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Sunday, January 01, 2017

Happy 2017 : A Wish inside an ambulance that has been granted.

Happy new year to everyone. It will be another beginning of a chapter in everyone's life.

I really hope that 2017 would be a better year even though there is already a bad news for all of us..yes, petrol price hike for January. So I believe 2017 would be another tough year for all of us who happen to be living in Malaysia.

This new year eve and count down, as usual, for me, is just a simple TV watching and fireworks hearing activity in my house. At least last year I was doing the same thing but with my family sleeping in the room, this year pretty much I am alone. What to do, have to sacrifice for master study or perhaps I should blame it to Airasia and all other airliner who set the airline ticket price so beyond the normal value during this holiday season.

And finally, all my allowance are taken officially as I am not considered working, I am a student who is being paid 'fully' just to study. Thanks government. Now I feel like I am working in my home town as they have taken away that special allowance which was given to those who work far from their hometown. Like I was born in KL sarcastically.

They may even deduct my salary to compensate what they have already given to me since June.

Nevertheless, I wish that I could survive and I have an advice to all who plan to further study, please save your money like how you saved before you get married. That would be very helpful.

At least last year and this year I was in my home looking at the clock and count down new year in my head. That was enough for me as a celebration. Year before that, I still remember from 2012 until 2014, every new year eve I will be inside ambulance escorting critically ill patient from my district hospital to tertiary hospital located about 2 and a half hours away. Return trip will roughly took about 5-6 hours plus 1-2 hours passing over session and break session in that hospital. So, pretty much I will left my hospital and come back a in a different year. I've been through that.

During those risky trip where our ambulance driver look really tired and sleepy, a patient that could die in any moment, overworked and underpaid Assistant Medical Officer who kept bagging the patient with his eye half closed, nurse who pretty much actually asleep but still manage to check vitals sign every 30 minutes, I always pray and wish that somehow in the future I would be spending a new year's eve in my home just doing nothing. God listen to me and I am living in that future that I prayed for.


Somehow, after two years celebrating new year like this (doing nothing), It make me remember more about my district hospital. My team member there, the nurses, AMO, driver, PPK and other hospital staff. They could be still doing what I did in those years of practicing there. They will still be an unsung hero tonight. A salute to them and all the hospital staff who happen to be working tonight. If they were making the same wish that I made during my days, just be careful what you wish for. Sometimes, celebrating new year inside an ambulance could be more fun than doing nothing alone.

I don't mind, cause this is what I wish for. Now, I wish that I could celebrate new year with my family in the next year's new year's eve....
The team of hospital MO. 



I believe this is the team of pediatric.

And this the team of A&E

I have all department team picture but lost in somehow somewhere in my Cloud drive....

Monday, December 26, 2016

Are you still practicing real medicine?

Medicine is like a religion. Some follow it strictly, some don't. Some just using it for money.

Just about two weeks ago, my wife asked me whether this trending therapy using gluthatione, a therapy to make your skin whiter. I have to say that I am still practicing medicine in a real way. It's not my expertise but I am not pretty sure what Gluthathione is good for?

My encounter with this Gluthathione thing was when I read my text book on liver disease. Well those who lack of this enzyme will be more prone to get liver toxicity due to paracetamol poisoning. Something like that. And obviously if you read on physiology an biochemistry, you will encounter with this thing. It's a essential substances in our body.

Ammonium is also essential in our cell metabolism but do we drink ammonium for health reason? That would be crazy. A lot of substances in our body are actually toxic but due to their micro amount, we manage to utilized them perfectly. Nature was a beauty.

This cat apparently does not need any crap supplement to make her look cute. She eat a good food, she was taking vaccine to prevent infectious diseases, and that's it. She live a perfect healthy cute life. She never complain her fur was not whiter or something like that.


Back to my wife question, I told her that it sound dangerous when someone start prescribing Gluthatione via IV for a reason like that. There are some condition that we can give that via IV but certainly not to a healthy person who want to turn white.  It does not make any sense. Who would dare to do that? Apparently, there are people who dare to do that. All of them, were trained doctors.
(there is evidence on topical gluthathione for inhibit melanin production in skin.  For your information, topical means you rub in on your skin. You don't eat or insert it in your veins)

Some medication were created for other purposes. However, in medicine, you tend to use that medication for other purposed you think beneficial for your patient. One great example is metachlorpromide. This medication is used to prevent a patient from nausea and vomiting.  However, knowing that this drugs also inhibit dopamine which inhibit prolactin - thus more prolactin will be there to increase lactation - we use this medication for mothers who have low breast milk supply, to help them to produce more milk for their babies. It was off label use. The manufacturer does not spesifically design the drugs for that purposes but we use them anyway.

However, try looking for the evidence on that metachlorpromide. I bet you, you will find a lot of journal out there showing that metachlorpromide and domperidone are actually safe and useful for that purposes. (Please search in sciencedirect.com, or some sort of Google Scholar article instead of just google. Cause google now are paid to show their result, so if you are looking for a thief, don't ask another thief to tell you).

Evidence based medicine. The real 'religion' for doctors. For something to be called real, you need a text to support you. Same like religion, Islam have Quran, Christian got Bible, Jews have Torah, and so on. For medicine, Those credible journals are our text to support us. There are a lot of journal which was written by company or person who love to ruined our 'holy religion', so beware.

As they were atheiest, they were also aesthetic.

When I woke up this morning, I read an article in the news and a facebook post by a doctor who finally have the courage to share his experience in battling one on one with the side effect of the skin whitening therapy.

I am not surprised because I have been talking about this so many times in my blog post. I have lost track on how many time I have written on such un-medicine therapy. Sometimes I get tired on writing on that subject, because apparently, those who created this mistake, was our own comrade in medicine.


As I have mention before, we are breeding monster everyday in medicine. From 100 medical graduates, 20 will be practicing real medicine, the rest will not. And from the rest who do not, more than 50% of them will become a monster.

I just wish that all the fallen comrades, from whatever they are doing, please think about our oath when they give us the licence. Do No Harm. A simple oath by our Father of Medicine which bring a real meaning to what we are practicing.



Thursday, December 22, 2016

Master in Pathology Entrance Exam: Interview Part.

Congratulations to all that pass Master in Pathology Entrance Exam which was held on 14 December 2016. For those who does not, do not worry, there will be another one next year. There are no limit on taking this exam so it will be all good.

I would also like to congratulate my wife on passing that exam. She was planning on taking Chemical pathology. Well, I believe if she does enter next June, our family would be a pathological family. Just remember, there is nothing pathological about a pathologist. This is why most pathologist are kind and warm hearted person. The pathological person usually will not become a pathologist. It could be good to our family then.

So after the entrance Exam which was held in my place of study now, UKM, I met a few friends and colleague who have gone through the exam and the interview. Well, most who pass concern about their interview score. Most of them panicked during the interview and give all sort of funny answer. I was planning to write on the interview part of the exam but I was too busy myself trying to calm my wife for the interview. I believe she also panicked and give all sort of answer which I laugh after she told me later.

For those who are planning to take this exam next year, you can take this as a tips or maybe just a random rant from me to give you the heads up on how are they going to interview you. I speak based on my experiences and experiences from other colleague who have gone through the exam. If you want to know the real information on what they want during the interview, you can ask the interviewer because I also do not know what exactly that they wanted to hear from us.

First, you must know when the interview will be held, and what you need to bring along during that interview. That is the most important part.

Then you must understand, why they held this interview anyway? Why take so much hassle to interview a lot of people if all of these people already score in the theory exam? Some university held their own interview at much later time (USM) for all the candidates that are accepted to join their university. So, double interview?

You need to understand that this interview after you pass the theory paper, is held primarily by Ministry of Health. They actually will not interview you regarding pathology itself but they actually want to know you much better. You already passed your paper so no need to doubt on your knowledge. They want to see your attitude, aptitude, your trainability. They already told this in Mock Entrance Exam. So the question now will be very general.

Remember, they are two thing that they want to give to you at the end of all this. One, money for you to continue study (they will pay your salary, your University fee, exam fee, even give you Cost of Living allowance) so think about a person who want to give you free money (or lend money), how are you going to answer them if they ask you how are you doing?

Second thing, they want to fill all those empty vacancy around Malaysia. All those places in Sabah and Sarawak who need Pathologist, they need to put someone to work there. Where to find someone? You are the one. So all the candidates now passed their theory, so they want to ask whether you are a good candidates to be given money to study and be able to work back for them in the future.

So, by remembering this fact, your answer will be different. When someone ask you whether you are hungry, you will answer 'Yes, hungry for knowledge and experiences'. If someone ask you where you want to work, you will answer 'I am willing to work anywhere'. If they ask further on how about your family? You will answer ' Forget them, I am going for it no matter what'.

Different answer will come out from you if you know the person infront of you wanted to gave you money but want you to serve them later in a place you probably never heard of before (are you even Malaysian?). I am a bit exagerated here. Don't answer like that, but use that spirit.

With that spirit to answer like that, take a deep breath and now come back to reality. You must answer based on reality. Don't answer ' Yes I am willing to work even on the moon if I have to'. That would be unrealistic. Or some candidate might answer ' I will not marry for 4 years time, or I will not get marry ever until I finally settle at my allocated work place', this is also unrealistic. Or even answer ' I will not have another baby until I finish my study'. All of this unrealistic.

Be honest a bit. Realistic and a bit of honesty will make you superb in the interview. You might answer ' I can't say that I will not get marry along the 4 years of study, but if I do, I still can focus on my study, that would be a motivation for me to study harder'. This is realistic, and a bit of honesty. Not total honesty because if total honesty, you will answer that you will take 6 months off for honeymoon. That is what you actually want. But just a dash of honesty to make thing a bit funkier.

If the answer is too bitter even with a dash of honesty, don't lie, but speak from your heart. If they ask you whether you wanted to work in Sabah or Sarawak which is very far from your family , just say ' I need to think a lot about that because my family / husband is here, I am willing to go but I cannot answer for them. Maybe have to make a bit of adjustment later'. Don't lie and say " I will, forget my husband, I will find a new one'.

You can be totally honest if at the same time your brain is working well during the interview. One of my colleague said that she does not want to work in Sabah and Sarawak because there were a lot of time studying medicine and training during House officer and even during medical officer spend far from family and hometown, and when she became specialist her vision was to keep close with her family after missing all those precious time before. A good answer, a good spontaneous thought. Honest, brave and it is working well

They won't ask much about your knowledge on pathology or experience, but they can ask that. For those who are from Pathology department, that's a bonus question. But, for those who never work in Pathology before (most of the candidate now), you can take example from what a philosphy that I read when I was studying medicine. I forgot who say it but I remember it.

"Its better to come to a place with an empty cup rather than a full one. Because an empty cup can be filled with whatever new thing you will encounter. A full cup will have no use later".

"The best property of a cup is when it was empty".

This philosophy can be used to give an impression to the interviewer regarding how willing are you to learn more even though you do not know anything about that field. Don't talk about a cup nevertheless. When you are panic, sometimes, you remember this philosophy but you end up spending 10 minutes just talking about cup.

Speaking about that, times is always your enemy. There will be no time limit for an interview. The quicker the better. So please be aware of the time even if they did not ask you to. Answer as brief as possible. Aim to finish the invterview within 5-10 minutes. Not more, nor less. Less time will make you loose your point to impress them. More time means you are digging your own grave. If it was already past 10 minutes, please look somewhere else, take a deep breath, and start thinking how deep your grave has been dug. Try to stop or get out from it.

A few standard question they will ask is about your role later as a specialist. There was a scheme on that. Just read it or ask those who work in pathology before. Help physician to make diagnosis, to make sure you provide a quality result, to provide a quality service, quality control, bla bla bla, continuous education to stuff, and bla bla. I am into pathology because I am very interested in it. So all this answer for me is just a bla bla bla. When you love someone, you do not need to read or ask others on what you are going to do with it. You just automatically know what you are going to do. So, I can't really remember all the answer scheme but I know what to do.This part, you lean it by yourself. You can even google it. For example google " Role of a Chemical pathologist".

The last thing is to be prepared. Make sure you make your own CV and bring it along. In that CV you will write in a point form or in a table all the experience that you have, good thing about you, your interest, your hobby even if you want. They won't ask for it but this make you feel confidence when you enter the interviewer room.

Don't look too smart unless you are naturally born smart. If you end up looking too clever while you are not, they will catch you. Just be yourself.

Dress appropriately. Do not need to wear coat like you are going for CEO position. Just plain simple, not too exposing for female because the interviewer were usually female. So using your body as a tool here will never work. Use a nice shoes, not high heel. Dress confidently.

Wear tie for male, don't forget that. Wear tie, not to bright colour shirt, clean shoes, shaved, iron your shirt please.

Hold something in your hand, a file with your CV in it (that's another purpose for that), don't walk in there with an empty hand. For female, usually they will bring their big handbag, good for them, but just hold a file for whatever reason. Holding a file make you look that you are going for an interview seriously.

Don't bring bags. You will have no place to put your bag later. Some candidates bring their luggage because, for obvious reason, they were catching flights after the interview. If you do, leave that outside the room. If possible, be comfortable when you go for that interview. For me, holding a file and leaving all my bags in the hotel was a good enough.

That's all you need. Pray before the interview could be a good idea. One last thing, do not show your emotion during that interview. I was asked last time on what should I do if I was accepted in Master program and my children and my wife have to stay in Sabah. I am pretty emotional about that question but I try to control it (I am not very good at expression. My face will look the same in any emotion. Good for me). I answer them " I have to think about that, maybe I will ask my wife to join master program and migrate here with me later. That maybe took sometimes, as for the time being, we have to live separately until we find the solution".

For Sabahan, you are lucky enough because Sabah still have low level of Pathologist through out Malaysia. You can count the pathologist there which covering the whole Sabah. So if you are Sabahan, you do not need to try hard in that interview. Just relaxed, and say 'I have no other place to serve other than serving my own people there in Sabah'. High score for you. Pretty unfair. But what to do. For Sabahan, your sacrifice will be during 4 years of Master study. For Peninsular Malaysian, your sacrifice will be after you finish that 4 years study. It will be fair somehow later.


This post is a bit late. But I hope next candidate for Master Entrance next year can answer less funnier than what we answer last year or this year. It's a mind game. Don't lose it.
This is the picture of an interviewer when you start saying that you are not going to get marry or have children during the 4 years study program. In her mind she was saying "oh really? You think your hormone can be supressed by just saying that?" hahaha.
A jokes from a friend of mine regarding her interview. I don't think she mind when I share this, but I just block name and picture. It s a very good joke and example on how panicked you will be during interview.