believe me, giving instructions, or telling people to do something with a raised voice gets the attention better. I have this one colleague who always give instructions instead of asking properly, and 'favour' done as instructed.

Hey, what is wrong with being courteous? Maybe they like instructions better.


At the workplace

UK
If a doctor needs to perform a procedure, a nurse will be around (we call them dirty nurse) so to help us keep sterile while they can get things for us. Even when I was a medical student, I get my own dirty nurse to insert a catheter.

Here
Me (in sterile condition needing another catheter of different size as I failed to insert two different sizes that I already prepared myself together with the catheterisation set) : Akak, boleh tak tolong amik CBD saiz 12 tak? Tolong eh kak, tengah sterile ni. Translate: Miss, can you please get me another size of catheter, size 12 please, I am currently steriled (shouting at 3am to the ***** who was gossiping at the counter, who were supposed to prepare the set after nicely being asked, twice.

***** (went to get the catheter that I asked for): Nah. Translate: Here you go (putting it on the trolley, without even bother to empty the sterile catheter into the sterile area, then went back to gossiping).

Don't I deserve a chaperone, even if you don't want to help me preapring the stuff or be my dirty nurse?

*ooops, I think this is a complaint already aye?

On the road

UK
I am not a good driver, but driving in the UK was way much easier. Imagine you were turning right at a T junction or you were changing lanes. Even if it was not too busy, they will flash their headlights to mean that "you go on. I will slow down for you".

After you give way to people, they will flash their headlight twice implying "thanks", and not enough with that, they will put up the hand, mumbling thanks, again to show their gratitude. And you will put your hand up, mumbling "you're welcome, glad to help".

Here
If somebody flashes the headlights, it means "It's my road. Don't you dare take over. I am speeding, can't you see?" I don't even dare to flash my lights to give way if I see someone is coming out of a junction I am turning into, just in case they misunderstand. So you see, there's no room to be courteous. You just cannot be humble on the road.

I was not in rush and let those from the front to pass first at the guard at entrance of my house, and I hardly get a hand showing thanks. Don't bother the lights.

And when I was grateful that people waited for me to pass the guard and put up my hand of gratitude, they just stared. Oh how I miss the courtesy of driving in the UK.


At the parking lots

UK
Disabled parking lots are really meant for the DISABLED. And the disabled people do come out and enjoy their life even if they have to use wheelchair to move. The buses are even properly designed for them so they can travel easier.

Here
SOOO many disabled people (parking for the disabled are always, always full), but I think most disabled people are usually stucked at their house and the only place they usually visit is the hospital.


And the ones below.... I cut and paste from Iris' blog, a good friend at the university, who is currently working in Selangor and just entered O&G department:

In encouraging labour
England
Midwife: Come on, push. Good girl. Push. You can do it. Push. You're doing very well. Just bear down. No, you're pushing the wrong way. Bear down. Push. Yes, gooood girl. You're doing reeeally well.
Here
MO: Push, push, push, push, PUSHHH. What are you doing? You're not pushing! You want the baby to die? If something wrong with the baby, it's on you. Push. Do you understand ar? How many times I must tell you?? EYYY, don't push to your face..see, flushed already.. haiya... DON'T LIFT UP YOUR BUTTOCKKKK!!

On the welfare of the juniors
England
During handovers amongs specialists and senior doctors, there are always cups of tea that you can have...with some biscuits..someone might bring their homemade cake to share. And I was only a medical student then. And the cups of tea flow endlessly. From 3rd year to final year. Made for you. By nurses.
Here
The Biggest Stitch: (On the suggestion to increase the number of beds for oncall house officers to sleep on) Actually I don't think housemen should sleep at all. It's good enough if you can sleep straight up in a chair. Or bring your own camping gear and camp in the parking lot. You think oncalls are for sleeping?? During my time............ etc.

Ego
England
When you gave the wrong answer to a pretty basic question:
Consultant: No, I don't think so. Try again.
Here
When you gave the right answer to a pretty basic question:
Specialist: [stare at you after your answer] Some more?
Me: Erm.. can't think anymore
Specialist: [to colleague] Read out your list of answers (prepared beforehand)
Colleagues: bla bla including the answer I gave earlier
Specialist: Why didn't you say that answer?
Me: I did!
Colleague: She did.
Others: Yeah. She did.
Specialist: No, I didn't hear it. Oh no, it's because I caught you cheating. You shouldn't be spoonfed. That's why I didn't count that answer.
Me: ????

*LOL on the labour room situation* She is in Selangor and exactly the same words are being used, I can imagine. Can you see, it is happening not only at my place, but also at other city. I bet if you go to the north, or south or West of Malaysia, in general, the situation would most likely be the same. Oh how encouraging we are!

I won't deny that I am also losing the courtesy, I wish I won't. And I blame the environment. Tell me, am I guilty for missing UK so much?

BAD WEEK

These few days I have been feeling very upset with the lab, with the nurses, even with the patients, but especially with myself. The peak was on Saturday, when I actually lost my temper on a patient that I think every patient in my ward could almost hear me scolding him. And I feel very terrible, it is still haunting me, even in my sleep. All those advice to be a good doctor received when I first graduated keep haunting me. But words are those things you cannot possibly take back. You can only wish you can turn back time and do it differently, but the fact is there is no time machine available and there will never be and you just have to accept that.

I blamed myself the most for not being able to cope with it. Being post call, the tiredness and the hunger, also the upsetting blood takings which sometimes provided me with no results at all, and the nurses who were not as helpful as what I expected them to be, and the patients with difficult veins and high demands not when the m.o.s are around, but only when they have long gone and I am left on my own to manage, plus, loosing 3 patients in a day - these all just add up to the weakness in me - I thought I have been very patient so far, but I lost it. I lost it already. I gave up.

It is never the patients' fault if they refused to do things we told them too - it is so up to them to decide, as the outcome will eventually be on them. (but again, how patient can you be with a non compliant patient who turned up to the ward very frequently even on day 2 post discharge?). We doctors just help managing them, in other way 'fix' them if possible and allowed to. I know I should never have scolded patients for moaning because who are us to determine how much pain they were in? I might not endure the same pain as my patients are enduring now.

The Prophet (saw) said, "The real patience is at the first stroke of a calamity."
Sahih Bukhari Volume 2, Book 23, Number 389

It hit me straight to the heart when I read this post at facebook from a good friend of mine. Indeed the real patience is far from me.

Today is the first time in medical posting in which I doubted my decision of coming back to work here. It makes me feel terrible. I actually very much enjoyed being in nephro ward, that I even asked for Kak Salmi to place me in the same ward for another 9 days before I move on to the next posting - surgical. But I just can't help it anymore.

How I wish there are tubing system here like in the UK where I can make sure blood goes right to the lab and not being wasted after all the hard work of difficult venesections. It hurts the patients too ok - and it took time to plead them for femoral blood as peripheral veins are either too thrombosed, or they are invisible and impalpable.

It is upsetting when I called the lab for important blood results at night time, when I had to wake up all night to review patients, and even waked them up from sleep just to see if haematocrite was rising - but nobody at lab even bothered to answer the phone because they were BUSY sleeping. Or when I needed ABG sent stat at night time, the PPK is nowhere when there are no diet to serve, nothing to do at night time but sleep and chat - yes, and it was all my duty so I had to leave the patient with a GCS of 6, went down to lab in hurry but then had to ring the bells for 4 times (harshly) to wake the lab staff up. If this is the case, PPK might as well work up to 10pm only, because doctors have to send blood to lab anyway.

And why is there no ABG machine in medical ward at all? (supposedly no budget, of course, how I forget Terengganu is one of the poorest country in Malaysia despite the money we should get from the petroleum). I have sent this suggestion to have the machine at least at neuro ICU, and the last time I went to the lab it was still there in the suggestion box, which funnily provides no pen nearby, as if no suggestion is encouraged at all.

This week has been terrible. I accepted the fact I am weak, but being unsatisfied with the system and all, I am changing my opinion to why doctors in the end leave government, or why medical students from developed country refuse to come back to Malaysia - it is because of how the system works here. I have to agree to the first few parts of this article, honestly because I have on my own been in this situation.

WHY WE LEFT AND WHY WE WILL CONTINUE TO LEAVE...

"Why be a slave in your own country, when you are a king in another?" He replied.

Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field).

I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority. When I was working there, doctors are so ill-treated, while the nurses and the medical assistants are overpowering us.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Read the rest of article here.

I am loosing my innocence (konon) day after day, and I hope I won't loose my patience inappropriately anymore as I do not want to be who I am afraid I will turn out to be.

CASHIER AND PAKCIK GUARD

Did a little shopping yesterday.

And a couple of incidents reminded me of one thing that I wished to post long time ago.

I don’t know if this is merely my feeling. Or perhaps it only happened to me. I was at one supermarket and found a couple of nice long sleeve shirts so I headed towards the cashier to pay for that. It was in the afternoon and there were only a few customers on the floor. Right when I was just about to hand in those shirts to the cashier, she said “Pergi buat bil dulu”. No greetings. No smile. In fact the way she spoke - she was like yelling at me with a frowning stare!! Then there was a chinese staff next to her, she asked me for the clothes and started to scan the price tag. (tak mintak bil pon – ergghhh…emo la ni. Sabar…sabar)

I don’t know if it was just me being sensitive. But if you ask me, I would say she was very rude. So suddenly I remembered another time at the same store, only on different floor, when my sister was paying for her roller blade, that cashier was very unfriendly too, rising up her voice because…I can’t remember why. Muka masam macam cuka.

Not that I expect them to be so nice to me. At least please don’t scold the customers. And not that I want to condemn this kind of people – but am going to make compare some cashiers in Malaysia and some of those at UK, based on my experience. Because I think they are much better in this and it’s not wrong to learn what is good from them, right?

In the UK, I think most of the time the cashiers greet me first. They smile and say ‘Hi ya’ or ‘good afternoon’ and some of them even ask me whether I was doing fine. Is it so hard for some people to at least smile if they are too lazy to open their mouth and speak up? Or even if they are so reluctant to smile, can’t they just speak normally and not making angry faces and not to rise up the voice. I thought one of the cashiers’ roles is to cheer up the customer, not only to accept cash from them and put the things purchased in a plastic bag and hand in the receipt. And what’s wrong with smiling anyway? We were both females. In addition, bukan ke senyum tu satu sedekah?? Bak kate Aisyah, awet muda ape….smile vs botox =)

Not that I am saying all Malays are like that. And all British are good.

In fact, earlier in the morning, I was at the HSBC bank, wishing to take out some money from my oversea account. I was about to take my number (for the turn) when the guard approached me and asked if I need any help. Then when I said I have an account oversea, he asked me to wait at the special counter (coz he wasn’t sure about that), not at the other one where people normally deposit in or take out money (I guessed). So while I was waiting for a girl in front of me to settle the things up (I think she was opening a new account), there were a couple of makcik, came in to deposit in money using the deposit machine – I believe they didn’t know how to use that machine (not that I am insulting them, I’m not sure if I know how to handle it either). The point is, that guard generously helped them with the machine. And after quite a long time, he came to me smiling.

Pakcik guard: Lame kene tunggu ok?
Me: (smile). Hmm…nok wat gane.
Pakcik guard: Meh gi tanye kat kaunter nung la. (tunjuk kat kaunter biase tu)
Me: Buleh gok. Daripade tunggu je sini.

And it was quite funny when akak tuh cakap buleh amik kat ATM machine kalo ade kad. Hehe, so easy. But anyway. I can clearly see the different between pakcik guard and akak cashier (or maybe adik cashier). He volunteered to do more than he was expected to, but she did not do what I hoped to get from her. Although I spent much more time waiting in the bank, I was not pissed off at all. And even though I did not have to wait in line to pay for the shirts, I got out of the store feeling so angry with zero percent of satisfaction. InsyaAllah, banyak pahala pakcik tuh dapat.

Takpela… maybe that cashier was having problems, or tired of waiting in front of the cashier machine feeling so hungry coz it was about lunch time, so she just couldn’t control her mood.

P/s: Remind me of a movie – Changing Lanes. If only Ben Affleck asked politely where Samuel J was heading to, they both have nothing to loose. If only that cashier did not rise up her voice on me, I would have not think of writing this. Lucky I don't have the gut to hire a guy to cut off her account. Hehe, of course I don't. Like it is a big problem anyway.

Peringatan untuk kita semue bile kerja nanti. Like for me, a career as a doctor (insyaAllah) will not just mean meeting the patients, diagnosing them and prescribing medicine. I might have learned that thousands of time in ethics and PPD seminars – roles of a doctor, putting the patient first, etc. And I might have repeated it many times during the interview to get into med school…. But when it comes to working, I believe it will be much harder. It will not be just theories. Hope that we can give more than we are expected to. Wait…or at least give what we are expected to. =P