I have been working in Australia for over three months now, including a brief side-trip to attend a conference/vacation in Bangkok, Thailand (see photos).
 | |
| Chris and me in front of one of the many elaborately decorated buildings at the Grand Palace, Bangkok, Thailand |
Prior to coming to Australia, I had been told that Aussies think Canadians work too hard, and that Aussies were more relaxed because they just work more efficiently. Efficiency is a matter of interpretation. The state of Western Australia is still benefiting from a mining boom and has a lot of money to spend inefficiently as well. In my 3+ months here, the main recurring themes are redundancy and inefficiency, and overstated casualness. And of course, alcohol, beaches, kite-surfing, cycling, and summer music festivals.
It's just casual....
Western Australia is known to be the more relaxed state, and people here like to live up to that reputation. They try very hard to show it. This culture is evident in not only the colloquial language (more on that soon), but also in the interprofessional and doctor-patient relationships in health care. Once medical professionals and allied health professionals get to know each other and work together, it is natural to drop the fancy titles and call each other by first names. It is almost seen as aggressive to call a colleague by the title "Doctor". In fact, the polite way for a doctor to introduce themselves to a new patient is:
"Hello (insert patient's first name). My name is Amy and I am one of the anaesthetic doctors."
And for the remainder of this doctor-patient relationship, the patient knows me primarily as my first name. This is a contrast to the level of formality I maintained when I was back home. When in Rome....
Aussies like to shorten words, even medical words.
We use a lot of acronyms in medicine. Almost every medical condition can be written as a 3- or 4- letter acronym. At least I thought so, until I began learning even more acronyms and short forms here.
Some examples:
Example #1: NOF - an acronym for Neck Of Femur fracture.
At home, we would call these "femoral neck fracture" or "intertrochanteric fracture", or simply a "hip fracture". The first time I heard this term, the conversation went something like this:
Surgeon: "Amy, we are booking a NOF..."
Me: "A what?"
Surgeon: "A NOF"
Me: "A NOF?"
Surgeon: " Yes, we're booking a NOF"
Me: "A what?"
Surgeon: "A NOF"
Me: "Huh?"
Surgeon: "A NOF"
Me: "A nof... ok, WHAT'S A NOF??"
Surgeon: "Oh, you know, a N-O-F"
Me: "No, what is a NOF? It sounds like an acronym I am not familiar with"
Surgeon: "a neck of femur fracture"
Me: "Oh! ....Oh?... Oh boy..."
This was a very inefficient conversation.
Example #2: "Sux Apnea"
I am not biased against orthopedic surgeons. This one is an anaesthetic problem. I discovered this oversimplification/confusion while giving a mock exam to a group of registrars. This conversation went something like this:
Me: "Tell me about malignant hyperthermia"
Registrar #1: blah blah blah blah...uhhh?
Me: "Ok, tell me the genetic basis for this disease"
Registrar #1: "blah blah blah... uh... EU and EA genes...??"
Me: "Ok, let's pause here. Does anyone else want to comment that?"
Registrar #2: "I think she is getting MH mixed up with Sux Apnea"
Me: "What did you say? Sleep apnea? A genetic disease??"
Registrar #2: "Not sleep apnea, I said 'sux apnea'. She was talking about the genes related to sux apnea"
Me: silence... thinking....
Me: "Are you referring to pseudocholinesterase deficiency?"
Registrar #2: "Yes, sux apnea."
Me: "Wait, you're telling me you call it 'sux apnea' rather than pseudocholinesterase deficiency?"
Registrar #2: "Yes. I guess we call it that too. But 'sux apnea' is shorter."
Me: "But pharmacohogically, a proper dose of sux should make every patient immediately apneic. Isn't that confusing?"
Registrar #2: "Uh, yeah..."
This was also not an efficient conversation, and potentially dangerous if one side didn't understand the other in a clinical situation.
Example #3: "Scoline allergy"
During a weekend on call, working on my own, I found out how dangerous these Aussie short-forms can be. "Scoline allergy" was marked on a patient's anaesthetic record. The patient had been reviewed by one of the anaesthesia trainees with no other mention of how this would impact the anaesthetic. One of the anaesthetic technicians brought it to my attention. I've never heard the term "scoline" before this. She told me that it's another word for suxamethonium, which in Canada, is called succinylcholine. A so-called "allergy" to sux could actually mean a life-threatening anaesthetic disease.
There are many reasons why this casual oversimplification of words is also dangerously life-threatening. This was also a very inefficient use of a short form.
Example #4: "Do you want a Larry for this one?"
One of my anaesthetic techs asked me this question while preparing for a case. The conversation went on something like this:
Me: "No, the patient's name is not Larry, it's...."
Tech: "I meant for the airway"
Me: puzzled look
Me: "Um, for the airway? I would like an LMA for the airway"
Tech: "Oh yeah, sorry, I forgot you are Canadian. An LMA, ok. A "larry" is an LMA. It's short for a 'laryngeal mask'."
The acronym LMA was the universally accepted short form for the term "laryngeal mask airway". Little did I know there is an even shorter form for the acronym itself. This conversation was also very inefficient.
"To Follow"
Bookings for surgical time, or rather "theatre time", are not made by surgeons. They are made by booking clerks. This takes away the ownership and responsibility of the surgeon. It is also inefficient because the clerks don't know how much time is required for each case. It also leads to a lot of cancellations. Rather than a schedule with dedicated times allocated to each case, the operating room schedule, I mean, theatre list, looks like this:
8:00 - Case A
T/F - Case B
T/F - Case C
T/F - Case D
"T/F" stands for "To Follow". So it is difficult to know how long each case is going to take, even for the surgeons themselves! All the patients, A to D, are also asked to come into the hospital at 7am. It makes it easy then for the doctors to see all the patients in the morning and rearrange the schedule if one of them "accidentally" ate breakfast or if the correct equipment won't arrive until later in the day. But it is very inconvenient for the patient who arrives at 7am for an operation that won't start until 2pm, and it also blocks a bed in the pre-op/day surgery unit. It is also not uncommon to cancel patients because the lists were overbooked. So, to correct this, the other extreme occurs - underbooking, with large amounts of theatre time wasted. The doctors don't really complain much, because in the public health care system, we are all salaried. No one seems to complain that it is public money wasted.
Fortunately, Western Australia is a wealthy mining state. Until the mining boom busts, it is hard to predict any change in efficiency. But I'm pretty sure Aussies will continue to shorten as many words as humanly possible.
No comments:
Post a Comment