The hurdle to enter medical school

Honestly, the thought of becoming a doctor did not click to me until i was doing my A Level. Previously, i had many ambitions such as becoming a radio dee-jay, an accountant, a teacher and also imagining myself as an executive doing clerical work in a high rise building overseeing the city. Blame it on the media!

However, being typical Asian parents, my mom and dad told me to choose a professional line such as lawyer, doctor or engineer. At the end of it, i was stuck between being an engineer or a doctor. I remember meeting up with my dad's friend who was an engineering lecturer and my engineer aunty for words of advice. Somehow, they tried to make me to choose the latter for various reasons.

At the same time, I was really grateful the fact that I did my A Level in an international school which had a special department handling higher education matters. Since medical applicants had to apply to UK earlier than other fields, we were preparing for our applications even before I have finished my Year 11 (lower Six form). We had to come out with a personal statement as well as doing attachments in hospital.

I still remember how I had difficulty to write an essay on why would I want to be a doctor. The typical answer; "to help people" was no longer accepted. They demanded me to read more regarding the profession and perhaps to include some experiences that I observed during my hospital attachment and related it to scientific facts. At one point I almost gave up since the tutor kept on making me to alter my essay. She said that my essay did not show strong reasons and that I lack of enthusiasm in it.

I also had to undergo a mock interview session organised by my tutors in order to prepare beforehand. We were given with a thick booklet on the common questions that interviewers would usually ask and that we had to practice answering confidently. It was not easy guys!

I remember that it was during my Surgical elective in 2010 in Brunei General Hospital that I made up my mind about it. I was shadowing a Surgical medical officer and I noticed that his life was always on the move. One day, he would be doing ward rounds, then the next he would be going into the OTs then later on, he would be doing clinics. So i thought to myself that probably I would enjoy being on the move too and that I did not have to be stuck at my work desk the whole day. Furthermore, hospital is also a fully air-conditioned place too.

I also did weekly attachment at a private GP for about 3 months just to expose myself with the world. Here I met with a great private GP who kept on discouraging me from day 1!! He told me how his lady doctor friends ended up getting married at later age due to commitments, and that his non-doctor friends earn way much more than him and that our medical students life would be miserable due to long hours and numerous exams. He even mentioned that in the next coming decades, Doctor's lifes will be competitive and the doctors will be oversupplied. Again, at some point i did feel like giving up on the profession.

However, by the end of it I took his words as a challenge to make me pursuit the life. So I do not actually have a real reason on why I do want to be a doctor specifically. I guess all the experiences that I have gained throughout attachments have made me more comfortable with the life and made me to go forward. Mind you guys, I did all the attachments before i even entered the medical school. I had not even completed my A level yet at that time. Hence, I was well aware of what I was putting myself into such as long working hours, competitive student's life, sacrifices that I have to make with my family and friends.

Hence, to all the aspired young doctors to be, I would really encourage you to expose yourself with the medical career way before you enter medical school. Start as early as possible, attach yourself to a private GP during your weekends. Sacrifice your holidays by doing attachment at the hospitals. I was really glad of doing it beforehand since it gives u the advantage compared to other applicants. The interviewers will definitely think that you are committed and hence, can see the passion that you have.

Keputusan Ujian Bahasa Melayu

SAYA LULUS!!

I finally received the slip. Take a look at the date. It was back in May and I only got this slip in February this year! This calls for a celebration!! HAHAHA

My 2 cents to the soon-to-be Houseman

here is a piece of useful advice to my soon-to-be-junior doctors on your first few days of life.

You might think that on your very first day there will be patients who collapse in front you and that you have to treat them and putting their lives in your hands. Or perhaps, you are imagining that you will be pushing the patients into the operating theatre like those that you always see in the TV. Well, hold your thoughts right there and let me bring you back to the Mother Earth.

Here is a brief recap on what will happen on your first day. (im not sure whether this will be the same situations in other hospitals)

By 8am, make your way to the administration office and introduce yourself as a 1st day houseman. There will be a person who is incharged of houseman and he/she will hand out endless of forms to be filled up. It will be useful to bring all the documents along (i.e bank account slip, certificates, birth certificates, MMC letter, SPA letter etc). By the time you finish this alongside with the orientation of the hospital, it will be almost midday.

Then you will be informed on which lucky posting you will start with. So, introduce yourself to the HOD as well as the Sister incharged of the respective wards. It will also be very polite to introduce yourself to the nurses, MOs and HOs of that department that you happen to bump into. I was quite lucky the fact that I was asked to start my day the next day. Hence, i had the time to unpack and complete other unfinished forms for the remaining half of the day.

Once you have officially started, the Sister or your colleagues will start to orientate on the ward, the system and the people that you need to make good friends with. (This includes the PPK, JM Nurse and sometimes including the cleaners!). You will also need to learn how to fill up the forms, where to get the equipments and the numbers to dial for tracing lab results. Then you will realise there are tonnes of forms to fill up for everything i.e ordering blood, referrals to other departments like physio/dietitian/social worker/booking ambulance, ordering radiographs  prescribing medications. These are the skills that are NEVER thought in the medical school. I personally felt that all these tedious stuffs are actually time consuming. Honestly, I also did not have any clue on how to give paracetamol for the patient. Noone taught that we were supposed to write Tab PCM 1g QID in that yellow prescription sheet.

Then you might be taught on how to write your very first own history clerking and with physical examinations. I was quite relieved the fact that I was taught in a local hospital setting and hence, I was already familiar with the short forms and the styles. It made my whole adaptation process much easier compared to those who were trained overseas. I noticed that some of my colleagues who graduated from Russia for instance write in sentences instead of point forms for history taking. I always tell that those who are graduated from non-local unis might have to work 2 times harder than those trained locally.

One thing that you realise later on is that you need to be super fast with your work. I remember i used to take up to 1 hour just to complete the history and writing the physical findings on that paper and I had not even started with the management and doing procedures such as inserting branula, doing VE and taking blood. The nurses will then start to nag and you will feel even more pressured when the patient starts to complain. It was quite unfortunate that I started in the labour room which required you to complete managing a patient within an hour! So what I did was I timed myself and tried to be faster with each patient. It also helped the fact that I had a senior who kept on pressuring me to be speed up.

On the other hand, since you are a newbie, you will definitely not be incharged of complex and challenging tasks. The most that you will go on your first day is perhaps setting branula or taking blood. Be prepared to feel like shit when you cannot even get that bulging vein and you start to mess up the room with the patient's blood.

Otherwise, let me tell you this.

First impression really matters. ALWAYS respect your seniors regardless whether they are housemen, staff nurses or even JMs. Accept their criticism and be humble. Though you might be the flying colours students with a CGPA of 4.0, always instill that you know nothing and need to be guided. You might think some things are done inappropriately and you might disagree with some decisions but it is best to just be the observer for now. Do not argue with them cause once you show that negative attitude, trust me your hell starts right away.

Well, I've written quite a bunch there but those are things that are never mentioned in the thick medical textbooks. I have many more to write but it is already late and i am doing oncall tomorrow. Just pray that I have the energy to write in again soon Or else, you might need to wait months before my next entry! Until then, the photos below are taken during my winter trip to Paris last January!

 The Eiffel Tower

 The Lourve

The famous macarons Pierre Hermes

3 January 2013

First of all, i want to wish the readers out there a happy 2013! 2ndly, Happy 25th Birthday to me today!! hahaha

Well, who would have thought, I have survived my 1st year of housemanship. Cheers to another year of hard work. Time really flies by. I was just a new 1st poster and here I am with a few weeks more to end my 4th posting.

Alhamdulillah, God has been great to me. Till date, I am still standing strong. I have been a group leader in almost of the postings (except for medical) and my bosses have been treating me well. I have never even took one emergency leave. Though there were times which i felt super exhausted, my determination has not let me down.

On the brighter side, I love the feeling of getting your own income and financially not depending on your parents. I have travelled to a few cities in the Borneo and able to treat my family either for a great dinner or some surprise birthday gifts.

I hope God will still continue to shower me with His blessings. I am forever grateful for the life i am living in and i hope i can be a useful and productive tool of His to service for the mankind.

Why

Why did i create this blog?

It started while i was preparing for my final Pro Exam for my medical course. I was the kind of student who preferred to study through powerpoints and blognotes. Furthermore, I did not like to pen my notes down and memorising the facts. Hence, i use blog as an alternative.

Following that, before i started my housemanship, i was in a dilemma over which hospital to choose for as my ground training of 2 years. There were not many references that i could refer to especially of that relating to Miri Hospital. So i thought it might be useful to write and share my journey with others as a houseman as well as keeping it is as my medical notes. .

Why did i choose my current hospital for my training?

There are some seniors of mine who are doing the HOship in East Malaysia and the reviews were encouraging and welcoming. Furthermore, since i was raised in Brunei, Miri was the only town that i was comfortable with. I also chose Miri in order to run away from the KL city which I know can be a distraction for me. (HINT : SHOPPING!).

No SPM Malay? Worry not!

I spent my primary and secondary education back in Brunei Darussalam. While other local Malaysians were supposed to sit for UPSR, PMR and SPM, i sat for PCE, PMB and GCE OLevel instead. This led to a problem for me of not having SPM Malay. Even though i sat for Bahasa Melayu paper in my GCE O Level and got a Distinction 2 for it and sat for Bahasa Kebangsaan papers during my medical school, they were still not adequate and not acceptable as a substitute for the Malay paper. I was told that without it, problems can arise especially if you plan to stay in the government. Your confirmation of service with the government can be delayed and hence, leading to late promotions. 

I have heard of some who did the June SPM Malay paper as a private candidate and some house officers even  attended tuition classes a few weeks prior to the date. I could not imagine how ridiculous it is for us to be learning all those especially after an exhausting work. However, the good news is that your target mark will only be a PASS. 

So, upon starting work in my current hospital as a house officer, i managed to meet up with the admin as well as the Hospital Director regarding this. They were also quite clueless on the matter but how relieved I was upon finding out that there is an alternative paper that can be done! I am very thankful for the hospital administration team for this! 

So earlier this month, 6 of the house officers from Miri Hospital flew all the way to Kuching to sit for Peperiksaan Bahasa Melayu Khas. The good thing was that this was considered as an official trip and hence, you can claim for the expenses (exclusive of shopping of course!). We only stayed there overnight and the exam was done in JPA building. 

The exam consists of 2 sections; written and oral. If you are already comfortable speaking in Malay than you should not worry too much about it. In my opinion, the difficulty level is as that of Primary 6 syllabus and they are all of MCQ or short answer questions. (Thank God for no essay this time!) I really hope these papers can really compensate for the SPM Malay and hence, putting a closure for this issue. 

I hope some people out there with the same prolems will find this post useful. I know not many really know about this matter and not many resources can be found online. Feel free to ask for more if in doubts!

Something to ponder about

Sent my patient for a chest Xray. I call it a right lower lobe HANDneumonia!

A half year pressie!

As a hardworking HO, i deserve this reward! Hahaha

Welcome To My Life

0600 - Alarm clock rings. Snooze, Snooze.

0630 - getting ready to leave, perhaps having a quick munch for breakfast.

0645 - card punched in. Heading towards my ward

0700 - starting my morning round.

0800 - doing round with my MO

0930 - Specialist round!

1200 - Quickie meal. (This slot is optional)

1230 - back to work, completing the uncomplete

1500 - PM round starts again with the MO / Specialist

1700 - time to leave! AS IF.

1830 - this is the time that i ACTUALLY usually go back

2000 - dinner completed. Heading home.

2100 - 2230 - wasting time surfing the net. stalking on friends. window e-shopping. enjoying my mp3 collection.

2330 - time to head to the bunk!

What was I thinking?!?!?!

my friend the other day pointed me at my ridiculous mistake.

can anyone spot it?

Another reminder to soon to be HO

Lately, the nation is shocked with the death of a Houseman in Hospital Kajang. Some said it was a suicidal attempt but other said he might be overdosed with the stimulants since he was on 5 consecutive calls.

I cannot comment much on this matter simpy cause we need two sides of the story before pointing our fingers to whom might be responsible. What i can only mention here is to share my experiences as a half a year HO.

I was one of the lucky lots who managed to Go through the 2 systems. My first posting was O&G which is usually an active call. I usually ended up sleeping about 30mins per night. on very bad days, i could not sleep at all! It was very tiring and exhausting. Imagine this. Today i will be oncall which means i start from 7am and only to go back TOMORROW at 5pm. Then, i continue to work the day after. Then i'll do on call the day after that. I really feel like i did not have a life. I would be doing 8-9 oncalls per month!

Then, with the introduction of the shift systems, i do feel a bit of relief. My average calls drop to 5-6 per month. We are allowed to go back by noon considering that our job is done. Of course, we lose a few hundred ringgits allowances but the rest worth em all.

for now, i do not complain much on the workload. I dont whine with my oncalls. In fact, i am grateful with the shift. The number of new housemen coming in is also rising. Hence, more manpower is around to distribute the job.

I am not sure how hell life in the hospitals can be but i guess to those who are still looking for hospitals to choose, please do come to the East Malaysia. I do not recommend however going to the big hospitals such as Sarawak General Hospitals and Queen Elizabeth. My hypothesis is that The less HOs there are in the hospital, the less likelihood that the seniors will trash you simply because they appreciate the manpower and they know you work hard.

So, be adventurous and please be mentally and physically prepared before you embark on the housemanship. It's tough and challenging. You've been warned.

Anyway, before i go, the picture above is a view of KK from the plane during my KK visit last weekend! Well, when you work hard, travelling is the way to go!

Things that should have been mentioned during medical school

Working life is a bit different in compared to that of a student. Sure we were taught of the diseases but there are certain things that are new to me.

For instance, when you work later on, you have to learn on how to fill in numerous amount of forms. If we order blood sample, you should be familiarise with the KKM form. If your patient has dengue, you have to fill up the "Notification form". Referral to other departments also require form filling. As Miri General Hospital is still not computerised, you need to fill it by hand. At this point, i surely appreciate free pens. So, Please bring extra pens in your bag and also smooth pens will be an advantage. My current favourite is Faber Castell Grip X5.

Other things that you need to learn is how to be confident. Family members will always ask the current state of the patient. So you need to clear up their head by explaining the prognosis and the current plan. Be aware that patient's confidentiality still is a priority. Dont feel pressurise if there is a YB for instance asking about the patient's condition. If they are not related, dont spill out everything.

Some patients can also keep you crazy with their never ending complaints. Headache, stomachache, chest pain are a few examples of common complaint. Some of these should be taken seriously based on the patient's premorbid status. Otherwise, some just require verbal reassurance.

You should also be familiar on how to refer cases. As a houseman, you need to sell your stories to your MO. If it is not convincing, be prepared for some scoldings or rejections.

There are some other things tht i can list but i'll stop here. Dont worry, i'll continue some other days. Bye!

Good Friday

Tomorrow will be a public holiday in Sabah and Sarawak since it is a Good Friday. We do not have such celebration in the peninsula though. This is another uniqueness that i learn throughout my 6 months being away from Cyberjaya. Ive learnt some of the culture and the language here. It is also interesting to know about the subgroup of the natives here; Iban, Kenyah, Melanau, Bidayuh, Penan and Kayan. I still do not know how to distinguish each of them though.

Since i am oncall tonight or 'night shift', ive got some spare time to blog. Heard that new batches of Housemen will be starting soon. Hoping for some to come and join us here. Hey, It is not a bad place to work afterall. I've survived my 6 months, Alhamdulillah and i havent regretted my choice.

Anyway, I will be away this weekend to visit Kota Kinabalu. It will be my first time there and i cannot wait to shop! Hahaha Otherwise, I am praying hard to have a bearable and Good call tonight! Wish me luck peoplee!!

significance of the Q wave

Q wave is the first downward deflection after P wave. it simply denotes the absence of electrical impulse which usually caused by an MI. It takes a few hours to days for it to develop, hence it is one of the ways to determine the occurence of MI.

Q Wave can persistently be there unless reperfusion takes place early. Therefore, persistent Q wave indicates presence of previous MI.

Midway through medical

In a few days time, it marks my 6th month as a houseman. Time really flies and all thanks to God for being there with me to survive through this whole ordeal.

At the beginning of this 2nd posting, honestly i was sceptical about it. Medical in my dictionary is equivalent to the word "BORING" and "YAWNING". nothing makes sense since i cannot imagine of the pathophysiology. How am i suppose to imagine calcium going in and out of the channels and causing the symptoms? It is not as pictographic  as the one for instance in O&G. furthemore, medical books consist of mainly texts. Another yawn factor there.

However, after going through this posting, i kinda have some ideas on how to manage the patients. Though not as crystal clear but at least i can handle the common presentations. Oh, workload wise; it can be more tiring than in O&G since we have to handle more patients but i am thankful for having supportive seniors and superiors.

Another thing to keep in mind is that this posting bears a lot of risk. I notice quite a lot of the patients have infectious blood borne disease; Hep B, Hep C and HIV. hence, universal precaution is vital in preenting needle stick injury. Life is precious so please donttake this likely.

Alright then. Those are all for my ramblings today. Ive been motovating to regularly update my blog but i havent got the determination. Perhaps i am mentally tired nowadays. Bye then!

Oncall then comes the word Jonah / Hot

Once you enter the housemanship, you might think life will go on like a breeze. Well, one think that you should be preparing yourself into is the ONCALL. This routine will always be stuck in your life once you obtain the title Dr in front your name. Even the consultant will be put on the oncall schedule. So please correct your understanding on how your life will if you choose to take medicine. 


In Malaysia we have come out with few terms which can help your colleagues to prepare mentally on how the night would be. If you are regarded as a Jonah, then be prepared for restless or sleepless nights since it will usually be eventful. To put it into simple word, you are basically a patient magnet. Admissions will be non-stop or if it isnt, then perhaps your current patients in the wards will be problematic. Since i am in the medical posting, the common complaints will either be chest pain, shortness of breath, abdominal pain, CBD pain or  headache in the middle of the night. 


In Sabah or Sarawak meanwhile,  they don't use the word Jonah but instead, they are more used to the word "HOT". This word can also be used for the MOs or Specialist and even the nurses. As for myself, i used to be HOT in the previous posting. I seldom got to sleep due to non-stop admissions. Nurses dont really like it if i am oncall. HAHA but what i like about that despite being tired is that i feel proud by the end of the day since i survive the whole ordeal. 


Other thing that comes with the word Hot / Jonah is the superstitions. Some believe that you should take your shower during the night session to prevent the Hotness. Some also would avoid wearing light/bright coloured clothes and that also to include your innerwear! But throughout my observation, personality can also affect the situation. I notice that those who are easily agitated and have temper management would also lead to hotness oncall. 


I am really interested in knowing what other superstitions that other hospital practices in. I do not fully believe in it though. Guess those are all for this time fellas. I am going to enter my oncall in a few hours time. Meanwhile, enjoy a few shots through my iPhone camera of life in Miri.  

Posting numero 2

26th Jan 2012 is my first day of tagging in Medical posting. When you think about it, i have done my housemanship for 4 months already! Im glad and grateful to God for letting me to get through my first posting successfully. I hope He will still be guiding me for this posting.

So, for today, I noticed that being a 2nd poster does have the benefits. For instance you dont feel that tired by 10pm. Whoopss, it might still be too early to judge that but we'll see!

Otherwise, the procedures and form fillings are something that i am already getting used to. It's just that i need to get used to be seeing male patients!

Ending the first posting!

It's 22nd Jan today! I am glad to announce that I will be ending my current 1st posting in a few days time! I must say that it did feel short and that i have wasted the opportunity to master the posting. It is a mistake that i must not repeat in the next posting; to be proactive and to learn how to do as many procedures as possible.

Otherwise, since I have spent almost 1 month in the gynae ward, i am already feeling comfortable of it. Things becomr easier and faster to handle. The followings are the common cases in gynae ward :

1. Miscarriages
2. Hyperemesis gravidarum
3. Ectopic pregnancy
4. PV bleeding
5. Gynaeoncology
6. Insulin commencement for Pregnant mothers
7. Post SVD complications; episiotomy wound breakdown, retained POC and maternal pyrexia

Before i forget, i want to remind the first poster of this : to send SKT forms and your logbook at least 2 weeks before u end your posting.

ketua darjah

since i am currently the most senior houseman in the posting, i have been chosen to be the HO leader. it is definitely not an easy job. i have to come out with the oncall timetable, something that is easier to say than done. i have to make sure i distribute the days evenly and not being biased. at the same time, i have to fulfill the wishes of those planning to have holidays during the festive season.

since Chinese New Year is 2/3 weeks away, many of them were asking for leave and that remain us with only few housemen left. Thank God for His mercy, He has given us with new housemen coming in. Even though i have to make changes to the timetable whenever new faces come in but i do appreciate the extra man power.

otherwise, i am currently working in a gynae ward. Not as fun as it should have been to me. Gynae ward gives a different environment compared to the maternity ward. The patients consist of the terminally ill patients who refuse further management as well as those who fear their unborn babies will end up being miscarriaged. For a houseman, Gynae ward involves some "medical elements" such as management of electrolyte imbalance, fluid regime, analgesia level to be given to patients. We also have to do quite a lot of referrals to the surgical, medical and radiological department who kinda not keen on having extra work. There are times that i make successful referrals and i still fail in some.

Since i am close to the end, i am sad to leave the current department. I have heard of other postings, having to deal with emotional stresses dealing with the colleagues and senior doctors who like to torment the housemen who are not at par to their eyes. I am glad that my current dept treat housemen as their working colleagues and treat us professionally. Such a good posting to start my housemanship with.

Well, well, to those who wonder, i am going to a killer posting next; MEDICINE. throughout my medical school, i am definitely not interested in the posting. it is such a complicated topic, creating a lot of differentials just for a symptom. i hope i can finish my 4 months posting there without difficulties. Hence i should be mentally and physically prepared for my 4 months of....... struggles.... NOW!

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