Tuesday, July 13, 2010

preparation for housemanship

berikut adalah reply from a lecturer doctor after a friend of mine asking him for advices before getting into housemanship. may u benefit something from this

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Masa saya kat USM dulu (9 years ago), Prof. Norhayati (Pathologist) pernah bagitau "you need only 20% of your knowledge to survive housemanship". Huhu..macam tak percayakan. Punya susah study nak gi final exam, 20% je nak guna masa kerja. Actually, that is true...absolutely true. So how about the rest (lagi 80%) tu ??? Discipline, attitude, common sense, sincererity....
Masa HO, kita adalah front runners. Semua patient masuk ward kita kena attend dulu. Dalam erti kata lain, ilmu yg paling penting masa HOadalah acute medicine (bukan emergency medicine tau..). Bukan semua yg belajar sepanjang course 5 tahun tu adalah acute medicine. Pastikan ingat management untuk common diseases for each posting. Sebagai contoh, dalam internal medicine, selalunya patient masuk ward sebab IHD, COAD/Asthma, Hypertension, Uncontrolled Glucose, Stroke dan RenalFailure. Yg lain lain tu ada jugak, tapi jarang la. MO dan Specialist selalunya anticipate yg HO mesti tau manage common diseases acutely. Contohnya, kalau patient masuk ward sebab AECOAD, lepas clerk, MO selalunya anticipate HO akan order basic investigations (ABG, CXR, ECG, other related blood investigations), start patient on some nebulizer medications, put patient at acute bed and then inform MO on call. Nampak simplekan...tapi ramai HO lupa. So, nasihat saya, buat sedikit light revision on management about common diseases especially how to approach them acutely.


First day HO selalunya the worst. Transition between student to worker mindset usually takes time. How long???? Bergantung pada individu. Selalunya selepas 2 minggu, kita akan biasa dengan persekitaran - make sure kenal dengan org yg akan bekerja rapat dgn kita - contohnya
specialists, MOs, staff nurses. mesti ingat, masa first day kerja, you are already a doctor...therefore you got certain responsibilites to fulfill. Jgn risau pasal ilmu yg dah lupa...memang penyakit ilmu, kalau tak amal, ilmu akan hilang. Inshaallah, bila dah start kerja,
ilmu yg dah pernah belajar dulu akan dtg kembali, cuma on and off kena buat revision sikit. Satu lagi, learn about your superiors (Specialists and MOs) - apa yg diorang suka dan tak suka. Like it or not, workplace politics are everywhere...so, you must know how to deal with it.


So kesimpulannya mudah. Bila masuk kerja, ada beberapa perkara yg Specialist dan MO anticipate: 1. Able to respond appropiately - dahulukan mana yg penting 2. Able to clerk and come to diagnosis especially common diseases / problems 3. Able to do/send appropriate investigations 4. Able to order/perform basic management (yg advance tu let the MO/Specialist think about it hehe..) 5. Able to decide which patient need to inform first..kalau 20 patient masuk, takkan nak inform semua at one shot..betul tak? The rest....berserah dan do'a banyak pada Allah supaya kita dan pesakit terpelihara. Bukankah Allah telah berjanji sekiranya kita hampir padaNya, maka Dia juga akan hampir dengan kita. HO adalah masa yg amat mencabar - segala galanya tercabar especially kesabaran. Jadi, sabarlah banyak banyak.

Saya tak de petua...cuma prinsip saya tangani setiap masalah dlm hidup ni satu per satu. Masalah tetap akan ada...cuma bezanya macam mana kita nak handle. Sama mcm HO jugak, mana yg penting, kita dahulukan, yg lain tu, kita selesaikan kemudian. Dengan cara mcm ni, hati pun tak serabut.


Lastly, hadapi HO dengan hati yg terbuka. Anggaplah apa yg berlaku semasa HO akan membawa kebaikan untuk diri kita dan pesakit pada masa hadapan. Dan mesti ingat, kita dikelilingi oleh manusia jadi janganlah terlalu terbeban dengan perangai manusia yg pelbagai.


kita tak boleh nak puaskan hati semua org, jadi buatlah yg terbaik...insya Allah, Allah akan memberikan ganjaran yg selayaknya. Get to know about other people around you...mcm Sun Tzu tulis dlm Art of War "kenali musuh anda, anda sudah menang separuh peperangan". Bukanlah nak suruh gi perang, tapi pengajarannya kenali org lain, kita dah mendapat separuh apa yg kita harapkan. Housemanship is all about people and relationship, jadi jagalah kedua duanya. Anggaplah housemanship sebagai platform untuk kita jadi doktor yg lebih baik pada masa hadapan. Dan jgn lupa, document every single thing dalam patient's case note. It will saves you..believe me. Lastly, saya doakan yg terbaik buat Dayah dan Tini. Lepas habis Houseman, boleh mula fikir nak buat master, terus cari ilmu dan jangan berhenti. Banyak ilmu kat luar sana untuk kita terokai dan jadi pakar perubatan Islam yg menepati Sunnah.

Wassalam.

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Thursday, July 1, 2010

current condition is really in accordance to Laplace Law, which indicates that the tension of the myocardium is proportional to the intraventricular pressure (P) times the radius of the ventricular chamber.

the radius of things to cover up is too a lot that the stress starts to increase in gradual manner. currently its summer in egypt, plus those juniors have massively started to go back hence wat i have in mind follow them boarding the plane, leaving the mind unattended with only the body stayed back, plus havent bought my ticket, plus 'oh bestnye kalau ade kt umah' kind of thought, plus uhuk2, plus ehek2, oh tensen2..

the best thing to be done when the tense builds up- makan!