Open close, open close eyes, finish already 2013 (pejam celik, pejam celik dah habis dah 2013)!

Seriously, what is a A&E doctor supposed to do with a complaint like this:


Right ear seems longer than left ear for many years. Claims due to father pulling his ear since young. 

QUICK someone call Dr House MD....!

Palace of Justice

As mentioned in my earlier post, I have been rather busy lately. The thought of leaving government service has always been on my mind. When opportunity comes your way, you should try and strike it while it is still hot. It is easier said than done though. Those familiar with Robert T. Kiyosaki's books will be familiar with his QUADRANT. I am in an environment where I have been preconditioned to be an EMPLOYEE. The mantra is:

Study hard, get into university, get a job in government sector, get pension = great life

Read his books!

Have you ever had to grit your teeth and suppress the Wolverine inside of you? Being so angry but there is nothing much you can do? I had one incident today. I am not really an angry person. But when things get to annoying I can really go out of control. Thankfully nothing happened...no one got hurt.

• Unruly, out of bed hair..................check
• Sweat dripping all over the place....check
• Unshaved beard for a week...........check
• Muscles......................................in 10 years

Can you see the similarities with MOfrust?

When I first read the headline, I thought to myself... Housemanship IS a 2 years Bootcamp for medical officers. What happened to the final clinical years while at medical school anyway?

My MBBS degree consisted of 2 pre clinical years followed by 3 clinical years. It is during these clinical years that things started to make sense. You can read all you want about hypertension & diabetes but it is not the same as applying all that knowledge by clerking & examining patients. The term "the patient is your text book " still holds till today....I am ever so grateful to my lecturers. And it is during my clinical years that I was able to see how it was to have on calls. I still remember how it was to follow my lecturer doing rounds & doing hand surgery at 4 am. It was a wonderful experience. Studying medicine wasn't easy but I cherish every bit of it...even through the darkest hours.

That was 4 years ago. Now, the enthusiasm is gone. The white knight I intended to be (I.e. Doctor) is gone. MOfrust rises. I love my patients. I am happy whenever they get better. I am happy whenever patients come back with better sugar & blood pressure control after adjusting their medications.

Things go bad when patients refuse to follow treatment, then accuse doctors of not doing their job. When a diabetic foot needs amputation, it's the doctors fault although they have been advised on the risk of poor sugar control. When doctors advice patient to stop smoking & refrain from sexual promiscuity, doctors are told to mind their own business. That's the reality. The ever increasing numbers of medical lawsuit is putting a dent on my interest to treat patients as well. At the end of a shift I just want to make sure I don't get sued.

My advice to aspiring doctors out there is to think properly about your choices. It is not a bed of roses. Just go through my blog posts. Comments like "just do what you are paid to do" puts a dent in your morale. Yes, I live a comfy life. I don't have to worry about my next meal. I am grateful for that. But am I happy with my work?....colleagues, please answer this question sincerely for me. Please leave a comment on what you think....

It has been very quiet lately. I was rather busy this past week. I had issues that needed to be resolved. Future prospects to consider...which I will share in due time. I don't subscribe to NST due to my personal views regarding its contents but my colleagues shared this on Facebook.

No Jobs For Medical Grads Next Year

The issue of excess medical graduates has cropped up multiple times. Even during my medical student days, I have heard of this. As the Malays say it rasa nak muntah dengor nye!

Every year when SPM or STPM results come out, parents will complain that there aren't enough places for their kids to do medicine. Parents will complain to politicians and these politicians will play hero and tell universities to increase their intakes for medical courses. Basic economics dictates that when there is demand, there will be supply. Any business minded person can see this opportunity, thus private medical universities flourish. However, the institution where a doctor studies does not determine 100% whether the doctor is good or not. ATTITUDE is the most important factor.

Today I met a patient who has lost her sixth sense...her COMMON sense. As the saying goes,

"Common sense is not so common anymore"

This lady has hypertension and is on medication. Just amlodipine OD. Her previous BP were well controlled with monotherapy. However, today her BP was sky high...170/100. On further questioning..

"Makcik dah 5 hari tak makan ubat darah tinggi"

The reason for her non compliance was mind boggling to me. The reason she why she did not take her daily medications was because....

"Makcik makan collagen. Takut la pulak tak effective makan collagen tu tambah dengan ubat darah tinggi"

I was dumbstruck. It was late afternoon and my last caffeine dose was at 8 a.m. It took me a while to register. I didn't bother to scold her as I wasn't in the mood and was rather tired. Let's recap:

For her, it is OK to not take antihypertension but it IS NOT OK for her collagen to not work!



What on earth is this collagen thing anyway? I've had patients coming to my locum clinic asking for collagen injection and vitamin C injection etc. Have these people gone mad?! Is it worth it to risk getting a stroke and myocardial infarction for beauty?

This brings me to another issue. Sometimes when doctors try to knock some sense into patients with fear, such as:

"If you don't take your meds properly you'll end up paralysed on not able to work"
"If you don't take care of your diabetic control you will end up with an amputated leg"
"Rokok is haram and you should stop smoking"

Some smart relatives will tell us off.

"Kenapa doktor takutkan mak saya! Doktor buat kerja bagi ubat sudah la"

Sigh....we are giving examples. Clear, graphic examples. With fear, they will try and control their disease. Yes, it is not the best method and this is the LAST RESORT. Of course when we tell them about HbA1C and hyperglycemia complications at micro and macroscopic level, we will also be told off because we are using to many medical jargons.

Back to this collagen non sense. I have nothing against people wanting to look beautiful with non conventional method. But please put your priorities into perspective. Do consider the complications of taking all these stuff. My wife has been pushing me to use my Clinique facial wash since we got married....and I have only used it 10 times. But my skin still looks beautiful....behind THE MASK :)

The only thing that I can remember from the PMs budget announcement was

"Kurangkan manis dalam minuman, tingkatkan manis dalam senyuman"

.....or something like that. I managed to listen some parts of it on my way back from work.

What was puzzling to me was why was the announcement on the reduction on sugar subsidy bundled together with the 'Health' budget (I think it is just an excuse to reduce the subsidy). Seriously, can an increase in the price of sugar result in a reduction in Diabetes Mellitus incidence? Diabetes Mellitus is so much more than just reduced sugar intake. They are taking kencing manis (sweet urine) quite literally. Well, I am sure they have done they're research on this. I am just a regular MO, I wouldn't know much anyways. If it does help in reducing DM cases, then I will be happy. I can go sit back and just focus on non-DM cases.

A few years back, I couldn't understand why any one would even bother anticipating the annual national budget. I find the reviews and analysis of the budget on TV a nuisance. My mindset at that time was

"I am a government servant. Whatever happens to the economy, I will still get paid."

I was totally wrong. I was ignorant. Even though I was in my late 20s, I had a "Everything is well" mindset. Have some extra cash....splurge on holidays. The business section in the newspapers are used as lapik punggung when on picnics. I spent almost RM 5000 a month on TV, holidays etc. once. I had no idea where all the money went.
Warren Buffet is the old dude that has lots of money, Donald Trump is the guy who FIRE people and has a bad hair do. Robert Kiyosaki is Robert who????
Money is meant to be spent, not to be saved!

 

While the whole of Malaysia wait for the 2014 Malaysian Budget next week, there is ONE component in the healthcare system that we can do without.

Klinik 1 Malaysia

Klinik 1 Malaysia is not completely useless though. I do send patients over for removing sutures, dressing and doing EOD (every other day) blood pressure monitoring. However, as a doctor at Klinik Kesihatan, I feel that we are stretching the Ministry of Health's resources to the limit. The staff, medications and funding can be put to better use at the other health facilities that are already available.

The never ending debate with regards to a raise in doctors consultation fees continues. The public still refuse can't understand why there is a need for it. All other expenses has increased, cost of healthcare is the last thing the public need. Of course, the easiest thing to tell the public is:

"Kalau tak suka nak bayar, pergi cari rawatan di luar negara"

I read a letter in The Star on Wednesday and I totally agree with Dr Ong Hean Teik.

BRINGING HEALTHCARE COSTS DOWN

Selamat Hari Raya Aidiladha to all my Muslim readers. In my previous post ( M.C. ), I predicted an M.C. Mega Sale to happen on 14th October 2013, the day before Hari Raya Aidiladha. However I was unable prove whether I was correct or not. I was on duty in an Orang Asli village....I didn't bring my M.C. book along. Tomorrow (Wednesday, 16th October) wouldn't be a good day to work as well. On top of the regular M.C. seekers, there will be Makciks and Pakciks who ate too much lemang, ketupat, rendang and all sorts of meat. Not to mention the free flow of soft drinks served at open houses. Fortunately, the holiday wasn't as long as Hari Raya Aidilfitri.

Patients tend to peram (??marinated...pardon my translation) their illnesses. Orthopaedics and medical wards will be full on the day after a long festive season. Diabetic foot ulcers will be peram kau kau. The smell is awesome!

You can only understand it if you are a 90's kid

I refer to the following article in The Star.

Waiting for 12 hours at the ER

It is most unfortunate for his mother to have waited for 12 hours at the emergency department. During my stint at ED, I had a few patients who had to wait at the ED for more than two shifts...slightly more than 14 hours. I guess at Hospital Serdang, it is seldom as busy as on the night the columnist brought his mother to the hospital. In the place I used to work, it was ALWAYS a mad house. Sometimes, there aren't even enough seats to sit on....katil apatah lagi!

In the world of social media, whatsapp and mobile phones with cameras, keeping things confidential can be really difficult. What is worse is the value of keeping things confidential is fast deteriorating. I am referring to a recent case of a recent case where pictures of 8 underage boys accused of raping a girl went online.

The picture being circulated

This was recently circulated in Facebook last week. It is a newspaper clip from Utusan. I don't find the contents and articles in Utusan worth reading but this article seems like a good read. Most FB-ers merely post and give hateful comments but how many FB-ers have actually read the full article? I am not trying to be a smart ass politician here but is it fair to give opinions without reading the full article and understanding it with an open mind?

This morning I received a notification regarding a comment from a reader in Specialoid: When Patients Become Specialist. It has since been deleted by the author (NOT me). I assume the reader's Google account was hijacked thus posting a slightly provocative comment (...membuatkan diri ku ini terasa T_T).

Sometimes alternative medicine do work. Sometimes doctors suck. Lain la kalau specialist, leh caya gak. I always doubt doctor's diagnosis anyway.

Gulp, it was a bit hard to swallow! After a while I said to myself

Good riddance, one less patient to see!

But then again, I am a doctor. I am supposed to treat without prejudice! Even if others step on my head or spit on me, I will have to uphold my profession! This is exactly why there are so many doctors resign to look for greener pastures. Sigh....

I am sure most of my readers have encountered the full version of this letter. I am unable to verify the authenticity of this letter, thus I crossed out all the names involved. This letter should have been confidential in the first place. It is a good effort by the husband to uphold his rights as a husband. Although the words used may be a bit harsh with the emphasis on HALANGAN.

This post is a response to a comment by one of the readers in "In The News"

"Whether you guys (doctors) like it or not, you are public servants. So stop picking on the patient and continue to do your work....."

I am sure most of my fellow readers have seen this video. It was on Facebook yesterday. It's in Free Malaysia Today's portal yesterday. Despite trying to prove that they are smart by wanting to sue staff if anything happens, it clearly shows how idiotic ignorant these people are. These are the day to day things that medical staff have to encounter despite trying SAVE LIVES.

Dear Mr E, please don't compare your case of fever for one day with a disaster of 40 casualties in a bus. Do you expect the hospital director to initiate the disaster protocol for cases such as URTI, Soft tissue injury etc.? You should be very glad that you are not being seen IMMEDIATELY. That means you are being triaged as a GREEN case and is stable. RED means you are in serious trouble. Would you really want to be poked with at least TWO large bore branulas, a central line and a urinary catheter?!

I encountered this scenario while at work yesterday.
A young lady entered the consultation room. Wearing makeup, perfume and dressed to kill!

Me:     Apa masalah harini Dik?
A:        Saya nak MC harini
Me:        Apa?!
A:        Oops. Saya ingat doktor tanya apa tadi. 
Me:        Pastu? Awak ingat saya tanya apa?!
A:        Saya ada selesema, hidung sumbat sampai tak leh tidor bla,bla,bla….susah nak bangun                      tidur.bla,bla.

You don’t have to be a doctor with years of experience to know that she is trying to ‘kencing’ (local slang for a 'bluff') me.
Would any sane person give an MC for runny nose? The last time I checked, I didn’t have an ‘S’ on my forehead…not Superman but stupid. It didn’t help that it was 11 am and there were many other patients. Worse, my perut tengah meragam and had to visit the loo more than 4 times.


Would YOU, my dear readers, have granted MC for this girl?
This is a straight ‘face palm-super-fail’.

Specialist:  "frequently refers to an expert in a profession"
-oid:          "of similar form to, but not the same"

When the two words combine, SPECIALOID is formed. In my profession, a specialoid is a

patient who thinks that he or she is a specialist and all other medical staff should bow to his or her every need and wishes

Of course this is a rubbish definition I coined myself. But some how, Malaysia is churning more and more of these specialoid instead of specialist! It is reasonable for patients to engage in proper discussions regarding the management of their illness. I love patients who can recall their medications and exact dosages. I appreciate when patients and their relatives try to understand their illnesses. It helps in the management a lot.

Specialoids are unlike these good patients. I encountered one such patient today. Consider this scenario:

Middle aged gentleman with cough and runny nose for ONE day only. No fever, no shortness of breath. Vital signs was stable, no fever. Examinations were unremarkable. Lungs clear, throat not injected. 

Today, I will don a new outfit. Off goes the white coat and stethoscope and I have a pan in my hand. Instead of MOfrust, today its CHEFfrust.

What do you do when you are hungry at lunch and you are left with a car that is half filled with petrol (or half full), its raining outside and you have to get to work at 1.30 p..m. I posted yesterday about the need to reduce spending. I am now walking the blog!

What do you need? Anything that can be found at home. I found some chicken breast in the freezer, some spices in the spice jar, some pita bread, carrot,2 tomatoes and a capsicum. Equipped with a contraption called Periuk Ajaib (I really needed miracles to make sure it tastes good), I started cooking.

I went to my local AEON Mall today to get some medications from the pharmacy. I was quite surprised by the way things are. It's abnormally....NORMAL for a Friday evening. On Tuesday, the price for RON 95 and diesel was raised by 20 cents. Facebook was inundated with comments and posts full of anger and frustration. Fortunately, I managed to fill up my tank at 6 p.m. Way before the mad rush for petrol at fuel pumps. The dark force was really strong that day. Supporters of BN supported the move while supporters of the Opposition had a whole lot of "bullets" to use against the government.

There is a never ending debate on which system is the best. Before I discuss any further, let's go through some terms and definition:

On Call:
Despite "on" & "call" combined to make a word, it does not mean "turning on your phone and wait for calls from the hospital from the comfort of your home". It is common for people to get confused. Some fresh housemen seem to assume this is the actual definition.
On call-ers will be in the hospital through out the day, even after office hours. They are part of the team that keeps the hospital running at night. Usually there is a small room for doctors to rest at night. If you are lucky, HOs can get some amount of sleep. The job scope of HOs at night (at least back in those days) is take blood, attend to sick patients before help arrives, insert branula, clerk new patients and perform procedures. Usually its one HO per ward but it is the norm to have 1 HO covering the whole wing (5 floors of male medical ward)....back in those days.

Pre Call:
Pre call is the day before the on call day. On this day you get the sinking feeling of uneasiness. Simply said "malas". On this day, you try to get everything at home done. Munch on anything you can get & pack on the calories. Its the day you prepare for war!

Just stuff everything in!

I guess I have to postpone my intention to get myself a proper Bane mask for USD 99 on ebay. The price of petrol has gone up by 20 cents to RM 2.10. Soon, everything else will get more expensive. I can't afford any luxuries such as a decent Bane mask. I'll just have to make do with my crappy do-it-yourself mask. Maybe I'll become MO Frust Menonggeng.

I'm sure everyone else in the social network and media has TONNES to complain about. I'll view it from a different approach; what's coming!

I hope it is not too late to wish Selamat Hari Merdeka to ALL Malaysians. I hope it is not too late as I am writing this post at 8 PM when I should be posting it at 8 AM. I guess, "My Malaysian IS showing"...doing things at the last minute. OK what, at least got write!

Pardon my first attempt in meme

DOCTORS: Have a heart for those earning far less

With regards to the topic, this letter to the editor from NST was brought to my attention by a fellow colleague, Dr I. We both experienced the frustrations of working in Emergency Department. She has seen the green grass on the other side i.e. private care while I am still a governmant SERVANT.

While it is true, doctors in private practice CAN be rich but many are not. The example given that many are driving luxury cars & stay in guarded communities might not be true. I have done a fair share of locums & I have seen these doctors drive old Wiras. For me, I am living in a rented house for RM 450 a month driving a second hand car. Just have a walk at our staff parking lots and just count how many LUXURY vehicles there are.

This driver has a terminal illness; STUPIDITY. It can't be cured!

"Blood choke doctor". That's what I found when I tried to translate it in Google. I can't really find an appropriate translation in English. Cekik darah is such a strong word.

Working in Emergency Department and clinic setting can be really tiring and stressful. But it is rather interesting. Interactions with some patients can get really interesting...when you look back. During the first encounter, you just have to grit your teeth and 'WHOOOOSSAAAA"

Here are some of the interesting conversations:

With a forced smile on my 'Kami Sedia Membantu' face:

" Selamat pagi pakcik, apa masalah pakcik harini?"
" Mana la pakcik tahu masalahnya, doktor la patut bagitau saya!" he shouted.

Now, there is a thing called a "Patient-Doctor relationship". A lot of people don't understand this. Maybe this pakcik has been seeing too many bomohs lately.
DOCTORS ARE NOT BOMOH and CAN'T READ MINDS!
Our thought process are like this (Kids, please pay attention)
1. Get the basic info like comorbids, drug history etc
2. Patients are supposed to tell us the chief complain i.e. sebab apa datang...sakit kaki ke, demam ke apa! (patients are supposed to have that in mind upon entering the clinic)
3.Physical examination. We have to check the relevant systems. If you come for shortness of breath, cough or chest pain, the doctor has to listen (auscultate) to your lungs and heart.
4. Come to a diagnosis and treat accordingly.

If at any point patients are uncooperative, we can't get a diagnosis and we can't treat you. If you can't commit to telling us the truth and giving full cooperation, don't hope (jangan harap) to get a proper treatment. There has been countless episodes whereby patients do not disclose everything about their history. A patient might be in denial about their disease but it is of utmost importance to let doctors know.

I recently posted on PTPTN & CCRIS. The latest news is PTPTN loans will not be entered into CCRIS after some input from the Cabinet. It is a welcome relief to some but this is a wake up call.
Personally, I have had no experience with PTPTN but I have heard a lot of negative comments regarding PTPTN. I won't comment any further about PTPTN as it can get political.

The "wake up call" I am referring to is regarding newly employed graduates from all fields. Throughout my short life span I have seen all kind of people trapped in debt and pensioners with inadequate savings to last through their remaining years.

When I was a houseman, I didn't get my pay until the 3rd month...in one lump sum. What would a kampung guy who has never seen that much money in his account do? Splurge it on all sort of luxury stuff of course! The first thing was a flat screen TV! I already applied for a credit card back then. At the back of my mind was, "swipe je dulu, duit ade dalam account. Sure tak kene interest".

A few months back a junior MA (PPW) asked me:

"Doctor, ape k/c/o DM/Htn/IHD/COAD, p/w SOB?"

Its - known case of Diabetes Mellitus, Hypertension, ischemic heart disease and chronic obstructive airway disease presented with shortness of breath....you wouldn't expect a doctor to write that in full!

So, what is PTPTN and CCRIS. The latter is a relatively new term for me. I only got to know of it in January after attending a workshop. PTPTN is Perbadanan Tabung Pendidikan Nasional while CCRIS is Central Credit Reference Information System. So what??

"PTPTN loan holders now listed in Bank Negara's credit reference database"

This article was in The Star this morning. The front page was even more interesting as a can't comment much as I don't have a private practice yet.

I do agree that there might be little bit too many doctors (read: Houseman). However, there are not enough MOs around. To make it clear, housemans are Pegawai Perubatan Siswazah. Its like a 'lesen P'. Its two years of rotation in 6 postings for training purposes. After completion of two years of housemanship, they automatically become MOs. HOs don't have full responsibility of patients while MOs need to be fully competent.

This issue has been going on for years but I have yet to see the numbers in service. Some hospitals have barely enough MOs to run the department, especially in Emergency Department. Even at the clinic I work at, we only have 5 MOs to cover a big district. Patients are still being seen after 1 - 2 hours of waiting. Even though we see patients at supersonic speed! Just look at this article from a disgruntled patient.

A few weeks back, there was a big 'hu-ha' about top scorers in Malaysia unable to get into undergraduate programs of their choice, mainly Medicine. Politicians utilized this issue the best they can to show that they care. Most of the time, its the parents who are over concerned. In most people's mind, being a doctor is the noblest and best profession around. You can get rich, get respected and all good things. This may be true five decades ago but nowadays, it is far from the truth. Yes, you can get achieve that but it is a long and torturous road.