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NEONATOLOGY – NO MAN’S LAND?

It’s time again for M.O.s to change postings. Six months ago, I had applied for Family Health Service with the intention of trying out the life of a family physician, seeing a hundred patients a day, cooped up in a little 9-feet by 6-feet clinic, with no other intellectual stimulation and social companionship other than that of my clinic assistant. Well, with the last 6 months being the period with the most number of public holidays, Polyclinic rotations were far too popular and I, a neophyte M.O., ended up in ... you guessed it – Neonatology.

I was so dejected at the thought of spending half a year in a subspecialty posting which I thought had little relevance to family practice that I sat moping on the floor in my room for a good half hour. I then had the bright idea of going to the Singapore Medical Association to put my name down for a switch of postings. You guessed it again – practically everyone else given Neonatology had done the same thing. Needless to say, my last 6 months were spent handling babies from those as little as 565g to those as large as 4900g.

You may well ask at this juncture why I am writing this. After all, everyone knows that Neonatology is hard work, that it is a subspecialty and that the younger M.O.s invariably end up there as no one chooses it except those aspiring to a Paediatric traineeship. My point is that I have benefited much from this rotation and I say Neonatology is a very useful posting for those of us planning a career in Family Medicine.

I had not done Paediatrics as a H.O. and would not have a chance to do it as a M.O. unless I become a trainee. These 6 months have given me valuable experience with younger children. I did not just look after premature, sick babies in the Intensive Care Unit as I imagined I would. Instead, I screened many healthy newborns after delivery as well and managed those with minor problems such as regurgitation, vomiting, poor suck, fever and jaundice in the Special Care Nursery. In addition, I had outpatient clinics where those with problems of talipes, torticollis, clicky hips or risk of developmental abnormality are followed up till they are 2 to 3 years of age. I became very comfortable handling little ones and knowing what their normal behaviour was; I learnt to pick up the subtle signs and symptoms of disease. If I had not gone through Neonatology as a M.O., I doubt I would be able to judge what degree of jitteriness is normal and when it becomes excessive and pathological. I would otherwise not be confident after seeing an infant that I have elicited the relevant history from the parents and done an adequate examination to be able to sleep tight for the night if I were to send them home. Clinical skills become even more critical with small babies as these patients cannot tell if they are not getting better and with less room for error, it may just be too late when they are eventually brought back for a second consultation.
 

The Neonatology department at KKWCH has a strong teaching programme. Traditionally, there was a daily lunch time series comprising talks by invited specialists, slide shows, x-ray sessions, journal club, morbidity and mortality rounds and a weekly grand teaching round. It was unfortunate (well, not so unfortunate after a call without sleep) that the period I was there coincided with the preparation for the amalgamation of the two neonatal units and the shift to the new hospital. Most of the teaching time was forfeited for meetings among senior staff about common protocols and matters pertaining to the shift.

Well-thought-out protocols based on sound studies and past experience is another strong point of the unit. It minimised confusion for the junior doctors and the nursing staff and helped the department to run smoothly.

I profited from the formal teaching and the good organisation and gained in some less tangible ways as well during my sojourn in the department. I was impressed with the academic atmosphere and the stress on research and the most current management and hope I have imbibed some of these attitudes.

Neonatology, a posting which has not been a popular choice because it involves quite a bit of hard work and it is also a subspecialty posting. M.O.s in past rotations would remember the nightmare of having five to ten babies on two or three-hourly hypocount monitoring in 6 different wards at differing wee hours of the morning! The situation is now much improved since the nurses took over the monitoring of hypocounts and some other duties.

How hard one has to work is related inversely to the number of M.O.s the department gets. During my last 6 months, it was manageable in the beginning but towards the end, with a number away on examination leave, maternity leave, Haj leave and annual leave, we were rather stretched. When more had to go for the A&E course, we were in dire straits and registrars had to run M.O. clinics. We even had to get help from M.O.s completing National Service to help out for two weeks. We all survived of course. To quote an anonymous source, “No one dies from a little hard work.” There may be no mortality but I do wonder about the morbidity. Will more doctors be disillusioned with remaining in service if they continually have to work so much harder than they are being remunerated and with little hope of the situation becoming better?

In spite of the hard work, I am glad I did Neonatology for six months for I have gained much. I still want to do Family Medicine and I would recommend the posting to all who want to be family physicians, especially those who have not done Paediatrics.