January 4, 2014

Tagging & Expectations [1]

Continuing from the previous post...

Once you enter a department, you will be doing ‘tagging’ which usually last for 2 weeks for most departments, especially for a first poster. Working hours for a houseman generally starts at 7 a.m.. During tagging it’s usually from 7 a.m. to 10 or 11 p.m. everyday until you’ve been given off-tag.
So what do you have to do during tagging?

1. On the first day or the day before your first day into the department, go and introduce yourself to the Head of Department, and then to the ward’s Sister so that they know you’re coming.

2. Clerk as many patients as you can. Clerking means to get full history from the patients, do full examinations, come to a diagnosis and different diagnoses, plan and take related investigations and do your own plan of management for that particular patient. The more cases you see, the more familiar and comfortable you are with taking history & doing examinations. The more variety of cases you see, the easier it is to remember the management. Usually every cases will be seen by an MO after you finish clerking- learn to present properly, fluently and with confidence.

3. Learn and practice how to do procedures- basic procedures such as venupuncture, inserting branula, taking blood C&S using aseptic technique, inserting urinary catheter, inserting Ryle’s tube are all things that you are expected to be able to do by the end of your tagging. Paediatrics may be a little different; and some department also require you to be able to insert central venous long line, do peritoneal dialysis, wound debridement, inserting tibial/calcaneal pin etc.

4. Learn what form to fill for which investigation and which bottle to fill in. Learn how to trace the results. Learn to to refer cases and write referrals.

5. If you are in O&G, surgical or orthopaedic, learn to book/post cases for operation, how to fill in the form etc. Find out from your senior colleagues if there are special/extra requirements that you need to complete to be off-tag. This depends of the department and hospital you’re working in. For example, if you’re in O&G, you may need to conduct 10 deliveries and assist 5 C-sec to off-tag.

Expectations (Part 1)
Not in order of priority/importance, I’m writing this part as a fellow senior houseman who has passed her housemanship:

  • Niat: Please correct your intention of working in medical field. We are doing service-based job so we deal a lot with people with different attitude, expectations and behaviour. This can be very stressful but in the end there are only two things: we’re trying to help patients and we seek to find barakah in our job. My previous Dean of Medicine gave us this du’a and most of my colleagues and I recite this in our prayers: "O' Allah, please let us be the tool of Your Mercy in serving the humanity regardless of race, creeds and religions"

  • Able to clerk cases and present: You have 3-4 years of clinical years to practice this. By the time you graduated, you ARE expected to be able to get the chief complaint(s) and rule out differential diagnoses and summarise the case.

  • Able to recognize signs and findings in examination: Of course, this will help you in your diagnosis. So the more patients you see, the more signs you’ll find, the better you are at recognizing things. Do know basic stuff like normal vital signs values, heart sounds and murmur, different sounds during lung auscultations, neurological abnormalities etc. We need you to be able to elicit signs from patients.

  • Attitude: Which is sometimes a major headache to senior colleagues, MOs and specialists. Do have the right attitude: be polite and humble. Don’t be arrogant. Basic rules as a houseman is "jangan berlagak terlalu pandai, jangan jadi bodoh sombong" or so to say. 'Menjawab balik', giving excuses and justifying yourself are all different- know who you are dealing with. If you don’t know, ask, ask and ask. Do NOT assume. Be polite to ALL patients and relatives even if you are tired and hungry- they don’t know that. Respect everyone including the cleaners, staff nurse, MAs, your colleagues, MOs, specialists, consultants. Sometimes it’s not easy when you meet colleagues who are not cooperative and not of exemplary behaviour- just recognizes who they are and avoid having that kind of attitude. Be friendly.

  • Be a team-player: Know who your houseman leader, follow rules set by the department and be a team-player. If you have finished with your task, help your friends in need. If everyone help each other, you can finish ward work faster and everyone can go and eat lunch or rest earlier. Also, when you see your MOs doing round and are still around, even if your shift finishes at 5, wait till they say you can go home or something along that line, in case there are still works to be done. How can you go home earlier than your MOs/Specialist? -.-; The same goes if there are still a lot of ward work to be done and it’s already 5 p.m.... Finish your work first then you can go home with eased heart. Pass over if you need to know learn what kind of cases that need to be passed over

To be continued...
Next (final entry): Expectations [2]

January 1, 2014

Taking that first step...

I wrote this a while ago for my younger brother who's reading Medicine in Egypt, just as a sneak peak into housemanship- just some tips and tricks working as a junior officer in medical field. This will be posted in 2 or 3 entries since the actual draft is quite long. I hope it'll give a rough overview of what's to come for those who will be joining the medical fraternity soon.

Before that, let me wish you Happy New Year! Let's pray 2014 will be more meaningful & beneficial :)


Before I give the overview, just to let you know that to each houseman his or her own experience; everyone faces different things and there are a lot of factors that need to be considered so what I’m writing is solely based on what I have experienced in my 2-years of housemanship. Be informed that I’m jotting this as someone who initially was doing medicine in Australia for a bit then came home to a local private university to graduate- so I am fortunate enough to be given sneak-peak of how a HO life would be during my clinical years and I do understand the anxiety that overseas grads are facing.

Second of all, I’m also jotting this down from a medical officer point of view; just to give a feedback what are some of the expectation of a ‘functional house officer’. I have no intention of scaring any of you but I’d like to prime you on the current situation of a houseman life so that mentally you are prepared of what to expect when you come home.

After you have graduated, you will have roughly 2 to 3 months before you’ll be called to work. Choose wisely of what you want to do during this time because the coming 2 years (if you’re not being extended in any department) will be... kind of gruelling.

Choosing a hospital

First of all, where you choose your housemanship is important. Factors that you need to consider is distant from home, support system & how well you can adapt to new environment, what you expect to achieve by the end of 2 years and what you expect to experience. For the last 2 points, it basically means that, do you want to go to a district or a tertiary/referral centres? Or do you want to go to hospital with computer-based or using BHT/patient’s file. Generally speaking district hospitals have less patients, limited investigations and no sub-specialty- so basically you will have to learn to do investigations within limited resources and need to refer to hospital with facilities or with subspecialties if you encountered patients that needed to be referred.

For example I was doing my housemanship in Batu Pahat Hospital, a district hospital- quite a busy hospital with common cases. Our radiology department have up to CT-scan machine so studies like MRI, barium studies, MCUG all needed to be referred out. If we receive cases like ICB, intussusceptions, coronary artery diseases, oncology cases, these need to be referred to tertiary centers such as HSAJB, HKL, Selayang, IJN and so forth.

If you choose a tertiary centre, sometimes you probably find yourself managing high-profile or rare cases. Your ward may be very busy but you may learn a lot of things. Some hospitals used computer so you have to familiarize yourself on how to clerk with laptops, how to find results via the computer and so forth; the good thing is you don’t have to run to the lab to fetch the results and you can trace patient’s past record easier.

If you choose to go to Sabah and Sarawak, be prepared to learn new dialects. The advantages of going to West Malaysia, you’ll probably be more skilled in terms of procedures i.e. vacuum delivery, Caesarean-section, appendicectomy etc. Once you are allocated a hospital, you will need to report to the hospital right after the induction week finished, and then to Jabatan Kesihatan Negeri. Usually they will be a few days of hospital orientation after you report duty.

Next: Tagging