懒人一个

从来没有那么懒惰过...
几个星期没有读书，不想翻书...
有违良心，但也不理了。

从昨天起，不想去医院了...
supervisor放假去了，
最后一个assessment做完了...
我自由了!!!

懒人还有其他很多顾虑:(

当人心渐凉

上个星期最脍炙人口的新闻莫过于中国佛山两岁女童被车撞倒后，躺在血泊中，经过的十八名路人没有一个肯伸出援手。从闭路电视中看到他们绕女童身边而过，并没作出任何惊讶的反应，像当作没一回事。
这段影片看了让人心寒。

即使只是看见有人跌倒，人的本能不就是会慰问以下“你还好吗？”怎么看见一个人受伤躺在路中央却可以挥袖离去？再怎样，如果你怕血，不懂该做什么，也总知道停下打电话叫救伤车吧！

后来读了一些相关报道才发现原来中国曾经有案件，帮助伤者反被伤者诬蔑，然后得赔医药费。种种的原因，让想做好心人的人都却步，害怕惹事上身。

想起六年前我被掠匪抢劫的事件，跌破了头，流着血，朋友赶紧到附近的住宅找人来帮忙，一位好心的叔叔开车把我送进急诊室。那时候，我觉得社会再怎么险恶，我都相信会有好人存在。只是，那是六年前了...

人心，渐凉了吗？

天才冲冲冲 - 神鬼任务

搞笑到...

Gotye - Somebody That I Used To Know (feat. Kimbra)

No.1 hit song on Fox FM...
like the rhythm so much!!!
And the MV is sort of cool :)




Now and then I think of when we were together
Like when you said you felt so happy you could die
Told myself that you were right for me
But felt so lonely in your company
But that was love and it's an ache I still remember

You can get addicted to a certain kind of sadness
Like resignation to the end
Always the end
So when we found that we could not make sense
Well you said that we would still be friends
But I'll admit that I was glad that it was over

But you didn't have to cut me off
Make out like it never happened
And that we were nothing
And I don't even need your love
But you treat me like a stranger
And that feels so rough
You didn't have to stoop so low
Have your friends collect your records
And then change your number
I guess that I don't need that though
Now you're just somebody that I used to know

Now and then I think of all the times you screwed me over
But had me believing it was always something that I'd done
And I don't wanna live that way
Reading into every word you say
You said that you could let it go
And I wouldn't catch you hung up on somebody that you used to know...

But you didn't have to cut me off
Make out like it never happened
And that we were nothing
And I don't even need your love
But you treat me like a stranger
And that feels so rough
You didn't have to stoop so low
Have your friends collect your records
And then change your number
I guess that I don't need that though
Now you're just somebody that I used to know

I used to know
That I used to know

Somebody...

Woman on the Road

Beware! I will be driving =)

急诊室

快刀斩乱麻又不可以遗漏任何一点，
急诊室的工作不适合我。
可是，学习是不错的经验啦 =）

First Suturing

On ED rotation now...finally got to do suturing on a real person!!! As usual, I felt bad for the patient, but thanks for the sacrifice...god will bless you :P

6 weeks away from being an intern, I will have to admit that it is a bit late...ah well...Really grateful to the registrar, who waited for me to come out from another patient's cubicle and offered to let me do the suturing. Before we went in, he got a suture set and a tissue box for me to briefly practice the knots.

I was thinking if I should get consent from the patient...and my answer was hell no (dont lecture me on ethics...)...unless the patient really screamed refusing me doing it...

It was a 23 year old guy who accidentally lacerated his middle finger while fixing his mountain bike. There was a flap of flesh over the PIP joint, bleeding profusely. The registrar supervised me doing a ring block and then suturing.

I decided that it wasn't a good idea to tell the patient that "Hey, you are the first patient that I suture...but don't you worry coz I have good skills in sewing!" So I just did whatever I needed to. 3 stitches done, bleeding stopped. Amazing!!!

The patient took a photo of his wound and the stitches with his iPhone. I bet you it is on FB somewhere...haha!

A consultant...

A consultant is someone who only has to come to the ward once in a while to take the bradmas of private patients and then 顺便 does a brief wardround by saying hi to patients.

A consultant is someone who sits at the corner throughout the endoscopy list, playing Angry Birds on his iPhone/window shopping on eBay whilst the registrar is busy scoping. He then 拍拍屁股leaves at 4pm, whilst the registrar is still scoping the last patient.

A consultant is someone who accepts essentially any patients referred to him on phone, wrapped up nicely with a "gastro" story, without thinking much...whilst the registrar is frustrated, "Who said this patient comes under gastro? No one told me about it!"

包你听得懂的印度歌

好有趣的一首歌，黄明志又再创造惊喜了！

飚高音有新歌了

星光七冠军 - 铁肺女王 李佳薇

《煎熬》

太棒了！



期待正式的MV

25 ways to wear a scarf

Have a try...
But it might be a little too late as winter is over...

国庆日

没有假期的国庆日，
就像其他的日子一样，
很容易被淡忘。

祝你生日快乐！

当冬夜渐暖

扣人心弦的一首歌。
藤井树的词，
孙燕姿的声音。

中文电台

突然有点想念中文电台。
上网听988，
好像又回到了在家读书的感觉。

http://988fm.listen2myradio.com/

做好心理准备才听

刘子千是鬼才刘家昌的儿子，最近出了一个专辑，主打歌《念你》引起了很大的回响。网友大量批评他的唱腔，大量创作恶搞短片放上YouTube，这首歌也因此红翻了。
歌词琅琅上口，简直家喻户晓。
除了有点刺耳之外，其实还不错。不需要骂到酱吧！

我看我学我做

遇到很好的医生，
学习他的态度，
记得然后付诸于行。
geriatric有很多这样的医生。

阅人

阅人是一种技巧。
自己仔细观察，然后心里有数。

今天阅到一种人，
他会尝试说服你，让你掉落和他一样的等级，
那别人就看不见他的弱点。
我知道他不是故意也没有藏坏主意，
那只是本性，
让他在社会里生存的一种本领。

名字

我的名字很少人会记得，尤其是洋人。因为那个发音是完全无法和任何东西联想起来。我没有怪他们。但也坚持不要取一个可以让人琅琅上口的洋名。
我曾经把名字切成一半，让他们叫我"Yeu"，但也闹出很多好笑的事。
比如说：“Hey,Yeu!”（Hey you!)听起来很没礼貌。
或者A told B that I was going to do something.
A,"Yeu was going to do that."
B,"Me? I didn't..."
A,"No, not you. I meant Yeu."
后来我决定了，还是全名好了。

曾经有个病人，我帮她放一个打点滴的针，然后跟她解释一些她的状况。她很善意地记起了我的名字，甚至隔天都还记得。我感动极了...

我的respiratory registrar，geriatric nurse，花了最少两个星期来记得我的名字。刚认识他们的第一个星期，他们每天都给我叫不一样的名字。有一天终于叫对了！

有件奇妙的事，友望告诉我，在DD 的registrar，竟然屡次把她的名字叫成我的名字。这真是破天荒啊！她问我说我究竟在DD做了什么惊天动地的事。

但我还是常觉得我的名字好酷...哈哈！

温馨的爱情故事

老婆婆大小便失禁，神志有点不清，说话含糊。
老公公在她身边，
笑说：“我听不懂你说什么！”
老婆婆嘟起嘴，然后笑笑。
老公公也笑了。

老婆婆两年前中风了两次，原本已在康复中，
有天突然情况急速恶化，
原本说话只有小问题，突然听不懂她要表达什么，
原本只有小便失禁，突然大便也失禁。

老婆婆要被送去做脑部扫描时，
他们还嘴对嘴亲了一下。

好幸福的画面。

在aged care，很少看见那么老还有个健康的老伴，
还依然那么幸福。

Geriatric Rotation

Just entered a whole new world of geriatric. Interacting with elderly doesn't require much skills but just patience. They are generally nice. Once you sit down and have a chat, they can tell you what happened to them 50 years ago. Not very helpful in terms of history taking but no harm listening to their stories since my rotation is quite relaxing. I talk to one patient each day, so at the end of my rotation, I will have gathered about 30 life stories. Unfortunately, most of them will be sad or unfortunate stories...about terminal illnesses, lacking family support, loneliness, neglect...Most of them always smile and get very excited when they talk about their children and grandchildren. I guess the memories are what keeping them going, especially when they are sick.

干净。有可能吗？

看到面子书朋友们po的Bersih 的“和平”抗议，就知道什么叫做贼心虚。人家要和平抗议一下，就阵脚大乱，动用武力。
听听我们的minister怎么对外说：


He said, "Our police has succeeded in handling them gently, right?"

一个特别的际遇

上星期接触一个很特别的病人。他是一位聋哑人士。所以拿病历都是通过纸与笔。我写一句，他写一句。
五十五岁的他，是我在这短短六个星期内，第六或第七个肺癌病人。他满脸胡子，胡子上和手指都有明显的尼古丁痕迹。他也是我的第一个pleural tap的病人。我的registrar当时还开玩笑说，给我找了一个“好病人”，又聋又哑。他今天出院了，将由肿瘤科接手。
不幸的事，发生在幸运的人身上叫不幸。不幸的事发生在不幸的人身上，那叫什么？

医院里，病人来来去去。
有时会很好奇他们后来怎样了。
希望他接下来的治疗会让他好起来。

五个病人的完结篇

第一个：老老的公公，右肺积水，抽取组织化验是肺癌。在医院只呆了两个星期就去世了。
第二个：不算很老的公公，pulmonary fibrosis，一次肺部感染就被击垮了，每况愈下。从每天可以对我招手打招呼到呼吸困难，连话也没办法说。上个星期也走了。
第三个：老老的公公，COPD 进来时情况已经很糟，respiratory failure，进院隔天就去世。
第四个：不算很老的公公，没有朋友，没有家人。进院因为呼吸困难，切片扫描看见有不妥需要抽取组织化验。在还没来得及进一步去检验，突然不省人事，送入深切治疗部，过了一个星期，没有好转，上个星期也走了。
第五个：老老的婆婆，没有家人，最终我们找到了她的一位老老的朋友来看她。COPD 病入膏肓，只能够palliate她。今早走了。

短短的几天走了五个病人，
虽然死亡并不是好事，但对这些病人而言，是很大的解脱。
呼吸不了但也断不了气，是一个很痛苦的死亡过程。
如果你看过这些病人怎么痛苦，你不会想拿起一根烟。

找工作的故事

折腾了一个月多，
今天终于告一段落了！
终于可以不必再重复那美丽的谎言了！
我的良心可以回来我身边了。
我并没有我口说中那么好，
我只是要一份工作。

一切已尘埃落定，
更艰巨的路在前方。

肺科病人的故事

病房里有个二十八岁的华裔病人，肺积水入院，原本怀疑是肺结核，但组织化验结果竟是小细胞肺癌。
病人一向身体无恙，也不抽烟。这对他来说一定是晴天霹雳。
作为旁人的我，目睹主治医生告诉他真相的当儿，我屏着呼吸，心跳加速，深怕多吸一口气都会让他觉得更难过。
我们比较容易接受老人生病，人到了一定年纪体内的机械一定会当机，那是正常的。
我们比较容易接受吸烟的人得肺癌，认为那是迟早的事，不需要惊讶。
相比之下，健康的年轻人生病，我们会觉得特别难过。
我最不能接受的就是看见无知的小孩生病。我宁可远离他们，当作我没看见，当作我不知道小孩会生病。

每个在肺科病房的病人，每口呼吸都在挣扎，
真的重复又重复地提醒我：可以正常的呼吸真的是很幸福。
很可惜，人总是会为了物质或精神上的烦恼而忘了这些提示，
甚至会觉得，若我得不到我所追求的，能够顺畅的呼吸那又怎样？
我可以担保，病房里的那些病人，会宁可放弃所追求的一切来换取正常的呼吸。

听Mat Salleh 用马来话说 Lynas 的故事

观后感言：昏君当道，民生潦倒。鬼佬的马来文比我好。

泼辣女人的故事

话说有一天，我在一家餐馆吃晚饭。隔壁桌共有五位中年人，二男三女。

突然，其中一位女的说：“饭都快吃完了，怎么我们的卤鸭还没来？”于是，就招了个侍应过来。

侍应来到，恍然发现卤鸭已经卖完了，却漏了给这一桌上这道菜。就道歉说卖完了。

其中两个女人，你一句我一句像在唱戏的，调高音量，引起了周遭的人的注意。
女人说：“我们就是听别人介绍，冲着吃你的卤鸭来的。你的服务怎么可以这样？我们快吃完了饭，才告诉我们卖完了？”

侍应有点不识嘴脸地说：“可是就真的卖完了，那你到底想我怎样呢？”

那两个女的，听了更气急败坏。狰狞的脸孔也出来了。重复地说着是为了吃卤鸭才来的。

“不如我送支红酒给你好吗？”侍应尝试赔罪。

“我们不要红酒，我们已经有酒啦！”

在这个枪林弹火的过程，那两个男的，不断地在扒饭，甚至整个碗都快盖住脸了。一句话也没说。有点像母狮子在外猎食，雄狮懦弱地在等吃。看了颇好笑的。

我想，以我的个性，我应该永远都做不出这两位华人女士的“我是顾客我最大”的态度。而且如果我是同桌的话，我会想找个洞钻进去。

心里总觉得，留一线，让人下台会死啊？
然后再补一句，或许他上菜的话你今晚会被鸭骨啃死呢！

有个医生这样说

For Future Doctors: General Misconception of being a doctor PART 1
November 11, 2010 by Pagalavan Letchumanan

1) Guaranteed Job and Good salary/can make money

Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already.

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

2) Medical degree recognition

If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from.

3) Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4) Hard work and post graduate training

20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG - Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1) Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2) District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.

Next: Postgraduate training…………………

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 3)

Let’s look at the postgraduate training in Malaysia. I have written about housemanship, district/rural postings and problems of oversupply of doctors in the near future. The issue of oversupply of doctors by 2015 will lead to another very big issue: postgraduate training. Many of the budding doctors and medical students are not aware that the postgraduate training in Malaysia has many limitations and problems. At this point of time, most postgraduate trainings are dependent on Master’s programme conducted by the local universities. Once upon a time, we were totally dependent on UK-based exams and training but unfortunately we lost it along the way. Currently, only MRCP (UK) – Internal Medicine, MRCPCH (UK) – Paediatric and MRCOG (UK) can be done in Malaysia. FRCS (for surgeons) used to be available to Malaysians but not anymore. None of our hospitals are recognised as a training centre for FRCS, which is now known as MRCS. Thus, for any surgical field in Malaysia, you will need to do Master’s programme!

MRCP (UK) – Internal Medicine

Membership of the Royal College of Physicians (UK) is a well-known exam all over the whole. It has a very strong reputation as an entry exam for speciality training in UK as well as in other parts of the world. It is conducted regularly, usually 3 times a year in various countries. Malaysia is one of the centres for the MRCP exams, all 3 parts.

MRCP Part 1 can be taken about a year after your graduation. It is a theory paper. After passing your Part 1, you need to clear your Part 2 (written paper) and Part 3 (clinical) within 7 years. It is usually coordinated by University of Malaya, where the exams are usually held. Just for your info, the passing rate for MRCP (UK) is always around 45-50% worldwide! You need to have a proposer to sit for these exams, who can verify that you have undergone sufficient training to sit for the exam. If you fail miserably, your proposer will be notified.

Since MRCP (UK) is not a specialist exam in the UK, the Ministry of Health, Malaysia only recognises and gazette’s you as a specialist after undergoing further training of 18 months post MRCP (UK). You will need to submit a log book and recommendation by your HOD before being gazetted. This rule applies for all other overseas degrees which include MRCPCH and MRCOG. You need to undergo this gazettement process in order for you to be recognised as a Physician by the National Specialist Register (NSR).

MRCPCH (UK)

MRCPCH is similar to MRCP (UK) but meant for those who wants to become a Paediatrician. It‘s examination structure is similar to MRCP (UK).

MRCOG (UK)

MRCOG has 2 parts but the second part has both written and clinical component. However, you need to undergo training in O&G department for at least 4 years before being allowed to sit for Part 2 exams. One of the major issues in sitting for MRCOG is the fact that there are not many MRCOG holders in MOH to sign as a proposer for you!

Master’s programme

Now, this is where a big problem is going to appear soon. For all other fields, you are totally dependent on Master’s programme. This includes all surgical fields. Master’s programme is a fixed 4 year programme.

In order for you to be eligible to apply for the Master’s programme, you should have completed at least 3 years of service with good SKT marks of at least 85% and above, recommendation from Head of Department and confirmed in service. You also need to attend an exam or an interview before being selected for certain disciplines.

The major problem that I foresee in the future will be the number of places that are being offered. As of this year, the total number of places available is only 600, all disciplines included. Imagine, with 6000 new doctors coming into the market every year from now onwards, only 10% is going to get into the Master’s programme annually. Furthermore, you must understand that the selection process is never transparent, the typical Malaysian scenario as well as the quota system! Most of it is done by the Universities.

The government is planning to increase the number to 800 next year but the situation is rather critical in the Universities as there are not many Senior Professors to supervise the programme. I must say that the standard of Master’s graduates have dropped significantly over the last 5-10 years. We have Master’s graduates who can’t do surgery but have passed the exams! I just hope that the Master’s programme do not become another “specialists mill” like our undergraduate medical schools!

There are 2 types of Master’s programme, the open and closed system. In the closed system, you will do the entire 4 years within the university, like in UKM Hospital, UH and USM Hospital. The open system may have various programmes, like 2 years in MOH hospitals and another 2 years in the Universities etc. You may even do the entire 4 years in MOH hospitals for some of the fields.

After completing your Master’s programme, you need to undergo another 6 months of gazettement process before being recognised as a specialist. Furthermore, you will be bonded for 5-7 years for receiving scholarship during the programme, which is compulsory!

Subspecialty training

With the advancement in medical field, every discipline now has subspecialty training. As such, everyone will try to do certain subspecialty after gazettment as a specialist by MOH. Generally, the subspecialist training is about 3 years except for certain field like Cardiothoracic and Urology which may take 4 years. Again, whether you get a place or not depends on availability of post and demand for that particular field. For example, the waiting time for Gastroenterology training can even go as far as 1-2 years.

Recently, to overcome this major problem, MOH has taken another step backwards. You can only apply for subspecialty training 1 year after you have been gazetted as a specialist. For MRCP holders, this means 2 and half years after passing MRCP (UK)!

Usually, the subspecialty training is divided into 2 parts, the first part (the first 2 years) will be done locally and the 2nd part (remaining 1 year) will be done overseas. The MOH will provide a fully paid scholarship for overseas training of 1 year but you will be bonded for 3 years. If you have received undergraduate scholarship and Master’s scholarship, you will be bonded a total of 20 years in service!!

Singapore

One good advantage that we have is Singapore. Unfortunately, only UKM and UM undergraduate degrees are recognised in Singapore. Our Master’s degrees are NOT recognised elsewhere. Thus, we would not be able to work in Singapore with any other medical degrees or even with our Master’s degree.

However, Singapore does recognise MRCP, MRCPCH, MRCOG and MRCS. Thus, if you have any of these degrees, it supersedes the undergraduate degree and you should be able to get a job in Singapore. Singapore is also a recognised centre for MRCS Part 3 training, which you can’t do in Malaysia. So, if you have MRCS Part 1 & 2, you can go to Singapore to finish your MRCS training and sit for the Part 3.

I must say that Singapore’s postgraduate training is more structured and organised with their BST (Basic Specialist Training) and AST (Advanced Specialist Training) programmes. I have written about this in my MMA article “Back from the Future: From 1st world to 3rd world”.

For all of you out there; budding doctors, medical students, houseofficers and medical officers; the future is very bleak for the medical field in Malaysia. The oversupply of doctors will get to you sooner or later. My advice to those who insist on doing medicine for passion is to choose an undergraduate course that is recognised internationally. Then, pursue a postgraduate degree that is also recognised internationally. If not, you will end up with a lot of frustration in the future. Jobless doctors in the future will be a reality!

读后感言：
由于本人现在不是一个很有大志的人，所以他所说的我都觉得还好啦。每个人都会有自己的故事，我们不需要一定要跟着别人设定的道路走。可是人会变，万一有一天我突然有大志却无法得志，我会怨吗？
哈，幸亏Monash是受别国承认的=)应该感到幸运。

出卖

此出卖非彼出卖，
此出卖是要把自己卖掉，
把自己当一个商品介绍然后推销给医院。

该怎么卖？

我对着电脑发呆...写不出来。

I dont want to grow up

I have never had such a strong feeling against growing up...
Maybe because now studying has almost come to an end,
and there is no more time to avoid thinking about working.

Yes I am, in denial.

OMG, I am grieving =(

电影：The Notebook

明知道故事是很老土的情节，
明知道看下去就还是会哭，
然后还是看了，
所以还是哭了。
傻瓜！

*好感动*

The paediatric consultant

I had my assessment with Dr. Graves yesterday.
He asked me a couple of questions about the rotation,
thanked me for choosing their specialty as an elective,
and thanked me for doing some of their jobs.

So he wrote on my report.
While he was doing so, I tried to formulate in my head my final/ ultimate question.
"I am trying to get a job here..." hmm...that doesn't sound quite right,
"I am in the process of applying for a job here and I need a reference, can you be my refree?" That...sounds like a proposal...
"I am in the process of applying for a job here, can you give me a reference?" This sounds better and direct. I practiced the sentence in my head.

"Ok, done."
When I was about to say THAT sentence,
he continued,
"If there is anything that I could help, it will be giving you a reference. Just make sure you establish direct contact, i.e. call me, because I don't always respond to email. In future, if you need something more than the online reference, I am happy to do it. You know my contact."

First thing that came to my mind,
"Wow! Where got consultant like that one?"
Second thing that came to my mind,
"Thank you...really really do..."

Gosh...I miss paediatric developmental disability!
I met lots of wonderful people there. The paediatricians (Dr. Graves, Sabine, Dr. Fullerton)and the registrars who are keen to have students (Czarina, Jasuina, Svatslana, Julia and Talia...haha they rhyme), the psychologists who are always smiling and warm(Crystal, Nicola and Jane), the speech pathologists whom I never really spoke to but they are very good with kids, and the ward clerks in the clinic.

Daniel said, "You girls are always like this, miss every rotation that you have gone through!"
I said, "Nope, only if the people of the team are nice."

The colorectal team is asking to go out for Peking Duck gathering again...haha!

身不由己

终于看到一个有Prader Willi Syndrome的病人。
身为医学生我感到兴奋，
身为一个人，我为他感到难过。

他现在的体重是119kg，曾经一度190kg。
每天必须要克制食量，做运动。
但这并不容易。
因为这个病，他会不停吃但不会感觉到饱。
因为肥胖，走动也很难，更别说运动。
也因为肥胖，任何跟肥胖有关的疾病也尾随而来，
所幸的是他还没有患上糖尿病，高血压，不过这是指日可待的事。

有时侯看见各种不同的病人，
会启发很多想法与感想。
像这个病人就让我觉得，
很多时候事情不是表面那么简单，
很多时候别人也是身不由己。
就像肥胖不一定是因为贪吃不运动，也可以是因为生病。

昙花一现

三年前，买阿掌的时候，有想过它到底会开什么颜色的花。
三年后，终于知道答案。

白花

而且是日落后才开的

伫立在窗前

第二天就已经撑不住了，必须用花瓶来支撑它

阿掌的花，只是昙花一现，很可惜。
就像很多的生命，
有些人没有绽放过，无疾而终。
有些人是昙花，一夜精彩。
有些人是塑胶花，永垂不朽。
而，更多更多的人，是慢慢地绽放，慢慢地接触这世界，然后再慢慢地枯萎。
是平凡，也是快乐。

命运。运命

命已在掌心，无法改变。
怎么去运命，仍然操纵在你手里。

我接受唔到咯！

想像一下，
一个五十岁育有二子一女的女人，
孩子已经二十几三十岁，
她离婚了，
然后遇到一个好男人决定要一起生活。

没问题，我觉得这是可以接受的。

妙的是，
她想要再生一个孩子，
科技发达，试管婴儿可以让她梦想成真。

虽然我觉得以她的年龄会有一定风险，但这并不是无法接受的。

更妙的是，
她用的精子是现任老公的，卵子是她女儿的。

我接受唔到咯！
说我思想老土也是酱的啦！

生命力@窗台

这棵仙人掌在我的窗台住了三年。
今年阳光多，加上我不小心淋多了水，它长出了个小幼苗。
小幼苗的生长速度不可思议，短短的几天已经超过十公分。

窗台上，除了有个不断摇啊摇的太阳能“摇摇”，
现在还有个静静地，默默地，努力在生长的仙人掌。
它会开出一朵花吗？

你家有过动儿吗？

他没有办法静静坐下，
他就是会不断地走动，跑，爬高爬低，不断地说话。
他没有耐心等待，
还没轮到他他就已经抢先做，
还没问完问题他已经回答，
他会很常打扰或闯进别人正在进行的活动。
他很粗心，
他记忆不好，
常弄不见东西，
没有专注力，
跟他说话是他好像没有张开耳朵，
他没有办法完成指令，
他讨厌，不想做需要用很多精神的事情，所以他不做功课。
他很容易被周围的琐碎小事吸引。

他有
用不完
永远不会完
没完没了
的精力！
但这些精力都用在不恰当的地方，而且他在学校的学习能力也因此严重地受影响。
除了改变环境和态度，
他需要药物的协助。

酷！

搞笑得有意思

典型的asperger

A Helpful Website for Paeds

I came across this website when I was google-ing for some pictures of dysmorphic features.
The photo gallery is quite helpful, especially for describing findings for newborn exams.

Disability at a glance

Sitting in the clinic for a day, I came to a conclusion.

First class disability:
physical disability or severe mental retardation (eg blindness, congenital diseases that cause physical disability and mental retardation)
You earn sympathy. Your parents earn respect for taking care of you. People will try to help you and try not to discriminate you. People forgive you for whatever you can't do or did wrong.

Second class disability:
moderate mental retardation, no apparent physical disability
You still earn some sympathy. Your parents still earn some respect for taking care of you. People may try to help you but may tell you off when they are having a bad day when you did something wrong.

Third class disability:
No mental retardation, no physical disability, but you have Asperger syndrome (especially if you have high IQ)or ADHD.
You dont earn sympathy. Your parents get blamed for not teaching/educating you. You get nothing except for a world that doesn't quite accept you and your diagnosis.

Is life fair or unfair?
Well...it depends how you look at disability.

I was in the consultation session of a girl with Asperger + attention deficit disorder. She has an IQ of 120 and is on a private school scholarship. She cried in the consultation.
Mum said: The teachers only see the final results. They don't see how hard she struggles to get there.
(Mum cried, daughter cried and both hold hands)
The story was that she couldn't focus on planning and writing her schoolworks. For example, she spent a whole day to write an essay and she got really tired. She got excellent marks for her essay though. Mum was complaining to the teachers that she struggled to get the results but teachers don't see the problem.

Right...I don't see the problem also.
To me she doesnt have a disability lo.
I tried very very hard to sympathise...
Maybe this is because of our chinese upbringing or unfamiliarity with the diagnosis.

Demotivated

My runny+stuffy nose makes my breathing difficult.
My facial movements ie smiling, talking, eating make my mouth ulcer painful.
And DD is not really very stimulating.
Every person that I bumped into, asked me why did I choose DD...
I just couldnt lie and say "Oh, because I am interested..."
I would give a simple answer "It's not that I like, I just don't mind doing it..."
So ya...that is the extent of my enthusiasm.

I miss real clinical, ward-type of thing :[
And I will have to wait for 11 more weeks.

当科学碰上预言

曾经读过一本书，说人类越探讨科学，就会发现科学和宗教越来越接近...
好期待它们碰在一起的一天！

热忱，信仰，坚持

才在Developmental Disability几天，
我所看到的不多但感受到的，很多。

第一，这是一份需要很多热忱的工作。
我的supervisor已经年过古稀，
领着一群年轻的儿科医生，为这群特别的孩子服务。
头发已经全白，架着一副眼镜，
左手还不时地颤抖。

他宣布他已经决定要关闭他的私人诊所，
理由是他的私人助理兼太太觉得她已经负荷不来工作量，
是时候退出休息了。
而他依然决定留在医院里工作，说直到医院不要他为止。

他每天的工作，除了诊断这些孩子，
就是得准备一份又一份的报告，资料，
好让父母可以把这些资料带给学校作为沟通的管道。
可是很多时候，学校没有办法接受这些特别的孩子，
原因包括学校没有受过训练的教职员，没有办法教育他们。
有些孩子太顽皮，没办法控制脾气，总在学校捣乱，引起学校的不满。
他的工作就是去学校见一群教职员，跟他们解说孩子的病况，改变学校对孩子的期望指标，并希望达成共识。

我常想：这不是等于丢盐进大海？学校和社会真的有可能被你游说吗？尤其是自闭症的孩童，难道你解释说他们的顽皮和怪异是因为他们的脑子的问题，学校就会接受吗？
所以，除了热忱，第二：这份工作需要坚持和信仰。
还是有学校愿意配合，或许只是少数。
他相信，这些孩子只要能够留在主流学校，就能过将近常人的生活，
在特殊学校，他们就永远是被社会排斥的特殊孩子，因为在那里他们不会过像一般孩子那样的生活。
而我又想：真的吗？一般的孩童会愿意跟他们做朋友？或许我太悲观了，不尝试又怎么知道答案？

这个问题就像种族歧视吧，
无论我们假装我们不是其中的一分子，或是觉得根本不关我的事，
或是某部分的人多么努力地提倡反种族歧视，
多数的人心中还是觉得：肤色不一样，就是不一样，我没有歧视，但不代表我得无条件接受。

这是一条很漫长的路...
它不像一个骨折或一个细菌感染的伤口，时间或药物没有让它痊愈的能力。

我很感恩接触到了这一块领域。

又是新开始：Developmental Disability

Developmental Disability(DD)掀开了我final year的新的一页。

从忙碌的colorectal ward work 到只有outpatient的DD，是一个很大的转变。
这六个星期，我将会见到的病人包括了ADHD(注意力不足过动)，autism(自闭症)，intellectual disability (智障)，spina bifida(脊柱裂)，cerebral palsy (大脑性瘫痪)，Down syndrome （唐氏儿）等等...不幸的孩子。

今天我跟着我的registrar去上一个autism的课程，很不错，很充实，学了很多。

八十岁的阿公

最近很出名的一个短片，是一伙儿的八十岁阿公们骑电单车环岛。
说人活着就是为了梦想。

这几个星期来，早出晚归，
见习医生们的忙有个模样给你看，没有时间吃午餐，没有时间睡觉。
当医生，怎么讲也不算是梦想。
今天走路时，朋友说：“生活太规律化了，没有意义...”
什么叫有意义？我不懂。
它并不是有一条线画在一张纸上，
线的左边是有意义，右边是每没意义。

梦想应该是偏离正常人所能领悟的，
就像阿公们那样。
但又有多少个八十岁的老人能够完成梦想呢？
而梦想完成了，是不是就叫有意义呢？

我还是不懂。

我会想念colorectal surgery

不知不觉已进入第五个星期了，
来匆匆去匆匆的wardround，
做不完的paperwork，
一切即将告一段落。

突然觉得有点不舍得。
三个interns都很好人，很好相处。
最让人羡慕的，应该就是其中一个intern
宴请我们吃北京烤鸭来慰劳我们吧！
去到paediatric developmental disability，
应该就没有这种福气了。

Prof是有点可怕，
但是他的人也很特别。
尤其喜欢看他生气的时候apply他的anger management technique。
他会说：“I am going to turn off my switch."
重复几遍，直到他可以控制他的气。
他对他的registrar很严，
对学生还不错。

总之，我还是会想念colorectal surgery ^.^

Home sick?

When I was walking home with a friend who just came over to Melbourne to study,
Friend: Do you miss home?
Me: Hmm...it hasn't really been a problem to me...(sounds a bit cold-blooded but it's true though)
Friend: I really miss home. Every time you go back and see your parents, they are getting older and older...That makes me want to spend more time with them.
Me: Ya...I understand that...(trying hard to empathise)
Friend: I wasn't close to them when I was small, but I am getting closer to them as I grow older...
Me: Really? I wasn't close to my parents either...and I don't think I am getting closer to them...(yea...a bit sad...just the way i was brought up)

I don't know why we had this conversation.
I just know her for about an afternoon.
She is nice though.

Sleeps

Even if i sleep 9 hours during weekend,
still can't make an average of 6 hours of sleep per day
=(

Zzzz...

Oh third year!

We have third year med students on our rotation,
I am so proud of them!
One of them managed to get the IV cannulation done today!
That's like much much better than me =P

I was eating lunch with them,
and then when we were about to finish,
I said, "Let's go take a history and then I can sign your log book!"
(p/s: I looked and sounded so excited)
Then one of my colleagues said, "Why are you more excited than them?"

Hmm...I am deprived of history taking and examination for the past 3 weeks,
Yes, I am yearning for one!

I should leave some of the intern job behind and go do my own learning,
but I really pity my interns, they havent had lunches for the past 2 weeks...
I feel bad not helping them...

We make sure patients are on Clexane,
We make sure patients have their TED stokings on,
We make sure they have enough painkillers so they can mobilise,
We monitor them by monitoring the bloods and obs,
"obs stable, afebrile"
"good"

We just never listen to the lungs during wardrounds.
Just don't have the time? Or not necessary unless they are symptomatic?
Hmmm...

We had a very sick colon cancer patient died from PE.
Well, we have tried "our best" to prevent it.

灰色星期五

Colorectal surgery 是个噩梦,
对intern们来说。
永远取悦不了大老爷，因为他的要求太高，
甚至太不合理。
听说大老爷有情绪管理问题，以前会摔东西，
但现在好了些。

星期五，
很好的registrar放假去了，
很神秘的locum registrar请了“病假”。
整个部门由一个parttime的registrar顶替，
太多东西做，很多紧急的病人，很多麻烦的病人，
还有没有预料的死亡，
intern们喘不过气来。

我做完他们交待的paperwork,
五点三，拍拍屁股走人，
可怜的intern们，
还没有吃午餐，
还有做不完的工。

晚上下雨，听说墨尔本淹水。
hmmm...哎...

年龄

intern: how old are you?
me: i am turning 24 this year.
intern: me too. When?
me: this month.
intern: oh, you are older than me. how come?

why do i always need to explain our malaysian education system T.T

关灯的人

如果末日来临，
就让我毁灭吧，
让那个整天把走廊的灯关掉的人活下去。

我没他那么爱地球，
因为那条走廊实在是又长又黑。
恐怖...

过年？

很久没有“过年”这个歌仔唱了。
年三十，年初一，年初二都还是得去医院。
这里是没有农历新年假的。

婆婆去世后的这几年来，
因为上课也没办法在家过新年了。
其实感觉也都还好。
只是有点想念新年饼和姑姑煮的团年饭。

拿不拿红包只是小事，
感觉上我的年纪好像是得开始赚钱然后给红包长辈了，
而不是还得伸手要钱。

新年衣嘛，
不时都会去血拚，
都不需要像小时候只有新年前才有机会买新衣，
所以都没了那种兴奋。

和家人团聚才是最重要的。
祝大家新年快乐，
团团圆圆咯！

大老板要回来了

下个星期一肠肛大老爷要回来了，
听说他很严厉，很不友善。
中老爷这么说，
小老爷们这么说，
就连路人也这么说。

希望他刚放完假，心情会比较好吧！
不然接下来我可就心情不好了。

我们的job description：老爷们的跑腿，吸血僵尸及陪笑团。

Nice To See

The first time I saw her across the desk,
she was asking the intern some questions.

I asked the intern who was next to me, "Is she a Japanese?"
"Yes, Japanese." answered the intern.

Just feel nice to see a Japanese nurse on the ward.
Soft and sweet.
And I will look at her secretly every time she appears within my visual field.

Something to appreciate in my very first rotation: colorectal surgery.