A Family Doctor's Tale - FACTORIES, SHIP AND HOUSECALLS

FACTORIES, SHIP AND HOUSE CALLS

On the very first day of  work at the group practice, I was told to go to the PSA (Port of Singapore Authority) clinic to attend to patients. On the night before this I had an urgent call from a partner of the group practice telling me to go to the Cycle and Carriage Clinic instead while he will take over my PSA clinic.
Apparently on that day he has found out that the employees of Cycle and Carriage were going on a sick day strike which means lots of employees will be going to see the doctor for medical leave. So he was pushing his work at Cycle and Carriage  to me.

I arrived at the Cycle and Carriage Clinic at 9am to see an overwhelming crowd of employees lining up to see the doctor. The nurses there were very busy getting their medical record cards out for me to see the employees. In the meantime I was trying to familiarize myself withe the medicines available for subscribing.

There were so many patients. I just did my work as fast as I could for a beginner at this clinic, prescribed medicines, wrote medical chits and finally finished the clinic at 3.30pm. It took me another 45mins to rush to the main clinic in the downtown business district. It was an exhausting day.What was worse was the partner who called to exchanged duties with him had the impunity to blast me for coming in late at the clinic.
The other doctors were more understanding after I explained the situation to them.


I was given a pager (no mobile phone at that time) by the clinic for my house call duty the very next day.
With all these factory and house calls thrust upon them, I could understand why the assistants at the clinic quit or resign so easily. I could also understand those who were promised partnerships and were not get the partnership did not wish to stay long.


Since I was new and had not much patients seeing me, I was sent for house calls and factory clinics to do most of the work. Factory work are usually in the morning. At the PSA clinic for example I was to see about 90 patients in 3 hours. Luckily there were nurses at the reception who vetted the patients coming for consultations. They took their temperature and wrote in all their complaints. All I have to do is look at their complaints and examine them before prescribing some medicines.Surprisingly I manage to finish all the patients by 12noon.

I made friends with the nursing staff and the pharmacist. They were very helpful. They even told me one of the doctors of the group practice was called the robot doctor. He was able to finished his work in especially fast time. Apparently even before the patient had entered the room and was about to sit down, he was given his prescriptions and shown the door out. 

It was another reason why I did not like group practice - the way they treat all the factory patients as malingerers unless proven otherwise.


It was completely different when they treat their own patients who are friends, family or big company directors.There was a double standard for  the treatment of the rich and the poor. 
It was a type of practice which I have never expected from doctors.
I was pretty disgusted by the attitudes of most of the senior partners of the group practice.


The junior partners were on the hand more friendly having gone through their assistantship with the senior partners. 
One of the junior partners especially helped and taught me a lot from his experience as a general practitioner for another group practice. 
He was an all rounder able to do minor surgeries, treat fractures, do intrarticular injections. It was no wonder that the senior partners requests for his return as a junior partner.

Besides doing the morning factory clinic and  most of the house calls, I also have manned a clinic at the Hyatt Hotel on alternate Sunday in the morning. The afternoons can be relatively free so I spent time learning from my friend the Junior partner. Some of the patients that I see in the morning factory clinic sometimes come to to the main downtown clinic and specially requested to see me because I treated them well.


Soon I managed to get a following of patients after a few weeks.
During one of the house call at night I was able to reduce the dislocation of a Caucasian who had dislocated his shoulder while diving into the swimming pool. I read up about the procedure of reducing the dislocation of the shoulder before going.
Luckily the patient himself had recurrent dislocation and so he know how to help me reduce his dislocation.
The next day he was to present himself to the clinic for an X ray to make sure the bone was securely in the socket. After this incident there was a new respect from the other doctors for me. From then on they keep asking me to stay on as an assistant after my locum. I was adamant in my mind about starting my own family clinic and not join a group practice where there was always in fighting, disagreements and politics among the doctors.

The other part which I dislike about  this group practice was the ship calls. I have to weather high waves and turbulent waters to get on to a ship which the motor boat bringing me sometimes could not even find. Once there I have climb a slippery ladder up the ship and give vaccinations and certificates to the crew. After that it was another turbulent journey back to dry land.
All the companies, factories, ship and house calls money goes to the group medical practice. It was easy money for the senior partners but not so easy for the assistant or locum. 

I learned all I could about contract practice and how to charge for various procedures.

At the end of the 3 months I thanked the partners of the group practice and happily got out of the clinic.