on call or shift system?

i am one of the lucky few who managed to experience the both sides of the world. well, truth to be told, i only did the old-school on call for a month but i guess my 2 cents will be worthy to some.

what i like about the previous on-call system is that it made you stronger and be proud by the end of the day on how mentally-abled you are, surviving the ruthless hours of work. yes, you get the whole experience and do more procedures but being a "normal" human being, i cannot help but to feel exhausted and "lame" since i spend most of my hours, in the hospital. there goes my life, to experience adulthood. other pro is that, you can save your salary from shopping and spending them on meals cause you are stuck in the hospital. so, you reduce the petrol consumption and you get free meals from the hospital. (well, this depends on your hospital). and to those who puts money as a life goal, oncall will earn you even up to rm1k per month.

otherwise, the reason of doing "on-call" can save your ass from being kicked around all the time. NOTE : not ALL the time. i noticed that the superiors will have more empathy towards you and they will have less expectations on your work performance on that day.

so now what about the shift system you may ask? well, i don't care whether you want to label me as a lazy HO but being a normal human being, i am in fact happy that such system was introduced. i noticed that i feel more motivated to work since i know i can go back early to rest the next day. at least, i do not feel that i have to push myself to last until 5pm. on-call is not tiring since the adrenaline is pumping in but the feeling of POST-CALL sucks. i have slept a few times on the counter and drooled my patient's notes for being too sleepy (even though it was only a 10 minutes nap!!).

i also have more time for myself and this keeps me energised and refreshed to work the next day. and after going through the conventional method, i do appreciate the extra time given. hence, i do not complaint if i have to work after 8am and help my colleagues.

so the problem that causes the superiors to loathe the new system is that the housemen seem to be taking this for granted. i admit that ever since we do shift duties, some become more "berkira" about their work. they tend to pass the job to the next shift and moan if they are asked to stick around to do extra job such as doing discharge summaries or attending the clinics. other than that, we might spend less time in the hospital but at the end of the day, it depends on the attitude of the person to make use of the limited time. i dont think the system should be blamed for lessening knowledge and exposure but instead, blame the person for not showing extra efforts and initiatives.

furthermore, the shift allowance is rm600 and to some this means earning less than they could possibly do. but i notice that i do not even have that much of time to spend my salary on. if they really want to earn extra cash, i suggest them to come to Sabah or Sarawak. we get an extra of rm1000 compared to those working in the peninsula. And oh yea, to those who whined about receiving less exposure ever since the shift system was introduced, i really recommend them to come to sabah and sarawak or otherwise, stick around in the hospital a lil longer, voluntarily.

otherwise, in conclusion, to date, i am really enjoying the shift system. at the end of the day, i think it all depends on our work ethics and attitude to properly utilise the time to equip yourself. before i leave, i'll just random shots from my phone on things that i see afterwork. thanks to the shift system, i can see the sunlight and do chores without feeling like a zombie!

 My Post-Call Treat. 

A pool at Taman Awam, Miri

O&G in Miri Hosp at a glance

20 days from today, we will be welcoming another new year. I dont think i will be celebrating the new year's eve since i am on call and i have a feeling tonnes of mothers will be flocking the labour room in the hope of having a new year's baby. Well, i cant blame them since i am myself almost a new year's baby but late by a few days! Hehehe

Anyway, some might be wondering, what are the cases encountered in Miri Hospital in case of Obst. Well, yours truly here have come out with list :

1. Normal labour
2. PROM / PPROM
3. GDM
4. HPT disorders in pregnancy
5. IOLs
6. Oligo / poly
7. Placenta Previa / Placenta Abruptio
8. Prem Labour
9. IUD
10. Abnormal presentation (breech/transverse/abnormal lie)
11. Trial of scar
12. Multiple pregnany (esp twin)
13. Asthma in pregnancy
14. False labour

It doesnt really differ much than those i've seen in Hosp Putrajaya and Hosp Serdang; the 2 hospitals that we got for my clinical training in medical school. If you happen to be a medical student reading this post, please master the above topics. They will be handy when you work later on.

Otherwise, please study your CTGs very well! The prob that i got for now is to properly analyse and interpret the CTG. Sometimes, they can be tricky. Whatever it is, the fate of the unborn child will be in your hands. A few minutes of delay can cause a permanent damage to it (ie cerebral palsy). Always remember that in O&G, a child should be born healthy until proven otherwise.

So there goes my saying on the current field. I only have a few weeks left remaining in the dept and i am yet to enter the gynae ward. Up till now, i am so far, enjoying my time in the dept. I have heard of scary stuffs in other dept and i am nervous about it! Let's hope i can at least swim despite having difficulties!

Sent from Hanani's iPhone! Woo!

The end of the year!

It's already the beginning of December; a few weeks more to go before we end the year. So far, my life has been in line and my confidence grew each day. I dont think i am super competence but i can now handle straight forward cases independently. 

I am now working in ward, a simpler and less adrenaline pumping environment. There'll be days when i handle the whole ward all by myself. That is, covering about 30 patients all on my own. I love the challenge but i still fail to finish my work before my MOs or Specialist comes over. 

Otherwise, i am planning to move out of the quarters real soon. I can't wait any longer cause i am yearning to have my own bed and a comfortable room! However, i am worried since the new housing area is not developed fully and there are Construction workers all around. I dont understand why but many people around here like to stare especially to that of girls. 

Otherwise, It has been almost 2 weeks and there hasnt been any new housemen coming in. I hope the public out there especially the soon to be graduating doctors will consider Miri as the choice. So far i dont think we learn less here compared to that in the Klang valley hospitals. In the end, i think it all depends on your attitude towards learning. 

Orite then. It's weekend and i have finished my work! It's time for lunch! Bye!

Sent from Hanani's iPhone! Woo!

A lil hello!

It's been awhile indeed! Lately i've been spending my already limited time on other things to detoxify myself. Hence that explains for my hiatus. Otherwise i would probably be dozing off especially after postcall. 

Without realising it, i've been a houseman for almost 2 months! I know i've been saying this a lot but hell yes, it does feel short! 

Workwise, i am now more comfortable being an O&G houseman. I learnt a lot especially from my nurses, colleagues and superiors. And yes, up to now, i am still relieved and glad to be posted here. 

They said, O&G is the busiest posting but so far, i am indeed enjoying this place. Teamwork is excellent and everyone does not mind helping others when they are in need. Specialists are approachable and MOs are also very cooperative. To sum it all, i can say i am in a good posting.

I am not sure on how things are like back in The peninsula but throughout my observation based on my clinical attachments in 2 Klang valley hospitals, i can safely say that things are worse back there. Though One of the cons is that they now use Laptops for reporting purposes, i think handwritten can still safe time. 

Since i am halfway through the posting, i need to make sure i buckle up my procedures as well as the practicals. Then i might need to undeego Viva exit exams. I hope this feeling of luckiness persists until my nezzt HOship.

Pic above : my first movie out as a HO! yeah, i know it's outdated!

Sent from Hanani's iPhone! Woo!

It's 2.45am and i am wide awake!

Hello there!

I am now doing my so-called night shift. Miri General Hospital has introduced shift system but unfortunately, since we are lacking of housemen in O&G department, the system still looks like normal oncall schedule.

So for those who are doing night shift, we will start our day at 7am and stopped at 2pm. We are given with 3 hours break until 5pm and then to come back again to work from 5pm until 8am.

We can go back early the next day provided that we have attended the compulsory sessions such as CME and pass over and rounds with specialist. I have mixed feelings about this system since by doing so, there will only be 2 HO per night shift. Depending on the days, good calls can give some time to sleep. On "hot" days, u will definitely feel like a living frustrated zombie.

It's still too early to give my comments on the system but i hope our teachings and experiences will still remain optimised!

Week 4 - O&G

Another week passed. It's kinda hard to believe that I am already here for a month. Time flies in a blink of a second!

The good thing about this week is that, i got my first pay! I am glad i got it in a month! I have to say the amount is good but i havent had enougj time to spend! Furthermore, Miri does not have that many great shopping malls. Indirectly, it is a good way of saving!

Workwise, there are ups and downs. Sometimes i feel i am not competent even though after being here for a month. There are then other times that i am happy things went the way they should have been. My MOs dont really scold us that much, something that i should be glad at sometimes. But being that way, i might have not known my mistakes.

I am glad that until this date i havent got the feeling of quitting. I should be thankful to be having an uplifting and motivating environment. Teamwork here is great! I really hope that i get my confidence asap.

Sent from Hanani's iPhone! Woo!

Life as a houseman : week 3

Here i am again, updating you guys on my current life in Miri Hospital. 

What i can conclude is that, i pretty much like my Housemanship here. Even though we do not have that many housemen to begin with, at least the staff is very helpful and friendly. I learn many new things every single day and I enjoy getting to know the cultures here. In my opinion, the people and races here are more of 1Malaysia than in Semenanjung. We have Ibans, Melanaus, Malays, Chinese, Indians, Penans and many others which i need to discover.  

To those who are still planning where to go for housemanship, i suggest for you guys to write down Hospital Miri in that little column of your form. You do not even have to put in any other Hospitals in since you will definitely get it. But let's say that if you dont, then REAPPEAL! Do not listen to any rumors mentioning Miri Hospital is already full. 

For now, Miri Hospital definitely needs tonnes of House Officer. I do not understand why many choose Kuching over Miri. Miri town is not as hulu as what people might think it is. Hello, we do have Starbucks, Coffee Bean, Parkson, Giant, Watson, Guardian, Big Apple, Sushi King, Pizza Hut and GSC is coming soon too! We also have 24 hours McDonald's and KFC in case you need food during your on-call! Not bad at all for a small city. 

Other things that i can say to promote this Hospital is the working environment. I have been spending some years in some Government Hospitals during my clinical years as a medical student. What I can say for now is that, the staff here respects each other and the teamwork is so far, more dynamic than the ones in KL. You still can get some of the scoldings here but at least, they are work related. Come on, it's not a housemanship until you get that yellings and scoldings. 

Furthermore, we get to do a lot of procedures here as a houseman. For instance, I can play along with the ultrasound machine in the delivery room and practice it to the patient. I know some hospitals in KL do not even allow housemen to touch the machine! Assisting caesarean section is not much of a competition to do. You will always have the opportunities since we do not have enough housemen here. I am also planning to perform the surgery myself once I am confident with it. 

Sure thing, the workload can be quite frustrating sometimes, but if you have already expected a hell-ish life for 2 years, then you might not really feel the burden here. Sometimes, you just need to understand that working hard now might provide extra benefits later on. 

There are many other things that I can say to promote this hospital but I am already sleepy now. My next oncall is tomorrow and let's hope things will go fine in the end! But until then, remember this : 

Welcome to Miri Hospital!

O&G week 3

Seems like McD has been filling up my tummy on weekly basis! 

I tried to update this blog as often as possible but somehow, i failed to do so. I usually use my already limited time to sleep or go out for good meals. Hence, the plan is always postponed.
anyway, In week 3, i was no longer a tagger. Good thing, i get to go back by 5pm. The otherwise, i am already in oncall system. So far, i've done 2 oncalls. What i can tell is that, oncall does not really make me feel sleepy; perhaps the adrenaline helps me to survive but postcall sucks. You are expected to perform as if you have slept 8 hours the night before.
So far, i seem to be able to adapt to the whole O&G arena. However I tend to be slow when dealing with abnormal cases and there are days when i find myself horribly slow and unproductive. Otherwise, i am still taking it day by day. Who would have thought, i have been working for almost 3 weeks! Indirectly, that means i have 13 weeks more for O&G!
As for the accomodation, i am still looking for a good place to stay. Some of the houses are okay but expensive.

OBS n Gynae

I was supposed to post this yesterday but somehow i could not figure out what went wrong with the post. Here is the repost: 

They said O&G is the busiest posting in Hospital Miri. I cannot comment further on this since this is my first posting. However after going through it for almost 2 weeks, there were times that I feel like giving up. But then, due to good support by my friends, that feelings turn into motivation to hang on with it. 

The patient load in this dept varies from day to day. The fact that this dept invovles 2 lives, serious considerations should be given at all times. A few minutes of late decisions can cause a permanent damage to the baby i.e cerebral palsy. 

Though there are only 10 available beds in labour room, the cycle can be non stop! What makes things worse if there are emergency caesarean that could be due to Acute Fetal Distress or Poor Labour Progress. The whole labour room team will go haywire! I can say that the varieties of cases here are not much differ than those elsewhere. 

As of to date, Ive conducted deliveries, do ARM, assisted caesareans. The housemen can also use the ultasound machines. Something that I know some other hospitals do not allow to. 

Otherwise, I am stil havin problems with V/E and physical examination skills. I can feel down the whole day because of this. Theory wise, I think i am doing okay. Gaaahh, i just need to put in more effort for exposure. 

Ok then, I have a patient to attend. See you later!!

Sent from Hanani's iPhone! Woo!

Obs & Gynae

Week 2 tagging

Hello all. Here I am, updating my current routine for week 2.

Nothing much but more frustration since I am still not competent with my V/E, delivery and episiotomy. Otherwise, i am slowly getting hold of the whole responsibility.

Expectation rises since you have been spending your whole week at the hospital. They expect you to be able handle common cases on your own.

A lil bit on Miri Hospital, for those who want to stay in the quarters, I suggest you to think twice. The HO quarters are located at the 4th floor and the apartment is not well maintained. You can only stay for 3 months max. There are times that I have to get shower at the hospital due to poor water pressure.

Week 1 Tagging

I have been working for almost a week now. I am posted to Labour Room of O&G. truthfully, i experienced culture shock starting Housemanship.

1. I still felt like medical student on my day 1. Then after handling a few patients, I realised the responsibilities that I carried.

2. I've realised that what you learnt in Medical School are not what you will practice in real life. In OSCE, you have 1 hour to clerk case and do Physical Examination but in real life, you are required to clerk case, do physical, take blood and manage patient within one hour!!

3. Documentation is totally a pain in the ass. You need to learn the short forms, filling up forms, sign here, sign there. It is beneficial if you have chop ready with your MMC registration no. You will need them!!

4. Miri Hospital has on-call system. I'll be doing 8 oncalls for October alone! If you want shift systems, dont come here.

SPA Induction Course - Part 2

the following is a summary of what happened during our induction course.

Date : 20th until 23rd September 2011
Venue : Hotel Impian Morib

Day 1 - registration started as early as 2pm. We found out that we could choose our own roommate. However married couples are not allowed to stay in together. A bit weird though. Then at 4.30pm, we had our briefing and icebreaking session. we were divided into 7 Groups and each was given with group task. The night ended about 11pm, after the results of our placement were officially released. Alhamdulillah, I got Hospital Miri with 2 of my other friends.

Day 2 and Day 3 - started the day with breakfast as early as 7am. To those who were not satisfied with the given hospital and appealed for a new placement, they had to submit the appeal letter by 10am. Then the day was filled with various talks and meals which ended until 10.30pm each day.

Mind you, the meals provided were 6 times daily! Everyone was happy with the quality of the food though. Since the place was also provided with swimming pool, some took the dinner break to have a swim. otherwise, you just need to sit in the seminar room and listen to the various talks which basically informed us about our roles as a government servant.

Day 4 - we had exit exam at 9.30am. Format was in MCQ and Short Essay Question. None touched on medical background; it is more on topics that we should be aware of as a government servant. Then the day ended with the performances for our Group Tasks. Since we are already used to perform and present a lot during our medical school, we didnt have much problems in completing it. Before Friday prayer, we officially ended our course. To those who reappealed, results would only be revealed by this time.

other thing that worth mentioning : bring day and night wear for the seminar. at night, you can wear collared tshirt with pants.

SPA induction course part 1

I finished the induction yesterday. There were 88 of us in which about 3/4 were from CUCMS. it felt like a mini reunion and we had a blast.

So we got our placement results on 20th itself at about 11pm. Three of us got Miri while 10 of us will be going to Sandakan Hospital, 4 people got Tawau, 6 to Queen E, 1 Sibu and about 2 to Kuching. Yes, most of us want to go to East Malaysia because we got positive remarks from our seniors.

The rest otherwise got the hospitals in Peninsula. For Klang valley, popular choices are Ampang. 1 got Sungai Buloh another one got HUKM, one got UMMC. None applied to HKL, Putrajaya or Serdang.

So we are asked to report in to our hospital on this Monday. Ive bought my flight ticket and you can claim it later.

Guess our new chapter is starting real soon. It was sad that we have to be away from each other but i know, we will always support each other! Goodluck everyone!

Sent from Hanani's iPhone! Woo!

Pack your bags!

As mentioned earlier, I will be starting my Induction on 20th until 23rd September. Indirectly, this means I have another week left to go before starting housemanship. Everyone at this point in nervous either waiting for the place of their choices to be confirmed or even to start Day 1 as a house officer. 

In case you are wondering what are the things inside the envelope below this post, well it has :

1. Induction Confirmation Letter

2. Reply slip

3. A page of what-to-bring list and what-to-wear 

You will be required to either fax or email the reply slip to one of the officials. Then you will be required to check in at the stated place (jn my case, I got Hotel Impian Morib) from 2.00pm until 3.30pm. The last day will be on Friday, 23rd September by 12pm. Proper itenary will be given on the registration day itself. Not to worry, food will be provided about 6 times per day (here goes my muffin top!). You will be allocated with another person in each room. 

Since you are already a government servant after you register, then you are entitled to claim for the transport expenses. However, I am still not sure whether there is any limit to the amount. I will update all these info once I am there. Oh, please do not forget to Photocopy your MMC letter stating that you already have the Temporary License.

Until then, I want to enjoy as much as possible before tomorrow! 

This is it!

I received a note from Mr Poslaju yesterday after coming back from shopping. I kinda knew what the letter was all about since my friends posted on FB that they had received the SPA induction letter.

So today i went to the Poslaju to collect my love letter. I didnt feel much upon reading it, maybe I was still in denial phase. Im sure There will be almost 60 of us (CUCMS) since we requested to start after Hari Raya. Oh, we are starting from 20th to 23rd Sept.

The next step? Well, we were told to scan and email the reply slip to Miss Betty, the person incharged for this.

Goodluck then!

Vera Wang for Labcoats in KL

For most medical students, they might be familiar with the above pictures but i only managed to locate this shop after finishing medical school. I went there to do 2 new labcoats in preparation for Housemanship. Well, it might not be easy to find it but thanks to Kamal Bookstore, at least I know where to start! 

There were 2 personnels; an elderly aunty but very experienced in labcoat making and a man whom i really sure is the aunty's son. The shop is small but you could see white cloth everywhere! The aunty would ask what kind of designs you prefer and she seemed to know it all. Happy and eager, i ordered 2 sets right away. 

The thing is, i went there about in the final week of June and was told that the 2 labcoats could be finished by 30 July. My BF was annoyed the fact that he had called several times in August and they still couldnt get them ready. Thank God, our housemanship is starting by the end of this month and when i called them yesterday noon, they were all ready! 

So, i will go and get them tomorrow and hoping there will be no more dramas! i am also hoping that the labcoats fit well and hence, crossing out another to-do list before going for the induction!

selamat Hari Raya 2011

This picture was sent in today by PetPlayground since it was 1st Syawal for Malaysia.

However, Brunei will be joining the celebration on 31st Aug. And with that, Selamat Hari Raya Aidilfitri. Maaf Zahir Batin. May this Syawal makes us to be grateful of our life.

I'm glad for being able to celebrate Raya this time with my family members. The fact that a few people that i know have left to meet Him this year, i cannot imagine how tough this Syawal will be for their families. My prayers are with all of you. May their families remain strong and united to go through this tough time.

otherwise, this marks my last Syawal before embarking on the Housemanship. I'm getting closer to the starting line!

Sent from Hanani's iPhone! Woo!

SPA update

I can't remember when was the last time i update you guys on this matter.

Well, i can summarise here that :

1. I've completed my Medical-Check Up forms. Since i did mine in Hospital Limbang, the whole process took about 2 weeks. The first time i went there, i just had my vision tested (Please bring your visual aids along. I did not use contact lenses for the visit), gave Urine Sample for UFEME and Drug Testing as well as did CXR. The reasons why the whole thing takes time were the fact that it takes about a week for the drug testing to be done as well as to queue for the MO appointment (mind you, this is a small, hulu hospital). If you want it in a hurry, then perhaps u can do it in private sectors. If you do it in the Gov Sector, it'll be for FREE since you are already considered as a government servant.

2. I've also done my Surat Akuan. I simply went to Bangunan Majistret Limbang, went to the Reception Counter and within 10 minutes, i got the whole thing done, also for FREE!

3. I have returned the Surat Terima to SPA.

4. I am surveying on the Shipping Car service from KL to Miri town.

So as of for now, i am just waiting to be called in for the Induction Course. Since most of us wanted to start the HO-ship after Raya, we told SPA to put on hold of our applications. There are pros and cons though but i guess, there is no hurry to start the terrifying "tortures".

Gone

A few weeks back, i received a shocking news that one of my Paeds lecturers, has left us forever. She died due to complications of cancer. I am not sure which one it was but probably due to Krukenberg Tumour, since she had GI symptoms and some of gynaecological complaints. It is an aggressive cancer with poor diagnosis. I was already in Brunei that time and i missed the opportunity to visit her while she was in the ICU in Selayang Hospital.

The last time i met her was in Paediatric posting, which happened to be my last posting as a medical student. I did not actually have her as my Paeds supervisor but she did give us a briefing on the posting. This was way back in May. she was as cheerful, funny as motivated as always. Noone would have guessed that she would be leaving us 3 months later, forever.

She was an inspiration for us all. She was one of the doctors who sacrificed her own health just for the sake of her patients as well as her students. A few months before she experienced this cancer symptoms, she was already in a wheelchair due to knee trauma. Despite being told by the specialist to take MC and rest at home, she still went to the hospital, cut short of her holidays and did her rounds as well as teaching the students. "Who will take care of my medical officers and even teach them if i were away?", she said. That is a quality that is rare and lacking in doctors nowadays. The Passion, to teach and care.

Today, i actually dreamt of her. I had a phone call from her, advicing me to be a good houseman as well as reminding me that the Viva questions are no longer as those of Medical school. I could not understand the latter but what i could interpret from this dream is that, i should not be worried of entering housemanship since i have many supports around me. I should also remember her, whenever i am faced with troubles or hurdles throughout my career.

To Allahyarhamah Dr Norrashidah, May You Be Placed Amongst The Mukmins. Thank You For All Your Words of Wisdoms and Encouragement. You are a precious gem, and you will surely be missed. Al-Fatihah

Her last words for medical personnels can be read here.

http://shidmikegambit.blogspot.com/

Things That I Wish I Know Before Entering Medical School

1. Your family members expect you to help with their diseases. They will be complaining about their pains and you will be clueless on what to advice them.

2. Reading non-medical texts or do non-medical activities will make you feel guilty.

3. Your lecturers will always have these quotes :
"back then, i had to handle the whole ward by myself but you cannot even prepare 1 patient well?"
" back then we did not have technologies like MRI or CT Scan, but we survived. We did not have Internet but we could still study"

4. Whenever it is your turn to present the case, you will not wonder how perfect it will be but instead, how many scoldings will you get this time.

5. No matter how long you read, you lecturer will never be satisfied with your answers.

6. You feel guilty for not spending the night in the hospital.

7. Your friends will regard u as a nerd or goody for doing medicine.

8. It is a sin to think of money or complain about not getting high salary. Everyone wants you to be sincere working as a doctor.

9. Your holiday will be shorter than other courses.

10. You have thick and numerous books that you may not even finish reading.

11. You will never remember anything. You read it last month and the chance is, you may have forgotten it by now.

12. Expect long hours of standing during ward rounds. This can even be up to 3 hours of continuous standing.

13. If you whine a lot, mostly you will be told to quit medicine.

14. They want you to have good communication skills; being able to interpret body languages, to always be nice and courteous towards patients, to not have miscommunications with your colleaguea.

15. you will be comparing yourself with your non-medical friends in terms of number of classes and the numbers of holidays. By the end of it, you will also compare their salary to yours.

16. You will feel extremely excited when you first own a stethoscope and a labcoat. The tendency to show off these apparatus is high! Afterwards, you will feel lame coz you don't know how to interpret the sounds.

17. There will be times you wish you can drop medicine or switch courses.

18. You realise medicine is not as what the TV series "House" displayed.

19. You will be confused with the techniques of physical examinations coz different doctors have different styles. In the end you just don't know whom to follow.

20. You pray hard that you will not be picked to answer questions during rounds.

All these are things that i experience during my 5 years training as a medical student. Hence, some of the facts may not be reliable, depending on where you study. Perhaps, my next list will be that on housemanship.

Sent from Hanani's iPhone! Woo!

Psychiatry-Related Book

SPA letter. What's next?

In my previous note, i mentioned that i got the SPA acceptance letter for my Housemanship. Since there were many documents attached to it, i finally managed to figure them out.

So here are the steps.

1. Fill in borang SPA 6a. Send it back to SPA indicating you have agreed with the offer.

2. For Surat Akuan Berkanun, Medical Check Up forms as well as another copy of Borang SPA 6a, you are only required to submit them to your Hospital Director, NOT to SPA back.

3. On the day of report duty, bring along the documents stated in no 2 as well as MMC certificate and Ask for Surat Janji.

So, those are the summaries on the subsequent tasks after receiving the letter.

MMC Registration

On the same day as well, i went to register for MMC license in Putrajaya.

The documents which u need are :

1. Form 4
2. Appendix A
3. 2 passport sized photographs
4. CERTIFIED COPY of your whole results for the whole course!
5. CERTIFIED COPY of SPM
6. CERTIFIED COPY of IC & Birth Certificate
7. ORIGINAL COPY of Dean's Letter saying you have completed the course
8. Postal order worth RM20 (go to Post Office for this purpose)

Then go to Precint 1.
Find Parcel E
Go find parking as close as to block E1
Then go up to level 2.
MMC office is the one on your right.

NOTE :
- MMC is very fussy with the documents. make sure you have your names right. or else, you need some Surat Sumpah.

- for the person to certify your documents, please make sure you fulfill the criteria!

please click on the link below for the forms

http://mmc.gov.my/v1/docs/form/1.Provisional%20-%20updated300311.pdf

SPA letter of appointment

Today, 22nd July 2011, I got SPA acceptance letter. it has been 2 weeks since i did my interview. it was very quick i must say! all this while, i was hoping to start my Housemanship a bit later than the rest since i postponed my SPA interview for 3 weeks! well, i guess the Pengerusi must have really liked me a lot! *perasan*

the thing is now, im a bit clueless on what to do next. I thought it is just gonna be a letter stating " you got the job, congrats!" but to my surprise, there were few other forms that we have to fill in. eurgh..

a) medical check up form (MO must fill in the sections)
b) surat Sumpah (to be done in front of commissioner of Oath)
c) Acceptance of Appointment Form
d) surat Aku Janji

In that letter, it was also stated that i have to report duty within 1 month from the stated date, which was 14TH July! Does that mean i have only less than a month to enjoy?!?!? i have a feeling we will be starting job before Raya this year. BOO HOO!

SPA interview

today, 5th July 2011, i had my SPA interview. before this, i tried to google on SPA questions for Pegawai Perubatan UD41 but i did not find that many. (or perhaps, my googling style is still noob-ish!)

so, this entry is for y'all! i will put them in briefly. i dont think you need to know the subquestions anyway.

i had two interviewers : an SPA officer (pengerusi) and a medical doctor. my BF who was there along with me said that i was in the room for about 35 minutes. i kinda felt like it was a bit too long too!

so, to start off, simple questions were asked. Thank God, none of them asked on the political / government related things.

since i had interesting personal background, the pengerusi was asking me on that for almost half of the convo :

- my origin, my family
- my education background
- reasons for doing medicine
- my choice of hospitals for HO
- my university
- my financial assistance

then, he passed the baton to the medical doctor. questions asked were

- my clinical postings; which ones were my favs
- emergency cases :

• Dengue cases - what do you know about dengue, what ivx, how would you monitor the patients based on the Ivx, dengue shock
• a lil bit on anaphylactic shock - causes
• breast cancer - i just blurted out all of those that i remembered : risk factors, ivx, tx, chemo, radio, surgery, staging

by the end of the session, the Pengerusi was giving me advices on how to be a good houseman. overall, they were impressed with my CV and performance. He even advised me to go to MARA for loan reduction. 

what i brought for the interview. (PLEASE PHOTOCOPY THEM ALL)

1. Resume / Curriculum Vitae + MUST HAVE PICTURE ON ITS FRONT COVER
2. IC
3. Birth certificate
4. Primary School Cert (UPSR etc)
5. Form 3 exam slip  (PMR etc)
6. O Level (SPM etc)
7. A Level (STPM / Matrics)
8. certification letter by the Uni
9. final exam slip saying that u passed the final exams
10. Uni exam results transcript

10. other academic certs that you have

NOTE : you also have to bring the original documents for the above list. They want to countercheck with your copies. PLEASE order them in your file based on the above sequence. (i.e place your Primary School result first, then followed by form 3, form 5 etc)

Otherwise, the interview went well.

Just be yourself, appear confident, pray hard. People say that this session is done as a formality. Otherwise, you are almost guaranteed to be offered the position.

GOOD LUCK.

SPA resume

My SPA interview is scheduled next week.

One of the requirements is to prepare a resume. I am in a total mess right now since i have too many certificates to list down in. My dad told me it would be easier later on if i can fill everything in this resume.

Well, as if they have the time to read up EVERYTHING on my past achievements. Bet they dont even understand them all!

I think i need to buy a new file after this. My current file is already too clogged up with all the certs!

PS : Some of you might think i am showing off about my certs in this post. Well, you have the right to be jealous! :p

housemanship, SPM Malay, O Level Malay

I studied in Brunei, did my Olevel there. Hence, i do not have SPM Malay.

Since i am applying for Housemanship in Malaysia, one needs to have SPM Malay no matter what.

I have called VARIOUS government sectors about this. Well, here are some of the facts that you might need to know.

MQA has stated that Brunei O Level has the same standards as those of SPM. However, you need to confirm with the ministry that you are attached to whether they can accept the substitute.

KKM :
- since i'll be an employee of the ministry, they told me i need to have SPM Malay. I have 1 year after registration to do so.

So, what do i have to do? 

Once my housemanship starts, i need to refer to the hospital's admin and ask them whether they can apply the SPM Malay for me.

Lembaga Peperiksaan stated that i have to register in March as a private candidate. You are required to register with Lembaga Peperiksaan Negeri. Since i am going to Miri Hospital, i need to register there.

Since i do not have SPM at all, i will sit for November paper. However, some said u can skip this, and do the June papers; which are easier instead. I still need to confirm about this once i start working in Miri. The papers will be the same as those normal SPM paper.

I spent about 1 hour, just to get confirmation on this matter. I called MQA, JPA, SPA, KKM and finally, Lembaga Peperiksaan. I got directed to many numbers, having to say the same things all over again! At one point, i got pissed off about it!

Haish, why do they make things complicated?!?! As if we use perfect Malay in our everyday life anyway!

psychiatry related movie #2

since it was a break for me, i have been catching up some movies that i missed. i was surprised that this movie showed some elements of a psychiatric illness which lead the character to go through a tragic ending.

the reason why i watched this movie is because it has Leighton Meester and Gwyneth Paltrow. An easy going movie but with strong emotions displayed by each characters. An enjoyable movie to conclude it all.

I will not write its sypnosis or even explaining on the whole plots here since i am not the kind of person who likes to spoil a movie. So, to all the Psychiatrist wannabes, go and watch this!

MBBS Final Pro Exam - Medical Case

candidate : MS 33

Examiner :

1. Dr R (external examiner) - alpha female

2. Dr ??? Malay, female lecturer of CUCMS kot since she was wearing the labcoat. - didn't ask much. angguk2 for most of time 

Station : BBQ station of Medical - not my favourite. (NSTEMI)

My patient is a middle aged chinese lady who could not speak Malay properly! 

After about 5-10 minutes, i gave up and decided to inform the staffs for a translator. 

The admin took time to find one and in the end, i got another old chinese lady in wheelchair as the translator -.-;; better, but still had difficulty in translating some words to Malay and they took some time to talk to each other. 

-.-;;;;;;;;;

in summary,

Madam L, 58 y.o, Chinese lady

Day 8 of admission

Underlying DM for 17 years and HPT for 20 years

C/O : SOB 

• a/w central chest pain +  palpitation
• no failure symptoms
• no hyperglycemic symptoms
• compliant to medication and not informed of having any TOD during her regular follow up
• then, patient was admitted to the ward and she mentioned "tiga", "tiga". so i suppose 3-vessels disease lah right?
• Hx of gynaecological surgery at the age of 40. the translator mentioned CHIGONG CHIGONG, sakit sakit. have no freaking idea but patient got menopause after that. i suppose hysterectomy kot. 

physical : displaced apex beat but otherwise DRNM, presence of dressing at the femoral area (post angiogram), diabetic dermopathy changes (dry skin, hyperpigmented legs, loss of hair), all others seem to be ok. 

QUESTIONS : 

1. How was your patient? Did you have any difficulty? 

- yes, i experienced language barrier with her. 

2. Did you mention about this to the admin? 

- yes, i tried to clerk her but after 5 to 10 minutes i decided to just inform the admin.

3. Did u manage to get a translator? Is the translator provided for the patient or is it only just on the spot? 

- yes, they gave me another elderly chinese lady but i still had difficulty. i am not sure who she is but it could be one of the patients for the exams. 

4. It's okay. We will note that down in your marking sheet. So present your history. 

5. what is your diagnosis? 

AMI

6. Okay going back to your history, if you could clerk the patient properly, what else should you asked the patient about for the shortness of breath? symptoms of pulmonary embolism, PUD, pneumothorax

7. what is the different between the pain in pulmonary embolism and AMI? blur blur blur. she asked is it diffuse or sharp? 

i said sharp. "are you sure look" pops up. 

8. name me other types of pain that you know of? colicky, dull, burning, sharp, radiating pain, pleuritis

9. okay, what would be the kind of pain in PUD? worsened by food, hx of NSAID

10. how can you tell patient has good control of DM and HPT? 

- she said her dr didnt mention of any TOD

- i want to look at her HbA1c and BP trend 

* still tak puas hati lagi* you have already mentioned that in your hx.

*pause*

oh, she has been DM and HPT for quite some time but she is only on 1 type of OHA and anti HPT. *Yes. Good*

let's meet the patient

11. show me the relevant negative and positive finding. in the end, she asked me to show reflex at the lower limbs. 

- for ankle reflex, i told the patient to position her legs like the way i demonstrated to her.

E : shouldn't reflex be done in a passive manner?

Me : err.. 

E : what should be the condition of the muscles if you wanna do the reflex?

Me : relaxed

E : so, if you ask the patient to position herself, wat would the muscles be?

Me : contracting. she gave the "TAU PUN" face.

then, went back to discussion room

12. since you mentioned patient is big built, did u take her BMI?

- i did ask the admin for a weighing scale but instead, Dr M came in and said, no need. then she roughly estimates her (by the power of observation) as 60-65kg. 

Oh. so u did try to get the BMI?

yes, i did. 

13. ivx that you would like to order - ECG - to look for MI changes

14. How do you differentiate the symptoms between Unstable Angina and NSTEMI? answered ivx but she insisted in hx. 

(battery span at that time- 50%). she answered : well, it's quite hard to distinguish but there are some distinguishing fx.

15. causes of ST depression? *thought block* no idea

16. which one are u more worried of? ST elevation or ST Depression?

17. other ivx? 

FBC - to look for anaemia due to chronic HPT and DM. she wasnt satisfied and asked the relevance of anaemia in MI. answered : oh. anaemia can further precipitate her to get Heart failure. which patient is already at risk of due to MI.

*Yes, that is even better answer than saying anaemia of chronic disease*

18. Others ? 

cardiac enzyme - which ones? Troponin and CK enzymes. relevance? so that we can estimate how long patient has been experiencing MI and to confirm dx.

Coagulation profile - for thrombolytic therapy later on / heparin

Lipid Profile - risk factor

Renal profile - need to make sure electrolyte is balance so that it doesn't further worsen her heart condition, to look for renal /dm nephropathy

19. since you mentioned about timing of MI, what is the relevance?

- can decide whether patient needs thrombolytic therapy or PCI.

20. which is?

- door to needle time is 30 mins. 

21. where should you thrombolyse patient? 

- in cardiac unit?

22. only in there? - not sure. 

well, u mentioned that you thrombolyse the patient A.S.AP, so you can also do it in....? 

Red Zone, ED. yes. 

23. so how are you going to take care of patients before she undergo bypass?

- ensure the glucose and BP are controlled

- advise ambulation to prevent DVT

- ensure enough hydration

24. how about medication?

- Start on B-blocker, ACE-i, Statin and Heparin.

25. how about other non-pharmacological? 

- since patient does not exercise regularly, then i would advise her to do light activities e.g briskwalking for 30 mins if possible on daily basis.

- advice her to control her diet

26. how are you going to advice her on diet?

- erm, i would prefer to refer her to dietitian. 

E: Oh, you cannot simply do that without trying to explain to her something about it. 

- well, reduce carb intake, increase on fruits, vegetables and increase protein diet.

*times up*

PENGAJARAN : 

1. a straight forward case but due to the problem i had earlier on, i did not have time to prepare for the discussion. ended up mengelabah like Shhhh... especially when answering the questions
2. to the juniors, if you experience language barrier, please call for help A.S.A.P. it is possible u get to change patient. 
3. follow your instinct : quite fortunate, i studied CPG of AMI the day before. at least i wasn't that hopeless in answering the questions. 
4. cramping everything up 1 day prior to exam can make u experience thought block.

you have reached your destination

This post is supposed to be up last week but since i was away to Melbourne for a week, so here it is.

Praise to the Almighty, i am no longer a medical student. I have passed my final pro-exam and right now, waiting for the offer to start my housemanship.

I am supposed to get the title Dr, but i still feel i do not deserve it. That title comes with great responsibility that sometimes i doubt myself whether i can handle that.

For housemanship, i have applied to Hospital Miri, Hospital Kuala Pilah and Hospital Putrajaya. 3 different states but all with the same aim; to be a skillful doctor, a good learner and a patient employee.

As for now, i am still waiting for my SPA interview. Then, we all need to wait for the results and hopefully, we get the places that we want to.

Meningococcal disease fact

• The vaccine for those who are performing Hajj and Umrah contains vaccines against Meningococcus serogroup A, C, Y and W135. 
• For paediatric patients, the vaccine is against serogroup A. hence, we see the decline in this infection in paeds populations.
• If you want to go to Africa / Middle east, the vaccine must at least contains against serogroup A and C.
• Why don't we have vaccination against serogroup B? because it lacks the immunogenic polysachharide capsule that vaccines can act on. 
• In teenagers : most prevalent Serogroup C. In infant : Serogroup B
• Meningococcus (Neiserria Meningitides) spreads via nasopharynx secretions. Hence, risk factors include immunocompromised and overcrowding places. 
• Presentations can either be, septicemia, meningitis or focal lesion (septic arthritis, pericarditis or conjunctivitis)
• rash can be petechiae or purpura (non-blanching). 
• Meningococcal septicemia is not known to have neck stiffness, bulging fontanelle. abdominal symptoms, photophobia and the tests (kernig's, burudzski) are negative. This is the otherwise in meningitis.
• Kernig's sign (pain elicited with passive extension of the leg in a supine patient lying with their thigh flexed on their abdomen and their knee flexed)
• Burudzski's sign (passive flexion of the neck in a supine patient results in spontaneous flexion of the hips and knees)
• In meningococcal septicemia, IV/IM Benzylpenicillin must be given immediately. In meningitis, it is not urgent since the progress is slow.
• complication : distal amputations, lossof hearing, cranial nerve palsies, scars due to skin necrosis, cerebral atrophy, hydrocephalus, mental retardation can occur.  

source of BMJ Learning Module