不說歧視

自強國崛起以來，單非也好雙非也好，強國人都爭相來到香港這片褔地插一支紅旗。由於強國人數眾多，加上兩地文化懸殊，他們霎時的出現令許多本港許多行業一時間都招架不住被這場「紅」水拖跨了。面臨需求無止境上升，公司機構既沒有額外資源接應，政府更加沒有樹立良善的政策支持，於是許多前線員工陸陸續續地在自己的工作崗位崩潰了，作為本地前線醫護人員的一份子，我不想用歧視的眼光去看待強國人，更不認同「一竹篙打一船人」，我只想說說我過去一年在醫院裡看到的一些事。

早在強國開放以前，勤奮的香港人早已出現「一人兼多職」的情況 ﹣醫生也好，護士也好，往往都是一個人打兩個人甚至三個人份工，就是由於大家都知道人手不足，病人又不能拒之於門外，所以大家都肯拼了命地幹活，三十六小時不眠不休不能錯，為的就是緊守自己的崗位，共同進退。同儕之中，大家都曾經經歷過「昨日是你，今天是你，明天都是你」的生活，雖然辛苦，但總覺得是值得。 至於懷身孕的同事更是操勞，頂著鑼鼓般大的肚子仍在水深火熱中，人家都在睡覺的時間裡當值，為的不是博得天下人的掌聲，為的就只要一份救急扶危的使命。

強國人來港，好幾年了。可能礙於強國實在發展得太行害了，身上有幾個錢的人多得是，而且更學會用錢買品味，用錢去買便利，認為有錢就能使得鬼推磨。這種心態，對於許多務實的香港人來說，他們都不Buy這套，因為他們相信錢雖然是多勞多得，但人與人之間還得有份尊重，那份尊重畢竟不能全用錢買回來的。

先說強國父母來港產子一事，其實就香港整體經濟而言本來可能是個好機遇，尤其是本港私人醫療市場更是一大喜訊，又假如公院能明確制定中港兩地不同收費價錢、改善「走數」情況的話，一班產婦將會為本地醫療帶來一筆可觀的資金。可惜，政府沒有做該做的事，私家市場不斷招攬內地媽媽，BB一出世即以港人身份權利轉送公營醫院的兒科深切治療部／初生嬰兒部「過冷河」，私家醫生／院／中介錢就收了，可憐一班兒科同事做到雞毛鴨血。這是政府沒有先見，從來都沒有監管這些牟取暴利的中介媒體的後果。當然私家醫生都有責任，但人家走得出來搵錢，多接兩宗生意實在是「預左」，難道要限制私症病人數目麼？橫豎都說不過去。

內地媽媽在港誕下的小朋友的居權問題，亦是政府另一樣該做卻沒有做的東西。內地父母見你香港福利好，教育好，醫療好，就算付一萬幾千疏通來港產子，也是絕對有賺冇蝕的。所以我體諒他們當父母想給子女最好的心情，但香港擺明資源有限，土地又好，醫生又好，總不能接待全中國十億人口，作為政府，理應早早看到這一點，然後施政舒緩供求的緊張，可是又一次毫無建樹，任由香港淪陷。

公院產房一直是前線之中的最前線。一眾內地媽媽為了「慳得一晚就一晚」的心態，每晚只願坐在病房門前的長椅上日復一日地等而堅拒入院。她們的預產紙，十居其九都是假的，肚比鑼鼓還要大還說只有十周大，雖然肯定騙不到我們，但只要她們假証件拿在手裡，不懂辨認的海關難道又不放人嗎？這班內地媽媽為了來港產子，可能已經付了中介一大筆錢，為了再省錢，很多孕婦連產前檢查都索性不做，直至作動BB要蘇的一刻，才衝入病房大叫救命。由於救仔緊急，一眾醫生姑娘根本不知道胎中塊肉到底是頭位還是屁股位，大B小B，抑或連有冇怪病／傳染病例如愛滋肝炎都一概不知，就要披甲上陣接仔去也。眾所周知產子期間血淋淋，萬一醫護人員被媽媽／BB的血濺倒因而惹了病，那可真非常可憐！說到底，這是內地政府在產前教育方面普遍比香港落後的問題。人們由於缺乏醫學常識，什麼事都認定「醫生實搞得掂」於是就理所當然。然而當她們很順手地把這些問題都一併帶進我們社會的時候，這一切一切又自自然然變成了我們要擔心的問題和責任了。

再講，最近一宗雙非爸爸掌摑女醫生的事件，起因都只是因為內地爸爸誤以為自己太太生產時間比人家長，是因為香港人歧視他們，所以才繼而爭執起來。但事實卻是香港的醫生其實並沒有歧視你，只是你自己一直帶著有色眼鏡來看待我們香港醫護而已，生產時間每位媽媽都不一樣，不管你再多付幾多個錢，BB都不會因此而早點出來對著你副德性的。內地人就是太著重金錢了，暴發戶成行成市，於是就連金錢的意義都給放大扭曲了。

有同事認為，可能醫生護士在大陸一向都不被人尊重，於是大陸人就利用同樣的態度來看待我們的同袍。曾聽聞過內地媽媽抱著六七歲仔女在病房內洗手盥就地大解，又有內地父母因為找不到酒店床位硬要小孩詐病騙床位，然後一家大細連行李就在醫院裡過夜，各式其色，可真是一樣米養百樣人。只於在診所裡吐口水，剪指甲，食橙，更加是見怪不怪。這些通通都是文化差異的代價。我相信每個國家地區，必然會經過這階段才會慢慢有進步，但無奈的是香港政府實在因為怕得罪中共，連一句說話都沒有幫過正被大陸同胞分分秒秒地剝削的香港人。於是香港人憤怒了，上街遊行，抗議，但我們真的能指望這番心底話會有人聆聽接納嗎？曾特首好一句「我會做好呢份工」，可見他不愁在自己食長糧之前最後一年才來破壞與中共的關係。近幾年，隨著CEPA，香港政府經已全心全意把這片土地變成大陸的後花園，錢是阿爺俾，就當然要聽阿爺的話。然而這班坐著幹事的官不是知道我們的水深火熱，香港的將來，究竟會變成怎樣呢？

香港人，醒來吧。人家都踩上心口了，生果日報還在搞分化 ﹣亂報所謂醫療失誤，既過份煽情又偏離實情，一次又一次挑撥港人和醫護人員之間的關係，鍥而不捨地打擊港人對香港醫療的信心。誠然，我不禁想像香港醫療的未來，我們面對的正是「外憂內患」，假定政府繼績視若無睹的話，來自大陸的病人只會越來越多，供不應求的情況只會愈趨嚴重，到最後，HA只會淪為一艘沉船，而付上代價的還不是我們一眾土生土長，年年準時交稅的市民嗎？

You’ve Got Mail

Hi,

I have read your recent post about mainlanders in your blog (well i have to say i am one of your many silent readers lol). I heartfeltly agree, and I felt myself going into a wrong profession as i didn’t expect our society to deteiorate so rapidly. My aspiration of being a doctor came from the perceived satisfaction in helping a patient. But it seems the chance is that when i start my practice, i will more likely see a patient who demands service, than one who seeks help from us with gratitude. That’s sad. What are your ideas towards this? To accept? To get private once one is capable? (i do hope i stay public, to help more patients in need) To emigrate? Any thoughts mind sharing with a puzzled junior?

Cheers,
A

p.s. i was really touched when i saw that thank you note you got from your patient! 萬分佩服! i hope i could get one some day in the future.

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Dear A

Thank you for your letter and this chance to respond to your thoughts. I’m sure as colleagues, we share the same frustration towards the kind of situation that we are facing right now, but more importantly, even more so than finding solutions to these problems, I want you to recognize that you had not entered a wrong profession at all – there is no bigger defeat than abandoning yourself, your faith and your determination altogether too soon, and a career in medicine is almost always rewarding in many sense if only you persist.

Honestly, being a doctor is the merriest thing that ever happened to me, and working in a specialty that I enjoy most is a huge stroke of luck indeed. Although there must be tough moments of disappointment at our current healthcare system, or how our society is changing for better or worse, there are certainly way more fun, satisfaction and meanings in the journey of a doctor.

In my humble opinion, the best solution for me to deal with this is to concentrate on delivering the best, of my capacity and ability, at every opportunity, to help, to be courteous while you learn to serve the sick people. Many a times I’m both humbled and amused by the wealth of stories that I heard from patients who entered my door or whom I met in the wards. My life experience grew enormously with their words of advice and sharing of wisdom, and bearing in mind that as trainees we do learn from our patients – their response and their feedbacks are the best guide to knowing the effectiveness of your treatment, or the surgery that you perform on them – textbooks or papers do not give you this, only real people do.

Remember, in moments of doubts, don’t let anybody else alter your conscience as to who you are and how you value yourself, as a student in medicine or a doctor alike. Yes some patients may not be easy to handle at the first encounter, but if you give them enough time and if you really try to understand their situations, you might realise their attitude would change too.

In fact in Hong Kong, there ARE still many grateful patients around who do not only appreciate what you have done, but also they understand your limitations (of what you COULD NOT have done) too, especially when you are a junior like me. Those are the times that I would wish so badly for an extension in my abilities, instead of worrying about how I am not going to meet their ‘demands’ in providing my ‘services’.

It’s perhaps very hard to describe to you, with my limited English vocabulary, the good feelings of building a respectful patient-doctor relationship, which involves plenty of trust and care. But I guarantee you soon enough you will have a first taste of that pleasant connection during your internship – despite all those sleepless nights and weariness from a hundred calls.

As to public VS private – well like any other relationship, whenever money is involved, it becomes more complicated. As interns, you’ll have your chances meeting some private patients (should you rotate in QM) and you’ll see how different they are from the public group of patients. Mind you, these people are actually paying for your service – they want their money’s worth, at least that is what they think their cash could do. Their tolerance was understandably low in case of things that go against their way, and whoever taking their money are required / expected to give not only an okay outcome, but the most perfect result that is sometimes beyond the power / realm of medicine. It might be too early for you to commit yourself into private practice before you even start your training. Anyhow you are going to spend a few more years in the public (unless you want to become a GP), so why not take the best out of your time in the public sector? and that now the system is crumbling, wouldn’t you want yourself to be the one who stay and fight for the ones who need your help?

Having said that, I do not reject or detest the idea of private practice. I just simply think that for every stage in life, our thoughts and perceptions change and evolve with the environment around us. Our demand for different sorts of experience arises and there are new impulses which will take us to our life’s next arena. But the same principles of who you are should stick. Well let me wish you the strength to find yours in the years to come.

Best regards,

AK

Us in 50 Years?

The Double-Nos & The D&G incident.

For those who know me I’m not into political stuffs, but lately the rising of ‘Double-No’ children and their invasion into our social security system has hit a nerve of many a local Hongkongers including myself, who’d lived our entire lives in this city.

As people now began to realise the aftermath of those once-popular cross-border marriages, they knew that if this matter was not handled well enough, a chain of fierce competitions at every level of resources is bound to follow. Not only are we talking about obstetric services that were already heavily impaired, but parents in China are already brining their double-no children across the border for schooling and education in Hong Kong. Ten years down the road, you could imagine it would become a competition for places in college and finally employment. All these pose great threat to local parents, because judging from what the current government had (not) done, these double no children are certainly going to take up a large amount of society’s benefits without paying much price at all.

The Protest Of The Deprived

Yet political parties fare no better than the silence of our government. The recent incident at the D&G store is the best proof to our citizens that even as daring as some political parties claim to be, none of them was bold enough to even make a tiny noise despite all that injustice and discrimination. None of them dared to make a standpoint on our people’s behalf against the billions of Chinese people, who are waiting (not) in line to cross that Shenzhen river, and who are ultimately backed by the supreme Chinese government.

Same thing happened to the replacement of traditional Chinese with simplified characters on public signposts and official government banners/ posters. Why did we not hear a voice of rejection from Longhair or any of those so-called ‘political activists’ when they were the ones elected by the people to speak for the people?

We all knew the answer, we all knew it too well and for Christ’s sake we are well aware of what is going on and which direction our society is heading. So are we going to be happy about the upcoming transformation? Or is massive rebellion our last weapon? I don’t know.

Is Rebellion Our Last Weapon?

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From ‘Please Help Me’ To ‘You’d Better Fix This!’ A Paradigm Shift. 

Over the past one year, we’ve heard / read way too many stories on the newspapers about alleged medical negligence, and biased accounts of how patients were being ill-treated by unkind doctors. Many of us, especially junior staff, would feel upset and discouraged by the way the media portrayed our profession in such a unjust way. We were annoyed and angry at how they dismissed our selfless efforts instead of recognizing them.

I don’t know if it’s because we are too young to appreciate the bitterness, or simply we had such a heightened sensitivity towards these unfairness, but certainly the media has done more harm than good by disturbing the society in this vicious cycle. Instead of finding resolutions to conflicts between patients and healthcare professionals, all the media did was keep pushing the line of boundary towards our limits. Their deliberate intention to cross the line oh-so-frequently challenged our tolerance, yet how are we going to defend ourselves even when the government remained silent and powerless.

Whenever there is a medical incident, or a dispute between patients and doctors, doctors are the ones to be blamed. Sooner of later, someone from the administration would come out to apologize in front of the cameras even before they look at the incident, let alone to wait for a thorough investigation. Under the influence of the media, patients nowadays are no longer afraid of challenging their doctors’ professionalism. They become demanding, and they are the ones who request your service, and some of them certainly do not see themselves as the ones who are in need of help. With the encouragement of the media, the culture of filing complaints  grew rapidly among patients who would now rather turn every little hassle into a public judgment instead of working hand in hand alongside their doctors.

So doctors are now MURDERING our patients?

So do I see our future in 50 years, both Hong Kong and our medical community -wise? No, not really. No I can’t. Can you?

 

Weird Things Happen At Quiet Calls

It was one of those peaceful nights that weird stuffs happened.

At 6 or 7 in the evening, I received a page from the emergency department of another hospital which was also covered by us during call hours. I returned my call promptly, and a Dr W picked up the line,

‘Hi, this is Dr W from Accident & Emergency, are you ophthalmology?’

‘Yes it is’

‘right, we have a woman in her 50s who complained of seeing a curtain like shadow from her left eye for one day, and we think she’s having a macula-on retinal detachment (an ophthalmic emergency where the retina is being ripped off but yet the most important part- the macula is still attached ‘ON’, often requiring early surgical intervention), we need your assessment.’

‘Alright, so what’s her VA (visual acuity) like?’ I asked.

At that point I was actually thinking to myself, oh my god this guy certainly knew some stuff, for god’s sake he knew the term macula-on RD! As excited as nobody else would be, I was all ready to receive this patient.

’20/15.’ said he in a calm voice, ‘My SMO also saw the patient and he thinks it’s definitely a macula on RD.’

See that line 20/15? she's seeing pretty well!

‘Alright then, could you please send the patient over here asap, and before you do please dilate her eyes okay?’

‘I’m sorry? But.. what? how do you dilate her eyes?’

Oh my GOD! They could tell a macula on RD without dilating an eye! Did their SMO use to work in our department? I don’t think I could tell a RD if the pupil isn’t wide open enough but apparently these two brilliant guys can! How amazing are they!

So I told him, ‘Mydrin P 1 drop every 5 minutes x 3, or you could use mydriacyl if you don’t have mydrin P.’

‘What? ..Sorry i don’t hear you, my- my- what? How do you spell it?’

‘…M-Y-D-R-I-N – P..’

‘alright thanks’ and he hung up.

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A few minutes later, he paged a second time, this time he asked,

‘Hi, it’s Dr. W again. By the way, emm where should we transfer our patient to? I mean, which ward?’

I was in disbelief. ‘No, No, NO NO you don’t transfer her to our ward, you transfer her to our Accident and Emergency Department, and then WE would come down to see her at A&E.’

‘Alright, but we don’t want you to miss her, because this is a case of macula on RD.’

‘Ok..fine, I’ll take her ID number and go pick her up as soon as she arrives.’

So I took the woman’s ID number and continued to wait – it usually takes these people HOURS to transfer someone from one place to another, even though that hospital is actually a 15 minute drive away.

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An hour later, my call partner and I were seeing other patients at the A&E, and she asked,

‘Hey did you get the call from Dr. W?’

‘Yes I did, of course.’

‘Well he said nobody returned his page.’

‘WHAT?’

‘Yea, he was telling me this lady with macula on RD and that his SMO also saw the patient and thought the same, he then asked for my last name, I told him, and then he asked, “so what’s the last name of the other guy who called earlier on?” So weird.’

‘Oh god for sure, that guy is totally weird…first he is all so committed about the diagnosis, yet he doesn’t know how to dilate a pupil, he does not know where to transfer his patient and now he was lying about me not returning any of his calls, so who the hell taught him how to dilate a pupil!’ I just didn’t see what’s going on in his mind.

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Finally the patient came, after an hour and half, and her retina was all attached and fine. No sign of whatsoever RD.

We thought of calling them back just to tell them they were wrong about the diagnosis, but soon enough we dropped that idea. Because we were worried about them taking a revenge on us – by sending all floaters to us throughout the rest of the night. Thank goodness neither of us received any of his calls after that.
Well, what I want to say about this is, false alarms are not embarrassing – these things do happen to us all the time. You have all the right to misdiagnose a condition because you are an outsider, and we do have a role in correcting the diagnosis being an ophthalmologist-to-be. But this was perhaps the weirdest false alarm that ever happened to me since I worked here – the communication was just weird – how they bragged about the urgency of their own diagnosis, and the denial of my returning calls. I still don’t get it, why did he have to lie about this? Was he trying to get a fresh second opinion from my call partner? Or did he not like the way I told him how to send over the patient? Or did I not spell Mydrin P right for him so he lost faith in me and turned to my colleague? No, none of this made any sense..it IS weird.

Oh but you think that was it? No… something weirder happened later that night…

Life is too short

Tonight, a colleague of my uncle whom I didn’t know, collapsed and died at the Disneyland. My uncle recalled seeing him just before the show started, but only moments later, bad news came and another life was taken away by a merciless heart attack.

At times like such, one can’t help but wonder how feeble and vulnerable it is to be alive, and how grateful one should be to be free from any sort of illnesses, to be seeing people whom you love around when you wake up the next morning, to be said hello to by your colleagues at work after a long weekend.

But as you look around, and you look at the world of people competing against each other every day and in every single way. Why is the world so hostile that people would worry about getting hurt by somebody else? Why are people competing against each other when instead the only person for you to beat is your old self.

Can we let go of our hatred and feel good about what we already own? Greed is a mistake, greed is a sin.

May the man find rest in peace.