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Medicine is your passion and nothing less will do!

I used to have “Nocturnal fever”, it’s not really fever but it’s often happened in the middle of night and it’s waking me up from sleep and the first thing came to my mind “Gosh i should be a doctor“. My first experience with it back in 1996, i’m a year away from completing my computer science degree. I didn’t get the “treatment” and I wait till 2001 before finally succumb to the ” fever”.

Yup, determination is important. Not everyone is an genius or born rich. Hurdles are on it’s way and the only way of overcome it is to have determination.

I have the opportunity to talk to the late Dr Dhamannanda as we are on the way back to Brickfield after a talk. We had a conversation on my dream and Venerable sir just reminds me that we must have strong determination if we wanted to achieve the dream.

That right, I kept my dream alive and  I waited another 6 years before I enter medicine school.

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Just returning from hospital after finished the oncall.

Here is the list of patient and the time seen.

in reverse chronological

4.30 am – seeing a young patient in heart failure. CXR shows abnormal heart.

3.50 am  – at ICU. Attend a young patient of mind who is serious ill with pneumonia. Noted ECG change and which actually due to anaemia.  Call up the blood bank MO and arrange for blood transfusion.

2.50  am to 3.30am  at A&, seeing a pt who developed APO and was intubated and subsequent asystole. He was failed to be revived despite the best effort from A&E team

1 am to 2.30 am  trying to get some sleep and woke up by a few phone calls.

12 am at CCU. Setting an IJC for a elderly which is intubated for arrhythmia and poor GCS.

10 pm  – at W1, attending a stroke pts who developed seizure. Managed to set a IV line and aborted with diazepam and covered with phenytoin.

9 pm at W1, attending a elderly man who condition is getting worst. It’s time to give my anaest friend a call.

8 pm at W2, seeing patient with kidney failure and a patient who have history of PTB.

On-call started at 5 pm So far so good. Doing round at ICU and CCU with boss.

It is very unfortunately for the ministry of heath enforcement team getting all the bad press after they decided to shutdown a dialysis centre in Penang for not follow the regulation.

Among the offence of this dialysis centre is fail to employ nephrologist to treating dialysis patients.

Here is the article in China Press (sorry, it’s it Chinese,  here is a section which is translated by google translate )

(Kuala Lumpur, 2, News) private and non-governmental organizations in establishing dialysis centers must be in strict compliance with laws and regulations, obtain a license before it is put into operation, or face seizure, the maximum fine of 50 million ringgit, or 6 months imprisonment.

According to the 1998 private health facilities and services Act (Act 586), without valid license dialysis center operations, enforcement action will commence in May when faced with strict punishment.

Moreover, those that were classified as “illegal operation” of the dialysis center, certainty of health law enforcement authorities sealed completely shut down operations. Ministry of Health will be launched in May this year, closed down operations.

Some private dialysis center industry is too stubborn, not only to ignore the provisions of the license application, also fail to control its operations”

This is the business name to dialysis as a senior executive professional reliable sources, today the “China Daily” said that an interview.

He said that before 2006, the Ministry of Health to allow dialysis center will be registered and put into operation, to give 3-year grace period, for a full license, 3 years after the application is successful, if  it’s fail, the dialysis center have to apply to extend the registration.

For the general public, which angered by the MOH move, may fail to realise the importance of regulate dialysis centres.

Private dialysis centre is a lucrative business in Malaysia.

There are more and more of patients sufferred from diabetes and hypertension and these are the major causes of kidney failure.

To set up a centre, what the centre need is to have basic setting up for dialysis and dialysis machine and with qualify nursing personnel and to complete the picture, a visiting nephrologist follow up with the dialysis patients.

A centre who failed to hire qualified nurses and doctor reveal the failure of the management.

Even the centre is aim for non-profit and doing charity work, it’s does not explain many other charity centers were able to obtain the license.

Back to my nephrology posting day, there is a new dialysis centre in KL who failed to hire a nephrologist. The reason is simple, the nephrologist refuse to visit  the a dialysis centre who ignored rules such as cleanliness.

The general public failed to understand the risk of getting infection during dialysis. The most common infection a patient can get is line-related sepsis, which in plain language, bacteria enter the body via a catheter which is used for  access.

The other serious infection is getting either hepatitis C or B from sharing machines with a dialysis patient which known to be a hepatitis B/C carriers.

I personally hope the MOH will published the main reason why they decided to shutdown the dialysis centre and regain the people confidence in our public health service.

 

 

I begin my working career in information technology.

I study computer science in 1993, those days Internet just started to roll and Google not even exist yet.

And Microsoft in the 90s is the often regard as rebel and manage to win over IBM.

For past 20 years, Microsoft managed to gain much market share in word process, spreadsheet and powerpoint.

With the steady yearly  income of Billions for Microsoft from the sales of Windows and Officer products, it’s took no brainer why Microsoft appear to be lag behind in the tablets and smartphones.

In the reality, Microsoft didn’t really need much innovation or new product. The present product line is a cash cow and the management give top priorities to the both products and nothing else matter.

NYTIMES had an article on the failure of creative in Microsoft.

I guess Microsoft is a dinosaur in the software industry.

I am no financial expert and this article in good faith and I shared some of my opinions on way of manage our money.

Contradictory to  the general view, doctors do not earn much and this especially to the junior doctors.

For a House-officer in Malaysia, average salary plus allowance will approx to 3K to 4K plus or minus few hundreds and more if one posted to Sarawak or Sabah.

And the medical officers probably earn extra hundreds around 5K.

Well, you might ask a person earn 4K to 5K per month should be able to pay of all the expenses and even have substantial amount for saving.

The above applied if a person is able to control his/her expenses.

Unfortunately, as a junior doctor, there are many bills to pay.

List of expenses

Car loan  – this is true since many buying new car after graduate , installment can up to thousands.

Travel – Airasia cheap air thicket is just too good to be missed

Food – dinar at expensive restaurant

Housing

Assessory- clothes and so forth.

Credit card loans

Enough said of this

HERE ARE THE SOLUTION( actually it’s  my personal view of solving the problem)

THE CENTER of the solution is TO CUT AND CUT AND CUT down the EXPENSES

MEANING You must controlled how much you spend

SO WHAT TO CUT?

NUMBER ONE is STOP TRAVELING and STOP GIVING MONEY To Tony Fernandez . Please ignore Airasia website. The advertisement is just too good and everyone get hooked. Ok, you may allowed yourself once a year a trip and not more than that.

NUMBER TWO is BUY less expensive car but safe car – NO MILO tin car.

NUMBER THREE is choose cheap travel mode of transport. Choose to travel in train or bus instead or flight if you travel from Penang to KL (example)

NUMBER FOUR is START TO THINK LIKE ” I JUST A POOR DOCTOR” which keep remind yourself you are not private hospital consultant who earn 5 figures per month.

NUMBER FIVE is reduce the number of clubbing and having dinner outside with friend.

NUMBER SIX is to eat hospital food and even better, eat the free meal serve during on0-call.

NUMBER SEVEN is try to remind yourself that you need to save money for the future i.e money for membership examination

NUMBER EIGHT is try to learn to make yourself a cup of coffee instead of donating money to starbuck.

NUMBER NINE is stop buying lenses – for guy who interest in photography. Those lenses are just too expensive and probably we don’t really need it.

NUMBER TEN is pay up the credit card. The credit card interest alone can make one to declare bankrupt.

NUMBER ELEVEN is to dress down and not dress up.  I just hope MOH can start to enforce no tie rule in ward and it’s will save thousand of money.

AND FINALLY ( you have more ideas, please share!)

Is to earn extra income and for doctors is to do locum.

EVERYONE is fighting for locum at government clinic which paid OBSCENE amount of money. (allowance for 1 call which last for 15 hrs  is RM150 and for the off hrs clinic it’s paying RM40 every hrs to see URTI cases )

And you can do as many locum at private GP or clinic.

AND PERSONALLY I don’s do locum and I discourage doctors from doing too many locum because it’s bound to interfere with our daily duty which we are supposed to do.