locum lokun life: serendipity + manpower woes + no, you can’t have antibiotics

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This is part of an ongoing monthly series capturing the highs, low (and everything in between) in my working life as a doctor in Singapore. If you’re interested in finding more about medical/non-medical job options or getting answers to doctoring-related questions you’ve always wanted to ask, check out my brand new Chasing Careers series!

Merry Christmas one and all!! In this month’s shitpost, as a not-so-festive gift, I’ll be telling the tale of antibiotics, serendipity/chance encounters, and manpower woes (in the public healthcare sector). 🎄

Let’s start with something lighthearted shall we? Over my past few months as a GP, I’ve found my own silly little hill to die on and stake my professional pride on – antibiotic stewardship.

For the non-medical readers, you might be wondering what the heck that is. And for the rest, you might be having flashbacks to the time the Infectious Diseases team left a blue letter reply advising your team to KINDLY ! STOP ! ABUSING ! CARBAPENEMS!

I’ll let CDC do the explaining:

Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.

Centers for Disease Control and Prevention (source)

Anyhow, antibiotics and the patients who demand antibiotics for COVID, this next bit’s for you xoxo.

a short PSA on antibiotic misuse

Some General Practitioners/GPs over-prescribe antibiotics, and it’s not ideal for patients in both the short-run (side effects) and long-run (antibiotic resistance and super-bugs that are tougher to beat than a Level 99 dungeon boss).

I’ve noticed this particularly acutely when I’m locuming/substituting in certain clinics, with patients coming in and asking for antibiotics on Day 1 of their flu, because their regular GP automatically dispenses it for the slightest sniffle.

Here are 3 premises that guide my prescription of antibiotics:

  1. A vast majority of upper respiratory tract infections/flu bugs (cough, runny nose, sore throat or fever) are caused by viruses, not bacteria
  2. Antibiotics are only useful against bacterial infections, and do noting for purely viral infections
  3. We can’t tell if your illness is caused by bacteria, but if it doesn’t clear up after over a week and you come back, it might be, so we’ll give antibiotics then

GP-ing isn’t just about providing good customer service and making sure your patients get whatever medications they demand (if it isn’t in their best interests), so I’ve taken it upon myself to ‘nag’/educate them in whatever small way I can, most frequently regarding antibiotics.

If you ever encounter similar patients, you could show them HealthHub’s info page on antibiotic misuse; surely they’ll trust that and won’t accuse HealthHub of putting out fake news?? At the risk of this entire post being overrun by the word ‘antibiotic’, I’ll end this evidence-based rant here.

serendipity

As I shared in last month’s post, I resigned from a full-time GP job for greater freedom of exploration in my career, travel & life.

It’s been a pleasant and rather liberating 3 weeks since I committed to being a full-time locum. I’ve spent 2 of those working, 1 exploring Vietnam (you can read all about it here!), and my quality of life & work has been on an uptrend ever since.

The 2nd of December was my last day at my previous workplace, and that date ranks pretty highly on my list of ‘most memorable days in 2022’. Here’s why.

On my last day of work, I had a serendipitous encounter during my dinner break (I was working till 9pm on that Friday night). Singaporeans being Singaporeans, tend to keep to themselves and rarely engage in small talk, so I was pleasantly surprised when a kindly middle-aged uncle struck up small talk about work & the weather while we queued at the same fishball noodle stall.

We then talked over dinner, at a table in an unassuming coffee shop. He was wearing his company’s uniform and had an Australian accent. I soon learned his name was Harpal, and he shared about his career that took him all over the world (from Australian cities to oil rigs in the middle of a sea in Mexico), various difficulties he had faced in life, and how he viewed work as more than just a way to save up for retirement. In his words, ‘retirement is just sitting around and waiting to die’.

I asked him for one piece of advice he would give to a 25-year-old like myself, and he said that I should quit my job, travel for a year, and explore the world. Mind you, this was before I even told him that I was a few hours away from leaving my current job. I’m not a huge believer in ‘fate’, but the timing felt like an affirmation that I was, in fact making the right decision in switching paths yet again.

We exchanged Facebooks, wished each other ‘all the best/Merry Christmas/Happy New Year’, then parted ways, as with most serendipitous encounters in life.

After another 3 hours of work, the clinic’s closing time rolled around. I spent a good half an hour slowly saying my goodbyes, hugging and taking photos with my clinic assistants-turned-friends over the 2 months. Thank god for Instagram, where we’re all still able to keep in touch and catch snippets of one another’s lives.

Later that night (and into the wee hours of Saturday morning), I celebrated my last day of work with dinner, drinks & excellent company, with Korea even beating Portugal in a World Cup match (sorcery!). On such a rare and wonderful day, I was brimming with nervous excitement at all the freedom this unwritten future could hold.

Let’s hope it only gets better in 2023.

manpower woes

I’m pretty sure everyone in the public healthcare system is sick of hearing the phrase ‘poor manpower’ for the Nth time, and it’s almost that time of the year again, where MOPEXes change over for yet another 6-month posting.

For those of you who got postings that allow you to see the sun (either before/after work, or both), congratulations. For the rest, it’s time to plan your departures, so why not check out my bond-breaking FAQ post?

M0HH adjusts manpower allocation every year (for House Officers/HOs) or every posting (for Medical Officers/MOPEXes), based on feedback from the doctors who were previously in those postings. Sometimes, the adjustment swings in favour of the incoming batch of HO/MOs, but sometimes it ends up pulling the rug out from under junior doctors’ feet, leaving them with even worse manpower constraints.

Legal disclaimer: My information is sourced from peers currently employed under M0HH. This blog assumes no responsibility for the correctness, accuracy, timeliness, reliability, and completeness of the content and information provided.

For instance, SGH Gen Surg doubled its number of HOs this year, magically transforming it from a posting notorious for 5am-9pm days, to one where HOs were routinely able to go post-call at 8am. Conversely, KTPH IM, which I touted as an excellent posting (in terms of QoL and manpower) when I was a HO in 2021, reportedly suffered some manpower cuts and is no longer as desirable.

Unfortunately, most of the stories I’ve been hearing from my friends seem to depict a tale of endlessly poor manpower. Certain teams in TTSH Gen Med were letting both HOs and MOs go post-call at 8am, but due to new manpower cuts, MOs might no longer have that privilege.

Special mention to TTSH Uro, which went from having 2 overworked MOs (each doing the maximum allowable 8 calls per month – absolutely appalling innit?) to just 1 in the upcoming Jan 2023 MOPEX, with Urology residents having to make up for the shortfall in MOs by doing more calls themselves. So…the solution to manpower woes is just making every last survivor work extra hard? :/

With more polyclinics and hospitals slated to open in the upcoming years (MOH’s website has a list of projects), but without a proportionate increase in the number of doctors in the public healthcare sector, it’s truly a Greek tragedy.

As always, please remember to take care of yourselves & your friends, and don’t be afraid to advocate for your own rights in the workplace, because no job is worth setting yourself on fire (or ruining your own physical & mental health) for. Get enough sleep (when you’re not on call), keep a close eye on your mental wellness/mood, and find a healthy outlet for your stress.

The road to finishing the bond might not be easy, so feel free to contact me if you need anything, whether it be GP/locum advice or just a listening ear, I’m here for you. ❤


And of course, how better to 🎁 wrap up a post on Christmas day without my favourite Christmas song of all time?

Once bitten and twice shy
I keep my distance, but you still catch my eye
Tell me baby, do you recognize me?
Well, it’s been a year, it doesn’t surprise me

I’ll be getting up to more shenanigans in 2023, so if you’d like to tag along, be sure to follow my Insta or like my Facebook page to stay up to date with my posts & life/travel updates. Merry Christmas, happy holidays (hope you’re not on call) and see y’all again next month!

xoxo,
Faith

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P.S. I don’t make any money from running this blog, so if you’d like to support my writing and help me bring even better content to you, you can buy me a coffee/donate on Ko-fi!


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2 responses to “locum lokun life: serendipity + manpower woes + no, you can’t have antibiotics”

  1. Hi faith! how do you think the advent of telemedicine services like Manadr and Speedoc will impact the GP scene in Singapore? do you see yourself doing telemedicine in the future (seeing as it provides great flexibility)? thanks!

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    1. Hey Andrew! Overall, I don’t think telemed will ever replace brick and mortar clinics, but it will definitely help ease the (sometimes insane) patient load in polyclinics and GP clinics, so it’s a much welcome service. Yep, I’m planning to take on telemed roles in future as well, we’ll see how it goes! 🙂

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