Saturday, 21 December 2013

Take Home Pay - Yahoo!


How Much Money Are You Making Monthly !!

This is an ACTUAL screenshot of a Houseman's Payslip
* this is his monthly payslip, in the 1st year of housemanship
** some info has to be censored for his privacy

- UD41 is actually your salary grade.
- More or less, this is the amount you're getting, during housemanship. RM4300 ++
- Your salary increases once per year (but there are 4 times in a calender year where this increment take place), together with everybody who works in the government sector (not private sector).
- It increases 1% per increment. (Based on my housemanship salary that time & according to what i was told by the "bahagian kewangan" of my previous Hospital). Some say the increment vary according to your salary grade.
- Take Home Pay = Total Income (minus) KWSP & Income Tax
** B.I Perkhidmatan Kritical = Critical Allowance
** You (as a houseman) need to work a minimum 50 hours per week to be entitled for this critical allowance !!! This particular term, applies for houseman only.
** As for year 2014 onwards, the government has increase the minimum to a 70 Hours per week and change their policy to contract-based housemanship job.
** In other words, if you don't work long enough, you don't get the critical allowance and if you don't perform, the government can cancel your contract or will not hire you as Medical Officer UD44 !!!

--- Happy New Year Everyone !!!

"We are working HARDER for LESS money"

With the rate of 4% inflation + house price of at least RM 400k in Klang Valley + Study Loan debt of RM 500k = Good Look ??

Ever heard of Inflation?
Does these conversations sound familiar to you :-
1) Tok Teh said, "Dulu, sepuluh sen boleh beli Nasi Lemak, Teh tarik, kenyang! Sekarang tak dapat laa..."
2) Ah Cheng told, "if you don't have RM10, don't dream to eat at Mamak in Bangsar laa"
3) Ah Moi replied, "what? With RM10, you can get a nice lunch in Kota Bharu maa" 
4) Star Newspaper : Fresh Graduates Can't Afford to Buy a House Nowadays
5) Astro Awani : Gaji isi rumah kurang dari RM3000, dikategorikan sebagai miskin tegar di bandar !!
These are the effects of Inflation !!!!
 For me, to be a successful housemanship or doctor, proper planning and financial management are crucial as well...
Please learn a thing or two about INFLATION in YouTube... Please... I beg you !!!

Does becoming a Doctor make you RICH automatically ??

Answer :
depends on what you do with your MONEY. Even a millionaire goes bankrupt, right?

To cheer you up, here's a special gift.... hehehe
A screenshot of a Staff Nurse's payslip. This is her payslip after 2 years of working !!

1) It is NOT my intention to look down on other profession, or judge people by how much money they make. Just for comparison purpose only.
2) The ONLY reason I'm doing this is to help you notice that, WHAT A SUPER-HEAD START you're getting, compared to those working alongside with you !! Please appreciate the opportunity God has given you. Use your money wisely. Don't make yourself poorer day by day !! Spend your hard earned money wisely, yeah?

P/s :
  • My definition of "successful" may be different than yours. 
  • Some things are not tought in school, but that does not mean it does not exist.
  • Just because you ignore it, that does not make it disappear in the real world.
I can only give advice, it's you who decide your future.
Next I will be posting on Income Tax for Houseman.
Kindly leave your comment below if you're interested.
If you're not interested, lets not waste your time and my time, agree ??
Remember, i was once a houseman myself, during my time, nobody bothers to guide me through housemanship (except my family), forget about how to manage my salary.
I have to learn it the HARD WAY, not only about housemanship but about REAL LIFE as well. Looking back, i'm glad to have done what i did back then. Some of my colleague struggle, if not in housemanship, they struggle in life, most of them struggle financially.

Tuesday, 10 December 2013


CirugĂ­a ~ Bedah ~ Chirurgie 
All Kind of Surgery Under One Roof

Surgical, the name itself says it all, obviously is NOT a medical-based department
In other words, besides the usual ward work, you have to go inside and help your superior in the operating theater as well, in case if you cant notice the difference!

Some people may have prefer OT (operating theater) but as for me, i find myself hating OT, because of ONE reasons :-

 Its damn cold in there!
- this is my main reason, if only OT is not too cold, I may have end up becoming a surgeon. Can you guys believe it, the damn nonadjustable-centralized-aircond is responsible for my future !! I believe all hospitals are the same, but i have no evidence to support that.
I don't care anymore, its all in the past. How about you? xD

" I am too HOT for this cold environment "
      - ancient Zimbabwe Proverb :p

There are several sub-division (if i can say) in Surgical Department,
but depending on which hospital you're at..
Example, HKL has neurosurgical department but Hospital Kuala Pilah do not.
What does this information has to do with houseman?
Say you're in a hospital where theres no neurosurgical, if a patient brought to ED (emergency department) with severe head injury that requires operation, the patient will be straight away sent to a hospital where there are neurosurgeon, less admission to your ward, right?
Less job for houseman !!

There are :-
1) General surgery : Appendicectomy, colostomy, laparatomy, hernia repair, Mastectomy ect..
2) Hepatobiliary : Cholecystectomy, Biliary Reconstruction, Whipple, ERCP, ect..
3) Urology : Cystoscopy, TURBT, TURP, ect..
4) Neurology : Craniotomy, Evacuation of Clot, ect..
5) Paeds : Appendicectomy, Hypospadia repair, Anoplasty, infected circumcision, ect..
6) Plastic : Skin graft, facial reconstruction, burn injury, ect..
7) Cardiothoracic : Heart problem, lungs problem, ect..
** not all hospitals have all sub-division
** not all sub-division are compulsory to housemanship

If you love surgical based, then more is better...

If you don't, less work = less stress...

I don't have detail info on every hospital in Malaysia, ask Mr Google yeah!

Surgical Houseman Preparation ^_^
Most common cases you'll find in surgical are :- (read & learn how to manage them)
- Acute appendicitis
- Urolithiasis
- Breast cancer
- Colon cancer
- UGIB / LGIB = upper/lower GastroIntestinal Bleed
- Intracranial Bleed or Cerebral Concussion
- Rib fracture

" Inspiration is like bathing. It does not last, that is why we recommend it DAILY "

# watch this movie for inspirational purposes only,
NO, the actor is not my father, nor does I am representing Johnson & Johnson in any way !!!
- this is a good movie for doctor, i personally recommend it

** Tips #1 : To be a successful houseman, the 1st thing you need to think of, when there is a new patient admitted to the ward (no MO around), is whether this is EMERGENCY case or NOT. You are expected to handle cases based on PRIORITY !! Always think and work smart. So go learn what are the cases considered as emergency in surgical.

** Tips #2 : To be a successful houseman, the next thing you need to consider is, to anticipate whether the new case is going for emergency operation / procedure or not. If you think your Specialist / MO will decide for operation, then you should PREPARE the patient for operation. Such as, keep nil by mouth (puasa) + set IV line + give IV drip + take all the necessary bloods + consider ECG / Chest xray for older patient (normally age > 40 or younger if with underlying illness such as Diabetes, Hypertension, asthma)

** Tips #3 : Always ask your MO FIRST if you're not sure, don't simply give your plan if you're in doubt. Give your superior a phone call, it is much better to get scolded via phone, than in front of everybody for doing the wrong thing. Senior houseman can be a good reference to you, but there is still risk as they are still HO anyway. MO is your best shot.

Thursday, 5 December 2013


Houseman's 1st Pay

" I hereby announce that we are going to pay your salary tomorrow "


Can't wait for tomorrow !!!

Next Morning

Dammit !!!

I'm late already...

No Sweat..

They wouldn't call me the 10sec man for no reason...

Zaaaassssssss.... !!!!

Damn Walao !!!

So long liao already !!!


After one Hour of queue...

Finally its my turn !!!!


Mooonneeyyyyy come to papa


Whhaatt the heck mannn  !!!










I forgot to tell you, there's not much money left in the federal reserve,

only this much..

So Houseman, i'll pay your salary next month !!

Houseman don't need money,

What you really need is TRAINING !!

** DISCLAIMER : Chill laa, why so serious, there is no need to be so stressed  !!  Later I will be posting on houseman salary, how much, what to do with it, how to be income tax savvy, ect
STAY TUNE, LIKE, & SHARE THIS - thats the only way I can tell you want MORE !!

Tuesday, 3 December 2013

Orthopedic - We Fix You

Bone | Muscle | Spine

"Where Getting Screwed Is Good"

 Remember this song?
Bob the builder, can we fix it?
Bob the builder, yes we can !!

When I first join orthopedic, although I was considered as a senior houseman already (erk..!), I have very little knowledge in this particular field.

During medschool, I spent only 4 weeks in orthopedic department.
So short, yet so many things to learn.

Orthopedic deals with Every Single Bone in our body ??
Of course NOT. Orthopedic only deals with the musculo-skeletal system. In other words, ALL BONES except the skull, don't forget to add the Spine as well. LOL !!

Housemanship To Do List
  • Remember what i always tell you, preparation is vital if you want to survive in any posting. If you think you're slow (at first), i highly recommend you to study some basic stuff BEFORE entering any department. This simple step may hold the key to your successful housemanship life or the ordeal of your lifetime !!
  • As for orthopedic, since you know what you're going to deal with (don't tell me you forgot already, i just told you, musculo-skeletal sounds familiar?), then open your 2 kg Anatomy Book, refresh every single names of the bone. What? You da power already? Sure meh? Carpal bones you remember all in exact order, triquetral or trapezoid or trapezium. Google-lah. Remember how many cervical bones are there? Seven? Eight? You sure its not the cervical nerve you're counting?
  • If you can't remember all, thats totally physiological !! Tips : Remember the long bones first, how to differentiate which one is medial or lateral. Then move on to the bones in hands and foot. Sure can one, Malaysia Bull-eh right !!! Overseas grad, don't be shy if you pronounce it differently, they may laugh at you, but thats how we pronounce it in our University isn't ?? I don't give a damn.
  • Study about Xrays, especially for fracture and dislocation. Always see in 2 views, AP and Lateral / Oblique view. Not all xray require lateral view, eg : pelvic
  • Refresh about open and close fracture. How to differentiate between open fracture and close fracture with laceration wound on top of the fracture site? **tricky question by my specialist**
  • Fracture classification is a must !! You can download the ebook for classification here, its kinda helpful.
  • Learn things like close manipulative reduction (CMR), skin traction, skeletal traction. Don't worry you'll learn alot as time goes by. Tips : ask the ortho MA (medical assistant) if you're not sure. Some of them has been in the department for some time, they have vast knowledge in orthopedic (good thing about specialization). Btw MA does the CMR, not HO.
  • There are so many things i can list down for you, but since i'm not getting paid to write this article (wakaka), i've decided to list only a few which i think are the most important. Its not like you're going to study all of them, lol.
** Quick Facts about Orthopedic ** 

1. This is a surgical based department
- expect to do some surgical intervention in the ward
- eg : suture, incision & drainage, wound debridement
- tips : go YouTube, watch and learn

2. This is a trauma-related department
- learn basic things about urgency & emergency in Ortho
- eg : fluid resuscitation in fracture, estimate blood loss in fracture, pulmonary embolism, compartment syndrome 

“To acquire knowledge, one must study, but to acquire wisdom, one must observe” - Marilyn Vos

 More Tips Coming :
- When you're clerking a patient, say he's involve in a motor vehicle accident. More or less your clerking should start like this, example ;

50 y.o / Korean / Male
premorbid : DM on OHA

PT 8H : alleged MVA (motorbike vs lorry)
hit the back of lorry due to slippery road
GCS on arrival full E4V5M6
no LOC / ENT bleed / retrograde amnesia
ambulating post trauma
c/o pain at left shoulder
(describe the pain then)
** PT = post trauma, PT 8H = post trauma 8 hour, LOC = loss of consciousness, ENT = ear nose throat

 “The secret of getting AHEAD is getting started”  
   - Mark Twain

My experience in Orthopedic

How many of you have given sedation to a real patient in your medschool clinical time? I bet non of you have, as medical student are not allowed to "play" with high alert medication.This happened when i was tagging (day 4 of life in orthopedic), haizz...

My ward mate that day, she entered the department 2 months earlier than me, so basically she should be more familliar with orthopedic procedure, right? She's a 5th poster as well.Happens to be, there was a patient, an ex-IVDU (intravenous drug user), who needed CMR for his dislocation. For your info, CMR is a painful procedure because we manipulate the dislocated bone, so we need to give some sedation and painkiller to the patient prior to the procedure. She help the nurse (newly started working nurse i guess) to prepare the high alert medication. Since the patient's IV-line is closer to me, she gave the high alert medication to me and asked me to inject it.When a senior poster gave me the medication, i somehow did not check the dose (out of trust) and directly inject the medication. The CMR went smoothly. It was late evening that time.
After a while, the patient did not wake up, still in deep sleep (sedated). The vital signs were normal. So i was not worried. Later that night, he was still in deep sleep and i noticed he was not breathing normally (respiratory rate of 10 per minute) !!! When i asked my ward mate, she told me that the sedation (midazolam) is 5mg, which is okay but the analgesic (pethidine) is 100mg, which is way too much !!! My ward mate then left me (as she is working morning shift) and told me not to worry as sedated patient is expected to be like this.

At 11pm, although i'm supposed to go back at 10pm, i was worried so i decided to take an ABG (arterial blood gases) before going back. Turn out the patient was in severe respiratory acidosis !!!
Then, my next step was, i informed my oncall MO. Since i wasn't sure what to do, (even if i know, i still need to call for help). When my MO arrived, i presented the case and told him what happened. Of course he scolded me. He said, "why the hell you inform this in the middle of the night, you should settle this with your ward MO in the evening, blaa.. blaa.. blaa..". He referred the case to Medical team then. My MO ordered IV naloxone (antidote for opioid analgesic). Patient then started gasping and breathing faster, he was restless and unresponsive as well. When medical team arrive, they plan to transfer this patient to ICU for respiratory distress !!! Can you imagine, small mistake i did turned out to be a disaster. But since we gave the antidote, medical team ordered me to repeat the ABG prior to ICU admission. It was already 2am and i have to work at 7am the next morning as i was still tagging, damn tired already. Luck was on my side this time, the repeated ABG came back as NORMAL, just slightly reduced oxygenation. Medical team than cancel their plan for ICU admission, patient started responding to call, breathing regularly and normally again. It seems that he was not breathing enough because of the oversedation, to excrete the carbon dioxide, causing the severe respiratory acidosis. Once he breath faster, more and more carbon dioxide got eliminated thus normalize the pH. After a while, medical team and my MO chow. I went back at 3am, sleep abit and came back 6.30am to work again.

Can u imagine what will happen if i did not repeat the ABG and pretended everything is okay?

" Mistakes will turn into failure if you don't do anything about it " - Anonymous

There's a reason why I'm sharing you my bad experience, we're dealing with people's life in medicine field, sometimes we just CANT afford to make mistakes in the very first place.

" Learn from your mistakes is power,
Learn from other people's mistakes is POWERFUL " - Martin Luther

May Almighty God help and guide us to the right path. No human being is perfect except prophet.