Me as senior house officer: Medical Dept

Asslamualaikum semua...

Aku masuk medical department as a fifth poster. Still remember when I was still tagging (day 1 in department), one of the patients desaturated but the PM shift HO is a junior poster. He did not know what to do hence I helped him managing the patient while waiting for oncall MO to arrive. Remember peeps, if patient desaturated ke ape ke, just use ABCD approach k, baru la tak lupa nak buat apa.

On my day 2 of tagging, after 4pm ada patient kat PKKN ni persistent tachycardia pulak. Terus suruh nurse buat ECG and I reviewed with my friend looks like sinus tachycardia. Patient looks dry as well and complain of pain kat tangan. So aku suruh run fluids and prescribed pain killer. The very next morning round dengan MO review balik ECG, still we are convinced it's sinus tachycardia. Kebetulan konsultan aka HOD lalu wad so MO panggil bos nak tanya opinion. Bos cakap it's SVT then mengamuk habis sebab aku tak passover kes tu to the oncall doctor semalam. Itu lah second time aku kena marah teruk sejak housemanship ni. The patient was sent to CCU immediately and discharged well after few days.

In medical, specialists and MOs are like friends. We work and eat together. Hewhewhew~

Since my 2nd week in medical, I was assign to be ward leader hence I was incharge of HO roster. Therefore, it's easy for me to arrange my schedule but it was so difficult to handle HOs yang suka EL. Pernah aku kena kerja 24hours kat medical ni sebab ganti orang EL. Totally unplanned and unprepared but I survived, alhamdulilah.

Paling happy kat medical ni ialah waktu viva department, dapat full marks. Dr J and Dr S claimed they never gave full marks to anyone before and asked me to join them in medical. Of course the safe answer I gave " Errrrr, I will consider it". Haha. The best part is waktu hospital viva, my HOD said "I still remember you in PKKN before, but you did so well throughout the posting. Dr J is really stingy to give marks but you got full marks. Well done". Malu I olls dia puji depan HOD department lain and timbalan pengarah hospital. >.<

Sebab bos semua baik sangat, aku struggle pegi beli kek ni dan ajak kawan2 buat farewell party the week we were leaving the department. TQ medical team for the bitter sweet memories.

All in all, the take home messages here are to always passover smartly to the oncall person and expect the unexpected. Anything abnormal, inform je bos awal2, lantaklah kalau kena marah sebab inform simple thing pun.

Thanks for reading!

"I am stronger because I had to be, smarter because of my mistakes, happier because of the sadness I have known and now wiser because I learned."

My housemanship summary: Senior year

Assalamualaikum,

Ha, baru ade mood nak update blog.. Six month apart pulak tu. LOL. My life is still the same. I still work as a doctor in the same hospital. Yup, my work means my life. I love my job now. I faced with love-hate relationship with my job before but now I really love my job. Dulu setiap minggu mesti mesej mak cakap nak quit la, dah penat la, nak quit and quit and quit. But I didn't because I don't have plan B which is what I'm going to do next if I quit. Being a rational person, I didn't quit but faced all the struggles instead. Now I'm glad I didn't quit. After being so long in the stormy days, I now found the rainbow. Ceewah =)

Allah dah takdirkan aku dapat posting yang banyak dugaan dulu dan pergi ke posting yang makin mudah kemudiannya. Orthopedics -- Paediatrics -- O&G -- Surgical -- Medical -- Anaethesiology. Ortho tu ko orang takyah tanya memang banyak drama. Somehow I missed the dramas. LOL. I enjoyed the drama actually especially during radiology conference; cuma aku punya adrenaline rush waktu grand ward round setiap hari Isnin tu memang paling aku tak suka. Anak Dato' pun boleh kena halau keluar wad tau waktu round kalau ko salah bagi simple info like patient tu ade diabetes dah 10 tahun tapi ko cakap dua tahun. Nasib baik aku tak pernah kena HAHAHAHA. Bila fikir balik, sebenarnya orthoLIFE training ni the best training. Ajar semua HO tentang love, integrity, fun and endurance. Bila HOD strict sikit baru la takde orang nak EL je kejenya. Yes, aku memang pembenci orang yang EL/ malas kerja ni.

Paeds busy tapi takde drama. Aku paling suka HOD paeds antara semua HOD, baik and sporting habis (HOD anaes pun best). Last week aku terjumpa Dr V, supervisor kat paeds dulu. Tak sangka dia ingat aku lagi dan suruh aku join paeds. Waktu dia cakap, "What do you want to do next? Oh you are considering paeds right. Come join us after this", I was like "errr  I'm not sure yet, I'm still considering paeds". Ok jawapan selamat. =B

O&G best jugak. Siap turun padang main bola jaring dengan bosses lagi. Tapi sebab hari tu aku postcall, aku rasa baiklah aku tengok je tak main. Huhu. Surgical pun best. Aku agak jonah kat surgical. Ade je patient hematemesis tengah2 malam waktu aku shift PM. Padahal patient tu KIV discharge coming morning kot. Urghhhh. Paling best surgical ni banyak cuti. Aku cuti 2 minggu ok untuk EOP!! Yeayyyyy

Nampak sangat muka postcall di situ! Heh

My 5th posting is medical. Memang posting yang the best lah! Orang kata save the best for the last kan. So memang 2 posting terakhir aku ni paling best. Medical ni busy dan ade drama sikit kalau kat wad PKKN tapi bosses dia baik nak mamp. Aku sayang gila kat MOs and specialists medical ni. Ade la sorang MO and sorang specialist aku tak suka tapi aku tak kerja bawah diorang sangat pun.

Aku suka buat scan untuk patients yang datang kat early pregnancy unit (EPAU). Heee~

Thanks for reading!

1 year housemanship experience

Assalamualaikum... This just a random talk about my experience so far.

I'm a houseman for 1 year 2 months already now. Currently I'm in my fourth posting which is surgical. I went through orthopaedic, paediatric and O&G before. During my first posting, I learnt a lot about people and working life. I had a not-really-nice experience during the first posting. But I kinda miss my first posting though; I missed the teamwork I had during the posting. I worked with superb colleagues (but some are annoying) and also the nurses!!! I love the sister and nurses. They helped me a lot and gave strength to me to cope with the department cultures. Yeah, the department had some weird cultures and MOs wasn't so friendly that time. They just make a big fuss about anything during rounds and they won't help to present any single case during rounds. There's one day, left me alone in ward during morning round and I have to present all the cases. In ortho, you cannot refer to any notes while presenting case during rounds. Of course I couldn't remember every details of all 28 cases in ward hence I got screamed at. Haha. My memory wasn't so great though. >.<

My mentor in ortho, the best and kindest specialist in the department. I still remember how I cried in front of him. Haha. Hope he's in best health and be blessed always.

Then I went to paeds. I had a bit of culture shock with the bosses. Many of the MOs and specialist are so nice which unlike the previous posting. I enjoyed being in paeds except when I have to take blood from the NNJ babies. I love babies and children but I don't like to poke them especially those with hard-to-get veins. On my last day in the department, my supervisor asked me to join paeds and of course I'd love too however the thing that made me still thinking about joining paeds is how to deal with the needing to poke the babies????

How can you have heart to poke these too cute babies? I still remember how I cried together with the babies when I took their blood. So heart-breaking you know?!

My O&G posting is also a great experience for me. I love working at labour room but it's usually so tiring especially when its a jonah day. I love doing procedures in labour room but you know sometimes it's like a war zone there which made you feel overwhelmed. Nevertheless, I wont pursue into this field. For me, O&G is equal to medicolegal department. So many medicolegal issues the department encountered. Perhaps, patients like to sue O&G doctors for any slightest mistake. So, it's a nay for O&G.

Me and colleagues during episiotomy suturing workshop.

Now I'm in surgery. Initially I hated this department. So far I will hate which ever department I going through during tagging time. Hiks! Now I kinda like it. The specialists are so cute like really cute. Some likes to shout during ward rounds (I found this cute too), some are just having serious facial expression all the time, some dressed up so nicely with pretty lipstick colour and high heels and some are just super nice, teaching during rounds and likes houseman to involve in deciding management for patient. I know all of them having a kind heart. I just know it from how they devoted their time for patients. They went back so late at night like at 11pm as they faced with difficult surgery which took hoursss to finish and if they are post call, they still works the next day as usual. They are so workaholic. May Allah bless all my surgeons!

As far as now, I met a very super super nice doctors and badas one. I kept questioning myself, how can this particular doctor, Dr S be so patient, talk so softly and teach anyone so nicely whereas another particular doctor so sarcastic, scream next to your ear and asked for explaination letter without checking properly into the matter. Surely I wants to be like Dr S but you know I got some temper sometimes. LOL

Now my concern is to finish my housemanship and get into any specialty. Somehow, I still do not know what specialty I should take. I really can't decide now as yet.

That's all for now peeps. Thanks for reading!

Professional examination OSCE for medical student

Olla peeps. It's been a year since I updated my blog. It's because I was coping with housemanship thingy as well as I forgotten my password to assess my blog. Just recently able to figure out the password. Haha..

So here, I just wanna share regarding my OSCE questions during my professional examination. Hope this can benefit anyone. Here you go...

LONG CASE: PP type 3 posterior

Causes uterine irritability

- braxton hicks contraction

- labour contraction

- uterine hyperstimulation by IOL

- abruptio placenta (usually hard uterus)

Methods use to detect fundus

- lateral grip

- fundal grip

- what else???

What can really determine uterus larger or smaller than date

- based on clinical fundal height more than 4 discrepancies not SFH

Possible causes of breech presentation for this patient

- Prematurity

- Placenta previa

- Congenital anomaly e.g. Neural tube defect (meningomyelocoele)

Other

- Polyhydramnios

- Multiple pregnancy

- Hydrocephalus

- Previous pregnancy with breech

- Abnormal uterus

Investigation to do

1. Full blood count- to check for anemia and maintain Hb > 10g/dL

2. GSH- if necessary, blood bank only hold pt’s GSH for 48hrs only

3. Fetal surveillance- CTG, US

When to transfuse blood

Women at or above 34 weeks gestation with haemoglobin less than 7 g/dL

Management: You’ve been called by a nurse informing that the pt develop bleeding. What are you going to do?

1. Attend pt immediately

2. Check amount of blood loss- might bleed a bit only

3. Put on CTG to monitor fetal heart activity and sign of labour (increase contraction)

4. Prepare patient for emergency lower segment caeseran section

  

SHORT CASES

1. Hand examination

- Present findings: pt has tenderness over distal radial side of wrist & +ve finkelstein test

- Dx: De quervain tenosynovitis

- Ddx: fracture of carpal bone

- Mx: rest, splinting, anti-inflammatory medication, injection of corticosteroid, surgical release of tendon sheath (rarely do)

- Cx steroid injection: tendon rupture, skin atrophy

2. Abdomen examination (obstetric)

- Calculate EDD and POA (at 40 w POA)

- Present your abdominal findings: scar, clinical FH 34w, SFH 35cm which is smaller than date

- Dx: Uterus smaller than date

- Causes: wrong date, oligohydramnios, congenital anomaly (renal agenesis)

- Questions u want to ask pt: ask whether she is sure of LNMP, does she has benefit of early dating scan, any hx gush of fluid (leaking liquor)

- Mx: to confirm date, to do VE in order to check any pooling of amniotic fluid, test fluid with litmus paper & nitralazine test and check bishop score. Give antibiotic to cover any infection.

- Bishop 4/10, what to do? – because cervix not yet favourable, IOL with prostin

3. History taking (psychiatry)

- Dx: OCD

- Ddx: GAD, panic disorder (pt has no symptoms to suggest MDD)

- Why panic disorder? – she has some symptoms of panic attack e.g. SOB, palpitation

- What organic cause could be for the symptoms? - hyperthyroidism

- What specific obsession she has: checking obsession

- How to mx? – give antidepressant such as SSRI, TCA and examples are fluoxetine, clomipramine

4. Examine motor & sensory of UL & LL

- Positive findings: reduced sensation over peripheral area

- What pt has? - Peripheral neuropathy

- Dx: peripheral neuropathy 2⁰ diabetes

- Ddx: peripheral neuropathy 2⁰ alcohol

These are simpler version of what I went through. Kindly read more about those topics and aim for distinction okayy?!

Best of luck all future doctors!!! ^^

Survived for 32days

Assalamualaikum

It's been 1 month since I started my first posting in Orthopaedic Department Hospital Sungai Buloh. All these while Allah helped me so much. Been a first poster, there's so many things I did not know. I absolutely agree that study medicine and work as a doctor has significant difference. Somehow I miss being medical student. Hukhukhuk~

Anyhow, I just would like emphasize on important tips to survive during the housemanship which is always be close to our creator, Allah SWT. Ask help from Him every seconds. Alhamdulillah, I'm so thankful that He always hear my prayers and gave what I asked for. Trust Him all your heart and don't forget that everything happens with His will. Next to it is that we must NEVER EVER EVER GIVE UP!!!

Remember, you are as strong as your next move. How hard life and people try to bring you down, you must ask Him to shield you from falling. There's 89 days for me to finish this posting. Every morning I woke up, adrenaline rush would be there and I hope I can stand with this until end of this posting,

26th Sept was my awesome day since been in this posting. I'm blessed with this mentor mentee group. :')

#prayforme
#mayAllahease
#tobethebestdoctor
#lillahitaala

Thanks for reading. May Allah bless us and please pray for my success!

Apa itu MD UKM AUCMS ?

Assalamualaikum

Sebelum melapor diri untuk bertugas di hospital pada hari Selasa nanti, eloklah untuk aku tulis entry yang dah dijanjikan ini. Yela, kang dah kerja nak bery pun tak sempat inikan nak menulis blog. Ihiks! :-B

Aku ni sejak kecil ditakdirkan untuk jadi pioneer. Pioneer untuk kelas rancangan khas, pioneer for math & science in English and the most recent is pioneer untuk program MD UKM secara kerjasama. Kerana batch aku ni pioneer, makanya bilangan kami hanyalah sedikit iaitu 31orang sahaja. Kalau campur dengan our counterpart in HUKM dan MD UKM UnPad jadi seramai 260+ orang. 0.o"

Mesti korang curious bagaimana kami terjebak dengan AUCMS ini kan kan kan... Actually, after dapat results SPM, kitorang laju-laju ke portal MARA dan memohon biasiswa untuk belajar oversea. Zaman hingusan dulu impian aku sangatlah menggunung, nak belajar kat oversea je barulah gempak... Hati teramatlah girang apabila mendapat tahu aku terpilih untuk interview MARA di UniKL. Beberapa lama kemudian, aku dapat surat tawaran:

AUCMS back then was known as ACMS. Mula2 tengok perkataan ACMS tu, aku & famili seakan pelik dan tertanya2, apakah itu? Namun, 07-07-08 ialah titik-tolak kami terjerumus ke lubuk AUCMS ni...

Pre-medical disini, waktu zaman aku tu, menawarkan untuk sambung pengajian di Indonesia, which is where I wish not to go for study (no offence ye). Kalau jalan2 best la kan... Tapi aku struggle habis-habisan jugak waktu premed sebab ada ura-ura boleh pergi Ireland. Gempak sihh kalau dapat buat medik di Ireland! Namun, suratan takdir aku adalah untuk belajar di Malaysia. Tawaran ke Ireland takde lagi waktu batch aku tu.. Aku pun tidak mahu ke Indonesia. Hati memberontak giler waktu tu. Kemudian, aku dipanggil interview untuk program MD UKM. Bagi aku, baik study di Malaysia ajelah begini.

Dengan berat hati, aku pun study kat sini...

Program kerjasama UKM ni, basically, semua modul pembelajaran adalah sama sejibik seperti di UKM Bangi cuma kami belajar di AUCMS Kepala Batas. All lectures given by UKM lecturers via teleconference. Tapi batch aku je yang ada teleconference, the next batches aren't allowed for that for I-don't-know reason. Kalau ada bab yang tak faham, kami tanya lecturers kat AUCMS ni.

For your information, semua exam papers came from UKM and their lecturers are the one who mark our papers. Sebab exam dia susah yang tak tersangka, ramai juga yang terpaksa drop year dan ada yang quit making us left with 31 orang je di final year.

Waktu Clinical Skills learning (CSL) module ketika di first year, kitorang pergi Hospital Kepala Batas. Semua masih innocent dan bersemangat waja ketika itu. ;p

Bermula tahun tiga, bermulah proses penghijrahan kami ke seantero dunia. Oh, bukan oversea, kami belajar hanya di Malaysia. Kami yang MD UKM - AUCMS ni posted at Hospital Kulim during our year three dan sebelum officially bermula telah ke HUKM untuk one-week basic clinical orientation. Lepas tu, kami kena pergi posting Jabatan Kesihatan Masyarakat (JKM) di Tanjung Karang for 7 weeks and one week at HUKM. Waktu ni lah kami berkenalan dengan our counterpart dan ada yang dari UnPad pun baru balik ke UKM. 

 Ni dah last day JKM posting. Gila kau, aku taknak balik Kulim kot bila dah lama2 kat sana.. :'(

Fourth year, kami ditempatkan di Hospital Taiping untuk posting ENT, Anaesthesiology, Ophthalmology and Psychiatry. Posting paediatrik dan orthopaedik, kami kembali ke Hospital Kulim. 

MUARC ni research conference. Memang modul wajib UKM untuk sape2 rasa nak graduate. Hihi.. Selesai MUARC, barulah officially kami mula posting clinical fifth year.

Fifth year pulak di Hospital Sultanah Bahiyah, Alor Setar. Kat hospital2 lain sebelum ni hanya kami je ada kat situ so tak rasa persaingan sangat tapi ketika di fifth year, ada kawan2 dari AIMST jugak. Sedikit competition untuk clerk patient berlaku tapi medical knowledge tu kitorang selalu share bersama. Aku pun ada sorang very good friend kat AIMST hasil sering bertukar2 ilmu. Waktu fifth year ni pun ada posting yang kena pergi ke HUKM, belajar kat sana seminggu or dua minggu then barulah baik ke Alor Setar. Banyaaakk sangat kami berjalan. Penat tapi best jugak.... :D

Memang kami kejap disana, kejap disini. Tapi kalau exam je, mesti lecturers dari UKM datang untuk assess kami. Dah kata MD UKM grads, diorang haruslah OCD untuk menjamin kualiti sebab tu sanggup turun naik flight jumpa kami.

Hari bersejarah- Professional examination results' announcement. Dean UKM pun datang Kampus Medik AUCMS di Kulim. Alhamdulillah, ramai yang pass. Yang tak pass tu, mungkin ada hikmahnya, dapat study lagi untuk 6 bulan di HUKM. It's still a precious experience though.

Personally, sekarang aku bersyukur tak study oversea sebab kalo study local, lagi cepat habis dan banyak exposure kat local hospital and diseases. Dulu memang memberontak tapi sekarang baru nampak apa yang Allah takdirkan untuk aku. Cumanya, aku tak nasihatkan for you to pursue your study at AUCMS sebab kolej tu macam tak stabil je sekarang. But the choice is in your hand.

In a nutshell, my batch is special and limited edition. We faced numbers of difficulties and challenges to reach where we are now and we hope to become dedicated and great doctors insyaallah. =)

Thanks for reading. ^^

Apa yang perlu untuk Program Transformasi Minda?

Assalamualaikum

Alhamdulillah, setelah hampir 5 bulan bercuti, aku telah dipanggil untuk berkhidmat bakti kepada kerajaan Malaysia. Weee,,, gembira hati I olls disamping turut berasa cuak dan gementar untuk officially berkerja sebagai seorang doktor. :')

Bermula dari batch PTM Ogos 2014, pihak KKM menggunakan sistem baru which is kita dapat tahu posting kat hospital mana dulu barulah dapat surat induksi/ program transformasi minda (PTM). Aku akan berkerja di Hospital Sungai Buloh. Semua yang bakal bertugas di Selangor berkursus di Hotel Flamingo, Ampang.

Nak berkerja sebagai seorang penjawat awam, wajib tau untuk datang PTM. Buat bakal houseman, kita wajib membawa 4 dokumen seperti di bawah ketika register di PTM masing2:

1) 1 salinan Sijil pendaftaran sementara MMC
2) 1 salinan borang pemeriksaan perubatan (ada dapat sekali dengan surat SPA)
3) 1 salinan surat tawaran SPA
* Sila bawa dokumen asal untuk semua salinan2 di atas
4) 2 salinan borang profil peserta (1 ori + 1 fotostat) berserta gambar setiap satu borang

Jadi, tak perlu pening2 ye.. 4 dokumen je kena bawak.

Bagi perempuan, korg mesti akan pening berapa banyak baju nak bawak, nak pakai baju apa and like oh oh I'm so confused! Jangan risau, tujuan post ini ditulis pun untuk membantu golongan seperti kalian.

Aktiviti PTM ni banyak dengar ceramah je sampai penceramah pun boleh ghaib depan mata anda (kalau you tidur -.-). Waktu ceramah kena pakai baju formal tahu. Bila bercakap tentang formal, haruslah bawa baju kurung. Nak pakai blouse dengan skirt labuh pun boleh asalkan nampak formal dan professional. Tudung tu boleh je nak pakai shawl atau tudung sarung, as long as you selesa, nampak kemas dan berkeyakinan tinggi. Beauty is confidence, girls! Muahaha... :p

Aku punya ptm dari 25-29 Ogos. Sebab 5 hari, aku pun bawak 4 pasang baju kurung untuk pakai waktu siang, 2 blouses with long skirt serta 2 jubah untuk pakai waktu malam. Baju tidur bawak 2 pasang cukup la, bukan nak tidur sangat pun. Habis program pukul 10.30pm lepas tu ade diskusi kumpulan. Depends on your group nak habis discussion pukul berapa. Group aku hari tu kul 12.30midnight je paling lambat. Yang pasti, pukul 6.15am esok kena berkumpul kat lobi dah untuk senamrobik. Ya, ada senamrobik setiap pagi.. Jangan rebel ye semua..Jadi, jangan lupa bawak at least 2 pasang sport attire dan kasut sukan ok?!

Selain ceramah, ada aktiviti berkumpulan- lukisan & soalan2 (seperti diatas) serta sketsa. Sketsa tu basically how doctors should handle certain situation. Korang bawak la crayon, alat tulis dan apa yang dirasakan perlu untuk kegunaan masa depan! Wehuuuu...

Ni antara tugasan yang kena buat iaitu jawab 50 soalan umum... Soalan2 ni pentinggg sangat sebab, nanti ada ujian and soalan2 ujian tu lebih kurang dengan soalan2 dalam tugasan kita ni,, Jangan terkejut tau, memang betul2 ada ujian 20 soalan objektif pada hari terakhir PTM. It's not a medical exam.. Soalan2 dia based on the lectures given dan soalan2 dalam 50 soalan tu... Tentang perlembagaan Malaysia, gred2 perkhidmatan awam etc.

Chill guys... enjoy your PTM and the most crucial part is to enjoy the foods provided. Dah la makan 6 kali sehari, sedap pulak tu semua makanan. I'm so in love with the hotel's foods.

Ni kumpulan I olls masa kat ptm itu hari. Ada jugak geng2 HO Sungai Buloh disini. :)

Ni geng MD UKM - AUCMS. We are special and limited edition... ;')

I think that's all for now. Thanks for reading guys.... ^^