Saturday, August 25, 2012

saya yang mengikut perintah

many letters from govt departments end with these words. it means that the writer is just following instructions "from above," even though that person may well be the head of the dept. i thought it rather odd - if everyone is following instructions, can no one do things differently, or must it be strict compliance to "the instructions" from whoever who issued them?

i was interrupted in my sleep early this morning by the nurse from ICU, informing that my patient's breathing was laboured & the oxygen  content in his blood was very low. having rushed to hospital in double quick time, i was dismayed that the nurse had administered to him only 2 lit of oxygen per minute all that time, a miserly amount given his dire condition. she defended herself by stating that was the flow rate the previous doctor had ordered.

naturally, i snapped at her & criticised her for not using her discretion. 2 lit/min of oxygen is fine for most patients who are not critically ill, but when they develop breathing difficulties that result in low oxygen content in the blood, the oxygen flow needed to be increased. the level of treatment must be appropriate for the condition of the patient - is that too difficult a concept to grasp???

anyway, everything turned out ok for the patient. i left the ICU with the sinking feeling that the public sector's "saya yang mengikut perintah" culture has already pervaded private medical care.



pilocarpine said...

Doc, this is not about perintah, this more bout common sense...

doc said...


if one doesn't have common sense, then safer just to ikut perintah.

kc said...

but i LOVE these old skool style writing!

doc said...


you mean, the blind repetition without knowing what they meant?

Yvonne Foong said...

The nurse was afraid of using her own discretion. If anything goes wrong when she uses her own discretion, she'd be in trouble with no one to pass the buck.

I feel all of us need to improve our way of correcting another person in all situations. Use constructive criticism instead of putting the person who has done wrong down. That can go a long way to encourage people not to be afraid of making mistakes. If the nurse had no fear of making mistakes, she would have used her own discretion without inhibition.

I admire how some of my doctors can advise their patients and colleagues so diplomatically that it sounds like a compliment.

Something I need to learn too.

doc said...


that she did nothing extra to help the patient belied her nursing training. in a critical situation when there is a lack of oxygen, giving extra oxygen will not kill the patient, but doing nothing will.

no length of nursing/medical training can expose one to all critical situations - they teach the basics & one applies them to each situation.

you may not be so gracious to that nurse if it were your family member in that near-death situation.

Yvonne Foong said...

I am not making an excuse for that nurse. Just saying why people, not just that nurse, can be afraid of exercising their independent discretion. If a person is constantly punished for her voluntary and independent actions, she will come to believe it's safer to just follow orders. No pain that way.

I have been cared for by nurses who were like the one you mentioned. My dad too. It was tough on me being cared by them, but all I had to do was endure.

But when my dad was similarly treated at UMMC, it hurt and angered me that my father was treated the way he was. So when his health declined again, the thought of sending him back to such nursing care itself was painful. I couldn't do it. So I sent him to another, better hospital near home.

I know what you mean. Yet I still would think how our healthcare could be better.

doc said...


those days when i was a trainee doctor, i could still learn much from the senior nurses but can't say the same for trainee doctors now, as the standard of nursing (& and medicine!!) has declined tremendously, esp those from local private colleges.

our healthcare can certainly better if resources weren't wasted on over-priced subs, armoured vehicles, dams, ports, etc., & the govt stop issuing licences to underperforming medical/nursing colleges.