Saturday, 21 December 2013

Take Home Pay - Yahoo!


How Much Money Are You Making Monthly !!

This is an ACTUAL screenshot of a Houseman's Payslip
* this is his monthly payslip, in the 1st year of housemanship
** some info has to be censored for his privacy

- UD41 is actually your salary grade.
- More or less, this is the amount you're getting, during housemanship. RM4300 ++
- Your salary increases once per year (but there are 4 times in a calender year where this increment take place), together with everybody who works in the government sector (not private sector).
- It increases 1% per increment. (Based on my housemanship salary that time & according to what i was told by the "bahagian kewangan" of my previous Hospital). Some say the increment vary according to your salary grade.
- Take Home Pay = Total Income (minus) KWSP & Income Tax
** B.I Perkhidmatan Kritical = Critical Allowance
** You (as a houseman) need to work a minimum 50 hours per week to be entitled for this critical allowance !!! This particular term, applies for houseman only.
** As for year 2014 onwards, the government has increase the minimum to a 70 Hours per week and change their policy to contract-based housemanship job.
** In other words, if you don't work long enough, you don't get the critical allowance and if you don't perform, the government can cancel your contract or will not hire you as Medical Officer UD44 !!!

--- Happy New Year Everyone !!!

"We are working HARDER for LESS money"

With the rate of 4% inflation + house price of at least RM 400k in Klang Valley + Study Loan debt of RM 500k = Good Look ??

Ever heard of Inflation?
Does these conversations sound familiar to you :-
1) Tok Teh said, "Dulu, sepuluh sen boleh beli Nasi Lemak, Teh tarik, kenyang! Sekarang tak dapat laa..."
2) Ah Cheng told, "if you don't have RM10, don't dream to eat at Mamak in Bangsar laa"
3) Ah Moi replied, "what? With RM10, you can get a nice lunch in Kota Bharu maa" 
4) Star Newspaper : Fresh Graduates Can't Afford to Buy a House Nowadays
5) Astro Awani : Gaji isi rumah kurang dari RM3000, dikategorikan sebagai miskin tegar di bandar !!
These are the effects of Inflation !!!!
 For me, to be a successful housemanship or doctor, proper planning and financial management are crucial as well...
Please learn a thing or two about INFLATION in YouTube... Please... I beg you !!!

Does becoming a Doctor make you RICH automatically ??

Answer :
depends on what you do with your MONEY. Even a millionaire goes bankrupt, right?

To cheer you up, here's a special gift.... hehehe
A screenshot of a Staff Nurse's payslip. This is her payslip after 2 years of working !!

1) It is NOT my intention to look down on other profession, or judge people by how much money they make. Just for comparison purpose only.
2) The ONLY reason I'm doing this is to help you notice that, WHAT A SUPER-HEAD START you're getting, compared to those working alongside with you !! Please appreciate the opportunity God has given you. Use your money wisely. Don't make yourself poorer day by day !! Spend your hard earned money wisely, yeah?

P/s :
  • My definition of "successful" may be different than yours. 
  • Some things are not tought in school, but that does not mean it does not exist.
  • Just because you ignore it, that does not make it disappear in the real world.
I can only give advice, it's you who decide your future.
Next I will be posting on Income Tax for Houseman.
Kindly leave your comment below if you're interested.
If you're not interested, lets not waste your time and my time, agree ??
Remember, i was once a houseman myself, during my time, nobody bothers to guide me through housemanship (except my family), forget about how to manage my salary.
I have to learn it the HARD WAY, not only about housemanship but about REAL LIFE as well. Looking back, i'm glad to have done what i did back then. Some of my colleague struggle, if not in housemanship, they struggle in life, most of them struggle financially.

Tuesday, 10 December 2013


CirugĂ­a ~ Bedah ~ Chirurgie 
All Kind of Surgery Under One Roof

Surgical, the name itself says it all, obviously is NOT a medical-based department
In other words, besides the usual ward work, you have to go inside and help your superior in the operating theater as well, in case if you cant notice the difference!

Some people may have prefer OT (operating theater) but as for me, i find myself hating OT, because of ONE reasons :-

 Its damn cold in there!
- this is my main reason, if only OT is not too cold, I may have end up becoming a surgeon. Can you guys believe it, the damn nonadjustable-centralized-aircond is responsible for my future !! I believe all hospitals are the same, but i have no evidence to support that.
I don't care anymore, its all in the past. How about you? xD

" I am too HOT for this cold environment "
      - ancient Zimbabwe Proverb :p

There are several sub-division (if i can say) in Surgical Department,
but depending on which hospital you're at..
Example, HKL has neurosurgical department but Hospital Kuala Pilah do not.
What does this information has to do with houseman?
Say you're in a hospital where theres no neurosurgical, if a patient brought to ED (emergency department) with severe head injury that requires operation, the patient will be straight away sent to a hospital where there are neurosurgeon, less admission to your ward, right?
Less job for houseman !!

There are :-
1) General surgery : Appendicectomy, colostomy, laparatomy, hernia repair, Mastectomy ect..
2) Hepatobiliary : Cholecystectomy, Biliary Reconstruction, Whipple, ERCP, ect..
3) Urology : Cystoscopy, TURBT, TURP, ect..
4) Neurology : Craniotomy, Evacuation of Clot, ect..
5) Paeds : Appendicectomy, Hypospadia repair, Anoplasty, infected circumcision, ect..
6) Plastic : Skin graft, facial reconstruction, burn injury, ect..
7) Cardiothoracic : Heart problem, lungs problem, ect..
** not all hospitals have all sub-division
** not all sub-division are compulsory to housemanship

If you love surgical based, then more is better...

If you don't, less work = less stress...

I don't have detail info on every hospital in Malaysia, ask Mr Google yeah!

Surgical Houseman Preparation ^_^
Most common cases you'll find in surgical are :- (read & learn how to manage them)
- Acute appendicitis
- Urolithiasis
- Breast cancer
- Colon cancer
- UGIB / LGIB = upper/lower GastroIntestinal Bleed
- Intracranial Bleed or Cerebral Concussion
- Rib fracture

" Inspiration is like bathing. It does not last, that is why we recommend it DAILY "

# watch this movie for inspirational purposes only,
NO, the actor is not my father, nor does I am representing Johnson & Johnson in any way !!!
- this is a good movie for doctor, i personally recommend it

** Tips #1 : To be a successful houseman, the 1st thing you need to think of, when there is a new patient admitted to the ward (no MO around), is whether this is EMERGENCY case or NOT. You are expected to handle cases based on PRIORITY !! Always think and work smart. So go learn what are the cases considered as emergency in surgical.

** Tips #2 : To be a successful houseman, the next thing you need to consider is, to anticipate whether the new case is going for emergency operation / procedure or not. If you think your Specialist / MO will decide for operation, then you should PREPARE the patient for operation. Such as, keep nil by mouth (puasa) + set IV line + give IV drip + take all the necessary bloods + consider ECG / Chest xray for older patient (normally age > 40 or younger if with underlying illness such as Diabetes, Hypertension, asthma)

** Tips #3 : Always ask your MO FIRST if you're not sure, don't simply give your plan if you're in doubt. Give your superior a phone call, it is much better to get scolded via phone, than in front of everybody for doing the wrong thing. Senior houseman can be a good reference to you, but there is still risk as they are still HO anyway. MO is your best shot.

Thursday, 5 December 2013


Houseman's 1st Pay

" I hereby announce that we are going to pay your salary tomorrow "


Can't wait for tomorrow !!!

Next Morning

Dammit !!!

I'm late already...

No Sweat..

They wouldn't call me the 10sec man for no reason...

Zaaaassssssss.... !!!!

Damn Walao !!!

So long liao already !!!


After one Hour of queue...

Finally its my turn !!!!


Mooonneeyyyyy come to papa


Whhaatt the heck mannn  !!!










I forgot to tell you, there's not much money left in the federal reserve,

only this much..

So Houseman, i'll pay your salary next month !!

Houseman don't need money,

What you really need is TRAINING !!

** DISCLAIMER : Chill laa, why so serious, there is no need to be so stressed  !!  Later I will be posting on houseman salary, how much, what to do with it, how to be income tax savvy, ect
STAY TUNE, LIKE, & SHARE THIS - thats the only way I can tell you want MORE !!

Tuesday, 3 December 2013

Orthopedic - We Fix You

Bone | Muscle | Spine

"Where Getting Screwed Is Good"

 Remember this song?
Bob the builder, can we fix it?
Bob the builder, yes we can !!

When I first join orthopedic, although I was considered as a senior houseman already (erk..!), I have very little knowledge in this particular field.

During medschool, I spent only 4 weeks in orthopedic department.
So short, yet so many things to learn.

Orthopedic deals with Every Single Bone in our body ??
Of course NOT. Orthopedic only deals with the musculo-skeletal system. In other words, ALL BONES except the skull, don't forget to add the Spine as well. LOL !!

Housemanship To Do List
  • Remember what i always tell you, preparation is vital if you want to survive in any posting. If you think you're slow (at first), i highly recommend you to study some basic stuff BEFORE entering any department. This simple step may hold the key to your successful housemanship life or the ordeal of your lifetime !!
  • As for orthopedic, since you know what you're going to deal with (don't tell me you forgot already, i just told you, musculo-skeletal sounds familiar?), then open your 2 kg Anatomy Book, refresh every single names of the bone. What? You da power already? Sure meh? Carpal bones you remember all in exact order, triquetral or trapezoid or trapezium. Google-lah. Remember how many cervical bones are there? Seven? Eight? You sure its not the cervical nerve you're counting?
  • If you can't remember all, thats totally physiological !! Tips : Remember the long bones first, how to differentiate which one is medial or lateral. Then move on to the bones in hands and foot. Sure can one, Malaysia Bull-eh right !!! Overseas grad, don't be shy if you pronounce it differently, they may laugh at you, but thats how we pronounce it in our University isn't ?? I don't give a damn.
  • Study about Xrays, especially for fracture and dislocation. Always see in 2 views, AP and Lateral / Oblique view. Not all xray require lateral view, eg : pelvic
  • Refresh about open and close fracture. How to differentiate between open fracture and close fracture with laceration wound on top of the fracture site? **tricky question by my specialist**
  • Fracture classification is a must !! You can download the ebook for classification here, its kinda helpful.
  • Learn things like close manipulative reduction (CMR), skin traction, skeletal traction. Don't worry you'll learn alot as time goes by. Tips : ask the ortho MA (medical assistant) if you're not sure. Some of them has been in the department for some time, they have vast knowledge in orthopedic (good thing about specialization). Btw MA does the CMR, not HO.
  • There are so many things i can list down for you, but since i'm not getting paid to write this article (wakaka), i've decided to list only a few which i think are the most important. Its not like you're going to study all of them, lol.
** Quick Facts about Orthopedic ** 

1. This is a surgical based department
- expect to do some surgical intervention in the ward
- eg : suture, incision & drainage, wound debridement
- tips : go YouTube, watch and learn

2. This is a trauma-related department
- learn basic things about urgency & emergency in Ortho
- eg : fluid resuscitation in fracture, estimate blood loss in fracture, pulmonary embolism, compartment syndrome 

“To acquire knowledge, one must study, but to acquire wisdom, one must observe” - Marilyn Vos

 More Tips Coming :
- When you're clerking a patient, say he's involve in a motor vehicle accident. More or less your clerking should start like this, example ;

50 y.o / Korean / Male
premorbid : DM on OHA

PT 8H : alleged MVA (motorbike vs lorry)
hit the back of lorry due to slippery road
GCS on arrival full E4V5M6
no LOC / ENT bleed / retrograde amnesia
ambulating post trauma
c/o pain at left shoulder
(describe the pain then)
** PT = post trauma, PT 8H = post trauma 8 hour, LOC = loss of consciousness, ENT = ear nose throat

 “The secret of getting AHEAD is getting started”  
   - Mark Twain

My experience in Orthopedic

How many of you have given sedation to a real patient in your medschool clinical time? I bet non of you have, as medical student are not allowed to "play" with high alert medication.This happened when i was tagging (day 4 of life in orthopedic), haizz...

My ward mate that day, she entered the department 2 months earlier than me, so basically she should be more familliar with orthopedic procedure, right? She's a 5th poster as well.Happens to be, there was a patient, an ex-IVDU (intravenous drug user), who needed CMR for his dislocation. For your info, CMR is a painful procedure because we manipulate the dislocated bone, so we need to give some sedation and painkiller to the patient prior to the procedure. She help the nurse (newly started working nurse i guess) to prepare the high alert medication. Since the patient's IV-line is closer to me, she gave the high alert medication to me and asked me to inject it.When a senior poster gave me the medication, i somehow did not check the dose (out of trust) and directly inject the medication. The CMR went smoothly. It was late evening that time.
After a while, the patient did not wake up, still in deep sleep (sedated). The vital signs were normal. So i was not worried. Later that night, he was still in deep sleep and i noticed he was not breathing normally (respiratory rate of 10 per minute) !!! When i asked my ward mate, she told me that the sedation (midazolam) is 5mg, which is okay but the analgesic (pethidine) is 100mg, which is way too much !!! My ward mate then left me (as she is working morning shift) and told me not to worry as sedated patient is expected to be like this.

At 11pm, although i'm supposed to go back at 10pm, i was worried so i decided to take an ABG (arterial blood gases) before going back. Turn out the patient was in severe respiratory acidosis !!!
Then, my next step was, i informed my oncall MO. Since i wasn't sure what to do, (even if i know, i still need to call for help). When my MO arrived, i presented the case and told him what happened. Of course he scolded me. He said, "why the hell you inform this in the middle of the night, you should settle this with your ward MO in the evening, blaa.. blaa.. blaa..". He referred the case to Medical team then. My MO ordered IV naloxone (antidote for opioid analgesic). Patient then started gasping and breathing faster, he was restless and unresponsive as well. When medical team arrive, they plan to transfer this patient to ICU for respiratory distress !!! Can you imagine, small mistake i did turned out to be a disaster. But since we gave the antidote, medical team ordered me to repeat the ABG prior to ICU admission. It was already 2am and i have to work at 7am the next morning as i was still tagging, damn tired already. Luck was on my side this time, the repeated ABG came back as NORMAL, just slightly reduced oxygenation. Medical team than cancel their plan for ICU admission, patient started responding to call, breathing regularly and normally again. It seems that he was not breathing enough because of the oversedation, to excrete the carbon dioxide, causing the severe respiratory acidosis. Once he breath faster, more and more carbon dioxide got eliminated thus normalize the pH. After a while, medical team and my MO chow. I went back at 3am, sleep abit and came back 6.30am to work again.

Can u imagine what will happen if i did not repeat the ABG and pretended everything is okay?

" Mistakes will turn into failure if you don't do anything about it " - Anonymous

There's a reason why I'm sharing you my bad experience, we're dealing with people's life in medicine field, sometimes we just CANT afford to make mistakes in the very first place.

" Learn from your mistakes is power,
Learn from other people's mistakes is POWERFUL " - Martin Luther

May Almighty God help and guide us to the right path. No human being is perfect except prophet.

Sunday, 17 November 2013

Paediatric - Rock My Baby

Mother & Baby Department

Actually Paeds is my 5th department, but after completing medical, which is my 2nd, i decided to do peads first. Why? Because after a "tiring & no life" department, i needed some rest to recover physically and mentally. In my hospital, paeds is a chill posting, the head of department, specialists and medical officers are damn nice to you, as long as you don't create trouble and do your job properly (of course!).

My advice is always plan and prepare for whats coming. We're not a fortune-teller....  but we're not a damn gambler either. With better preparation and planning, success is easier to achieve !!

First of all, paeds posting is divided into :-
  1. Nursery : aka special care nursery (SCN) or whatever they wanna call it. Basically you're going to deal with neonates. We all learn how to differentiate neonates and children in medschool don't we?
  2. Ward : From a baby of 1 month old and up to 12 years old, is your future patient here.
You will have to spend 2 months in each of the above. Either you'll start in SCN then ward, or vice versa.  

For example : they gave me ward first, and then nursery. So i did tagging 1 week and spend 2 months in paeds ward... then.... did tagging another 1 week and spend another 2 months in nursery.
So if you realize, the total tagging period is still 2 weeks and the total allocated time in paeds department is still 4 months, like other posting. But i did not have to do tagging for 2 weeks continuously, less tiring !!

*** Disclaimer : Beware of Parents, especially Mother, as they can be very protective, avoid doing procedure like blood taking and branulla (IV line) insertion in front of them.
The next thing you want to avoid is having parents complaint about you, saying you poke their child many times for blood-taking or branulla. Remember that some parents are not as educated as you are, their emotion can easily surpasses their logic thinking. The worst case during my HO time, the so-clever mother, complaint to the Minister using SMS !! Since its near the election, the minister gave a phone call to the Pengarah Hospital !! Then, the whole department is like being shot with a machine gun by the Pengarah.. lol

While some complaints are relevant, some are not !!
This is hospital, happy-health-go-lucky people don't get admitted here !!
Baby = Small Hand = Small Vein = Difficult
Very Sick Baby = Difficult x 99
** remember, sepsis causes peripheral vasoconstriction, causing even harder to get peripheral line access !!!
- if you;re not sure, ask for help, not for trouble

Houseman Job in Ward
  • Usual stuff : Clerking, present cases, blood taking, & set Branulla..
  • Specific stuff : You need to plot the growth chart (google image to see it). If the child is under-weight or over-weight, remember to ask the mother regarding the child's nutrition status (what they eat, how frequent, blaa..blaa..blaa). If the child is under-weight, consider chronic infection? immuno-compromissed? Get the history from the parents. Might need to do screening (Hep B, Hep C, HIV test) for the parents and the child as well. Don't forget to ask the development progress, 6 months old can do what? 1 year old can say what? Start crawling/walking/running/talking??
  • Physical Exam : Always check the throat (main cause of fever/poor oral intake), peripheral circulation (capillary refill time, warm/cold periphery). Always look for the danger sign, as you are the 1st doctor to attend the patient, child can deteriorate super fast, if you sense any danger, straight away inform your Medical Officer.

Houseman Job in Nursery
  • Usual stuff : Clerking, present case, blood taking & set Branulla
  • Specific stuff : Learn how to calculate the feeding. Neonatal jaundice, what level of total bilirubin need phototherapy? Neonatal Resuscitation is a MUST as you will be working closely with your O&G colleague, in a difficult/complicated delivery, they save the mother, you save the child. Also you need to know, the criteria of admission to nursery. APGAR score. (Will write a post of all these separately)

# My experience in Nursery
That day, the weather was nice, there's a rainbow and the birds are singing. I just started my duty, and was informed by O&G team that they are pushing a mother to the operation theater for an Emergency Lower Segment Cesarean Section (LSCS) for suspicious CTG (remember my O&G post?) and suspected chorioamnionitis. So me, a nurse and my MO went there with resuscitation kit and we prepare for the baby.
- The Anesthetic team, gave the mother general anesthesia, because of failed spinal anesthesia.
- Baby was born vigorous, APGAR score full, no resuscitation given. My MO checked the baby and then he said, "ok, discharge to mother lah, baby all ok right, i go out first okay.."
- 1 minute later, when i was writing the discharge ordered by my MO in the mother's file, the baby suddenly stopped crying, became bluish (pale blue in colour) and limp !!
- The nurse started to panic, but thank God, i have my Neonatal Resus Skill like at the back of my hand, when you understand the resus flow and know exactly how to react, you won't panic.
- So i gave the baby Positive Pressure Ventilation (PPV) for 1 minute and ordered the nurse to give a shot of IM naloxone to the baby. The next minute, the baby became pink again and started to cry with good muscle tone, although i was ready to do chest compression, if necessary. Praise to Almighty God !!
- Can you imagine what will happen to the baby if i am not well equipped, knowledge and equipment wise?? My medical officer (MO) already left at that time. Lucky him to have me (hehe).

During my medschool, I never know what Neonatal Resuscitation is, let alone performing it. But I learn it during tagging time in Paeds with all my heart..
If an average medicine student who knows nothing about resuscitation during medschool, can save a baby's life..
You sure can too, medicine is a lifelong learning process !!! 


Monday, 11 November 2013

Medical - the STAT department !!!

When I was a medical student, there are Internal Medicine Dept, Cardiology Dept, Neurology Dept & Respiratory Dept, had to spend one to two months in each department....
Never crossed in my naive mind that in Malaysia, all 4 departments are combined into one, which is MEDICAL !!!

My specialist once said, "All patients presented to Emergency Department (ED) is a medical patient, until proven otherwise".. (in my head, i was like, walao wei !!!)
This explains why in every government hospital in Malaysia, medical has MORE wards compared to other departments !!!
This is why in the beginning, i always say, medical is the busiest department of all !!
So as a houseman, especially if you're given medical as your 1st posting, what should you do??
 I can't teach you everything you need to know in this short post, if its possible, why the heck we spent years in medical school, right?? What i can teach you is, how to become a successful houseman in this department.

Learn How To Do Houseman's Job
With all the knowledge we gained from medical school, it will be useless if you don't know how to use it in real life. When i was tagging in this department, they gave me a list of things i need to master in order to get off-tag (start oncall/shift schedule). So basically, they were telling me, "Aidil, if you know all these stuff, i am confident to let you work night shift alone, because you know what should you do, in case anything happened while the MO is not around"
  • Basic Life Support : Medical Officer (MO) will be busy as well, they can't stay in one ward, ED will always bother them, not to mention, referrals from other department. So if a ill patient suddenly stop breathing, your job as a houseman is try to keep the patient ALIVE while waiting for your MO to arrive !!! Thats it bro..!! Btw, Know the case (read the patient's file briefly), because you need to inform your MO mostly via phone call.
  • Branula : Most of medical patient will need intravenous line, HO need to insert them by hook or by crook.
  • Blood Taking : Medical is a department where they rely on blood too much (sry to say that). There are too many diseases and blood investigation is very vital for diagnosis and treatment evaluation as well. Taking blood from the vein is easy, in medical you need to learn how to take arterial blood, its very common in this department, compared to other.
  • ECG : You need to know how to perform the test and do your own interpretation of the ECG. I will teach you on how to read ECG later. This is expected of you as a HO, as heart attack is the number #1 killer in Malaysia.
  • ABG : Arterial blood gas, yes you need to know how to take them, and do your interpretation as well !! Of course, you need to know weather the blood is artery, vein or mixed. If its not arterial blood, you have to repeat it!! (Poke the patient until you get it right).
  • Glasgow Coma Scale : All HO must know and memorize them. If a patient GCS suddenly drop, your MO will ask about the GCS, because they need to know if the patient need emergency attention (eg:intubation) or not.
  • Basic Treatment : What will you do if the blood (buse/creat) you took, came back as hypokalemia or hyperkalemia? The ABG you took showed poor oxygenation or metabolic acidosis? ECG you perform showed myocardial ischemia? Patient develop hypoglycemia?? Your decision can save a patient life or prevent their condition from worsening. Learn, ask your senior HO, and ask your MO. Better be safe than be sorry. Trust me, you don't want to get extended in this department, its damn tiring dude !!!
  • Learn to prioritize your workload : Nurse will inform you everything, from high blood pressure, low glucose level, patient has shortness of breath, to patient request paracetamol !! Because they don't want to take the responsibility if anything happened.

At times you will wonder, if you had chosen the right path...

Nothing is impossible, the word itself says, “I’m possible!”
–Audrey Hepburn

Believe you can and you’re halfway there. –Theodore Roosevelt

Sunday, 10 November 2013

I Can't Read Your Mind

Dear Visitor,

  • Kindly "like & share" my blog with your facebook or twitter if you find it helpful... Together, we can survive better and help each other out...
  •  Leave a comment, ask me anything, tell me what you want to know, i'll write something in return
  • Like i said, i never learn how to do "mind-reading"...
  • Your interaction will benefit everyone
  • Thanks alot !!!

Saturday, 9 November 2013

O&G - 1 2 3 Push.....!!

Obstetrics and Gynecology

Bear in mind,
O&G is a surgical based department..
what do you have in mind?
as a 1st poster in this department??

These are the things you need to learn before going into this department, especially as a first poster !!
Based on priority, of course !!

1) Clerking O&G cases
- As all department has their template for clerking cases, O&G has several addition to the regular clerking template
- Remember since you're dealing with pregnant lady (obstetric), or women with menstrual problem (gynae),
always remember to add-in (or ask) about their :-
  • Menstrual Cycle : Menarche at what age, how long does the "period" last, the duration of each cycle, does the cycle comes regular or irregular (in terms of duration), any history of dysmenorrhea or any usage of contraception drug/device.
  • Sex life : Married or not (if not married, we call them "Single Parent or Single Mom", if they are not married, ask about their sex partner (do they change sex partner? bangladesh? singapore?)
  • Previous complicated delivery : Any prolonged labour, history of caesarean section, still birth, rhesus positive baby (delivered by rhesus negative mother), multiple pregnancy (twins/triplet)
  • Pregnancy-induced disease : Anemia in pregnancy, Pregnancy-induced hypertension, Gestational Diabetis Mellitus
  • Screening Status : HIV, Hep B, Hep C, VDRL, TPHA (normally done in the  1st trimester at Klinik Kesihatan). If they come without screening (as in single parent, or foreigner), we call them "unscreened". So we have to do the screening for them regardless the age of their pregnancy.
  • 4 Sign & Symptom of Labour : Contraction, Leaking of liquor, Show (blood + mucus) and Fetal Movement
2) Branulla (Intravenous Line) Insertion
- If you never learn how to set an IV line in medical school, its better to learn it before you start working as houseman !!!
- This is the department where 99% of their patients need branulla, even an expected delivery without any complication will need branula

3) Vaginal Examination
- This is very very important !!
- You need to be able to tell, whether the cervix is dilated and the opening is large enough to proceed with delivery or not. Sometimes your MO is too busy, get help from senior HO or staff nurses, as large cervix opening can deliver in the matter of seconds.
- Imagine what will happen, if you fail to identify the large opening of the cervix, the next minute, the baby head is delivered but the body is stuck and you're not in the labour room !!!
- If you're not sure, don't be shy to ask senior HO or staff nurses to reconfirm your findings. Everyone will be busy, but just open your mouth and ask, better save your ass first

4) CTG (Cardio-Tocography)
- Basically this is the monitoring of the baby's heart rate and mother's uterus contraction time
- Normally done at term (> 37 week of pregnancy) lady who shows sign of labour
- You need to identify the pattern of CTG : reactive (good) or non-reactive (bad)
- If its bad, theres a chance the baby is dying inside, this may be an emergency/complicated delivery !!!

 Pregnant lady with ongoing CTG

5) Scrub In
- Surgical based department will always need HO to assist in the operating theater
- Most hospital will arrange 1st poster for a briefing on how to scrub into operation properly
- Watch and learn !!

6) Common cases in O&G
- Urinary tract infection (UTI) : May cause false labour or threatened preterm labour. Check the urine biochemistry (any leukocyte or nitrate found in the patient's urine)
- Placenta Previa (low lying placenta) : Causing bleeding per vagina , check the mother & the baby !!
- Pre-eclampsia : Check the blood pressure, blood workout for Pre-eclampsia, look for protein in urine biochemistry, careful patient may develop seizure !!
- Chorioamnionitis : Mother comes with fever must be taken care immediately as this may be a sign of infection in the amniotic fluid. Check the CTG, any other source of infection, inform your MO as this is an emergency, they will definitely ask for CTG and will proceed with ultrasound scan

7) Common Drug used in O&G department
- T. Cefuroxime (zinnat) 250mg bd : use to treat UTI
- IV Cefuroxime (zinnacef) 750mg tds : use to treat UTI in threatened preterm labour mother
- T. FeSo4 400mg bd : for anemia in pregnancy
- T. Folate 5mg od : supplement to prevent spina bifida / folate insufficiency
- Ural sachet II/II tds or potassium citrate 15mls tds  : use to alkaline the urine, in case of UTI
- T. Papase II/II tds : to reduce swelling at vagina, after delivery / episiotomy done
- IM Pethidine 50mg (or 75mg) stat + IM phenergan 25mg stat : to reduce labour pain
- IM tramal 50mg (or 75mg) stat : to reduce labour pain, if the cervix opening is more than 6cm, do not use pethidine, use tramadol !!!
- T. metoclopromide (maxolon)10mg tds : to reduce nausea / vomitting
- IV metoclopromide (maxolon) 10mg tds : to reduce nausea / vomitting
- T. Amlodipine 10mg stat : to reduce high blood pressure for pregnancy induce hypertension or pre-eclampsia
- IV Magnesium Sulfate 4mg (8ml) stat then IVI Magnesium sulfate 1mg/kgBW/hour  : to treat Pre-eclampsia or eclampsia or prevent fitting. Monitor urine output, respiratory rate and knee jerk reflex during the infusion intravenous injection to look out for mgso4 toxicity

REMEMBER THAT... Generally it took ONE HOUR for the cervix to dilate 1 CENTIMETER...
will be faster in Multipara mother !!!

Sunday, 3 November 2013

1st Posting

Aren't We All Curious About "The FIRST"

First Love...
First Salary...
First Child.....
First Home.......

"The FIRST time I stepped on the NBA court, I became a businessman"
         - LeBron James

So you should be (if you're still not) curious about your first posting !!!
What to expect??
Will i screw up things??
Is the senior houseman helpful??


Here is an interesting fact about FIRST POSTING
- 99% of those who quit housemanship are in their FIRST posting !!!
- Most of them can't even endure the FIRST month of housemanship !!!

Erk.... !!

Okay, the key @. the vital part @ the X-factor thing... that you need know in order to become a successful first poster is.....
To be prepare of whats coming !!!

What you need to prepare may vary according to the department you're going to be assigned to..
I'll explain this in a different post, to make it easier for your future reference..
Cheers ! 

Is Family Important During Housemanship??

"My kids give me the balance to live RIGHT"
                                                                                - Celine Dion

So straight to the point...
Is family important during housemanship?
Absolutely !!!

And why is that?
You're going to need your family to be by your side at some point of your life..
Most people tend to look for family when they're in trouble..
Housemanship can be troublesome !!!

Does it apply to everyone?
Of course NOT.. !!
It depends on your character & personality..
We often watch on TVs, the main character try so hard to avoid his/her family know that he/she is having difficulty in life..
As for me, i am blessed to have my brother & sister-in-law by my side in the beginning of my housemanship life...

I don't know what will happen to me, if they weren't there in the 1st place...
They helped me alot (they might not realize it) in terms of mentally !!
I might quit housemanship due to the overwhelming stress, workload & workplace culture shock in the first few months !!
But thanks to them, although the 1st posting was hard for me, i manage to buck up & keep on fighting till the very end..

Some people don't express the same concern like me..
With or without their family, they can go through the hard life of houseman themselves..
Trust me, there are some people like that..
They just don't feel anything when being scolded or shouted at..
These kind of people, i labelled them as "takde perasaan"
Kinda nice ability to have, especially during housemanship !!! haha..

I've Made It...
What About You.. ???

Friday, 1 November 2013

Should I Stay in Klang Valley or Not ??

The Klang Valley Dilemma For Houseman

If you have no idea what this post is all about, its either you're too junior in the medical field (1st year student) or you're unaware of the typical new housemanship dilemma.
You can't be both !!!

Prior to housemanship, you will be given a chance to choose 3 hospitals which you are willing to work at.
One of the condition is, if you choose hospital within klang valley (kl/selangor) for your housemanship, then upon finishing housemanship, you will be transfer OUT of kl/selangor within 6 months after becoming Medical Officer (MO aka pegawai perubatan UD44).

Situation :-
Alex Ferguson chose to do HO in Hospital Kuala Lumpur (HKL) because his parents live in Kg Baru, so that he can stay with his family during housemanship.
After 2 years of housemanship, he received a letter from the ministry saying that he will be transferred to Sabah, to work in Hospital in Kota Kinabalu. His appeal was rejected and was told that he needs to work there (KK) at least 2 years, then only he can apply for transfer to hospital in semenanjung, let alone KL !!

It is almost certain that you will be transferred out of kl/selangor once you become MO, if you choose to do your HO there. You CAN NEVER stay there.

Looking from a different angle...
If you choose to do HO outside of kl/selangor, say Melaka or Johor...
Once you become MO there, you can apply for transfer to hospital within KL/Selangor...
Or you CAN stay there... !!

Choose KL / Selangor :-
1) If your parent stay in KL/Selangor, they will be by your side, encouraging you to go through hard HO life
2) You can stay in your parent house & save money. Bfast / lunch / dinner served direct from the kitchen
3) Sometimes parents can help you send your car for service, wash & iron your clothes, ect
4) You get to see your parents everyday !!!
5) Family looking after you if you fall sick

Outside KL / Selangor :-
1) You're far away from your parents (if they live in KL / Selangor laa). Busy & tiring HO life, make it harder to see them as frequent as you wish
2)  You'll spend some (or more) money, to buy bfast / lunch / dinner
3) You need to wash & iron your own clothes. But you can send it to the laundry shop nearby
4) More freedom & control of your life (which can be "pisau bermata dua") !!
5) More subject to stress / boring life (subject to personality)
6) Most IMPORTANT is, you can apply to work in KL / Selangor once you've finished HO !!!!

So should i choose my workplace according to where does my parents live???

* If they're staying in KL/Selangor, you have to think & choose....

* If they're staying outside of KL/Selangor, no dilemma laa, just choose, later when become MO, 80% can stay there also !!!!!!! 

Sunday, 6 October 2013

#5 : Killer Department

Killer ??? Shouldn't we all be Healer ???

The ugly truth is that, not everyone is professional, even the specialist !!!

Every hospital has killer department at least one. If theres two killer department and you still choose to go there, i can't find a better word to describe you than "Insanity" !!

What makes a department becomes a killer department :-
1) The Head of Department (HOD aka Big Boss)
- eg: very strict, one wrong dose of paracetamol, straight away get extended. Forgot to wear name tag, you'll get warning letters, ect.

2) The Specialist
- eg : have a special request like, HO must remember all cases while presenting the case to him/her, they will take the patient's file away from you. Cannot set up IV line at patient's leg (even if its damn hard to set in the arm). Many more. Some i find very childish & stupid, like i said, not all are professional

3) The Medical Officer
- eg : all orders given by him/her, must be settle before evening round. Some are beyond HO power, like to call the family member to come to hospital to sign consent. Or to make sure the discharge patient go back before evening round. ** i'm not making all these, it happened to me when i was a HO**

4) Lame sister / nurse / attendant
eg : you want to take blood culture, but the blood bottle is not there. You order nurse to give oxygen, but oxygen tank is empty. Ask the attendant to take the blood investigation result at lab, but they only bring back patient's food (although lab and diet department is on the same the way). At the end of the day, you'll get scolded by your superior for "not" doing your job on time.
** some department has very cekap staff, while others, just makan gaji buta, specialist & MO never blame staff **

#4 : Busy Department

Busy.... Busy.... Busy....

Do you know that in United Kingdom, they have rules & regulations saying that the maximum working hours for doctor is 48 hours per week, that includes junior doctors as well.
Which can be translated to, working more than 48 hours per week, is AGAINST THE LAW !!!

Developed country strongly believe that mistakes will only increase if doctors are overworked, thus they implemented such rules. Malaysia, the next promising developing country yet to be classified as developed country, is somehow....
doing the direct opposite. Didn't the West did what we are doing right now years ago and they failed ??? Why can't we learn from their mistakes, they tried everything before becoming a developed nation, isn't it ??

"Those who cannot remember the past, are condemned to repeat it "

Whatever lah, Malaysia Bull-eh, hehe...
Ok, to be successful in HO life, my advice is to choose your department wisely. Most of the HO who quit, are in the 1st & 2nd posting. Most of them can't even endure the 1st month in HO life, then they went missing.
The solution, don't even think of doing the busy department as your 1st posting if you are not well prepared !! Call your hospital admin before duty-reporting date, ask them to change, give them 999 reasons to help you !! 

It is generally known that, Medical department is the MOST BUSY of all, regardless of states, be it in KL or in Kelantan.
In my hospital, the ranking goes like this (from the most busy, to the less busy)... :-

1. medical
2. surgical / ortho
3. o & g
4. paeds

of course Emergency dept is busy as well, but it'll be your last or 5th posting only.
The word "Busy" here is directly proportional to number of patient, i am not talking about some annoying specialist who ask HO to do hourly vital signs monitoring for all patient making you "busy" as well (nurse will be jobless then). The ranking changes, but medical will always stay as the KING !!!

Tips : Find out the number of wards allocated to each department, you'll get a rough idea on which department has the most patient.
Example :-
If Medical has 8 wards altogether meanwhile o&g has 4 wards + labour room, doesn't that tell you something ???

#6 : Old Hospital

New Hospital Is Always Better


The New vs The Old School

New hospital has advantage compared to old hospital. Its the computerized system that makes them superior. Only a computer, whats so special about that???
Thats why i'm here to tell you !!!

Old hospital don't have computerized system. Meaning that every documentation is done by writing, do you think MO loves to write??
Old system makes you tired of writing the same thing again and again. For an example, the same patient that needs 5 different blood investigations. You have to write 5 different forms manually.
Old system makes you tired of walking / running. The only way to know the blood result is to go to the lab and get the result. When Specialist / MO need the patient's old file in 1 hour, you need to walk to the record unit and trace them yourself.

New hospital with computerized system makes everyone's life easier !!!
Patient documentation stored in computer, if there is no new plan added, you can just copy & paste. You can print out the patient's name (sticker) with barcode, stick it to the patient's blood bottle & send them right away. Old files?? Patient previous admission?? Previous medications?? It is just a click away !!!

You can do more field work and spend less time in formality !!!

"Technology is there to make our life better"

p/s : All hospitals should have computerized system by now, if not for corruption, lol

#3 : Live Far From Hospital

Just Apply For the Hospital Quarters / Hostel

Most of HO tend to stay at their parent's house, as they don't own a house obviously.
If you choose to do HO at hospital near your parent's house, thats fine.
But try to get the hospital quarters / hostel also, if possible. Why?
Its easier to go to work without having to wake up so early in the morning just to beat the traffic, or have to drive for 45mins when the clock shows 11.59pm.
Some of my friends got involve in car accident after falling asleep while driving (too tired after working). Lucky that no one was hurt, but still you lose your hard-earned money to repair the damage !!

If you choose to do houseman far far away from your family, then applying for this hostel is a must for you. Don't fall into the society trap, doctor has to life in a mansion, driving BMW.. Thats all crap !!
Just live a moderate HO life, for 2 years only maaa...

Because this quarters / hostels are limited in numbers, they may reject application coming form HO whos parents live nearby.... Thus, making those doing houseman far from their family a STRONG applicant  !!!

Live as near as you can from the hospital, you will save energy, time, money & might as well save you YOUR LIFE !!!!!!  :D

#2 : Less HO in Department

This can only be applied after you have entered the hospital of your choice. Why?
Because Hospital admin will always put new HO (regardless of 1st posters or not) according to the number of HO in a particular department. They cannot allocate all 10 new HO to medical (already have 20 HO there) when Orthopedic only have 10 HO left, right?
They will try to balance the number of HO in each department so that there are no jobless HO in one department when there are overworked HO in the other department.

The point here is, 1 month before finishing your 1st posting, try to find out whether the next department you're about to enter is depleted of HO (ask those in that department). If its not, then you will not face any problem with lack of HO. If it is yes, what you should do is....

1. Go to your hospital admin (normally it's call bahagian sumber manusia)

2. Ask the officer in-charge to change you to another department, normally they will ask which department you want to enter. (again, do some research on which department has sufficient number of HO, if not, you'll end up in the tiger's mouth trying to avoid a dog-bite)

3. Sometimes admin is reluctant to switch you to another department. Just come up with some good & solid reasons. We're all born as liar at some point, why not use it for good reason, lol

Problems related to lack of HO in a department :-

  • +++ workload = one HO covers more patient, need to start your AM round early, go back late, miss your breakfast & lunch & dinner
  • +++ stress = many complaints, tons of issues need to be settled
  • Freeze Leave request = since less HO available, the department cannot afford their "frontliner" to go on leave (cuti), all your request will be rejected. Remember, your leave is not your right !!
  • Shift changed to On-call system = shift system for HO is less tiring compared to on-call system. With less HO available, its going to be hard to create a 3 shifts schedule for HO.  They will end up make HO do on-call system. You're not getting extra salary to do more hours, okay? Only few will thank you for your hardwork
  • Working on Big Holiday = muslim working on raya, chinese working on CNY & so on, while bosses cuti kaw-kaw... lol
  • Have to work even if you're sick = unless you are being admitted to the ward for falling sick, some will not tolerate, you might get extended in the damn department for falling sick. 

 " Do not expect the world to be nice at you, just because you are nice to the world. Its like asking the lion not to eat you, because you do not eat lion "

#1 : Busy Hospital

Rule of Thumb #1

Busy hospital = busy for everyone, not only HO !!!

How busy do you expect HO life is?? You don't until you become one !!!
Thinking back, HO time is the only moment in my life where i write and walk THE MOST... and... eat, sleep, holiday, rest THE LESS !!!  zzZzzZzz...

Since all government hospitals are expected to be busy all year long, what you can do is, use your head.
Since the population in KL/Selangor is bigger compared to Perlis, it is only logic to say, HKL is more busy than HTF. Do some research, if you want to.

Example :
HKL has neurosurgical department, but Malacca Hospital don't. So Malacca will have to refer to HKL if they have neurosurgical patient. Which will result to more patient in HKL.

Although all government hospitals are expected to have all sort of specialist in various field, still they are lacking of sub-specialist in some department. Say Hepatobiliary Consultant, only a few in the whole south region of Malaysia !!!

Tips : Busy hospitals have advantages as well. Such as KKM will allocate more HO for busier hospital, you can learn a lot from different cases. Sabah/Sawarak hospital let HO do some procedures where in Peninsular, they prohibit HO to do so, like LSCS (Lower segment cesarian section)


Life is about choice

"Which hospital is the best for me.."

                "My parents live in KL, whats the best for me...."

    "Do housemanship outside KL first, then come back as MO, hmmm... "


Don't make choices you'll REGRET later  !!

To become successful in HO life, you need to make the right choices, not after you become a HO, but even BEFORE you become one !!
Why am i saying this?? Well... Whats the point of dreaming becoming a specialist, when you can't even endure HO life, isn't it?? There are stages of doctor's life you have to go through to get to the top.
Have you ever read in the newspapers, specialist or medical officer died at work?? Or Specialist / MO complain about their workload??
Most of the complain comes from HO, yes you heard me...
Think again, why do these complaints arise in the first place?
Its like, why do people complaint when the government reduces the fuel subsidy (causes fuel price to increase)??? Why the government NEVER complaint, they are using the fuel themselves also, right??

Most complaint comes from HO because they are at the lowest hierarchy in doctor life and they are being  pressured a lot by MO/Specialist. Pressure is subjective, meaning some people can deal with tremendous pressure where others don't. So look in the mirror and evaluate yourself.

Rule of Thumb
1. Busy hospital = Tired
2. Less HO in a given dept = Tired
3. Live far from hospital = Tired
4.  Busy department = Tired
5. Killer department = Tired
6. Old hospital = Tired

I'll explain them one by one in the next post, these rules of thumb, should at least help you in making decision, on which hospital you should choose to serve as houseman.
p/s : during pre-houseman course, you need to tell KKM which 3 hospitals you're willing to work as a HO. So choose lah from now !!

Saturday, 5 October 2013

1st posting (department)

Almost a year since i last posted??? Walao !!

Then i'll just write what comes into my mind, because if i wait, this blog gonna be history.
Departments can be divided into 2 major categories, which are, surgical based and medical based.
By now, you all should already know which department belong to which category, right?

Based on my experience and my experience ONLY, the choice of department DO play a big role in your HO life. I'll tell you why...

Example :
You graduated from your university, went to the "Kursus Penempatan" or whatever they call it, now you know which hospital you're going to serve. Those coming from local universities have more advantage than those from the overseas (i graduated from indonesia, so chill laa, Malaysia Bull-eh). NOT in terms of level of knowledge (generally speaking) but in working environment.
Local grads, did their clinical years in local hospitals. Everyday they see how specialist do ward rounds, how things were done there, how HO get f***ed up & lots more. So its like ;

"well... i've been to Zimbabwe once with my family, next time, if i go alone also, i can survive one" said Ahmad with one eye closed.

Meanwhile, overseas grads, if they never do attachment in govt hospital during semester break, they will not have any idea on how govt hospital is being run. Its like,

"well... i'm a tip-top student in my university, how hard can housemanship be, sure can laa", said Bidil while sipping his favorite Starbucks' Cappuccino.

When i was a first poster (1st day in my 1st department), i was damn BLUR. I don't know what to do. Everyone is busy doing some work, i don't know what i am supposed to do. People told me to clerk the new patient. I don't even know what "clerk" really means !!! So i took one file, and... started READING for like 30mins, trying to understand what is written on the referral letter.

<<<< Referral Letter >>>
Dear doctor, kindly see this pt, 28/C/F, G2P1 @28w
p/w cont pain since 2am, no leaking, FM good, no show. Documented cont 2:10:15secs, CTG reactive, uFEME leu 2+
Imp : Threatened Preterm Labour d/t UTI
Kindly see her and do the needful. Tq

I was like, WTF !! this is NOT a letter written by human being, this is some kind of alien telegraph intercepted by the CIA.
When they saw me NOT helping at all, they then gave me an easier job, which was, trace the all the blood investigation STAT. Since i went to the hospital orientation before, i knew where the lab is, but still, i don't know what blood to trace, whos blood to trace, bloody hell laa wei... lol
The next day, i became a senior HO's shadow, i switched to mode "watch & learn".

Since you have a lot to learn as a 1st poster, it is going to be a lot harder for you to start in a "busy department" than in a "less-busy department", right?
Medical department is well known to be the MOST busy department of all, applies to all hospitals at all time. So, it is more wise NOT to start in medical as your first posting.

For me, i started in O&G. Still a busy department, but compared to medical, O&G is less busy !!
I have to learn the short forms, how to clerk cases, set up IV line (branula), take vein blood, trace blood & vaginal examination. If i were in medical, i have to learn all these (except vaginal examination), plus how to take & analyze arterial blood, do rectal examination, neurological examination, take blood culture, ECG interpretation and many more. (during tagging time of course).
Learn "one by one" slowly is far much better than" all by one", common sense !!

Remember, less busy = less stress !!

Tips : some hospital "administration officers" understand  1st poster's problem, after getting your "duty-report" letter, try to call your respective hospital admin officer (normally at bahagian sumber manusia), introduce yourself and ask them if possible, not to put medical as your first posting. They are the one in-charge of new HO's department arrangement.

p/s : medical is a big posting, you'll learn alot there, try to do it as early as possible, or if you can, as your first posting. HO always say, if you finished medical, you be more confident in managing a patient yourself.