BANJIR 2014

Most Malaysians would have already heard about the plight of the medical staff at Kuala Krai Hospital by now. The text has gone viral through Facebook and Whatsapp for the past 24 hours. Even the mainstream media got a hold of the story.

Does Anybody Care? Medical staff goes beyond their call of duty

Here is the original text I forwarded to me in Bahasa Malaysia:

Bismillah.

Sekarang generator sudah kehabisan minyak. Seluruh hospital bergelap, lampu kecemasan menyala di sesetengah bilik. Tadi kami intubate baby dalam gelap...SpO2 drop sampai 18, bradycardia. Anaest specialist sendiri datang menyelamatkn keadaan. Pesakit ICU dan CCU bernafas dengan mesin yang dijana kuasa bateri. Kalau bekalan tak pulih, kami akan bergilir2 manual bagging ...sampai..?

BANJIR 2014

While most Malaysians are at home with their loved ones, either celebrating Christmas or just enjoying the public holidays, some Malaysians will be spending the holidays drenched in flood water. Rescue workers and medical staff are on high alert at this moment to react to this disaster. Leave for medical staff in the Eastern states have been frozen. I wish my colleagues in the affected states all the best.."Kami sedia membantu"



I have taken the initiative to compile the details of the various NGOs which will be providing aid to Malaysians affected by the floods. I would love to join the relief efforts, but due to some family matters I am unable to do so. At least two NGOs are gathering medical volunteers to aid victims in the affected area and will be leaving for the respective locations tomorrow (25th December 2014). For those interested, do take the time to join them.

HO...HO...HO....looks like Santa Clause dropped by a week earlier this year!

The HO I am referring to is H-dot-O...Housemen. Last week might as well have been Housemen Week. A time when everyone in the medical field take some time to appreciate the contributions of Housemen. Without them the whole hospital would cease to function.

Who will trace lab results in the morning before rounds? Who will draw blood of in ward patients in the morning? Who will clerk new admissions to the ward? Who will run to the radiology department to get an early appointment for CT scan? Who would be called up at 3 am in the morning to set a new IV access?

Who else will do ALL these without housemen?!

Well, in another dimension called district hospital and even some clinics, MOs have to do it all by themselves. Its mind boggling how 3 to 4 MOs can manage a hospital all by themselves. Review patients in the ward, attend to new cases in the emergency room and then see patients in the outpatient department. To all MOs in district hospitals out there....I salute you!

All these 'hoo-haa' about housemen started with a letter from a disgruntled parent Disgusted Malaysian.

Two main issues were brought up in this letter to The Star;
1. Long working hours without rest.
2. Maltreatment by senior doctors.

Last week I wrote a piece on the case of a hospital being sued by a student for failing to inform her of the risk of taking antibiotics. That post garnered more than 10,000 hits in a day. A few days later, a private hospital was accused of causing the death of a teenager by negligence. A lot of doctors felt like doctors were being bashed left and right. It was a tense week.

Then out of the blue, a colleague from the Malaysian Primary Care Network (MCPN) stumbled upon a blog by a certain Professor Doctor XXX practicing alternative medicine.The content of the blog defied ALL medical knowledge.


I personally think that he was a THREAT to public health and safety. He has since taken down TWO ridiculous post from his blogspot but his company's site is still active. The Q&A section of the company's site has been bombarded with questions about his legitimacy since the revelation in MPCN....to the guys attacking his site; please don't be so harsh and use foul language.

I tried to check the company's details with the Traditional and Complementary Medicine website but I can't find a proper link. A search at e-pengamal TCM online was futile as well.

A very useful site to identify fake certifications

This lady had hypoglycemia. What she does next will make you  speechless!

A few days back, a screen capture of a surgeon bashing an MO from primary care on Facebook went viral. It even got the attention of the Health D-G. I won't paste the screen capture here as I am sure most of my fellow readers have already read it on Facebook or Whatsapp. Basically, it goes something like this (in no particular order);

"What la, KK MOs. Which hole did they come from?"

"It is worse teaching MOs from KK than HOs"

"These MOs are like cows"




But is this something new? Specialist (and even MOs) from each discipline will rubbish the other disciplines. Surgeons will say physicians only know how to order tests and gets nothing done, while the physicians will say surgeons only know how to potong. From my personal observation the top of the hierarchy always goes to the surgical based discipline while the bottom most are the doctors from primary care. Even the public has this mindset, doctors working in the hospitals are ALWAYS better than those in Klinik Kesihatan and primary care.

Housemanship. The mere thought of it sends chills down (almost) every medical student's spine. It's often referred as hamba orang or other people's slave. In the hierarchy of the hospital housemen are regarded as the lowest of the lowest....that's what people say la.....including me. Has any one ever wondered why I was never HOfrust? Why lompat terus jadi MOfrust?

There are TWO main reasons:
1.

Self explanatory

2. I wasn't really frustrated with my housemanship.

Budget 2015 is just a few hours away. Last year's budget wasn't that great to begin with and I have a feeling that next year's wouldn't be great as well. Despite efforts by the media to paint a rosy picture of Malaysia having a bright economic future, the rakyat maerhan (am I spelling it correctly?) are not feeling its benefits. Well, the stock market has been excellent and gold prices were at it's best (read as cheap to collect). Unfortunately, prices of everything went up but salaries remained the same. Hey, even the MPs are having a hard time; they have to tie their neck stomach (ikat perut)....so much for the RM 2,500 sebulan pun cukup!



It is only natural then that the cost of healthcare will go up with the GST coming in (NOT ALL medical equipment are zero-rated) and a few more rounds of subsidy rationalizations (you still need fuel for EVERYTHING!). When private healthcare becomes too expensive, where do the rakyat marhaen go to? Government health centers of course! I am expecting more crowd in government hospitals and clinics in the months to come. I have no complaints; the facilities are for ALL MALAYSIANS. But I have a few tips for the public to UTILIZE these services properly. Utilize NOT abuse!

EMERGENCY DEPARTMENT
1. Ambulance:

i. The ambulance service is for EMERGENCY cases only. If you can walk and talk, it is better to go to the hospital yourself. Being too tired because of a fever is NOT an indication.

ii. When calling for an ambulance, please call 999 call center. DO NOT call for one through a direct line or stop one at the side of the road. That ambulance might be heading somewhere to retrieve a dying patient.

iii. Ambulances are for those that are alive. NOT for the deceased. Please do not complain to the MARVELOUS Harian Mxxxxx when the paramedics have ascertained a person is dead and call the police instead. They are doing their job to SAVE LIVES, NOT to bring back the dead.

iv. Please provide the exact location and circumstances of the event. They are not being 'busy body' and trying to waste your time. The paramedics need to prepare themselves with the right equipment. Saying 'depan tiang elektrik yang ke sepuluh' won't help too.

v. Imagine yourself fighting for your life inside the ambulance. Please give way when you see the flashing lights and blaring sirens. (read You Are The Reason Why Ambulances Are Late)

Cardiotocography: A graphical representation of the fetal heart rate and uterine contractions. It is used to determine the well being of the fetus.

On 11th September 2014, the newspaper portal, Sinar Harian highlighted the plight of a 2 years old child with biliary atresia. The family is seeking funds of RM 150,000 to get treatment in India, possibly to get a liver transplant.

Biliary Atresia?

Biliary: The bile duct system.
Atresia: Absence or obstruction of an orifice.

Basically it means that the tube (duct) to transport bile from the liver to the small intestine is obstructed or absent. If not managed early, it can cause irreversible liver damage.

Bilirubin metabolism diagram

TWO things crossed my mind after reading the article.

1. Why the need to go to India? I thought Malaysia has a hepatobiliary center in Hospital Selayang.

2. What happened in the last 2 years? Prolonged jaundice should have been detected in the first month of life.

Consider this;

"I pay my taxes promptly. Why should I pay RM 1 to see a doctor at a government clinic?! Healthcare should be free."

"I paid taxes for this? Why should I have to wait so long? Such a big hospital and not enough staff to attend to my 37 degress Celcius fever? What a waste of tax payers money"

"Bonuses for government servants? Why waste tax payer's money on slow, lazy staff?!"

Its a common complain among Malaysians. I pay taxes, I should be treated like royalty! There is some truth to that. The rakyat should be treated like royalty. Rakyat di dahalukuan. But I am not here to talk on politics. If I say to much, I'll be charged with sedition (last week's word of the week). So let's stay clear of that for now.

Recently a pharmacist posted on Facebook about how she received a stack of mixtard, a type on insulin for diabetics, at her dispensary. Based on the picture, it looks like a year's worth of medications. She received the vials from a patient who has accumulated it over months but failed to comply to the treatments given. Unfortunately, the whole pile of mixtard were all expired.

A while back, a lady came to the clinic complaining of a skin lesion on her left ankle. She had a fall a week prior to the visit and claimed to have had a fracture actually she said...

"Retak ke patah, saya pun tak tahu doktor tu cakap macam mana"

I have no idea what that means either. Retak = crack. Patah = break. Break or crack, still fracture la kan? Anyway, a cast was put in place by the doctor and she IMMEDIATELY took it off and went to a Sinseh. The cast was removed and a concoction of herbs was wrapped around the injured area.

Any of this tulang can patah, retak or whatever you call it!

"If I had used the cast, I would not be able to walk at all" said the lady. I could see that she was walking but she was clearly limping. Her ankle was still swollen and I saw some resolving bruises around the ankle. The skin was bad too. It was dry and excoriated. Skin were peeling off. It is most likely due to contact dermatitis with the herbs.

First there was this press statement:



Then, there was this news:


And later in the week....


What is happening in Malaysia today? Too many bright students I suppose. Its good that the young lady has a passion to study medicine but does she know what she is getting into? Does she know what it takes to be a doctor? Its not enough to just have good grades! There is so much more to it! I really hope this meme does not reflect her reason for wanting to take up medicine (linked to my previous post on SPM Top Scorers).

Autism Spectrum Disorder

This cute video has been making its rounds on social media for a few weeks now. It was made by the nice people at the orthopaedics department of Hospital Sultan Ahmad Shah, Temerloh. Its a tribute to all the staff that will be working through out the Raya holidays period.

Thursday night, 17th July 2014. It was 11.50 p.m. I don't usually log in to Facebook before bed but I accidentally pressed the Facebook app on my phone that night. to my surprise on the top of my news feed was:

"Tgk cctv news channel 509...flight MAS 777 crashed kt border russian-ukraine..."

Is it another hoax or is it real news, I thought to myself. This friend of mine is not the type that post rubbish updates on Facebook. As I scrolled down, links from major news agencies popped up. Unfortunately, it turned out to be true.

I posted an update at MOfrust's FB page that night:

As a Malaysian I feel sad. I feel a great loss. Please don't politicize this. Please don't make it into a religious and racial issue. Please respect the families who lost their loved ones & please don't share fake updates...there's already a picture of a MAS plane when it looks like a photoshopped scene from Lost.

This is a scene from Episode 1 of Lost

.....tindakan tergesa-gesa seorang pelatih perubatan di sebuah hospital di sini mencabut beberapa wayar termasuk wayar ECG pada badan ibunya telah menyebabkan ibunya meninggal dunia.

Berita Harian, 10th July 2014

Did I just read properly? My Bahasa Malaysia is not that perfect, but DEATH BY PULLING OUT THE ECG WIRES?! That's a bit over the top isn't it?

"Doktor mengesahkan ibu saya mati secara MENGEJUT."

Despite common belief that I wear my mask to work all the time, I DON'T. I am just a simple doctor at a small clinic. I have facial hair like Hugh Jackman's Wolverine. Just imagine me as Wolverine with all the muscles but instead of six packs, I just have ONE big pack and a few spare tyres.

Yep, that's how I look like!

If I were to wear my mask to work, I would totally understand why patients refuse to trust my words as I would look like a joke. But why don't they believe me? Believe me and my colleagues? Why so like that one?!

I encountered TWO scenarios these past two weeks that left my mind boggling....just like a bad episode of SENARIOOOOOOO.

A few weeks back, I read a Facebook post about how a houseman (HO) talked a patient out of depression. I can't verify the authenticity of the post but it is inspirational. The whole post is rather long and in Bahasa Malaysia. Click on the link to read the post (but please don't click on MyMetro).

I tried translating it into English but it doesn't sound as nice. It doesn't do justice to the original author. If you can understand Bahasa Malaysia, do read the whole post.

Letter from a senior

While others are fast asleep with their loved ones at home, cuddling each other lovingly or hanging out with friends after a late night movie, people called 'doctors' are stuck in the hospital hard at work trying to save lives. Life is a bit more difficult for doctors in remote, understaffed and under equipped district hospitals. No specialists around to ask for help and a lot of times when trying to refer to a tertiary hospital some cocky MO will sound: 

"Aiyya, that one also want to send ah? So stupid cannot manage there?"

The sad part is, while you are busy saving lives and giving everything you have, no one is there when its your life that needs to be saved.

It was a sad day when news broke out about a medical officer who died after completing his on call. No one knew exactly what happened as he was alone at the time. He was only found after others went out to look for him. Maybe he was overly exhausted or may have had some underlying medical condition. The patients that survived that night at Hospital Alor Gajah might have been saved by this particular doctor.

Despite the somber mood of the Malaysian medical fraternity after hearing the sad news, some rubbish journalist published something uncalled for in the mainstream media. I am not sure if it was in their print copy though (I do not enjoy reading both of these newspaper anyways), but it was on their online portal. NST.com.my most probably noted the intense anger at the journalist and deleted the link (link unavailable since 12th June 1215am) but myMetro remains a nonsense newspaper.

"Naked doctor found dead in toilet" was the HEADLINE.

Is it so significant to highlight that the doctor was found naked in the toilet? Is anyone supposed to be fully dressed in the toilet?

Post call. 24 hours work. Tired. Need a shower. Need food.....those are the things most doctors think about after completing a hectic post call.

MyMetro was unnecessarily detailed as ever

"Seorang doktor lelaki atas panggilan yang sedang bertugas ditemui mati TANPA SEURAT BENANG dalam keadaan TERTIARAP di dalam tandas di Hospital Alor Gajah hari ini"

Why highlight the TANPA SEURAT BENANG and TERTIRAP? Haven't you got enough readers to attract?
Why stoop so low? Where is the respect that the doctor deserve?

Some may find this trivial but you just have give the doctor some respect. Give the family room to grieve. No need to highlight the fact that he was naked.

I fully support Dr Jim Loi's, President of Medical Practitioners Coalition Association of Malaysia, protest on the NST article.

Please show some RESPECT.

Sigh.....another day, another potential heart attack as I explore Facebook. Another fake public service announcement by some unknown, non medical source. Compared to my previous post on the relationship between not bathing for the first 3 days of menses and postpartum mortality, this THING about first response to stroke is BLOODY PREPOSTEROUS!!

Once upon a time, on one fine day, I received a group text from one of my non-medical Whatsapp group. My beautiful day was ruined. The contents broke my heart....


So FRUST la like this!

But seriously, I feel more 'frust' when people actually share this kind of rubbish. I have no idea how they can formulate a study for this. Cohort? Cross sectional? How will they be able to study the pathophysiology?

Here lies the beauty of being a graduate of The Medical School of Whatsapp. You can write all sort of rubbish and put a nice ending to it to make others share like:

"Share this if you love your lady friends"

"Share this to 1000 friends and you will CURE cancer"

This rampant spread of rubbish and nonsense on Whatsapp can get quite irritating for health care workers. We have to explain and counter all these rubbish in the group itself so that it won't get out of hand. But when there are more than 10 individuals in the group, there will always be one who will say'

"Take it or leave it! Tak nak percaya sudah. Ni kawan saya punya abang punya ipar yang bagitau. I LOOOVVVVVEEE all my lady friends and I want to spread it!"

In a country as hot and humid as Malaysia, imagine if ALL the ladies with 3 days of menses don't bathe.

2 Postings Housemanship

Current 6 Postings Housemanship

3............2.................1......................Fight! Its just like watching someone play Mortal Kombat.

When I first read the title, my knee jerk response was "WHAT absurdity is THIS? Marah kan nyamuk, kelambu di bakar." Is it really the doctor's fault?


Lets look at this scenario:

A patient with a severe back pain due to paravertebral muscle spasm went to a private hospital. On assessment by the MEDICAL OFFICER there is no neurological deficit (no numbness or weaknesses of the limbs) but pain score is 8/10. If the patient goes to a very busy government hospital with limited facilities and staff (and don't forget to pay RM 1!), all he will get is an intramuscular injection of analgesia (commonly diclofenac sodium) maybe do a lumbosacral x ray, less than an hour of observation, then discharge. And maybe an MC.

Recently, I have just been made aware of a nonsense practice by a local pharmacy. The pharmacy sells some kind of "magical" water to unsuspecting individuals hoping for some "magical cure" for diabetes and hypertension. Some kind of rock is placed inside a container and patients are asked to drink 3 huge containers of the water. The worst part is, it cost roughly RM 90 PER SESSION.

Hi Mr MOfrust, I am Amy (not her real name). I am calling from Maybank Visa. We would like to send a package to you because you have been chosen as a lucky winner. The package contains a holiday card with attractive discounts and can be used at over 1000 merchants....bla...bla...bla. Now I would just like to verify your details.....bla.....bla....bla.

Watching Budak Baru brings back all the memories of housemanship. Thank you to Simple_Prince for forwarding this video to me via my email (please do email me if you have any suggestions for this blog by filling in the form on the right).

I was doing locum one day and saw a young lady. She came to the clinic with her father, She had sore throat and runny nose for the past 4 days. She had preceding fever which has since resolved. Clinical examination revealed nothing much. She was afebrile and her throat wasn't even injected. There was NO EVIDENCE OF INFECTION.

I told them that it might possibly be a resolving viral URTI. The father wasn't convinced.

Bagi la antibiotik doktor. Doktor lain bagi je....

It was still rather early and I still had some juice left. So I explained to them regarding antibiotics.

I think most, if not all medical graduates will understand this meme. Well, at least half of the graduates were persuaded by their parents either forcefully or in a subtle way. I don't have any statistics but there is a large portion of medical graduates who do not practice or have gone FRUST.

Today's tech savvy teenagers have got information at the tip of their fingers. Although some would rather play Pou or Candy Crash, at least they have some way of getting to know about a course before jumping into it.

During my time, in a galaxy far far away, the internet was just at its infancy. Does anyone still remember mIRC chat? That thing was whack! Teenagers then had their parents subscribe to the internet just to use mIRC (remember the modem? kukukuk....krrrkekekeekekekkkkkkkeeeeekkkk).

Tax. Its not something that people look forward to, especially with the rising costs of living. However, for the past 3 years, April is the time of year I can get some money back...from the Government (Lembaga Hasil Dalam Negeri)...LEGALLY.

I have heard a lot of grouses from my colleagues about taxes such as..

"Why do we pay taxes when the politicians keep on abusing it?"

"I don't want to pay taxes because I am not getting any benefit from it"

Well, maybe you are not eligible to pay income tax in the first place because according to LHDN (IRB), only ONE million out of the FOUR million individuals with files in LHDN are eligible to pay income tax.

Welcome to The University of Facebook where all your dreams can come true. You can be anything you want. We offer courses for free. All you need to do is just register online and update status and get as many likes and shares. Just look at all these testimonies from our alumni.

Mr Stem:
I used to be a school dropout but after graduating from University of Facebook, I now have a Degree in Medicine and Masters in Oncology. I can treat cancer with 10,000 likes and Triple Quadruple Stem Cell!

Recently, a patient made me realize I am a human being. She did not give me any thank you card or flowers. She didn't really do anything actually. It was just a feeling I had from seeing her predicament. I haven't felt this way in a long time. It is not exactly a great feeling but it is what makes humans HUMAN. 

Let's look at the difference between these two news highlights.

DENGUE. You will be a frog under a coconut shell (katak di bawah tempurung) if you haven't heard about it. Throw a stone randomly and it will hit at least one person who had Dengue. I had Dengue back in 2007 when I was still a student. It was bad. It was the worse fever I have ever experienced. I was aching everywhere. Thankfully it was just Dengue Fever.

Despite all the awareness campaign initiated by HE WHO SHALL NOT BE NAMED, there are still some misconceptions about Dengue.

1. Definition

Doktor, saya mau check darah. Takut kene Denggi

No fever. No myalgia and arthalgia. No headache. Not from Dengue endemic area.
In an ideal world, where resources are unlimited and chemical reagents are as cheap as a bottle of mineral water, I can kau tim and do it. Mo man tai! But the truth is, HE WHO SHALL NOT BE NAMED's resources are already stretched to its limit.

The reason why it is called Dengue FEVER or DEMAM Denggi is because...your typical presentation would be to have FEVER.
Dengue fever goes through 3 phases; febrile phase, critical phase and recovery phase.

Self explanatory diagram

Doctors will usually perform lab tests after Day 3 of fever. As per diagram, hematocrit and platelet levels will only derange after Day 3. That's it is important for patients to tell properly when they had the onset of fever instead of dah lama daaaaahhhh!!!! and ish, doktor ni mana la saya ingat!

Malaysian doctors....

Anyone could easily Google these terms and suddenly everyone can master anaemia....and EVERYTHING IS AWESOME!



Unlike building Lego blocks, everything is NOT awesome when it comes to real life hypovolaemic shock secondary to post partum haemorrhage. The main difference between between a houseman, medical officer and a specialist is EXPERIENCE.

It is getting harder to become a healthcare provider these days. First the consultoids, then the Facebook & Google consultants and the "semua ubat ni Yahudi laknat punya kerja" group, last but not least the 'over the top testimony' marketers (refer to Frust Lagi!). Now there are people throwing dirt on medical staff. Its hard to do work with passion and sincerity when you get comments like this:

If you believe this, this blog is not for you!

"Swasta memang la best layanan die sbb tu la mahal..kalau kerajaan ni kan murah.. so layanan macam XXXXXXX murahan..semua staff2 nurse kerajaan ni mmg dah mcm XXXXXXX murahan.!!"

Can you spot the difference?