$s$ Income Tax $s$

How Much Are You Paying The Govt Back
** CAUTION **
I am NOT a qualified Tax Advisor, your FINANCIAL INTELLIGENCE is advised !!
Consult your Tax Advisor, They need to make a living as well, LOL

" Two Things Are CERTAIN In Life, Death and TAXES "
    - Benjamin Franklin (1706-1790)




Why Houseman Need To Know?

1. Obviously because you are required to pay income tax by law, ignorance is not a valid excuse
2. You don't want to pay EXTRA on income tax, unless you love to do so
3. In fact, the Govt already take your hard earned money, to pay income tax, before you even get your hands on those money. (refer to HO payslip screenshot, in my Previous Post, if you fail to notice that)

Take Control of Your Hard-Earned Money

I just can't understand why some doctors and nurses, don't bother to LEARN about Income Tax, let alone to learn about money. I have spoken to a nurse, who still has very little idea when it comes to income tax, although she has been working for the past 25 years, on top of that, her husband retired 5 years ago without any "pencen" and has 2 teenagers studying in local university. I pity her, for her financial constrain, but she CHOOSE to be like that, there's very little room for me to help her.

Self Assessment

This is the system we're using right now, meaning, we (taxpayers) are required to assess ourself (financially), fill + declare our own income per calendar year, calculate the taxable income ourself, make payment (or claim our money back) on time and the best part is, make it right for the first time !!

Who Need To Declare Income Tax ?

Answer :  Anyone who earns RM 26, 501 per calendar year, after EPF/KWSP deduction. Around RM 2300 per month of salary. Yes, we are required by law to declare our income. Other source, give a different amount, but the point is, Houseman NEED to !!

Source : LHDN , Says.com

How | Macam Mana

There are 2 ways to declare your income. Offline (using forms) and Online (e-filing LHDN).

My advice, declare using e-filing. Technology is there to make our life easier. Due to the nature of our work, using computer is better, instead of filling up forms and then submit via post or by hand to LHDN.

For first timer, you need to register at LHDN (just need your I/C), after registration, you can fill the e-form later using e-filing at the comfort of your king-size bed !! 

When | Bila

e-filing can only be access 1st March onwards.

Due for submission is April 30th for each calender year.

So this march, 1.3.2014 you will need to declare your income for year 2013 (year assessment).

What If I Don't

Theres Audit from LHDN, they will detect, sooner or later, they will find those who don't declare or under-declare.. but... if you over-declare, they keep their mouth shut !!

Remember, audit is done regularly and extensively, as i mentioned earlier, ignorance is not an excuse. Be prepare for penalty up to RM 20,000 , 3 years of jail or both, if found guilty, and not to forget, you still have to pay the amount of tax you did not declare previously, with interest of course !!

What Happens After I Declare ?

1. Notice (eg: Penalty if late, Request for more information/receipt)
2. Repayment (you receive back the money they auto-deduct)
3. Nothing (govt will spend your money WISELY)

How Much Do Houseman Pay ?

To calculate how much you need to pay (taxable or chargeable income), you need to know the formula. As shown below :-

Taxable Income = Total Income - Tax Relief

After you get your taxable income, there's a way of calculating it, using "income bracket"

Refer HERE, on how to calculate, because someone else has done a good job on explaining this, and i'm lazy btw, lol. Do check with LHDN website, as these bracket can change anytime the govt want.

Know The Difference Between "Relief" and "Rebate"

Relief is use to reduce your income, so that you'll end up in a LOWER bracket, thus lower percentage of tax. Meanwhile, rebate is the amount of tax money that you can CLAIM BACK (since they auto-deduct it).

Refer HERE / DI SINI as he did a great job there, hehe.

Example :-

At the end of year assessment 2013, our beloved govt has auto-deduct my income, total of RM 500. After i calculated my taxable income, the total income tax (after i deduct all the relief) i should be paying is RM 3400. My maths is telling me that, i need to pay the govt another RM 2900 ( 3400 - 500 ) right?

But wait a minute, i paid RM 5000 of Zakat in total that year. 

As any zakat is considered as REBATE, regardless of the amount, so now, i DON'T have to pay the RM 3400 (total of tax according to my bracket), which means, i DON'T have to pay the "remaining" RM 2900 and the govt has to REPAY me back the RM 500 they auto-deduct initially.

Note that i get RM 500 of "rebate from the govt" only, NOT the total amount of my paid zakat !!

There are many TAX RELIEF available

Always visit LHDN website as these relief can change from time to time !!

Save money LEGALLY

Stop giving "tips" to the govt

Pay Your Tax Accordingly

As our Country's debt increases,

what I can guarantee you is, Govt will increase TAX, its already happening, starting with GST, subsidy withdrawn (eg : oil prices), increase toll and so on.

Its the matter of TIME only

Learning How To Manage Your Money Is More Vital Than Ever Before And Managing Income Tax Is A Good Place To Start With

70% of Malaysian end up financially BROKE, 10 years after retirement

- If you retire at 65, your EPF is likely to finished in 10 years time. With increasing inflation, increasing tax and health problems, you will most likely to OUTLIVE your "saving".

That Includes Doctor as well !!

"No one can go back and start a new beginning, but ANYONE can start now and have a new ENDING"

Take Home Pay - Yahoo!

UD41 BASIC PAY

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

CAN YOU SEE ??
- 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 !!

** DISCLAIMER :
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.

S;U;R;G;I;C;A;L

Cirugía ~ 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.

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.

Paediatric - Rock My Baby

P-E-A-D-S
Mother & Baby Department

Actually Paeds is my 5th department, but after completing medical, which is my 2nd, i decided to do peads first. Why? Because after a "tiring & no life" department, i needed some rest to recover physically and mentally. In my hospital, paeds is a chill posting, the head of department, specialists and medical officers are damn nice to you, as long as you don't create trouble and do your job properly (of course!).



My advice is always plan and prepare for whats coming. We're not a fortune-teller....  but we're not a damn gambler either. With better preparation and planning, success is easier to achieve !!

First of all, paeds posting is divided into :-

1. Nursery : aka special care nursery (SCN) or whatever they wanna call it. Basically you're going to deal with neonates. We all learn how to differentiate neonates and children in medschool don't we?
2. Ward : From a baby of 1 month old and up to 12 years old, is your future patient here.

You will have to spend 2 months in each of the above. Either you'll start in SCN then ward, or vice versa.  

For example : they gave me ward first, and then nursery. So i did tagging 1 week and spend 2 months in paeds ward... then.... did tagging another 1 week and spend another 2 months in nursery.
So if you realize, the total tagging period is still 2 weeks and the total allocated time in paeds department is still 4 months, like other posting. But i did not have to do tagging for 2 weeks continuously, less tiring !!

*** Disclaimer : Beware of Parents, especially Mother, as they can be very protective, avoid doing procedure like blood taking and branulla (IV line) insertion in front of them.
The next thing you want to avoid is having parents complaint about you, saying you poke their child many times for blood-taking or branulla. Remember that some parents are not as educated as you are, their emotion can easily surpasses their logic thinking. The worst case during my HO time, the so-clever mother, complaint to the Minister using SMS !! Since its near the election, the minister gave a phone call to the Pengarah Hospital !! Then, the whole department is like being shot with a machine gun by the Pengarah.. lol

 YOU HAVE BEEN WARNED !!
While some complaints are relevant, some are not !!
This is hospital, happy-health-go-lucky people don't get admitted here !!
Baby = Small Hand = Small Vein = Difficult
Very Sick Baby = Difficult x 99
** remember, sepsis causes peripheral vasoconstriction, causing even harder to get peripheral line access !!!
- if you;re not sure, ask for help, not for trouble

Houseman Job in Ward

• Usual stuff : Clerking, present cases, blood taking, & set Branulla..
• Specific stuff : You need to plot the growth chart (google image to see it). If the child is under-weight or over-weight, remember to ask the mother regarding the child's nutrition status (what they eat, how frequent, blaa..blaa..blaa). If the child is under-weight, consider chronic infection? immuno-compromissed? Get the history from the parents. Might need to do screening (Hep B, Hep C, HIV test) for the parents and the child as well. Don't forget to ask the development progress, 6 months old can do what? 1 year old can say what? Start crawling/walking/running/talking??
• Physical Exam : Always check the throat (main cause of fever/poor oral intake), peripheral circulation (capillary refill time, warm/cold periphery). Always look for the danger sign, as you are the 1st doctor to attend the patient, child can deteriorate super fast, if you sense any danger, straight away inform your Medical Officer.

Houseman Job in Nursery

• Usual stuff : Clerking, present case, blood taking & set Branulla
• Specific stuff : Learn how to calculate the feeding. Neonatal jaundice, what level of total bilirubin need phototherapy? Neonatal Resuscitation is a MUST as you will be working closely with your O&G colleague, in a difficult/complicated delivery, they save the mother, you save the child. Also you need to know, the criteria of admission to nursery. APGAR score. (Will write a post of all these separately)

# My experience in Nursery
-  That day, the weather was nice, there's a rainbow and the birds are singing. I just started my duty, and was informed by O&G team that they are pushing a mother to the operation theater for an Emergency Lower Segment Cesarean Section (LSCS) for suspicious CTG (remember my O&G post?) and suspected chorioamnionitis. So me, a nurse and my MO went there with resuscitation kit and we prepare for the baby.
- The Anesthetic team, gave the mother general anesthesia, because of failed spinal anesthesia.
- Baby was born vigorous, APGAR score full, no resuscitation given. My MO checked the baby and then he said, "ok, discharge to mother lah, baby all ok right, i go out first okay.."
- 1 minute later, when i was writing the discharge ordered by my MO in the mother's file, the baby suddenly stopped crying, became bluish (pale blue in colour) and limp !!
- The nurse started to panic, but thank God, i have my Neonatal Resus Skill like at the back of my hand, when you understand the resus flow and know exactly how to react, you won't panic.
- So i gave the baby Positive Pressure Ventilation (PPV) for 1 minute and ordered the nurse to give a shot of IM naloxone to the baby. The next minute, the baby became pink again and started to cry with good muscle tone, although i was ready to do chest compression, if necessary. Praise to Almighty God !!
- Can you imagine what will happen to the baby if i am not well equipped, knowledge and equipment wise?? My medical officer (MO) already left at that time. Lucky him to have me (hehe).

During my medschool, I never know what Neonatal Resuscitation is, let alone performing it. But I learn it during tagging time in Paeds with all my heart..
If an average medicine student who knows nothing about resuscitation during medschool, can save a baby's life..
You sure can too, medicine is a lifelong learning process !!!