short case!

29/10/2010-->short case medicine group 2

as mentioned above..today ive been having short case examination..well not good la since i got cranial nerve exam which kinda hard for me..a lil bit konfius nk komfemkn finding which nerve yg affected..plus not well prepared pn..focus too much for other systems then kantoi on cranial nerve..sedey :(

act xsusah sgt pn..tp doc keep on asking things dat i dun really read bout dat..where's the lesion..cerebrum? cerebellum? brainstem? which nerve will u test further? what investigation to confirm diagnosis? ade la yg btol aku jwb tp ade jgk need 2nd 3rd answer..xbest la ble xdpt jwb btol2..huhu

another exam got cvs..IE patient..okeyy la..did well la kot tp still ade soklan yg slh jwb..malignant hypertension can cause MR? which book u read? through it away..haha..pndai2 je aku..seb bek lps tu dpt jwb yg btol..sory doc andrea..haishhh ssh tol nk perfect

so skang aku pasrah jela..tawakal..xleh nk watpe da pn kn..hopefully doc ckup baik hati luluskn aku n ofcourse sume ny dgn izin ALLAH..lps nie nk focus utk OSCE lak..then holiday~yeayyy..chaiyok2 cici!!

JKM --> Medicine

Assalamualaikum..So da lame sgt aku x menulis..byk sbenany nk tls tp jari2 aku ni sgt mls utk menaip..so before its too late..HAPPY RAMADHAN to all muslims in this world..Malaysians specifically..da 3 years aku puase kt Indon..bkk pose..sahur..masak sume sndri..so yg bestny thn nie dapat puase kt umah!!! Kebetulan 1st few days puase aku cuti..mmg masyuk laa puase kt umah..dpt melantak mcm2..haha xsdr dri da gemuk..berat da naik brkilo2..watever laa..yg pntg HAPPY! heh..

16/9 ni aku da start msk posting bru..InMed or name pnjangny internal medicine..agak cuak jgk since aku xprepare pape lg..yg aku da prepare is muke tebal n telinga tuli..preparation kalo2 nk kne marah..bgus kn aku..ngee~hmm before nie aku posting JKM aka jabatan kesihatan masyarakat..in my opinion JKM nie is all about prevention..yela kalo doctor2 kt hospital tu akn jmpe org yg mmg da skt..so their job is to care n cure..but JKM is dealing wif ppl who sick or even healthy..they prevent them from having the disease n control..dis is one of my viva ques btw..

basically JKM biase jela..senior asyik ckp HAWAII so aku pn set mind mmg hawaii btol la..padahal xpun! huhu..1st 3 weeks mmg bosan gle xtau nk watpe..plg2 pn pnat weekend laa sbb kne g survey..then after dat sgtla byk reports n presentation yg kne wat..yg best ny in group..so kurang sket la beban tu..but still durhhh..

So its Thursday already..esok da jumaat then sabtu n ahad..da kne blk KTDI..oooops i mean PRISMA..heh..will start new things..will face new situations..will have new stories..hope everything will goes well..since its RAMADAN so leh doa byk2 for da best! hmm da pnat..stop till here..nitey ^^

nothing ;p

Its SUNDAY 16 MAY 2010~5 more days to go n i'll enter a brand new version of my life..3 years of clinical year in UKM cheras..new place..new people..new skills..new 'teachers' of course..kinda scary actually bcoz i hve no idea what are waiting 4 me there..seriously dunno what to prepare..more than a months at home i've becoming a damn lazy doctor to be..huhu..please wake me up!

::dilema Malaysian doctors:: copied~

Why we left and why we will continue to leave...

Posted by: MS Mohamad

I read an interesting article today about a few prominent figures addressing their concern over the increasing UKM and UM medical graduates who have left the country to continue their medical practice overseas.

After reading the news for 3 times, I called a very close friend, an MD (UKM) graduate to ask his opinion on how the news might have affected him. He has been working in Singapore for more than a decade as a Consultant Surgeon with a certain sub-specialty

"Why be a slave in your own country, when you are a king in another?" He replied.

Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field).

I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority. When I was working there, doctors are so ill-treated, while the nurses and the medical assistants are overpowering us.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Even when I was a Specialist, the staff nurses had to be called again and again just to make sure the management plan for the patient would be done. I was already used to answers from them:

“I’m busy with something else"

“My shift is already over"

...it was routine for me.

The Medical Assistants were worse. They would hide behind their so-called boss, the Head of Medical Assistant. They feel hiding behind him would make them not under our jurisdiction, that we have no power to instruct them in managing the patient, that they have power to manage own their own. I've seen them giving medications not as we prescribed, performing procedures without our knowledge, as if they are the actual "Doctors". They are in their own world, and we have to do their job, taking blood, labelling samples, and even cleaning gadgets from the procedures that we have done.

Oh, but the ministry loves this group. They even let them run a clinic now, instead of upgrading the clinics already run by doctors. The government feels that the MAs are very important and should never be ill-treated by those big bad doctors. One time when I was a District Hospital Medical Officer, I was conducting a delivery of a baby. An MA insisted that I remove my car which was block-parking his car. I answered through the phone that I was busy.

He came to the labor room and yelled "Semua orang pun sibuk jugak, macamlah doktor seorang yang sibuk!”

It is insulting that an MA or a staff nurse claims that they are BUSY, as busy as a doctor? As a Malaysian Doctor, I have even worked for 72 hours straight. I have experienced working until my 6 month old daughter did not recognize me at the end of the week.

Is that how busy they are? I am very sure that they are so busy, that they can only spend 2 hours at the nearby Mamak stall, or can only leave at 5:10 PM instead of 5, or can only have 1 hour of lunch.

The management staffs are worse. I have to beg and plead so that I can get my on-call claims, of RM25 per 48 hours of work. While sitting in an air-conditioned office, they will at their own leisure, process my call claims so that I will receive them by the next decade.

The state health or Hospital Director would just give another inspirational talk (of bollocks) on team effort and beauty of teamwork.

That is how Malaysian doctors are treated in the government sector: without respect, without dignity and without significance. Why?

It is because we are bound by ethics to try our best to save lives, despite how ill-treated we are. We hardly have time to complaint because we are too busy or tired, and we would rather spend the precious time resting or seeing our loved ones. The burden of trying to save lives is on our shoulders alone. No MAs or Staff nurses would shoulder it with us. They have their own bosses: the Sisters, Matrons, or Head of MAs, which job description is to ensure that the big bad doctors will not ask their underlings to do extra work.

This is how the Malaysian Ministry of Health have treated their doctors. I am very sure that in each and every doctor, there is a slowly-burning patience in serving the Malaysian people, which will eventually fade and cause them to surrender to serving a place that treats them better.

A few colleagues who graduated from UK choose to serve there:

"The pay is more, and we get the respect we deserve"

Another works in Brunei:

“Here the staff nurses respect Malaysian doctors, and they are very co-operative" (He ended up marrying one)

A few are consultants in Singapore (working with me):

"Here we are treated well, we spearhead the management, and every else do their work to the best of their capabilities".

A few even enjoys working in Indonesia:

“The work-load is horrible since there are a lot of patients, but we are well respected by every hospital personnel" (They have migrated there for nearly a decade)

I am sure that people will see doctors as power-hungry individuals who want to be the boss in the hospital. Trust me, after having graduated 6-7 years of medical school, earning a DEGREE, and subsequently MASTERS, and SUBSPECIALITY, you would expect a degree of respect and being considered important. We are trying our best to improve patient's quality of life, or making sure he lives another day. Is it too much to ask from the system that we are important?

I find that Malaysia is the only country that is making doctors' lives miserable and treated like rubbish. It was never about the pay in the first place. It is about the treatment we are getting and the false political-based promises. Do you know that the so-called circular about doctors can have the day off after working 24 hours straight released JULY 2009 is not yet implemented? Do you know that the raise of UD 41 to 44 does not involve every doctor in the government service?

We are waiting for improvement. We have waited a long time when we were working in the system. Somewhere along the line we decided to leave and wait outside the system. Until the system changes, we will continue to work overseas, in countries which are appreciative of us. Trust me, Malaysian-graduate doctors are considered highly skilful and competent in neighbouring countries, and the 15 % brain drain is more significant than you think.

We will return when the system prioritize us and gives us the quality of life we deserve.

If it stays the same, Malaysian Hospitals would end up having Staff nurses and Medical Assistants as "Doctors", and we would have to send patients to Indonesia for an appendicectomy.

Hear our voice. We hardly speak, but will usually fade away from conflict (and fly to another place).

B A N D U N G (part 2)

Assalamualaikum~hye there..tetibe jd rajen lak nk menulis..nk exercise kn jari aku nie..da gemuk2 da sume ny penangan mkn xhenti kt umah nie..haha..so second part ekh..nk cte pasal bende yg aku xsuke sepanjang aku kt bandung..ade ke??? hmmm..

TRANSPORT! yup aku sgt xsuke transport kt cni..bkn sbb xde or ssh nk dpt okeyy..sbb kt cni transport nk g mane2 pn akn sntiase ade..kol 12 mlm pn korg still leh blk umah ngan selamat n xyah jln kaki..confirm ade..dun worry:)) ade mcm2 jenis public transport kt cni..ade teksi, bas, angkotan kota(angkot) n ade jugak ojek..haha..bas n teksi sape2 pn tau..tp msti ade yg xtau apekah gerangan angkot n ojek nie kn.. :p

BAS - aku xde la slalu sgt nek bas kt cni..jarang2 je..ble duit semput nk g kota bandung bru la guna public transport yg bernama bas nie..okey je bas diorg..cm kt msia jgk..hmm tak2..x mcm kt msia pn..sbb bas die agak buruk n sempit laa..sgt xslesa nk letak kaki..tp aku still boley je tdo ble nek bas tu..haha..tp bende yg plg aku xsuke ble nek bas nie is ble ade org ngamen..btw ngamen tu org mntk sdekah ngan care menyanyi or men alat muzik..sgt tension okey! bising! esp ble seat aku tgh2 n diorg g men gitar laa gendang laa ntah ape2 laa lg alat muzik yg wujud bpe inci je dr telinga aku..arghhhh nie la keadaan yg plg aku xske! huhu..lg 1 ble nek bas nie msti ade org nk jual2..everytime bas benti ade jela org yg nek nk jual nail clipper laa korek kuping laa (cotton bud) newspaper laa..yg xbest ny ko nk bli ke x diorg men bg je kt ko..diorg jln dr dpn smpai blakang n letak brg yg diorg jual tu kt tiap2 org..pastu die patah blk dr blakang ke dpn n amek blk kalo org xbli..tp sape yg bli tu byr jela..aku ingt lg ade dis one time aku wat2 tdo..die pn melepasi la seat aku tanpa letak brg jualan die tu..pastu ble aku bgn da bkk mate tbe2 die leh patah blk n nk jugak die letak surak kabar die tu..hahahaha..saba jela.....

ANGKOT - okey ni transport paling common..g mane2 pn mesti ade angkot..angkot nie is like a van tau..not like a van tp mmg van pn..hmm ntah xtau cmne nk describe..tp yg pntg seat die xde la mcm seat van kte kt msia nie..seat dlm angkot tu cm seat nek komuter yg dok brdepan tu..haa lebey kurang cmtu la..angkot nie okeyy..ko xpggl pn die msti dtg je kt ko..sbb da byk sgt kn..tp yg xbest ny driver angkot tu..selagi xpenuh van tu selagi tu laa die nk sumbat org..pendek kate angkot tu leh muat smpai 15 org termasuk 2 org kt dpn..kalo cmpur driver jd 16 la..haa cube bayangkn..sendat tau x..kalo nek angkot nie mmg xsah la kalo xbercantum buntut n bahu ngan org kiri kanan korg..da naseb badan.....

OJEK - haa ojek nie sbenanye moto je..ye motosikal tu dijadikn pengangkutan awam kt cni..org tu bwk ko bonceng jela..ala mcm mat2 rempit tu..hahahhaha..tp kt cni aku ayu sket nek moto..aku dok sblh je..cm org zaman dulu2 nek moto..comey tau..cehh perasan..awal2 aku mmg xsuke lgsg nk nek ojek nie..yela nek moto ngan laki yg ko xknal kn msti la rase len sket..kalo korg tgk kang ingt boyfren aku lak..tp disebabkn keadaan last2 aku sauk jugak la..huhu..xkesah la tp aku slalu nek ojek nie ble nk g clas pg2..sbb umah aku jauh ngan U n aku pulak suke bgn lmbt..so ojek nie la pengankutan terpantas n termudah yg boley digunakan..mahal sket laa dr angkot..lg satu umah aku after kol 5 mmg da xde transport..tggl ojek je..so papehal pn kalo nk g mane2 mlm2 mmg wajibla nek ojek nie..i xpnah pgg pkcik tu tau..i pgg blakang tu je..pkcik tu busuk laa..xkuase nk rapat2 tau! ooops hehe..

hmm tu jela kot yg aku xsuke kt cni..TRANSPORT! yg lain2 sume okey je kot..kalo psl kes malaysia-indonesia tu aku mls nk komen..byk je leh komen sbenany tp malas! lgpun aku xpnh kne or trlibat ngan ape2 yg serius..selain dosen aku pnah provoke2 nk menaikkn kemarahan mase tutorial la..huhuhu..

owh yaa lg 1 org kt cni sgt suke duit..mmg la sume org pn suke duit..tp yg aku mksudkn nie psl tuan umah yg suke tpu duit org yg sewa umah..dlm batch aku je ade la dlm 3 kes kot..tpu duit bkn sket2 je ekh..byk tau!! da la kt cni byr sewa per year..bkn ny per month cm kt msia..aku n housmates aku pn kne jgk..Rp 800rbu lebey kurang Rm300 la lebuh cmtu je..mmg la xbyk sgt but still..sakit hati tol! papehal pn ibu D***h duit itu xpnah halal utk anda ye! harap maklum!!!

okey2 da pnat tulis n bebel pnjang2..smpai disini jela dlu ekh..esok lusa aku merapu lg..haha..good night (",)

B A N D U N G (part 1)

Assalamualaikum..helo2..it has been a very long time i leave dis blog..byk sgt nk cte smpai xtau nk tls pe..finally x tulis!! haha..neway im already in malaysia..da blk 4 good..alhamdulillah everything goes well..berkat doa mereka2 yg slalu mendoakan saye:))
Btw 3 years kt sane bkn la skejap..ive learn a lot of things..esp being independent!!

drpd xpnah kesah psl byr api air..kt cni aku amek tau~
drpd xtau msk..kt cni aku blaja sket2~
drpd mls basuh n iron bju..kt cni aku jd rajen~
drpd tkt nk bwk moto kt jln besar..kt cni aku jd berani (walaupn xde lesen sbenany..hehe)
drpd fobia nek bas sbb tkt sesat..kt cni aku nek la jgk..tu pn sbb nk jimat..haha
drpd boros men bli je ape aku nk..kt cni pn aku cmtu jugak!!!

haa yg nie aku mmg susah nk ubah..selagi aku suke 1 bende tu..xkesah la mahal ke murah..aku ade duit ke x..sure aku bli jugak..nie la bende yg paling aku fail..tu yg xleh nk simpan duit..
bayangkn~3 years dok bandung..dpt duit MARA rm800 sebulan aka 2.1 juta rupiah..but at da end of da years aku dpt simpan bape sen je la..tu pn half da abes gune kt msia..sengal kn..cmne nk kawen awal nie kalo xde duit simpanan..ooooopsss..hahahaha..tu cte lain okeyy!

pokok ny skang aku kne blaja menabung..cm zaman kecik2 dulu..isi duit dlm tabung haji..xpun tabung bentuk kelapa tu..tp skang xde da..huhu..xkesah la..yg pntg from now on aku nk mule menyimpan..sket2 lame2 jd bukit kn..aku nk simpan smpai jd gunung laa..haha..cita2 xleh bla..kang da dpt duit MARA bulan2 trus lupe diri..haish chiechie2..ble la nk brubah nie ;)

papepun ill try my best!! hee..dah..tu je nk tls mlm nie..esok2 aku smbg lg..adik aku da bising nk pkai tenet jugak..huhu..adios n gud nite (",)

c.h.a.n.g.e

change..yes.berubah!manusia itu sentiasa berubah..sama ada secara fizikal emosi mahupun tingkahlaku..ada yg berubah jd lebih baik tp ada juga yg sebaliknya..ive seen it by myself..my friends..they change..ble tgk yg berubah jauh lbh baik dr sbelum ny tbe2 tergerak hati utk sama2 berubah..utk jd seseorg yg bkn mcm diri ini sekarang..jd seseorg yg lebih mengejar akhirat tp bkn duniawi..lebih dekat dgn-NYA..da jauh diri menyimpang..kadang lupa..kadang alpa..bila tersedar baru mula nk merintih..menangisi dosa2 & segala kesilapan yg berlalu..ALLAH maha pengasih..maha penyayang..maha pengampun..tp sejauh mana diri ini menghargai itu semua..ampunkn diri ini ya ALLAH..lindungilah diri ini agar sentiasa jauh dari hasutan syaitan dan pengaruh duniawi..aku hambamu yg lemah lg hina~