Doc Why Not E-Book

Mark Weinert

• Herausgeber: tredition
• Kategorie: Lebensstil
• Sprache: Englisch
• Veröffentlichungsjahr: 2021

Seitenzahl: 261

Beschreibung

At Wellington hospital, the Kiwi runs differently. There, a hectic surgeon breaks the plaster out of the ceiling because he would rather go to the golf course instead of the operating theatre. The chief surgeon leaves the cut open patient in the middle of the operation and conducts a discussion of the situation. And when the lights go out in the operating theatre, only the newly arrived German anaesthetist seems to be bothered. But "she'll be right" says Doc Why Not, as he is soon called by his colleagues. In New Zealand, not everything is trimmed to efficiency, there is a friendly tone even after the biggest mistakes, and one can deal with earthquakes better here than with drunken fellow human beings. Without mincing his words, the doc describes his daily culture clash on the other side of the world.

Leseprobe

Dr Mark Weinert

Doc Why Not

The doctor Kiwis trust

© 2021 Dr Mark Weinert

1st Eng. Edition

Cover design: FAVORITBUERO, Munich

Editing, proofreading: Kanut Kirches, Cologne

Translation: Mark Weinert

This work was mediated by Frahlingur Kai Gathemann.

Publisher and printer: tredition GmbH, Halenreie 40-44, 22359 Hamburg, Germany

ISBN paperback: 978-3-95889-316-0

ISBN hardcover: 978-3-347-30328-7

ISBN e-book: 978-3-347-30329-4

The work, including its parts, is protected by copyright. Any exploitation is prohibited without the consent of the publisher and the author. This applies in particular to electronic or other reproduction, translation, distribution and making available to the public.

Bibliographic Information of the German National Library:

The German National Library lists this publication in the German National Bibliography; detailed bibliographic data are available on the Internet at http://dnb.d-nb.de.

www.drweinert.com

@drmarkweinert

The names have been changed the rest of the story is as true as I remember it.

Dr Mark Weinert, MD, D.E.S.A. makes people stop talking as a clinically employed anaesthesiologist and makes people talk better to each other as a communication and simulation trainer. He is committed to patient safety, and his passions are travelling and the people he meets along the way. He moved with his family to Wellington, New Zealand for three years. Today Mark Weinert lives and works in Munich. He believes that 90% of problems at work are due to interpersonal differences, not differences on substantive issues. If you are interested to know more about this topic you can download a free e-book about “the 5 most common mistakes in hospital communication” athttps://linktr.ee/drmarkweinert or visit www.drweinert.com for more information.

Dr Mark Weinert

Doc Why Not

The doctor Kiwis trust

Preliminary remark

"We would have a job for you in Wellington, do you know where that is? «

"In New Zealand, by the sea I think, the capital …«

"Do you want to go there?«

"I've seen mountains before, so yes, by the sea is good. «

That is how the conversation went that brought us to New Zealand, and it sums up exactly how much I knew about this country up until then. Where else in the world can you stand on a glacier, look out over the rainforest, and see the sea? Where else in the world is it possible to find all (!) the filming locations for The Lord of the Rings and The Hobbit? I digress.

Why New Zealand? During my medical studies, I could never go abroad for personal reasons, and I wanted, before settling down in a job with a permanent contract for life - sounds like marrying your job, strange - to go out and work somewhere in the world. I have always enjoyed travelling, that's what I have in common with my wife. We were particularly fond of faraway destinations. We thought we could do Europe when we had children.

So logically, the first longer trip with children went where? To New Zealand.

To work abroad, it is advisable to speak the language of the country. Consequently, most countries insist on proof of this. With English as the only relevantly mastered foreign language, the field narrowed down. Since English culture was closer to us than North American culture, I studied for the IELTS test (International English Language Testing System). A test that everyone who wants to work in Commonwealth countries must take to prove their language skills. My score was good enough that New Zealand was open to us. I applied for a job in Australia or New Zealand through an agency, as the bureaucratic formalities are considerable, but more of that later. The agency tells me that I can expect an offer in six to twelve months. So I tell my boss. After four weeks I get the call, followed by an interview. It is September, the job would be from 1 December. That's what I tell my boss. To this day, I give him credit for pushing for a termination agreement below my notice period. Although it pained him to let me go, he just said, "You should never stop a traveller. This is a great opportunity, go for it! " And so, we set off for the unknown country that and its people we have come to love so much. What was originally planned to be only six months turned into so much more.

Of course, clichés are served here. I hope our affection for the country and the people always shines clearly through the fun, and it's a balanced description that takes the mickey out of me as much as the endearing qualities of the people and the culture of the most beautiful country in the world.

My telephone interview

We waited anxiously to see if and when the phone would ring. That was before Skype Business, Zoom and Google Hangouts. Telephone interviews for a doctor's position are still rather uncommon in Germany, although the shortage of skilled workers is increasing like everywhere else in the world. The Australians are to blame. I beg your pardon.

Well, people who have decided to work in the health sector and who have gone through the training, be it nursing or medicine, to the end and graduated, have a high motivation to work in this profession. Not because they have a degree there now, but because they were willing to stick it out for so long despite all the hardships and the working conditions. It must give them a lot personally, otherwise you don't do it for so long. What that is can be quite different depending on the person. But the basic idea of helping people when they need it most is already widespread. No one does nursing care because of money. At least not because it earns so much money and money is so important as an intrinsic motivator. Or have you ever heard someone say: "Why don't you go into nursing; you'll earn great money there! And the working hours are great too! «

Probably not. And the doctors? At least I don't know any who studied medicine because they wanted to make a lot of money. There were some who came from doctors’ families and had plans to take over their father's practice, or who had an A-level and then chose an NC subject because they could. But that's at the beginning, many of them don't finish their studies or don't work in the profession. If you've worked in the profession long enough to complete an education, it gives you more than money. That's how it is with me, too. A-levels? Certainly not, I had a 3.1. My father was a doctor, yes, but without a practice, with the mantra: "Son, do something else! Anything but medicine!" What does the boy do? Medicine! Opposing the parents, as you do.

And what do Australians have to do with it now? The shortage of skilled workers in the health sector is worldwide. Qualified people often quit because of their direct supervisors or the corporate culture. There are now good studies on this. In other words, I don't quit my occupation - which also comes from vocation - but my supervisor's ass. And if he's OK, but the culture of my company or hospital is not - did I write privatisation? I mean, whoever thinks evil of that - changes, then I might have to change jobs. Because I simply can't stand it anymore. So, who has the best working conditions for health professionals? The Australians! Great working hours, great pay, great reputation. Nursing is completely academicized, which means that nurses there have studied Nursing. The training for doctors and nurses is considered one of the best in the world, and a lot of money is provided for further training. An excellent working atmosphere, flat hierarchies, and a great country. Okay, spiders and nine of the ten most poisonous snakes in the world. Actually, nine of the nine most venomous snakes in the world. That's why many New Zealanders want to go to Australia after their education, not because of the snakes, but because, apart from the reasons mentioned, they also earn more - about twice as much - there. Who could blame them? For this reason, and because New Zealand's university system does not produce enough graduates to cater for the next generation, there is a vacuum that must be filled. Gladly with British people. They go there when they can't get a job in Australia. And they are gladly accepted because they have a similarly good education, speak the same language, and come from a Commonwealth country, which eases the bureaucracy around visas and work permits. The resulting vacuum in England is being filled from Europe. Among others from Germany. Our vacuum will be filled from … Yes, who will fill it? Voluntarily? Near Eastern Europe, before they were in the EU. Now they like to skip Germany to go straight to the UK. And who fills the void now? Politicians are dealing with it. That means something like: The child has already fallen into the well and there will be no satisfactory solution, at least not in the foreseeable future. Whenever a system that is actually self-sufficient fails to find a functioning solution itself and 'politics' takes on the problem, you can be sure that it will be unpleasant.

So much for 'it's the Australians' fault'. Before the interview, I asked the anaesthetist who runs the agency that wanted to place me on the other side of the world how I could prepare for the interview. After all, it is a different health system - how different, I was yet to feel. He replied, "It's very simple. Medicine varies from country to country, but the principles remain the same. If you boil every medical question down to, 'What is the safest thing for the patient? ', you will never be wrong. That is the same principle in all countries.«

Wow, okay, I thought. Great, that sounds so right, why has no one ever told me that in Germany? So, nobody in the training at the two 'Ivy League universities' where I studied, or the normal five hospitals where I had worked until then? There, the question behind everything was: What is 'right'? But 'right' can be seen from different points of view. Right' in the sense of a guideline - that very often also coincides with 'safe' -, right in the sense of 'for the patient', here 'safe' is not always meant. Right in the sense of 'what does my senior physician want'. Here it sometimes already goes far away from the safest way. And finally: what is the right thing to do, in the sense of 'where does our money come from? ' From being able to bill therapies and procedures! From the point of view of administration and chief physicians. What is the most effective thing? What is the most efficient? What is the fastest? These are all questions I have been asked and, as a result, have often asked myself. 'What is safest for the patient? ', was not the all-caps question in Germany at the time. Now there is at least a Patients' Rights Act and the Patient Safety Action Alliance (Aktionsbündnis Patientensicherheit, APS), of which I am now a member myself. The fact that both are needed speaks volumes.

All these questions are running through my head as I pull up out of my chair - the phone rings.

"Hallo, this is Mark Weinert speaking.«

"Hello, this is Judith, your mother-in-law.«

"Not now, Judith!«

I hang up and, like many sons-in-law before me, demonstrate tact, sensitivity, and the talent to say the wrong thing at the right moment.

The phone rings again.

"It's inappropriate now!«

"Is this Mark Weinert?«

"Yes, it is. I am, I mean.«

It's off to a good start. Besides the poor connection around the world and my English, which I thought was quite good up to this point, I am hindered by the fact that I am surprisingly really nervous. Talking to someone in a foreign language who you can't see is much harder. You have no visual feedback as to whether the other person has understood you and how what you have said has been received. And here there are three on the other end of the line. Alexander Primrose, the head of training, Sandra Williams, the anaesthetist who was to decide with him on my recruitment, and a Maori representative, Paige Kaimoana. Their job is to decide whether I would get along with Maori culture or whether I would have problems working respectfully with people from other backgrounds. After a bit of small talk and general introductions, I tell them my CV, as I have done many times before. I am then asked a few questions about my motivation, why I want to go to the other side of the world and also a few technical questions about my work as an anaesthetist, all of which I start with "So the most important thing is that it is safest for the patient"…. Essentially, they want to know if I accidentally kill patients or am 'safe'. I am 'safe'. So far, so good.

Then the Maori woman comes up and asks if I have ever worked in a culturally diverse environment. Of course, I have. I worked in a hospital in Upper Bavaria for three years. For someone from Cologne, that's a challenge of intercultural diversity. And there in the Bavarian countryside, the majority of the nursing staff were from East Germany. So mainly Saxon was spoken. So much so that I once asked a new nurse who came from the village where the hospital was located and who spoke in the broadest Bavarian accent, whether she had problems understanding the accent spoken here. I don't tell them that, though. I say that Munich is a very multicultural city and that about 20 percent of the people come from other countries. And do I also work with people from other cultures in my environment? Yes, absolutely. The head physician of vascular surgery is Persian, his senior physicians are Greek. The gynaecologist is Hungarian, we have Spanish, Hungarian and of course many Turkish nursing staff. We have a Pole, a Turk, a Czech, a Chinese, a Spaniard, a Cypriot and two Bavarians, even a real Munich man, working in our department. Well, if that's not enough. Have I ever worked with Maoris before? No, not yet. Well, they would provide me with the crucial cultural information so that I would get along well. And that's about it. No further questions, your Honour. Two days later, the acceptance comes, and I have to explain to my boss that he could fill my position with someone else. And much earlier than planned.

Bureaucracy

"You have what, and you propose what exactly?«

In Germany, people think we have a sprawling, impenetrable bureaucracy that is unbeatable in terms of inefficiency. Far from it. In the meantime, there is even an app developed by refugees as a start-up to help them navigate the German bureaucratic jungle, but this is all harmless compared to New Zealand and its bureaucracy.

But back to Germany again: I don't understand my tax return, and yet I sign that all the information is correct. And every profession has its own logic. Legal logic, for example, the legal text on the so called joke declaration: "A declaration of intent that is not meant seriously and is made in the expectation that the lack of seriousness will not be misjudged", such a declaration of intent is void under German civil law according to § 118 BGB. This is a fivefold negation. Doctors also have their own logic. Anyone who has ever read a doctor's letter understands that they do not understand anything. The sentence at the beginning is popular: "We may assume that the previous history is known and refer to the detailed letter from …". "This means: I don't know what else the patient has or had. The letter is never available anywhere. And nobody knows what is supposed to be in it. Also, car mechanics, IT specialists, advertisers and probably also confectioners have their own language that follows their own logic. And so, do the bureaucrats. I was struggling with one at the moment - in New Zealand.

Since I had carelessly stated that I had flown as an emergency doctor on a helicopter in Austria for three years, I needed a clearance certificate from the medical association there that I had not fallen into disgrace as a doctor in Austria. This means that I had not been charged with a professional crime and that no proceedings were or are pending against me by the medical association. The document confirming my clean slate was issued to me promptly and without any problems already in English after a phone call. The 'Austrians' are on their toes. In Germany it was completely impossible to issue the certificate in English. "Where would we get to then? " To New Zealand, I wanted to say, but then held back. It was not possible for me to pre-write the Austrian document in English and have it confirmed by the German Medical Association.

Restraint is often difficult for me. I fell off the diaper changing table more than once as a child, and the filter through which most people pass everything they say has been broken. I often say exactly what I am thinking at that moment. I can do this without alcohol, and it is rarely interpreted in my favour. It took me thirty years of effort to install a halfway functioning filter again. It doesn't always work:

"You could write whatever you want in there!«

"That's only two sentences in English!«

"You can't expect me to be able to read that.«

Could I? Obviously not. "It's only two sentences!«

"No, that's not possible. We'll issue it to you in German, and then you can have it translated. «

Translate, not myself of course, but by a certified translator. Otherwise, I could just write something in. Anything. And then copy it and have it certified. And as I now know, not all translations are the same. There is more than 'true'. That there are different understandings of truth is nothing new. Since Donald Trump, we know that there are people who not only have different views of truth, but that they believe there are two different truths that are not mutually exclusive. Since wrestling with the New Zealand authorities, I know that there is not only 'true' (authenticated) but more than 'true'. That is, if they have authenticated it themselves. This means that for some documents, such as our passports, a normal notarisation was not enough. It has to be more than correct and 'true'. And when is something more than true? You can guess: when you do it yourself - or the government does it. Excuse me? Yes, that's almost as good as doing it yourself. And that's exactly where we were. We needed official certification of our passports because the notarial certification we had sent to New Zealand was not enough, but more of that later.

In order for us to get a visa as a family, I needed a work visa. For that, I needed the work permit from the Medical Council, which is the equivalent of the medical association in Germany. Entering the country on a tourist visa, as any German could do without applying, and then working there is a criminal offence. Even if the procedure for the work visa is already underway. It is precisely then that you are not allowed to enter the country with your tourist visa. If you were to enter with a tourist visa first and then suddenly think, hey, great country, I'd like to work here, that would be possible, of course. But since the work visa had already been applied for, there was no chance of that happening. I was told that there would be some difficulties and delays, and that all in all it would take between six months and a year to get all the permits. We had a ten-month lead time, so we were in good spirits at the beginning. Because the documents I needed from Austria came so quickly, I didn't think there would be any serious delays. But it was getting close. We were going to fly on 1st. November, and I was supposed to start working on 1st. December. Before that, we wanted to explore the country a bit.

The Medical Council decides on my work permit and then gives the embassy the green light to knock the work visa stamp into my passport. The work permit depends on many things. Do I have an education that is sought after in New Zealand (yes), do I have a work contract (yes). Do I come from a comparable health system (yes). How far along am I in my education (certificates from all employers translated and certified), licence to practise medicine (translated and certified). School certificate (translated and certified), birth certificate (translated and certified), health certificate for me and the whole family with a special doctor who is licensed to do this for New Zealand. So not myself or someone from my hospital (I could write something in there). Have I been vaccinated against hepatitis B? (Yes.) X-ray of the lungs, do I or my family have tuberculosis? (No.) Have I had contact with patients with tuberculosis? (No.) Well, I ride the suburban train in a big city, which actually means yes, but never confirmed, so 'no'. You probably didn't want to know that now. You also didn't want to know that you breathe in other people's dander when you ride the suburban railway or underground. That's one of the reasons why we wanted to go to New Zealand. So it's not that you didn't want to know that, but the clear air. I had an operation ten years ago on a benign salivary gland tumour: A confirmation from the operating (!) doctor that it won't come back (It won't come back.) Nobody asked me if I was a communist (no). A clean certificate of good conduct (all white), one from Austria (red-white-red). The clearance certificate from my medical association (translated and certified), we already had that. Three personal references from doctors I have worked under. Who they then wanted to speak to personally (they did). And after all the documents are in, the 'process', I couldn't help but think of Kafka, takes seventeen days until the decision is made whether I am good enough for the stamp, which then leads to another one, the visa stamp. Communication via email is reasonably fast, and we often have an email waiting for us when we get up in the morning, telling us what is still missing or what doesn't fit.

In the meantime, the departure date is getting closer and closer, and one day the email from the Medical Council arrives, saying that they had lost the copies of our passports, but that it was not so bad - that they had lost them - because the notarisation was not sufficient anyway and therefore, we would have to send them a new one anyway. This time I call. Another problem that arises is: our passports are already at the New Zealand Embassy waiting for the Medical Council's okay to stamp them. The embassy is in Berlin. We live in Munich. The cities are about 600 km apart.

"What do you need for a notarisation if a notarial one is not enough? «

"Well, it has to be a government agency - or we could do it. If you send us the passports. «

We have a flight booked in twenty days.

"Just so I understand you correctly: You've just lost the copies of our passports and you're suggesting that we send you our original passports to New Zealand so you can copy them and then you send them back to the embassy in Berlin to be stamped?«

"Yes."

"The passports are currently at the embassy in Berlin. Can't you just call them to have them make a copy, after all it's a government agency?«

"No, we can't call there, that's not their job or ours.«

"How long will the process take again once everything is in place?«

"It takes, generally, seventeen days.«

"Thank you, I will think of something ….«

Fortunately, a friend of ours works in the Foreign Ministry in Berlin.

"Thomas, can you get our passports from the New Zealand embassy, make a copy and put a stamp from your office on it so it looks official somehow?«

"Sure."

Within a day, the 'officially certified' copies were on their way to New Zealand by registered mail.

These copies were good enough. All that was missing now was the 'timetable' for my first day at the hospital, which had to state that there would be at least one hour of safety briefing and tour for me. This was to make sure they didn't throw me into the operating theatre on my first day - as is the norm here, in Germany, by the way - and I was shown where the emergency exits are and where the fire hoses hang. No joke. I call the hospital, Sandra, my 'liaison officer', by now head of the anaesthesia department, knows all of this and says: "No problem, I'll do it right away. When are you leaving? «

"If that's enough now, in nine days ….«

"Well, good luck!«

At home we sit on boxes and suitcases. Otherwise, the flat is empty and ready for our next tenant. Freshly whitewashed.

I call the Medical Council again: "Is anything else missing? Do you have everything now?«

"Yes, now everything is complete.«

"When can you give the okay to the embassy?«

"Now that we have everything, it takes: seventeen days.«

We are unpacking again. We have postponed the flight.

How to print money?

Many people are thinking about how they can print money. The Bundesbank can do that legally. So can the Federal Reserve, and it can print so much money that it provokes inflation if it wants to. Other people are forbidden to do that - of course that doesn't mean that no one tries, but it is difficult. As Bertolt Brecht said, "Only amateurs rob a bank; professionals start one." If you don't have the money and crowdfunding doesn't work for you, you have to come up with something else. It is popular to produce things that people need. Better, things they always need. Better still, things they depend on. Even better, things that are expensive. I'm sure you can think of many things. If you also have a monopoly on sales, great! Also good: your product takes up no storage space. Physically, I mean. And you don't have to manufacture it. Surely it would be best if you had a product that costs you nothing to produce, that takes up no storage space, that only you distribute, that people need and that they can sell over and over again. The fact that it is completely legal is another plus. It even serves safety.

What am I talking about here? Quite simply: about controlling a language proficiency test. If I want to work in another country, it makes sense that I speak the language of the country at a level appropriate to my work. So far, so good. If someone wants to work in Germany, they must take the European language test at a level of C1. With C1, you can converse, and higher concepts can be communicated. Translated into medicine: Can I draw up medication in the right dosage, and do I understand why I should do this now? For English, there are different test systems that prove the language level. Many people are familiar with the TOEFL test (Test of English as a Foreign Language), which the Americans require if you want to work there. It tests American English. For Europe, there is the Common European Framework of Reference for Languages (CEFRL). It turns out that not only Germans love abbreviations. Since the TOEFL tests American English, there's no way you can use it for England, Australia or New Zealand, because that would be like Germans understanding Austrians. And that's why there's the IELTS. This stands for International English Language Testing System. Since it tests American and British English, it is the best and, in the opinion of some countries, the only way to prove the correct language level. The test has four parts:

1. Listening (approx. 30 minutes)

2. Academic Reading or General Training Reading (approx. 60 minutes)

3. Academic Writing or General Training Writing (approx. 60 minutes)

4. Speaking (approx. 10-15 minutes)

It is divided into 0-9. 9 corresponds to a 'native speaker', meaning as good as a native speaker. You can take the test as 'general' or 'academic', depending on what kind of environment you intend to work in.

To work in Australia, you must achieve a 7.0 average across all four parts and not score below 7.0, anywhere. For New Zealand, you must get a 7.5 average and not be below 7.0 in any of the sections. I know an anaesthetist who wanted to take the test directly in the country because he thought his English would then automatically improve. His English got better, but a test rarely measures what it is supposed to, and after failing four times, he surfed for the rest of the year while his wife earned the money until they went back to Germany. Not the worst option, if you ask me. I've been learning English since seventh grade, have participated in two language student exchange programmes, usually go to the original English version at the cinema and read both novels and scientific literature in English. Nevertheless, I decide to take private tutoring after having a closer look at the test. With someone who has taken the test himself for many years and teaches me how to use special sentences to show off my grammar skills. Nevertheless, the test is more difficult for me than I expected. But no matter: in the end, I get a 7.5, and both countries down under are open to me. For the next two years. That's right, the test has an expiry date. Clever. After two years, you have to take it again if you have left the country. Which brings us back to the printing of money mentioned at the beginning. The test is not cheap. And in England, for example, it is required of everyone who wants to work there. Everyone? Yes. Imagine you are a South African anaesthetist. Your mother tongue is English. English is the national language, you studied in English and then immigrate to New Zealand. There you speak and work only in English, and you have a British passport - all residents of Commonwealth countries can apply for a British passport.

Now you have to take an IELTS for your year in England. Even though you already took it three years ago. And without the test, you can't get a work permit. That's what I call a legal money printing machine.

Officer Goodboy