Dr Maryam Tahir
@DrMaryam7
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A cat lover, A Doctor, MBBS batch 17 IIUM.
Kuantan, Pahang
Joined September 2014
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Life lesson:
There is no point in:
1/ Working extra hours. Leave when your work is done.
2/ Caring too much about others. Have limit. There is no guarantee they ll do the same for you.
3/ Friends come and go. Family most of the time stays. Choose family.
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Today, one of the ICU wards has been emptied for COVID cases in HoSHAS. HTAA dah tak boleh tampung the increasing numbers. Its real guys. COVID is not tipu2. If you were thinking its gonna end soon. Nope. We are far from reaching a HERD immunity yet. It ll at least take ~3 years.
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I cant believe i am going to say this. It is sad, cause i have always tried to see good in being a Doctor. Now, if you are still deciding on what to be when you grow up, please exclude being a Doctor in Malaysia. It is a noble job, but it is not worth it anymore.
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Severe Hypertension
Hypertensive Urgency
Hypertensive Emergency
Reference: CPG Management of Hypertension 5th Edition
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You wont see much difference now, but when the 60 year old Specialists start retiring and the new generations start quitting producing little to no new Specialists, long term prognosis: UNGUARDED.
MOH: Over 500 contract doctors resigned between Jan and Nov
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Dengue Fever
Reference:
- CPG
- WHO
- Nota masa medicorp dulu
- Dr Amalina (follow her telegram)
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Neurological Cases
Reference: Dr Muhammad Naimuddin's short case examination, CPG, Harrison's
1) Case: Hemiparesis
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I cant believe i actually cried a little because everything is so overwhelming. I am exhausted. Tomorrow i am having oncall again. Next month 2 MOs are leaving. Some others might leave as well in June if they dont get permanent post. We are lacking of MOs. Which hosp isnt?
Kepada YBMK
@DrZalihaMustafa
, saya fikir isu BIPK bukanlah prioriti buat masa sekarang.
Jika mahu buat kajian menyeluruh, buat kajian mengenai Elaun Oncall terlebih dahulu, isu itu lebih mendesak.
BIPK seharusnya tidak disentuh buat masa ini. Jaga kebajikan staf KKM.
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In a workplace, tak kisah medicine ke tak, you ll get exhausted with not just the work, but the toxic environment as well.
1/ In medicine, your work starts at 7 am, but you got to be in ward by 6 cos u will need to review pts dulu. A
So why did you take medicine in the first place if you're going to complain for being exhausted and tired all the time? Why not give the space you took in medicine to those who are willing to do it all and take the exhaustion as happiness? Be grateful.
#selfreminder
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Nephrotic Syndrome in Paediatrics
- Nota impromtu
- Reference from Paedas Prot, Dr Amalina Telegram, ncbi
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I am not saying i m a great doctor, but at least i am sincere in treating my patients, so for patient’s mother to complaint about me to the hospital and KPM for not allowing AOR discharge, and the need for me to explain my self in a meeting, i was definitely taken aback.
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Anemia in Pregnancy
Reference:
CPG
Sabah Obstetrics
RCOG
NICE guideline
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Hypertension in Pregnancy.
Reference, CPG Hypertension 5th edition
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Pneumothorax
Reference:
- BMJ
- NCBI
- Harrison's Principle 19th Edition
- British Thorax Society Guideline
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Faham kalau nak marah first posters kalau dia org buat salah. Tapi tak faham why need to make them feel like they are useless. Tak faham mindset taknak kerja dgn first posters. All of us used to be first posters kan. Ke ada yg start HO being senior poster? 😏
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Out of 8 MOs in my department, only 3 were appointed as Permanent Doctors. The other 5 MOs, mind u, are all great, 3 of them are even seniors.
This is scary... next interview will be my turn inshAllah, may Allah ease me in the future.
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SHOCK: How to manage hypotension and tachycardia.
Multiple refrences: Sarawak Handbook, WHO, Medicorp, Amalina Nudin (Cerita HO: Join this telegram!!), researchgate, bmj)
Cukup kut nota ni je.
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Approach to seizure (Paediatrics)
Pray i find back my tagging sheet 🙏
Reference:
1/ Paeds prot 4th ed
2/
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Berbaloi ke jadi Dr?
I dont think i am a right person to answer that as baru 6m jd Dr. Tapi in today's economy, the answer will be No. U work ur Axx off, come to work at 5am, go back 10pm, berlari sana berlari sini, toxic env...
But cant deny the satisfaction u will feel-
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Simogyi Effect and Dawn Phenomenon.
Need to consider this before adjusting patient's insulin dose.
Reference: medscape.
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Malaria
Reference:
1. Management Guideline of Malaria in Malaysia 2014
2. WHO
3. Medscape
4. Sarawak Handbook of Medical Emergencies 4th Ed
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Respiratory Cases
Reference: Dr Muhammad Naimuddin's short case examination, CPG, Harrison's
1) Case: Exacerbation of COPD 2 to Pneumoa
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The next notes are on Ovarian, Endometrial and Cervical Ca. Not mine, made by our UIA seniors (we dont exactly know who, may Allah bless them) approved by Prof Hamizah. Hopefully nampak la...
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Positive prrssure ventilation
- Introduction and Terminologies
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Transport of critically ill patient by Dr F. Its a simplified version. Quite easy to understand.
Mnemonic: ACCEPT D
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Infective Endocarditis
Modified Duke Criteria: Remember 2P ENDOCA and FIVE Minor
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ABCDE
I am making these notes because i want to be able to answer initial management without hiccups anymore.
References: WHO and ATLS 10th Edition
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Why do parents always change HOPI when it is Specialists turn to ask them? To be honest, it is really annoying and rasa malu cos Specialist will think we didnt do a proper history taking. Sekian.
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Jangan amik Medic kalau rase this profession is elegant with great future. Boleh ambik kalau betul2 minat no prob, provided u r able to take the risk of paying for masters/external exams on your own. Jadi doctor is not equivalent to jadi kaya. But, Medic best je ❤.
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I just really2 hope this new Gov will do something about KKM doctors. My mother who used to be the only supporter, the one asking me to hang in there all these years, have already asked me to quit, multiple times.
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When lab rejects your FBC 3x in a row saying its “clotted”, so you got to make a video showing how “not clotted” it is!
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Acute appendicitis, principle of mx, mx in ward, how to prepare patient for op and how to discharge.
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We need more gov hospitals, we need more staffs (Dr, SN, MA, pharmacist,… name it), we cant afford to lose anyone anymore.
It is common sense.
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I cant believe i actually opened up and cried out loud like a freaking baby to my father… I am so tired… tomorrow EOD oncall again (Friday and Sunday), and this weekend will be my 3rd weekend with no off, 3 weekends no off in a row… and i was oncall (EOD) during CNY…
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@AdDien90
Working in medical field, there were many times, patients were told they were allowed discharge the next day, even the next hour, but end up losing their lives within a second. Life is so uncertain. U just never know when will your last breath be. Appreciate and cherish it more.
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Whether or not this profesion has a good future, i am not sure. When i wanted to become a dr, during my childhood days, the future seem bright. Now that i am a dr, future seem dull, especially in gov sector. But again, future is just so uncertain. I am just gonna go with the flow
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So frontliners kerja masa covid (mmg takd work from home), treat patient covid, bujang so jadi first choice kena hantar sabah sarawak jadi MO covid, last2 rm100 pun tak dpt. Yg dpt, lanjutan kontrak. At least bagilah jawatan tetap. Sampai bila...?
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One of the reasons i wanna leave Sabah, is because of how expensive these tickets are. Its like going overseas. And NO, doctor’s salary isnt RM11,000!!!!!! It is not worth it becoming a Doctor in Malaysia.
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Stop expecting Doctors to be heroes. We are not, we r just normal people, who have their own lives, who struggles like everh other human being. We get sick too you know. Stop praising and thanking us for what we are doing, just increase our salaries, that ll do it!
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Composition of different fluids.
Penting ni! Especially Normal Saline and Hartman. Boleh masuk soalan Assessment.
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Traction in Orthopedics
(Pls pray my assessment goes well)
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Stoma
Cari2 nota pro exam terjumpa ni. Ada definition, types of stoma, indication, complications, how to examine and SCRIPT. Ingat: Some Naughty Surgeons Never Stay in the Evenings and Like Porches.
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I don’t really know her but how will she be able to understand the working dynamic of a Contract Doctor? KKM lead by someone working in GP? I hope it is for the best…
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Now, if i pass my interview and dapat permanent, i ll do Medex, if no then MRCPCH. Either way, need to stay positive. Opportunities are gonna come your way. Need to have sincere heart to do something. Need to keep moving forward. Need to keep swimming, keep swimming.
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Death
Sexual harassment
Mental torture
They cant leave the job, leaving means quitting. After quitting, they wont be able to practice as medical doctor. They ll have to start over if they want to work somewhere else. It's different.
Toxic environment ini terjadi di mana-mana; bukan hanya institusi kesihatan. Boleh baca jawapan2 tweet ini.
Saya agak pelik, nampak macam yang diviralkan hanya institusi kesihatan. Kenapa agaknya ya?
Jom kita sama2 bangkit; sebagai rakyat Malaysia. Semua bidang.
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Instead of 2 MOs, 3 MOs leaving…..
And apparently no more “oncalls” 🙃…. So after 5pm, who is going to attend patients?
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Nowadays i make sure i recite these prayers everyday whether i am working or not. May Allah ease everything.
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So, apparently, now that i am tetap, i am not really tetap yet. It ll take minimum of 1 year for them to “Sahkan” my tetap position. After disahkan, i will have to wait another 2 years, only then i can get to apply to transfer back to Semenanjung, which will take God knows how
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Its enough HO dont get enough leave or time off to spend with family or friends, to freeze leaves? We need the leaves, we hardly even go out, its for us to rest, lay in bed all day doing nothing. Ya, some of us spend our leaves like that. Oncalls can be mental torture 😭
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Contract Doctors
No place for Masters Program
No place for Locum
Basically no certain future
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Hartal Doktor 2021 HoSHAS. Congratulations to all yang join. It was indeed a peaceful event, no chaos, no riot. Alhamdulillah.
Tetap, bukan kontrak.
#blackcode
#HartalDoktorKontrak
#HARTAL2021
#PerhimpunanAman
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Assessment today. Anyone reading this, plsss pray i ll pass it and will be able to move on to the next posting. Ameen.
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Acute Coronary Syndrome. Post sbb ada yg mintak (taknak post actually sbb tulisan like 😫)... This is just compilation of notes from telegram medical groups. Credit to the original people! Double chk pls sbb ada yg salah.
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Head Injury and Chest Trauma
P/s kalau tau jawapan isi tempat kosong tu, jawab pls 🤓
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Masa medical student dulu, Our Psychiatrist lecturer, Dr Nizam used to talk about KOLAM HATI.
Hati ni kolam, setiao hari tambah air (stress), at one point, penuh, so air yg berlebihan tu akan menyebabkan mental illness, so jangan penuhkan air Kolam Hati, bg melimpah keluar 😜
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Hernia + Hasselbach Triangle (typo ejaan dlm nota; ampun)
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I love Paeds but staying far away from my support group (family and friends) is making it easier to leave KKM and join GP bcos once ur in Sabah, its hard to be posted back to Semenanjung. I just really2 wish KKM would just accept to post me back to semenanjung.
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And RM200 for an oncall is not fair as well. Even if it is a 24 hours oncall, that is like rm8 per hour. Yes, RM8. The least u get for locum is rm35 per hour. And if it is a weekend or public holiday, u just get extra RM20 (making it RM220 per day).
Isu oncall MO ni, pun perlu perhatian serius. Kepada ahli jawatankuasa HWCITF, kaji kembali oncall MO.
Cadangan saya, jika MO tersebut oncall, MO dibenarkan pulang pada jam 8 pagi keesokannya. Jika ada keperluan untuk round pagi, tak cukup staf, jam 12 pm sudah boleh pulang.
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Midnight thoughts:
The truth is, you ARE alone. No one is going to come and save you. Everyone is thriving. Everyone is the main character of their own life. Those embarrassing moments you had, others had it too, no one is talking about it anymore.
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Is anyone else having issues with MAE? I am not able to login. And i cant reach Maybank customer service.
@MyMaybank
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Will anyone be interested in Space (by twitter) related to HO-ship? I do know many of you out there who wants to know more about HO-ship. But, how the Space ni work pun i tak tau sebenarnye haha.
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Orthopedic notes
.
.
.
Sorry spam notes jap kat timeline korang.
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The simplest version of UGIB and LGIB notes. Just to give an idea on what to focus.
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Paeds Hypoglycemia
This is just notes from paeds protocol that i keep in my pocket. Was not planning to post but i lost this for few days and i dont wanna risk it again 😅
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I just love my work, love my specialists, love my department. I just hate that i am far away from my family, hate the working hours, hate the underpay situation.
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Case: Fast Atrial Fibrillation
Noted by SN, patient, 84 y/o, Imp mmsa bacteremia, recently intubated due to episodes of desaturation, developed tachycardia up to 170 bpm.
Attended STAT. BP supported on ivi norad 0.2mcg, HR 160.
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Knowledge can be improved, attitude will either make you or break you.
For all new houseman out there, be eager to help out with new cases, procedures, tasks. Be more present. Dont run away. Believe me, it will help you so much in your long run as a doctor.
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So yea, bukan tak sayang kerja, sayanggg sgt. Tapi complaining or venting about it sometimes help release our stress. Nak taknak kena teruskan tapi if venting helps, better do it than to keep it inside.
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That is a wrap as a HO and Floating MO in HoSHAS!!! It was a good run.
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Sometimes all i want is to start over, to have a new identity, go somewhere no one knows me, leave everything behind, but life is unfair.
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Disclaimer for those planning to be a Doctor. If you are doing it for the money, you will regret it unless u r in private sector.
Example, oncall claim in Gov Hosp:
- Oncall for 24 hours dapat RM 200. Do the math, around RM8 per hour.
Advantage in Gov, EXPERIENCE.
These kind of headline makes my blood boil. Ingat doktor fikir duit je ke?? kalau ye, die tak pilih jadi doktor lah.
Look at how Malaysia treats their doctors. Wake up and stop saying doctors are migrating sebab “dipikat tawaran lumayan” 😡
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NNJ based on duration
Also was not planning to post but taknak dia hilang lagi
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