The Companion who was on his phone

As I invited a little girl clutching onto her mom into her room, they were followed closely behind by ?patient’s dad or her mom’s partner. He was on his phone, loudly yacking away. I was irritated, but chose to ignore him as he seemed to be coming to the end of the conversation. It was only halfway through work, I didn’t want to spoil my day

Few minutes into the consult, I thought he was about to end the call when telling whoever it was that he is at the doctors, but horrors of all horrors, it was just a comment – not to excuse himself. And he seemed to be speaking louder and louder (or maybe I was hallucinating the volume, due to my irritation).

Me : Excuse me, can you continue your conversation outside please. I am trying to have a consult here.
He : Oh ya, of course.
And walked out.

Few minutes later Mr Rude walks in and as I was explaining things to the mom, he was making sarcastic comments aimed at her, or maybe it was towards me I wonder
eg: “Can you remember that or do you need it written down?”. It is my style to give patients things in writing as trust me, they forget half the things by the time they walk out of the practice.

She kept quiet & ignored his comments. Up till then, I too was ignoring him and focusing on explaining to my patient’s mom about my diagnosis & management. And then he said something like “All the doctors hate me anyways”.

Me (to him) : What was that?
He : I wasn’t speaking to you. I was speaking to her.
Me : In case you didn’t realize, this is a consultation and I’m having a conversation with her.
He was wise enough to ignore me & not turn it into a fight.

Continued some yada-yada to his partner (patient’s mom) while measuring his height himself, while I was printing out script and explaining instructions on consuming the medication to mom.

I didn’t hear what he asked her. I only heard her reply “No”.
“Then why do I need to come and wait at the F***ing doctors for 45 minutes?” he stomped out.

Earlier, as mom was coughing as well, I offered to have a quick look at her after the little girl.  By then, I was just staring at him.

Mom : How high was her temperature?
I rattled the digits (once again). She thanked me and headed out after Mr Rude.

Now, now this is why manners are essential!
Please inculcate them in your kids as early as possible to prevent them turning into this kind of morons!


I can’t expect anything civilized from a moron who has no courtesy to switch off his phone when in doctor’s consult room, can I?

Usually it is the patient who will be on the phone (fair enough, to kill time while waiting – been there done that myself). Most of them would have enough courtesy to end the call when their names are called, while a handful would continue talking till we reach my room, and a rare few even after being seated – as if my job is to wait for them to complete their call because I made them wait, right. I don’t entertain these kinda nonsense anyway.

Only once recently, the patient said it was an important call and was happy for me to take the next patient in first.

Next time anyone walks to my room without switching off their phone, I’m going to throw them right out! That is my right, no matter how long you have been waiting for your turn. As if doctors purposely make patients wait!

*

For the records, they waited 30minutes, not 45.
I have seen the patient before. I didn’t record anything about rude parents. I made sure I documented today’s incident in the notes.

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MC writer?

Friday the 26th May 2017 – half past 10pm.

A patient walked in declaring he needs mc for yesterday and today.

He was coughing.

After my yada yada trying to take history which he wasn’t cooperating with, I told him we can’t backdate MC. Anyway I need to examine him before giving one for today.

“I don’t need examination. I just need MC” he said arrogantly.

I just looked at him sarcastically smiling “Really? Suit yourself. My job isn’t to hand out MCs”

He “So who can give me for yesterday?”

I just reiterated my stand in fewer words & pointed to the door.

*

TGIF, eh?
Thank God for the day off on the morrow instead!

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Latest update – of EICS, AMC Portfolio & Fee Structure

Here is the long overdue PART 3 of my IMG’s Road to Australia series:

<<Part 2 : Getting Started – of AMC forms, EICS & English test

I chose to change tracks when I was almost entering the 4th decade of my life.
I know of others who did it at an older age. How old is too old? Well, NEVER – I’d say.

Rules keep changing. 1 of the reason I stopped updating on this topic is that I was getting confused with the ever changing rules.

But if you are determined to embark on the Road to Australia, please do it sooner rather than later. You might have family situations, financial issues, and any other hurdles at all in your way. But then if we let it be, excuses will keep building up over the weeks, months, and years. Before you know it, procrastination will only end up in things changing the very next year! And then, we hear the complaints….sigh.


At that point, it is futile to get frustrated and point fingers, or worse still cursing AHPRA or AMC, often even the country! There are alot of imperfect things in the system, especially when it concerns IMGs, but my Q for the complainers is, if you come from a perfect background, WHY MIGRATE? Stay in your comfort zones.

Save up the money, and just do it – asap!

***

Please remember, every 1st of July, exam fees skyrocket! With each new financial year, it only goes one way. Fees & Charges

1st July 2017 onwards, they are phasing out on the EICS verification – http://www.amc.org.au/assessment/psv, to be replaced with EPIC.

EPIC Fee explained.

I don’t remember paying anything for my EICS verification, and the good news is there is no expiration date for it. But if your alma mater is known to be tardy, please chase them up…bug them relentlessly until they respond to EICS.

Quoting from AMC Website:

Processing delays also occur when an overseas training institution is slow to respond or does not respond to verification requests. The AMC has compiled a list of overseas institutions that have not responded to requests or that have been particularly slow to respond. The institutions listed did not respond to more than 60% of all EICS requests sent to them from the AMC from January 2013 to December 2014. The AMC will update this list as it receives data from the Educational Commission for Foreign Medical Graduates (ECFMG) on the EICS request response rates of overseas institutions.

Regardless of whether your overseas medical training institution is listed (PDF 101KB), we recommend that you contact the authorised person/s at the institution to confirm that they will complete the EICS verification request and return it to the ECFMG for processing. The ECFMG will advise the AMC of the outcome and the AMC will notify you of it by email.

Latest AMC Portfolio summarized.

P.S: This isn’t a cheap journey. Especially if you come from a country where the exhange rate burns a hole in your pockets. Don’t say that you haven’t be warned. So, please make sure you have enough emergency funds & balance back home when you are investing (that’s what I see it as) in this pathway.

Posted in Down Under, IMG in Australia | 2 Comments

Uwek…

Patient X, a teenager, was waiting in middle waiting area. She was next. 

But there was a child who was feeling ‘sick’ in the front waiting area. As I was calling her name she was wailing and vomiting (into vomit bag).

While I walked the child and her family into my room, patient X’s mom asked if X wasn’t my next patient? 

I apologized and said since the child is vomiting, I’ll see her first and attend to X right after. Thanking them for understanding, I was starting to walk away when

X’s mom : We would like to be seen in a different room. 

Me : oh…if you can’t wait, its okay…please tell receptionist. If any other doctor become available earlier, you can see them. 

X’s mom : No we can wait for you. But see us in a different room. We don’t want to catch what she (glancing at the child) has.

Me : She vomited in the front area. You don’t catch vomit.

X’s mom : You don’t? 

Me : shook my heads 

(internally rolling my eyes big time) 

As we (the little child, family & I) walked down to my room, I apologized to the child’s mom & asked that she ignores X’s mom’s comments. 

*

I have no words to express my shock & disgust. 

*

Lol…what about us doctors, who gets coughed on, by sharing that small space in consultation room with all sick patient? Maybe we should start consulting in open area, to protect ourselves

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Another Gift Card – Refer a GP 

About 6 month’s after receiving my own $250 worth of gift card for using the patient education tool, HEALTHSHARE, early February 2017 I received another gift card.

This time, it is for referring a colleague. $25 (10% of the original gift card value) – not bad, eh ><
Totally forgot about it, until my colleague (working in another clinic) enquired about it.  Few weeks later, someone from Healthshare contacted me verifying my details, and there it was in my email!
So, we both received gifts this time – referrer & new user.

What a lovely way to encourage GPs to use an online patient education tool. I continued using it after the first 3 months & reaping the promised reward. Not because any the carrots, in fact the gift is a once off thing. I genuinely found it useful.
It is still one of my must open pages when logging on to my work computer for the day.

Good, quality material, mostly compiled from other reliable sources, which are relevant to Australian protocols/GP setting. Instead of patients going to Doctor Google, it is always nice to give them a print-out of part of the ya-da-ya-daa we have bombarded them with in those few minutes of consultations.


My $250 was well spent while my family was down on year end holidays – food, gifts, and some stuffs for a party I hosted last Spring!

Planning to spend this one on something more lasting – a keepsake of sorts 😀

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OPOF – Review

My concise 1 paragraph review of this book:

“OPOF is a light read, filled with a lot more than merely one pint of frustration – wit, truth, humor, sarcasm. An entertaining bittersweet compilation of truth in the form of storytelling by MOFrust (the blogging doctor) accompanied by cartoonist doctor(s), One Pint Normal Saline (OPSN).
Overall, this is a beautiful artistic collaboration by talented Malaysian doctors, that all Malaysian doctors can relate to. An easy-read of 150 pages, this handheld book should be available in all medical school & hospital libraries.”

Now now, I wasn’t paid to write any of these. Just a fellow colleague sharing honest opinion here 🙂

*

One Pint of Frust – I got my hands on this book yesterday. Was hooked onto it from the introductory page written by One Pint Normal Saline (OPNS), thinking to myself I’m definitely going to revive my blog with a review of this book.

OPNS : I have to say, your wit & talent has always made me (like many others) laugh & reminiscence my own HO days (about a decade ago) & MO days. Been your fan for some years now. Especially as I am hopeless with drawings, loved to see our experiences in that form. Not just National, but your work has reached International Level long time ago! 😀

I can proudly say I’m the first overseas recipient of OPOF in person (yeayyyy), from MO Frust himself, who was in Melbourne for the past few days. Apparently the first copy that made its way to Ozzieland too. Precious ni! 


As for MO frust :
Little did I know upon knowing you as my HO that you will one day be the MOFrust and eventually the founder of Medical Mythbuster Malaysia. Wishing your dream of realizing the MMM as a TV show becomes a reality.


I started reading the book in the Metro train, on the way back from Melbourne to my suburb, halfway through the journey as soon as I got a seat. As I mentioned before, was hooked onto it from page 1…and upon reaching page 49, just before the last subchapter of chapter one, I had to get off & head to work. What a bummer….

Thanks to the lovely namecard-cum-bookmark (which I accidentally dropped while standing in train earlier & only realized as I wanted to close the book), I could bookmark the page. Phew, it is a wonder nobody trampled on them!

Would have completed OPOF yesterday night itself as a bedtime story, but had a full  on weekend away planned ahead of me, so I put it on hold. Was planning to read it on Sunday night, at the end of my last full weekend off ahead for the next few months.

*

Unfortunately, I cancelled my weekend away and was in bed mostly today 😦

Finished the rest of OPOF within few hours this evening, while still in bed. It was indeed a ‘Chicken Soup for Soul’ that every Malaysian doctor will find themselves nodding away to. Page after page of wit & sarcasm that is very close to our daily experiences. Although the disclaimer on hakcipta (copyright) section says these aren’t true stories, I’m sure we have all faced many similar encounters ><

Personally, it was nice to read some paragraphs in Bahasa Malaysia (as handheld book/ hardcopy) after ages too.
Though for non-Malay speakers : Fret not, as mostly they are almost immediately translated.

A book that evoked an array of emotions in me. I laughed, winced, snorted, almost cried, and as I reached the end, I was just grateful for the kind of housemanship training that I had.

*

I reminiscenced my own HO days in Hospital Frust which was the setting for Chapter 2 on Emergency Department (ED) by MOFrust. Though often we find people lamenting about the HO days, I myself had mostly lovely memories of my housemanship, although there were many a crazy day and nights. But at that young age of 24+ and 25, lack of sleep, and food was nothing for 18 months of training. And definitely the tagging was no biggie, though in postings like O&G I didn’t see the sun for 2 whole weeks as we entered the Labour Room way before sunrise & went home close to midnight, if not past, on some days. But all that groomed and equipped my generation (and many before and after mine) to doctor patients as we have managed over the years.
I have to rub in about this tagging issue, as this is the current in-thing among Malaysian doctors, where a yet to be HO has written a letter to Editor to one of the leading newspapers in Malaysia, complaining about the tagging practice!

I was blessed by lovely colleagues & superiors (MOs & Specialists) mostly, which puts a smile to my face when I think of my HOdays.

So much so, although during my time we had no ED rotation, I ‘graduated’ from housemanship to MO-ship, equipped with arsenals to run a whole district hospital with a team of MOs, Medical assistants, and nurses, with no in house specialists. That was where my confidence grew….in that disctrict hospital, before I returned to work with specialists and house-officers in the Paediatrics department where MoFrust did his housemanship.

I digress. Enough of my reminiscence.

*

I found it funny the author had to explain himself after the sarcastic comments, but knowing our society, I know it is a must! Or they will quote “This particular doctor said so-and-so”, not realizing it was meant sarcastically. These are the kind of people who take everything at face value, but when we give evidence based opinion, they would challenge us – go figure!

My only grouch is that the comics should follow immediately after or just before the relevant topics. Some of the layouts were a few pages away.


To both the authors of One Pint of Frust:

Hope to see more printed work from you both. Keep It Up & Don’t Give Up on your good work, MoFrust & OPNS – both in workforce & in the art-form.
Don’t let the online communities that often use annoying phrases like “Kipidab, Dongibap” to spread half-baked information or myths about health.

Cheers & Well done on a beautiful work in OPOF. Looking forward to more collaborative effort from both of you!

For someone who started blogging during medical school days, I concur with MO Frust, WRITING IS THERAPEUTIC! 🙂

*

I know not only my medical friends, but even some non medical mates follow/like both MO Frust & OPNS’ pages. If you are either of their fans, even more reason to get a copy of OPOF. Artists need encouragement. Especially when they are busy doctors come blogger/writer and cartoonists. As it is, we don’t have many doctors who write/draw.

P.S: I wouldn’t be surprised if OPOF serves as a shoulder to lean on for other frustrated and disillusioned Malaysian doctors. Keep it your good work! If you are one of those whiners though, buck up!

Posted in Malaysian Doctor's Woes, Public Service Message | 2 Comments

The one with that patronizing relative

Sometimes you are just too exhausted to tell them off, knowing fully well it is going to create another angry-patient-shouting-at-me day if I decided to exercise my authority in chasing out that relo from my consult room, so I can proceed just with the patient alone.

Here goes, True Story from 23rd March, just one day after the fiasco with ‘the-patient-who-heard-the-name-wrong’


A patient I’ve never seen before, Y.
She came in with X, whom she verified as her step-sister. Funny that after all that concern & seemingly so authoritative to demand to drill and grill me in regards to Y’s issues, X claims that she’s Y’s friend.
Yes, after some high strung statements and questions from X, when Y appeared more calm and accepting of what I was trying to convey, I just had to ask “Sorry, you are X’s?? Friend? Relative?”

*
Okay okay, let me start from the beginning…

My colleague had ordered some imaging that morning.
Y has returned for her results. And I was seeing her for the first time.

After I explained the result to her regarding her CT cervical (neck) spine, and tying it up with her presenting complaint that morning, I asked if she suffers from a few other relevant symptoms?

Y was answering me when X butted in (Oh how I hate it when they do that) :”Are you sure she doesn’t have cancer? Because someone I know did have spine cancer, and no doctors picked it. All those tests they did didn’t pick it up. Her problem was back pain too”.

X : Why then, does Y have pain in her middle and lower back too?
Me : Do you, Y? (scanning through her previous records, I couldn’t see anything about those)
Y : Lower back is an ongoing problem since I was pregnant. Mid back just started this morning.
X: She is a single mom of 5, always puts herself last. I can’t stand to see mothers in pain. Even when my own mom suffered from pain, it made me so sick till I was vomiting.
Even now, thinking of driving Y home and leaving her in pain, I feel I could get a panic attack.

On the topic of cancer, upon further history taking (which refers to all those questions your doctors ask you), no constitutional symptoms identified.
X : You should send her for tests to make sure she has no spine cancer. I think she might. She is in so much of pain. You need to give her something that will take away her pain.
Like…send her for the most thorough & accurate test.

I had to stop myself form rolling my eyes.

For the records, I’ve already extablished that Y doesn’t take any painkillers, hardly even Panadol or Nurofen, even though in severe pain. Exception was today when she took panadol just before coming in to see me.  I’d already discussed about optimizing analgesics earlier – a discussion which has a lot of interjections from Y’s well-meaning step-sister! 

Me: Look. Firstly, she needs to be taking her painkillers.
By right, we should do an Xray, and if needed, CT scan later on for the lower backache that hasn’t been investigated before. The mid back pain just began, most likely it is referred pain or muscular origin.
If you want MRI for whole spine, it isn’t bulk billed. If you are happy to pay, I will refer you. Bone scans are not routine.

X: S0, someone might be dying, and you can’t bulk bill the tests?

Me: Everyone might think they are dying for one reason or another. Does that mean you do head to toe tests for everybody?
Look, I don’t determine if imagings are bulk billed. The government and imaging centres do. If you want any specific tests you are happy to pay for, I’ll give you the referral.
For now, since you are very anxious, I’ll give you the best tests under bulk billing – CT scans, which are more specific to look at cut section of the bones.

And while I could have thrown her out of the room, using my authority as a doctor, as I found X distruptive to my consult with Y by being patronizing, I didn’t.

Instead I ended up ordering CTs for both thoracic and lumbosacral spine. The later was probably justified by intermittent lower backache which began during her pregnancies…but my action in ordering CT T-spine with 1 day history of mid backache, sigh….I am guilty of over-investigating.
But honestly, it was either that or paving my way into another ugly night ahead if the relo turned angry and aggressive.

And I was too exhausted from yesterday’s drama, accompanying insomnia & the busy day that it already was and still was going to be for the rest of the night. I already had one colleague who stayed an extra hour to help out with walk ins, and I was going to be the only one left for the next 2 hours till closing time…


This is the trouble when we have a generation with entitlement mentality.

God be with us to handle these kind of characters day in day out _/_ I’m glad there were none in the same vein tonight…Tak larat dah!

P.S : X is a young lady probably in late 20s.

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