Hi! My name is Daniel Lim Jhao Jian. Here is where I share my experience, knowledge and ideas. You are welcome to leave comments and follow my blog. You are free to copy anything from this blog. Please recommend this blog to your friends.

Thursday 9 November 2023

A weird dream (Nov 2023)

On 8 November 2023, I had a really weird dream.

In my dream, my hospital organised an exchange programme for House Officers. Selected House Officers would be sent to work at hospitals in various locations all over the world, while trainee doctors from those countries would come to Malaysia and work at our hospital.

I was one of the House Officers selected for the exchange programme. I saw the name list which stated that I would be sent to London, UK. I was so excited and I quickly agreed to join the programme. The flight tickets were funded and arranged by the government, all I had to do was to board the plane with my personal belongings. 

On the plane, I looked through the name list for the exchange programme once again. I was shocked to find out that I had made a terrible oversight earlier. It's my colleague, not me, that would be sent to London, UK. Instead, I would actually be sent to Ulaanbaatar, Mongolia! I didn't even realise that I boarded the flight to Ulaanbaatar.

That made me feel quite scared. Mongolia has a very different living environment and culture compared to Malaysia, and I have never been to Mongolia before. Mongolia also doesn't have a developed healthcare system, so working as a doctor there would surely be challenging. Unfortunately, there was no turning back for me at that point.

After landing in Ulaanbaatar, a car came to fetch me from the airport. Travelling through Ulaanbaatar, I could see a lot of forests and villages which looked quite similar to those in Malaysia. Surprisingly, I didn't see any deserts or yurts (round tents) which Mongolia is famous for. I wondered, is that really Ulaanbaatar?

At one point of the journey, the main road ahead was closed for construction works. To bypass that, the driver made a turn into a smaller road and drove through a few villages. The rural scenes looked quite nice and were reminiscent of those in Kluang. I thought, perhaps being sent to Ulaanbaatar isn't that bad after all.

After some time, we emerged back onto the main road and continued our journey. The driver told me that Ulaanbaatar was fast developing and that's why there's a lot of road constructions. He also said he was sure I would like the place after staying there for some time.

Then, I arrived at the townhood where the hospital was located. There was a sharp change in the surrounding environment. There was no more forests, as that was a desert area. Still, I didn't see any yurts. There were a few concrete buildings, with their signboards written in Mongolian Cyrillic.

I began feeling uncomfortable about being in a desert area. After the driver dropped me off at the hospital residences, the first thing in my mind was to get some food, as I was feeling hungry. I didn't even bother taking a look around the residences or the hospital. There was only one restaurant in that area, so I went there straight away.

As it turned out, the staffs at that restaurant could only speak Mongolian, not English or Chinese. I don't know Mongolian at all and I couldn't communicate with them no matter how I tried. They then refused to entertain me further. In the end, I left the restaurant without getting to eat anything. There was nowhere else I could get food, and I was so hungry.

I felt really jealous of my colleague who got sent to London, UK. This question kept going through my mind "Why did they send me to Mongolia instead of UK?" I then decided that I should leave the exchange programme and return to Malaysia as soon as possible.

I wanted to immediately send a message to my hospital to tell them to bring me back to Malaysia. I knew I had to provide a good reason for that, so I thought hard to come up with one. Then, I suddenly woke up from my dream. I was so glad that it's just a dream.


In reality, November 2023 is the penultimate month of my housemanship at Kluang hospital. This dream may reflect the uncertainty regarding my future after completing housemanship. In the dream, I had no control over whether I would get selected for the exchange programme, where I would be sent to for the exchange programme, and whether I could quit the programme.

Being sent to Mongolia and feeling so scared about it in the dream could be a representation of my fear of being allocated to a district hospital in a rural area as a Medical Officer. Several of my friends from NUMed are currently working in UK and they are enjoying it a lot, which might be why I got jealous of my colleague who got sent to UK in the dream.

Lately, I have been going around exploring Kluang, especially the rural areas. That was probably the reason I dreamt about travelling through the rural areas in Ulaanbaatar and reminiscing about Kluang. I was feeling really hungry in the dream probably because working as a doctor often requires me to work long hours without having lunch.

If you liked this story, you may want to read this too:

Thursday 19 October 2023

NUMed MedX talk presentation slides

Since 2021, I have delivered several medical lectures as part of the MedX talk series of the NUMed Medical Education (MedEd) Society. The presentation slides of the lectures are available here. They are based on the UK guidelines.

Title: Bleeding Problems in Children
Date: 19 October 2023

Title: Intestinal Obstruction
Date: 25 February 2023

Title: Menstrual Disorders and Vaginal Discharge
Date: 19 April 2022

Title: Haematological Malignancies
Date: 28 November 2021

Title: Acute Red Eye
Date: 3 April 2021

Title: IV Fluid Management in Adults
Date: 27 March 2021

Thursday 21 September 2023

Why I chose Anaesthesiology?

For the elective posting of my housemanship, I chose to do Anaesthesiology. Why did I make this decision?

During the orientation at the start of my housemanship, we were told that the 6th posting of housemanship is an elective posting, where we could choose either one of Emergency Medicine, Anaesthesiology, General Practice and Psychiatry. I had always found General Practice and Psychiatry quite interesting, and the work is generally quite relaxing in these two specialties.

I immediately told myself that I must choose General Practice or Psychiatry. However, much to my disappointment, I soon found out that at my hospital, only Emergency Medicine and Anaesthesiology are available for the elective posting. I didn't like either Emergency Medicine or Anaesthesiology. 

Anaesthesiology is an area of Medicine which I had very little exposure to. There was no Anaest rotation in my MBBS course, and I hardly ever read up anything about it. I always had the impression that Anaesthesiology is very difficult because there's so many things to learn.

On the other hand, Emergency Medicine requires doctors to work very fast, which I had always been very bad at. I need to think before doing something, or else I would make mistakes or omissions. However, patients going to the Emergency Department may be very ill which requires urgent treatment.

Having to choose between Emergency Medicine and Anaesthesiology, I felt that Emergency Medicine surely would be more suited for me. At least, I had good theoretical knowledge in Emergency Medicine, unlike Anaesthesiology which I had so little knowledge in. Therefore, I made the preliminary decision to choose Emergency Medicine for the elective posting.

During my 1st housemanship posting in Medical, I often had contact with the Anaest team, who will come to review and manage the acutely ill and unstable patients in the Medical ward. I found the Anaest team quite terrifying. Whenever I saw them, I knew it meant there's some unstable patients which require a lot of work to manage. I also never really understood the Anaest management plans which looked so complicated. That made me want to stay away from doing Anaesthesiology.

Meanwhile, I had very little exposure to the Emergency Department throughout my Medical posting, so I didn't know how working there is like. House Officers in the Medical posting generally only work in the wards and they rarely get called to the Emergency Department.

After I got into my 2nd posting in Obstetrics and Gynaecology, I was allocated to the labour room and pregnancy assessment centre (PAC) for the first 3 months. I found the labour room and PAC a very stressful place to work at. For each patient that comes to the PAC, we have to take a full history, do abdominal and vaginal examination, insert an IV cannula, take bloods, perform CTG and plan the management. We also have to document everything properly in the clerking sheet and present the case to an MO.

Clerking a new patient at the PAC is a long and tedious process, taking 30 minutes at the minimum. Patients may come to the PAC at any time of the day and it's impossible to predict that at all. Sometimes, a new patient may come in before I'm done clerking a previous patient, or two or more patients may come at the same time. Whenever that happened, I would get panicked as I knew there would be a lot of work awaiting me.

House officers have always been told to prioritise the work when it gets busy. However, even with job prioritisation, we still have to complete all of the work at the end of the day. We are also expected to work fast and to multitask, which is something I'm very bad at.

Any of the patients at the labour room and PAC may have an emergency at any time, with common examples being pathological CTG, meconium stained liquor and bleeding. Whenever that happens, we have to stop doing whatever we are doing and attend to it immediately. I don't like leaving my work uncompleted and resuming later, as that greatly increases the risk of making mistakes and omissions, yet I'm forced to do so during an emergency.

I soon realised that the PAC is basically the Emergency Department for Obstetrics and Gynaecology. I felt that working at the real Emergency Department (ED) would surely be very stressful in a similar way, in fact it likely would be even worse than the PAC. Patients with all kinds of conditions of any specialty may come to the ED anytime, and we need to be able to manage them quickly and appropriately. I began to think that Emergency Medicine isn't for me.

By April 2022, I had decided that I wouldn't want to do Emergency Medicine for my elective posting of housemanship. That meant my only option would be Anaesthesiology. I began exploring Anaesthesiology. Whenever I entered the operating theatre for caesarean sections, I would take a look at how the Anaest team performs spinal or general anaesthesia. I could gain a bit of understanding about anaesthesia and I found it rather interesting.

In the subsequent Orthopaedics and Surgical postings, I often had to go to the ED to see new cases. I never enjoyed working at the ED, as I found the work environment there so stressful, especially when there's a lot of patients. I was even more convinced that I mustn't do Emergency Medicine.

The Anaest team reviews and manages the acutely ill and unstable patients in the Orthopaedic and Surgical wards as well. I made it a point to get to know and understand the management plans by the Anaest team. I also made sure to properly carry out the plans and communicate with the Anaest MOs regarding that. That enabled me to know the Anaest MOs better, and I felt that most of them are actually quite nice. I no longer found the Anaest team terrifying.

Later, someone remarked that he thinks I'm not suitable to do Anaesthesiology, so my only option would be Emergency Medicine which I should prepare for. I don't agree with what he said at all and I am determined to prove him wrong. That gave me the push for doing Anaesthesiology.

My friends who did the Anaesthesiology posting at my hospital gave really good remarks regarding it. According to them, Anaest has a really nice work environment, and the Anaest MOs and specialists are very willing to teach and guide house officers. Moreover, the workload in Anaest is generally quite manageable and house officers in Anaest rarely have to work overtime. That made the Anaest posting even more attractive for me.

A widely touted advantage of doing Emergency Medicine for the elective posting is that it gives us the opportunity to work as locum doctors at the ED of private hospitals, getting an additional source of income. Most private hospitals will only hire doctors with work experience in Emergency Medicine to work at their ED. While I appreciate that it may be beneficial to some people, I personally have zero interest in it.

I just don't like working at EDs, whether at public or private hospitals. The work experience as a locum doctor also contributes nothing towards becoming a registered specialist. Moreover, right from the beginning, I chose to do Medicine to help people, not to make big money. Working at a private hospital would go against that very principle of mine. Therefore, there's no reason for me to do Emergency Medicine at all.

In June 2023, I made the firm decision to do Anaesthesiology for my elective posting of housemanship and I communicated my decision to the hospital. I then received confirmation in August 2023 that I have been placed in Anaesthesiology. I started the Anaest posting on 6 September 2023.

Anaesthesiology has a rather steep learning curve compared to other postings, as there's many new things to learn. Despite that, the enthusiasm of the MOs and specialists in teaching and guiding house officers has enabled me to gain a lot of new knowledge and skills without much difficulties. I am confident that I will be able to master Anaesthesiology.

I hope the Anaest posting will be a great and satisfying ending to my housemanship.

Thursday 31 August 2023

My first time voting in an election

When the 1999 Malaysian general election was held, I was only 4 years old. I had absolutely no knowledge about it. The 2004 Malaysian general election was the first time where I knew what an election is. However, I didn't really understand its significance, and I got annoyed when I kept hearing people talking about the election.

By the time of the 2008 and 2013 Malaysian general elections, I had understood the importance of elections. I closely followed the news of the 2008 and 2013 elections. However, I still had little understanding about the parliamentary system in Malaysia.

The 2018 Malaysian general election was the first in which I was eligible to vote. Automatic voter registration hadn't been implemented for that election. I was in Year 4 of MBBS at that time. Considering that I would be in UK for my medical electives during the time of the election, I decided there was no point in registering for the election.

Although I was aware that it's possible to vote overseas, I felt that it was too big of an hassle so I didn't sign up for it. Due to the extensive news coverage of the election, I finally understood for the first time how the parliamentary system works in Malaysia. I told myself I should vote in the next election.

In September 2020, I found out from my friend that voter registration can be done easily through the MySPR website. I finally registered as a voter for the first time. I then got the confirmation that I would be voting in the Subang parliamentary constituency and in the Subang Jaya state constituency for Selangor.

I started my housemanship at Kluang hospital in August 2021. During the 2022 Malaysian general election, I was in the Orthopaedics posting and there was a lack of House Officers in the department. As a result, I couldn't apply for leave to go back to Selangor to vote in the election.

Since I am a healthcare worker, I could vote in the election through post. However, before I could complete the application process for postal voting, its deadline had passed. In the end, I couldn't vote in the 2022 Malaysian general election.

In the subsequent 2023 Selangor state election, I was determined to vote. I was in the Paediatrics posting during this election. Once again, there was a lack of House Officers which made it difficult for me to apply for leave. Therefore, I decided to vote through post.

As soon as the application for postal voting was open, I quickly applied for it, not wanting to miss the deadline again. I applied through the MySPR website, and as part of the application, I had to let my Head of Department sign the application form to verify that I would be working on the polling day.

My application for postal voting was approved. On 2 August 2023, shortly after the nomination day for the 2023 Selangor state election, the ballot paper was delivered to my house in Kluang through Poslaju. I then voted and returned the ballot paper. The polling day was on 12 August 2023.

I am glad to have exercised my responsibility as a voter for the first time. I certainly will be voting in future elections as well.

Saturday 5 August 2023

Dark mode for this blog

In view of the popularity of dark mode, I have now switched my blog to dark mode. This should help reduce eye strain and glare when you are reading it in low-light conditions and help reduce battery consumption.

Thanks for your continuous support!

Sunday 2 July 2023

NUMed ARCP Reflections Sample

Graduates of Newcastle University Medicine Malaysia (NUMed) who wish to apply for full registration with the UK General Medical Council (GMC) have to submit 3 pieces of reflections for the Annual Review of Competency Progression (ARCP).

Here, I am sharing my ARCP reflections. They are in a single PDF file. You may use them as a guide if you are seeking to apply for GMC full registration. However, please note that plagiarism is strictly prohibited.


Thursday 15 June 2023

ARCP House Officer programme for NUMed graduates

Newcastle University Medicine Malaysia (NUMed) runs a programme that enables its graduates to gain full registration with the UK General Medical Council (GMC) after completing a year of House Officer training at one of the 8 approved hospitals in Malaysia. This programme recognises the House Officer training as being equivalent to Foundation Year 1 (F1) in UK.

Currently, I am working as a House Officer at Hospital Enche' Besar Hajjah Khalsom, Kluang and I am joining the programme. Here, I would like to share some guidance for the programme.

The requirements for gaining GMC full registration through the programme:

- You must be a graduate of the NUMed MBBS course.
- You must undergo House Officer training at one of the 8 hospitals approved by GMC:
(i) University of Malaya Medical Centre (UMMC), Kuala Lumpur
(ii) Hospital Enche' Besar Hajjah Khalsom (HEBHK), Kluang
(iii) Hospital Sultan Ismail (HSI), Johor Bahru
(iv) Hospital Sultanah Aminah (HSA), Johor Bahru
(v) Penang General Hospital
(vi) Hospital Sibu
(vii) Sarawak General Hospital, Kuching
(viii) Queen Elizabeth Hospital, Kota Kinabalu
- You must have provisional registration with the GMC by the time you start working as a House Officer.
- You must complete 3 postings in your House Officer training successfully and keep the complete logbooks for the 3 postings.
- You must complete the Additional Procedures Form.
- You must complete the Your School Your Say (YSYS) survey and the Equality and Diversity (E&D) module.
- You must complete 3 pieces of reflective accounts. A sample of the reflective accounts is available here:
- You must keep in contact with NUMed and update NUMed regarding your progress in House Officer training when necessary.

The procedure for joining the programme:

1. After you get a place for House Officer training at one of the approved hospitals, apply for provisional registration with the GMC as soon as possible. You have to apply through GMC Online and pay GBP52 to GMC.
2. Email NUMed to inform that you would like to register for the programme. NUMed will send you the application form, Additional Procedures Form and Template for Reflections.
3. Complete the application form and pay RM2000 to NUMed. This should be done within 3 months of starting your House Officer training.
4. Within the first year of your House Officer training, complete the Additional Procedures Form and ensure that it is properly signed and stamped. You also have to write 3 pieces of reflective accounts based on the Template for Reflections.
5. At some point during your House Officer training, NUMed will send you the links for Your School Your Say (YSYS) survey and Equality and Diversity (E&D) module. Complete them accordingly.
6. If you have any extensions or unanticipated absence in your House Officer training, you need to inform NUMed about that promptly.
7. You have to complete 3 postings in House Officer training successfully. Ensure that you have complete logbooks that are properly signed and stamped for the 3 postings.
8. After you have completed all of the above, you will undergo the Annual Review of Competence Progression (ARCP). NUMed will inform you about the date of the ARCP.
9. Once you are successful in the ARCP, you will be given a Certificate of Experience which you can use to apply for full registration with the GMC.

The benefits of GMC full registration:

- Right after you gained GMC full registration, you are eligible to apply for the Foundation Year 2 (F2) Stand-alone programme and the Widening Access to Specialty Training (WAST) programme in UK.
- If you choose to complete the 2nd year of House Officer training in Malaysia after gaining GMC full registration, you may apply for specialty training in UK directly.
- There are also various locum posts in UK you can apply for with GMC full registration.
- Some other countries recognise GMC full registration, so you may be able to practise Medicine in those countries.
- Unlike GMC provisional registration, GMC full registration doesn't expire and is valid indefinitely.

Other information:

- In addition to this programme, NUMed graduates have the option of joining the 2-year UK Foundation Programme (UKFP).
- NUMed graduates are exempted from taking the PLAB, IELTS and OET when applying for provisional registration or full registration with the GMC.
- House Officer training in Malaysia is only open to Malaysian citizens. Therefore, non-Malaysian citizens are unable to join the programme.
- If you do not fulfill every single one of the requirements for the programme (e.g. you are not a NUMed graduate or you are doing House Officer training at a hospital not approved by GMC), you are not eligible to join it.
- If you are not eligible for the programme, it may still be possible for you to apply for GMC full registration provided that you have completed a year of House Officer training at any hospital. In that case, you need to apply to GMC directly and they can take into consideration your work experience as a House Officer. However, the process is quite complicated and there is no guarantee of success.
- Other hospitals may be added to the list of hospitals approved by GMC in the future, but no information on that is available currently.

For more information on this programme, go to these pages:

Tuesday 16 May 2023

My application for the F2 Stand-alone Programme 2023

I have been offered a place for the Foundation Year 2 (F2) Stand-alone Programme 2023!

Unlike the standard 2-year UK Foundation Programme where almost all eligible applicants are offered a place each year, the F2 Stand-alone Programme is much more competitive. In the recent years, there are 1000+ applicants but only about 100 places each year. This means just around 10% of the applicants can get a place, making it about as competitive as getting the Merit award at NUMed or getting a permanent Medical Officer post in Malaysia.

Never in my wildest dreams had I thought that I would get a place for the F2 Stand-alone Programme with such extreme competition. Still, I applied for it because I wanted to see how far I could go. I also knew that there were some useful things I could learn through the application process even if it wasn't successful.

I was off to a good start after I got a very high score of 368/431 for the Situational Judgement Test (SJT) in March 2023. My experience of taking the SJT for the 2-year Foundation Programme twice in 2021 and 2022 certainly helped in achieving this. Then, I managed to perform quite well in the interview held in April 2023, getting a score of 71%. This was thanks to my teaching and research experience which helped build a strong curriculum vitae, as well as my good English language and communication and my good response in the ethical scenario.

Now that I am successful in the F2 Stand-alone Programme application, it has shown that with the right efforts and opportunities and a bit of luck, I too can achieve what seems to be beyond my reach. I am now hopeful of my future, that I will successfully achieve my career goal.

Saturday 29 April 2023

Why I chose the Google Pixel 6A over the iPhone?

In April 2023, I got my new phone, the Google Pixel 6A. I can say that I am very impressed with this phone. It has a Google Tensor processor, 128GB of storage and 6GB of RAM. It runs very fast and it's battery lasts quite long, and the quality of its camera is excellent.

Google Pixel phones have never been officially sold in Malaysia. I had to buy the Google Pixel 6A online through Lazada. It costs a total of RM1400 including delivery, mobile protection service, screen protector, phone case and some free gifts, and the phone is a brand new set. I certainly think it's a very good value for money. Just like the latest iPhones and Samsung phones, it doesn't come with a charger, but I can use my old phone's charger.

My previous phone was the Google Pixel 2. I had used it for more than 5 years since December 2017, and it had been functioning well. However, its camera stopped working in April 2023. Since the camera is an important feature which I use a lot, I had to get a new phone.

In 2021, someone hacked my Google account and used it to create several Google Ads accounts, trying to make me pay for that. When I seeked help from Google, they were extremely unhelpful. They stated that they could only help me after I provided them with the IDs of those Google Ads accounts, but when I gave them the IDs, they insisted those IDs were invalid and refused to proceed with helping me resolve the issue. I was really upset with Google over that.

Google Pixel phones didn't support VoLTE in Malaysia, as they are not officially sold here. Worse still, 3G networks in Malaysia were shut down in late 2021. Consequently, Google Pixel phones could only use 2G for making and receiving phone calls. If I received a phone call while browsing the internet, the phone would automatically switch the network to 2G, and the low speed of 2G would interrupt the internet connection. The aging infrastructure of 2G networks also resulted in a subpar call quality.

Consequently, I decided in 2021 that I would never get another Google Pixel phone again and my next phone would be an iPhone. However, the circumstances changed over the course of 2022 and 2023.

Apple introduced iPadOS 13 in 2019. It introduced a lot of new features which brought the iPad much closer to being a laptop replacement. That contributed heavily to my decision to buy the iPad Air 3 in August 2019. I was hopeful that future versions of iPadOS would make the iPad even more useful, eventually becoming a true laptop replacement. Unfortunately, that wasn't the case. iPadOS 14 didn't bring any significant new features apart from Universal Search which is just a glorified Spotlight search. iPadOS 15 introduced a much needed new multitasking interface, but didn't go far enough.

iPadOS 16 in 2022 finally introduced Stage Manager which gives a multi-window interface similar to those in desktop operating systems. Unfortunately though, Stage Manager was only available for the iPad Air 5 and iPad Pro 3 and later. My iPad Air 3 will never get the Stage Manager, neither will the iPad Air 4 or iPad Mini 6. I was deeply disappointed with Apple about that. It wasn't even the first time something like this happened. Previously in 2015, Apple introduced the Split View feature with iOS 9, but only made it available for the iPad Air 2, leaving out my iPad Air 1.

In August 2022, the power button of my iPad Air 3 stopped functioning, while issues with its Lightning connector port made changing more and more difficult. This was despite the fact that I always took good care of my iPad. Knowing that an official Apple service centre would charge a hefty price for repairing due to my iPad being out of warranty, I got my iPad Air 3 repaired at a third-party repair shop.

While the repair went well, just a few months later in April 2023, my iPad Air 3 started having another major issue. Every few minutes, it will display a purple screen and then restart on its own. I had tried resetting the iPad, upgrading to the latest iPadOS version and even erasing all data on the iPad, but the issue persisted. My iPad Air 3 is less than 4 years old and it's already having so much issues. In contrast, my Google Pixel 2 lasted more than 5 years without significant issues. This indicates that the quality of Apple products is going down the drain. How can I be confident that an iPhone will last long if I buy one?

Apple has insisted on using the Lightning connector port on iPhones, even though iPads, Macbooks and most Android phones have switched to USB-C ports. The Lightning connector port is an outdated technology. It only supplies a very small amount of power to connected accessories which is often insufficient for them to function properly. The data transfer speed of Lightning cables is also significantly lower compared to USB-C cables.

iPhones are very expensive. Even the most basic iPhone 14 costs RM4200. I bought my Google Pixel 2 phone for RM4000, which was very expensive as well. However, Google later introduced the cheaper A series of Pixel phones, starting with the Google Pixel 3A in 2019. The A series of Pixel phones are often available for sale on Lazada at a price less than RM2000.

I have considered Android phones other than Google Pixel. Samsung is the most popular brand of Android phones. However, I don't like the fact that Samsung heavily modifies the interface of Android and adds a lot of bloatware in its phones. I used a HTC phone before and I really liked it, but HTC hasn't produced a flagship phone in quite a while. While Huawei phones are great, they are banned from Google apps and services which are essential for me. Nokia was initially doing well after it started producing Android phones, but it has been struggling to keep up with Android updates for some time. Meanwhile, I have little interest in Asus, LG, Lenovo, Motorola, Sony, Oppo, Vivo and Xiaomi.

There are 3 things I have always liked about Google Pixel phones. First, Pixel phones, including the cheaper A series, have excellent hardware specifications. Second, they receive Android version updates and security updates as soon as they are available. Third, they offer the pure Android experience, without any user interface modifications or addition of bloatwares. 

In late 2022, in response to popular demand, Google finally released an update which added support for VoLTE for Pixel 6, Pixel 6A and Pixel 7 in Malaysia. However, older Pixel phones including the Pixel 2 aren't supported. With that, I was once again interested in getting a new Google Pixel phone for my next phone. This eventually culminated in my decision to buy a Google Pixel 6A in April 2023.

Wednesday 1 March 2023

Tips for UKMLA AKT and PLAB 1

Starting from the 2024/2025 academic year, all final year medical students in UK medical schools, including Newcastle University Medicine Malaysia (NUMed), have to take the UK Medical Licensing Assessment (UKMLA) as part of their medical degree before graduating. The UKMLA has 2 parts, the Applied Knowledge Test (AKT) and the Clinical and Professional Skills Assessment (CPSA).

Currently, all medical graduates from non-UK medical schools, with the exception of NUMed graduates and graduates with a relevant European qualification, have to take the Professional and Linguistic Assessment Board (PLAB) in order to apply for provisional or full registration with the UK General Medical Council (GMC) and practise Medicine in UK. The PLAB has 2 parts, PLAB 1 and PLAB 2. Starting from 2024, PLAB 1 will be aligned with the UKMLA AKT while PLAB 2 will be aligned with the UKMLA CPSA.

The UKMLA AKT and PLAB 1 are in the form of a Single Best Answer (SBA) examination. I got a score of 75.5% for my final year SBA examination in 2020. I completed my MBBS course at NUMed and subsequently worked as a Teaching Fellow there. Here, I would like to share some tips on passing the UKMLA AKT and PLAB 1.

I am writing the tips based on how I revised for the exam previously. However, different individuals may have different learning styles, so you should just take this as a guide.

First, you have to start your revision no less than 2 months before the UKMLA or PLAB. I recommend studying at least 5 hours per day on weekdays and 7 hours per day on weekends and holidays. If possible, you should revise every day. To pass the exam, you should aim for a score of at least 66%.

If you do not understand any topic when doing revision, ask a lecturer or a friend for further clarification. Personally, I do not find group study helpful for the SBA examination.

All specialties will be covered in the UKMLA AKT and PLAB 1, including:
- Internal Medicine
- Obstetrics and Gynaecology
- Paediatrics
- Psychiatry
- Surgery
- Trauma and Orthopaedics
- Ophthalmology
- Dermatology

When revising, you should go specialty by specialty. Finish all topics in a particular specialty before moving on to the next specialty. Your focus when doing revision should be on risk factors, pathophysiology, diagnosis, investigations, management and complications. You should complete at least 4 full rounds of revision for all topics if possible.

Medicine should be studied mainly through understanding, not memorising. Basically, for every fact you come across in your revision, try to think "Why is this the case?" If there is an explanation, read it and make sure you understand what it says. If there is no explanation, try to come up with your own explanation based on your knowledge. Even if your explanation is wrong, it does not really matter as the exam questions will not ask for the explanation. You can also look up the internet for an explanation. The fact is that, when you actively seek an explanation for a fact, you will end up remembering the fact much better and your revision will also become more interesting. This is so much more effective than simply memorising the facts. However, do note that not everything can be studied this way. Certain facts have no possible explanation at all, so the only way to study them is by memorising.

You do not need to memorise the normal range of values for investigations as it will be provided in the questions during the UKMLA AKT or PLAB 1. You also need not memorise the doses of drugs apart from very commonly used ones.

The most important revision resource for the UKMLA AKT and PLAB 1 is the textbooks. I recommend using the following textbooks and resources for each specialty:
Internal Medicine - Oxford Handbook of Clinical Medicine (10th Edition)
Ophthalmology, ENT, Dermatology, Trauma and Orthopaedics - Oxford Handbook of Clinical Specialties (11th Edition)
Surgery - Oxford Handbook of Clinical Medicine (10th Edition) and Surgical Talk (3rd Edition) 
Psychiatry - Psychiatry by Ten Teachers (2nd Edition), Psychiatry - A Clinical Handbook and ICD-11
Obstetrics and Gynaecology - Obstetrics & Gynaecology by Lawrence Impey & Tim Child (5th Edition)
Paediatrics - Illustrated Textbook of Paediatrics (6th Edition)

These textbooks are not essential for the exam but may be helpful to refer to if you are looking for some specific information:
Davidson's Principles and Practice of Medicine, Kumar and Clark's Clinical Medicine, Apley and Solomon's Concise System of Orthopaedics and Trauma, Robbins Basic Pathology, Underwood's Pathology, Rang and Dale's Pharmacology

While Year 1 and Year 2 knowledge can be helpful at times, they are not essential for the UKMLA AKT or PLAB 1. There is no need for you to specifically revise any Year 1 or Year 2 topics.

You need to know the clinical guidelines for the more common conditions. Important guidelines are those that can be found in the textbooks, and you should look up the internet for the most up-to-date version of those guidelines. For obstetrics and gynaecology, use NICE and RCOG Green-top guidelines. For asthma, use BTS guidelines. For other conditions, use NICE guidelines. However, do not place too much emphasis on the guidelines, as it is more important that you revise the textbooks and understand everything.

You should also do practice SBA exam questions. Go through all practice questions provided by your lecturers. Passmedicine and Pastest have a large number of practice questions. They require paid subscription and I recommend that you subscribe to one of them. Some of the practice questions are similar in style to those in the UKMLA AKT and PLAB 1 while others are not. After finishing each practice question, check the correct answer and make sure you understand the reasoning behind every correct or wrong answer. Although doing practice questions is important, you should not prioritise it over revising the textbooks.

During the UKMLA AKT and PLAB 1, you will have a limited amount of time to answer each question. Therefore, you should always time yourself when doing the practice questions. As you are reading the question, you should already be thinking of the diagnosis so that you can get to the answer faster.

All the best in your revision! I hope you will be able to do well in the exam.

Tips for the Prescribing Safety Assessment (PSA) can be found here:

Friday 20 January 2023

International Recognition of MUET

The Malaysian University English Test (MUET) is an English language proficiency test in Malaysia, mainly used for university admissions. All public universities and vast majority of private universities in Malaysia accept the MUET.

Starting from 2021, there is a significant change in format of the MUET, and the band scores of the MUET are aligned to the Common European Framework of Reference for Languages (CEFR).

It is widely believed that the MUET is only recognised in Malaysia. In reality, the MUET does have international recognition as well, though that is quite limited for now. Here is a list of foreign universities that recognise and accept the MUET.

Branch of foreign universities in Malaysia:

Singapore Management University

Hong Kong:
Hong Kong Polytechnic University
Hong Kong Academy for Performing Arts

United Kingdom:
University of East London
Manchester Metropolitan University


United States of America:



Monday 5 December 2022

A weird dream (Jul 2022)

I had a weird dream on 31 July 2022.

In my dream, Kluang hospital organised a holiday trip to Penang. I and several of my House Officer colleagues joined the trip. We stayed at the top floor of a hotel in Penang.

At one point, the building of the hotel started swaying. I wasn't too concerned about that, as I had known that tall buildings are designed to sway during strong winds to help prevent damage.

Suddenly, the Medical Officer in charge of the trip told us to evacuate the building as it had suffered structural damage from excessive swaying. She scolded the House Officer leader for not relaying the evacuation order to us earlier.

When walking down the emergency stairs, my colleagues were quite slow and I was far ahead of them. I kept rushing them, saying that although I didn't think the building would collapse, we shouldn't risk our lives.

Influenced by me, they started speeding up. Eventually, all of us reached the ground floor. As soon as we walked out of the hotel, I saw its upper floors falling down. Luckily, it fell on another side, otherwise we would be crushed!

My colleagues then said that if they were just a bit slower in evacuating the building, they wouldn't have made it. They thanked me a lot for saving their lives by rushing them during the evacuation.

Later, we went to a restaurant and they treated me with a huge meal. I felt so honoured and I was over the moon. Then, I woke up from the dream.

If you liked this story, you may want to read these too:

Tuesday 29 November 2022

Instagram Close Friends list

Instagram has a Close Friends feature in which you can choose to share your Instagram stories only to those of your followers that you have added to your Close Friends list. Now, I use the Close Friends feature a lot, where vast majority of my Instagram stories are only shared to my Close Friends list.

When Instagram first introduced the Close Friends feature in 2018, I wasn't interested in the feature at all, as I wanted as many people as possible to see my Instagram stories. I always shared my stories to all of my Instagram followers. At that time, majority of my Instagram followers were my friends from the 2014-2019 batch of NUMed and my Taylor's College friends. I only shared Instagram stories occasionally, when I had interesting events.

In February and March 2019, I went through a crisis with my group mates in 5th year of MBBS. While I undeniably made mistakes in that crisis, the fact was that my group mates had their mistakes as well. However, they refused to acknowledge any of their mistakes, instead they kept exaggerating my mistakes and sabotaging me. Many others in the 2014-2019 batch simply believed the narratives of my group mates without bothering to get my side of the story, and they disliked and looked down on me. It made me realise I had many fake friends in the 2014-2019 batch, and I no longer valued them.

The crisis contributed to my failure in 5th year of MBBS, which required me to repeat the year by joining the 2015-2020 batch. In my repeat year, I wanted to move on from the crisis and the 2014-2019 batch. I started making many new friends in the 2015-2020 batch. While I didn't know them well in the beginning, I got closer and closer to them as time went on. They gave me a great experience for my repeat year and I liked and valued them a lot.

In December 2019, a guy TL, who was originally from the 2014-2019 batch and was repeating the year as well, started becoming a real annoyance to me. As I was quite nice to him, he kept taking advantage of me. I didn't like being close to him as he didn't have any sincerity in friendship. I preferred mixing with my new friends in the 2015-2020 batch so much more compared to him. I tried to stay away from TL, but he kept trying to stick to me.

In January 2020, TL developed a new habit. Whenever I shared an Instagram story, he would open it using his phone right in front of me and my friends and mock it. He also often spammed my Instagram stories with irrelevant reactions and replies. Those were his desperate attempts to seek my attention as I increasingly avoided him, and I really hated that. To put a stop to that, I could just remove him from my Instagram followers list or even block him from my Instagram, but I didn't want to go to that extent.

At that time, I realised that the Instagram Close Friends feature would be the solution. By sharing my Instagram stories to my Close Friends list, which most definitely wouldn’t include TL, he wouldn't be able to see my stories anymore. I added all my new friends from the 2015-2020 batch and those few of my true friends from the 2014-2019 batch to my Close Friends list. Initially, I shared some of my Instagram stories to my Close Friends list and some to all of my Instagram followers. As time went on, I increasingly used the Close Friends feature, as I felt more comfortable to be in control of who could see my stories.

In March 2020, the Covid-19 pandemic started and the Movement Control Order (MCO) was soon implemented. NUMed had to suspend all face-to-face classes and clinical placements. Consequently, I couldn't meet my friends in the 2015-2020 batch. I was very sad about that and at that point, I realised they were the ones that mattered most to me among all my friends. My fake friends in the 2014-2019 batch as well as TL were absolutely of no match to them. 

The Covid-19 pandemic brought huge disruptions to our daily lives, giving everyone a difficult time. Almost everything posted on the social media was about the Covid-19, and seeing them just made us feel even more stressful. Whenever we came across rare posts and stories that weren't talking about the Covid-19, we would feel better.

To keep in touch with my friends, I decided to update my Instagram story every day. My stories were mostly about my daily life, such as the food I ate, how I kept myself entertained when I was bored and my preparation for the final exams, as well as interesting things I came across on the Internet. I never mentioned anything about the Covid-19 in my stories. I was hoping that my stories would give a sense of normalcy amid the Covid-19 pandemic, which would make my friends feel a bit better.

I also decided that moving forwards, vast majority of my stories would only be shared to my Close Friends list. Having known who are my most valuable friends, I felt that only they should see my stories. I always had the habit of checking who has seen my Instagram stories after I shared them. I would love to see the viewer list comprising entirely of those friends that matter a lot to me. It's the quality that matters, not quantity.

Sharing to my Close Friends list would also make my Instagram stories look more special, as they would show up with a distinctive green circle instead of the usual red circle. Since not many people use the Instagram Close Friends feature, my friends would notice my Instagram stories better. When they see that they are in my Close Friends list, they would know that I value them a lot.

Due to the MCO, the MBBS final exams originally scheduled for May 2020 had to be postponed. A few students from the 2015-2020 batch together with a few who were repeating the year came up with a proposal to have the final exams online, so that there wouldn't be delays to the exams and thus our graduation. However, I strongly believed that having the exams online would bring more harm than good, due to unfamiliarity with online exams and the strong possibility of internet connection issues, so I voiced out against their proposal.

A highly questionable poll showed that majority of the batch supported online exams. Unfazed by that, I continued opposing online exams by giving compelling arguments against it, and a few students criticised me for that. I got a bit worried that it might lead to me getting disliked by the 2015-2020 batch, much like what the 2014-2019 batch did to me in the previous year. However, I was confident that I was fighting for the best outcome for the 2015-2020 batch.

One of my close friends then messaged me to state that she and her friends appreciated my efforts in opposing online exams. Some others in the 2015-2020 batch also felt that my opinions were valid. Soon, many in the 2015-2020 batch realised that having online exams was a bad idea and they too were against it. My courage in speaking up against online exams earned their respect. Eventually, NUMed maintained its decision to postpone the final exams rather than having it online.

This incident made it obvious that the 2015-2020 batch is different from the 2014-2019 batch. Most of the 2015-2020 batch are capable of thinking rationally rather than simply making baseless conclusions and disliking someone. It made me love the 2015-2020 batch even more, and I decided to expand my Instagram Close Friends list by adding in all of my followers from the 2015-2020 batch.

The MCO gradually eased starting from June 2020. NUMed was able to resume face-to-face teaching and conduct the final exams in July 2020. I could meet my friends in the 2015-2020 batch once again and I was overjoyed about that. At that time, it had become a habit for me to share Instagram stories to my Close Friends list almost every day, so I continued doing so.

After I completed my MBBS degree, I started working as a Teaching Fellow at NUMed in October 2020. While I didn't know my Teaching Fellow colleagues well in the beginning, I soon became very close to them. Of course, I added them to my Instagram Close Friends list. They were from the 2015-2020 batch as well.

In March 2021, many of my students in NUMed started following me on Instagram. I then decided to add all of them to my Instagram Close Friends list. I really enjoyed my Teaching Fellow job and I had a lot of great memories with my students, so they surely deserved to be in my Close Friends list. That greatly expanded my Close Friends list.

In August 2021, I started working as a House Officer. In the beginning, I struggled to adapt to the House Officer job and I had very few friends in the hospital. Later, as I gained more skills and experience, the situation improved a lot. I became good friends with many of my House Officer colleagues and I added them to my Instagram Close Friends list.

Basically, I only add those of my friends who have meaningful good memories with me or have contributed positively to my personal development to my Instagram Close Friends list. Some may think that I simply add a lot of people to my Close Friends list without second thoughts, but that's not the case in reality.

For the foreseeable future, I will keep sharing vast majority of my Instagram stories only to my Close Friends list.

Tuesday 25 October 2022

The Dvorak keyboard layout

Anyone who has ever borrowed my phone would have noticed something strange: The touch screen keyboard of my phone appears to be all jumbled up!

Everyone who had used my phone had found it very difficult to type using the keyboard, and what I would do every time is to change the keyboard to the standard QWERTY layout so that they could type normally.

So, why does my phone have such a jumbled up keyboard? You may think that it's due to some kind of a software error. In reality though, I intentionally set up my phone's keyboard like that, and that's what I use every day.

It's known as the Dvorak keyboard layout. The arrangement of the keys in this layout is very different from the standard QWERTY layout which everyone is familiar with. While far less popular than the QWERTY layout, the Dvorak layout is actually better.

Have you ever wondered why the keys on a keyboard are not arranged in alphabetical order from A to Z?

Before computers were invented, keyboards were first used on typewriters. In the beginning, the keys on keyboards were indeed arranged from A to Z, and such a layout enabled users to type very fast. While that might seem to be a good thing, the issue was that back in those days, the keys on typewriters would easily get jammed when typing was done too fast. Jammed keys was a huge annoyance as it would disrupt typing.

To help prevent the keys from getting jammed, the typing speed had to be reduced. To achieve that, the QWERTY keyboard layout was invented. In the QWERTY layout, commonly used letters are placed away from the centre of the keyboard and common combinations of letters are placed further apart from each other. That made typing significantly slower.

The QWERTY layout increased the efficiency of typing on typewriters, because although the typing speed was reduced, the occurrence of jammed keys was also greatly decreased. The QWERTY layout quickly gained popularity across the world, and nearly all typewriters adopted it.

When computers were later invented, the manufacturers simply used the QWERTY keyboard layout because of its popularity. However, unlike typewriters, jammed keys doesn't occur on computer keyboards. On computers, the faster the typing, the better it is. Therefore, the QWERTY layout actually confers no advantage on computers.

Because of that, the Dvorak keyboard layout was invented. In the Dvorak layout, most commonly used letters are placed in the middle row and all vowels are placed on the left side of the keyboard. This layout aims to reduce the movement of fingers and maximise the successive use of both hands when typing.

The end result is that the Dvorak layout not only speeds up typing, but also makes it less tiring for the fingers. Studies have shown that for someone who is new to typing, it's easier to train typing with the Dvorak layout.

While the Dvorak keyboard layout has advantages over the QWERTY layout, the Dvorak layout failed to gain widespread adoption. As a matter of fact, most people have gotten used to the QWERTY layout and are not keen on changing. Consequently, computer manufacturers continue to make keyboards with the QWERTY layout.

Very few people use the Dvorak layout nowadays. However, most computer operating systems do support the Dvorak keyboard layout.

I first came to know about the Dvorak keyboard layout in 2009. Since then, I have been interested to use it. It doesn't matter to me that the Dvorak layout has very few users. Instead, the most important thing is the fact that the Dvorak layout makes typing faster and less tiring. Although I could type very well using the QWERTY layout, I still wanted something better.

However, I didn't have a keyboard with Dvorak layout and it's very difficult to get one. There were suggestions on the Internet to manually remove the keys on a keyboard and rearrange them in the Dvorak layout. However, the keys on my laptop's keyboard are not designed to be removable, attempts to remove them would damage the keyboard.

It's possible to use stickers to relabel the keys on a keyboard. However, I didn't want to do that as it would make my keyboard look really weird. Another alternative would be to memorise the Dvorak layout, but that was too challenging for me. Consequently, I gave up on the idea of using the Dvorak layout.

Many years later in 2016, I discovered by chance that the touch screen keyboard powered by Gboard on my Android phone does support the Dvorak keyboard layout. That rekindled my interest in the Dvorak layout. I started using the Dvorak layout on my phone at that time.

Using the Dvorak layout was quite challenging for me initially. Being used to the QWERTY layout, I had to relearn the Dvorak layout from scratch. I struggled to find the locations of each key and that slowed down my typing a lot. I also made typing errors quite often. Sometimes, I had to switch back to the QWERTY layout when I needed to type fast.

Apart from my phone, I wanted to use the Dvorak keyboard layout on my iPad as well. Unfortunately, the touch screen keyboard in iOS and iPadOS didn't natively support the Dvorak layout. Still, it's possible to install a 3rd party keyboard app that supports the Dvorak layout on an iPad.

However, all the 3rd party keyboard apps I found had poor design where the keys were either too big or too small and they were quite laggy, which made typing quite inconvenient. None of them could offer the intuitive typing experience of my iPad's default keyboard. Therefore, I soon gave up on using the Dvorak layout on my iPad.

I had use the QWERTY layout on my iPad and on my laptop. Therefore, I had to master both the QWERTY and Dvorak layouts. Despite the challenges, I persevered with using the Dvorak layout on my phone. As time went on, I became more familiar with the layout and I got better at typing with it.

By 2018, I could type using the Dvorak layout at almost the same speed as I could with the QWERTY layout, although I still made typing errors occasionally. That year, Gboard added support for the Dvorak layout on iPhones and iPads. While Gboard on iPad had a much better design compared to other 3rd party keyboard apps, it's still awkward to use compared to the iPad's default keyboard, so I didn't want to use it.

By 2020, I have mastered the Dvorak keyboard layout on my phone. I use it all the time and I prefer it over the QWERTY layout. Meanwhile, I still maintained my proficiency at typing with the QWERTY layout. I was a bit disappointed about not being able to use the Dvorak layout without compromises on my iPad. I always hoped that Apple will add native support for the Dvorak layout on iPhones and iPads.

Now, my wish has finally been granted. The newly released iOS 16 and iPadOS 16 have added native support for the Dvorak keyboard layout. I can now type using the Dvorak layout with the great default keyboard on my iPad. This is surely one of my most favourite features in iPadOS 16.

Monday 19 September 2022

24 reasons why Dr Strange in the Multiverse of Madness and Thor: Love and Thunder are the same movie

1. MCU Phase 4 movie after Avengers: Endgame

2. Got banned in several countries

3. The protagonist has superpowers but isn't happy in his life

4. The protagonist's girlfriend left him many years ago but he still misses her every moment

5. The protagonist's girlfriend is now a scientist

6. The villain lost their children and wants to get them back at all costs

7. The villain's mind got corrupted by an object that gives them dark powers

8. The villain attacks the good guy's headquarters

9. Many heroes join forces at the headquarters, but the villain still defeated them

10. The protagonist and his ex-girlfriend fight the villain together

11. The villain managed to kidnap children with superpowers

12. The good guys pursue the villain across different worlds

13. The good guys try to seek help from a council of powerful people, but the council refuses to believe or help them

14. The council arrests the good guys, but the good guys successfully break free

15. The good guys realise that the villain seems too powerful for them and got really scared as the villain approaches

16. The final fight occurs at the place where the villain is the most powerful

17. A good fight took place, but in the end the good guys are unable to defeat the villain

18. The good guys admit defeat and allow the villain to have what they want

19. The villain realises their mistake and does the right thing in the end

20. The protagonist finally gets to confess his feelings to his ex-girlfriend, and she accepts it

21. The protagonist still doesn't get to be with his ex-girlfriend in the end, but he accepts the reality

22. The villain got the reassurance that their children will be loved

23. The villain dies in the end

24. The protagonist eventually goes on a new adventure with a new girl

Wednesday 24 August 2022

KSSM Form 4 and Form 5 Dual Language Programme (DLP) E-books

If you are looking for e-books for the KSSM Form 4 and Form 5 Dual Language Programme (DLP) subjects, you can download them from the links below.

These e-books are based on the latest KSSM syllabus, intended for Form 4 and Form 5 students taking the SPM.

Mathematics Form 4:

Mathematics Form 5:

Additional Mathematics Form 4:

Additional Mathematics Form 5:

Chemistry Form 4:

Chemistry Form 5:

Physics Form 4:

Physics Form 5:

Biology Form 4:

Biology Form 5:

Science Form 4:

Science Form 5:

Additional Science Form 4:

Additional Science Form 5:

To download, open the download link above. After that, click the Download button at the top of the page to start the download. The downloaded file is in PDF format.

Wednesday 27 July 2022

The critical phase

I have just entered the critical phase of my housemanship.

Since the first day of my housemanship, I had UK Foundation Programme (UKFP) 2022 as a backup option in case something goes wrong.

After I complete the 3rd posting of my housemanship, I will gain full registration with the UK General Medical Council (GMC). That will enable me to apply for the Foundation Year 2 (F2) Stand-alone and Widening Access to Specialty Training (WAST) programmes in UK, which will be my backup options in case something goes wrong.

However, my UKFP 2022 job offer only remained valid until July 2022, after which it expired, and I will only complete the 3rd posting of my housemanship in November 2022 at the earliest. During the 4 month gap between July and November, I have neither a UKFP job offer nor GMC full registration.

The 4 months is the critical phase of my housemanship, as I don't have any backup options if something bad happens that makes it untenable for me to continue with my housemanship. In such a situation, I will have to say goodbye to my career goal forever.

Almost the entirety of my 3rd posting of housemanship is within the critical phase. I definitely need to be extra careful and to put in real efforts in gaining skills and experience so that I can maximise my chances of getting through the critical phase.

Once I pass this hurdle, I won't have much to worry again, as I will always have a backup option available.

Tuesday 28 June 2022

My most bizarre night shift

Throughout my housemanship so far, my most bizarre night shift has to be on 16 June 2022. It was during my Obstetrics and Gynaecology posting.

On that night, I was supposed to be in charge of the labour room & patient assessment centre (PAC), while one of my colleague was in charge of the ward. However, my colleague took an emergency leave just before the shift started at 7PM. As a result, I alone had to look after both the ward and the labour room & PAC. That was a very tough challenge, considering the large amount of work in both places.

At 8:30PM after clerking a new patient and doing a postnatal review, there was no pending work at the labour room & PAC, so I quickly went up to the ward. There were 13 postnatal discharges and I started writing them. I expected that before long, there would be new patients at the PAC and I would have to go back down to clerk them.

As it turned out, no patients came to the PAC at all from 8PM until the morning shift House Officers arrived at 7AM on the next day. This is a very rare occurrence. Throughout the night, there was only one patient in the labour room, who was sent down from the ward by me.

I managed to complete all the 13 postnatal discharges and take all of the morning bloods by 6AM. I then proceeded with doing the postnatal examinations and baby updates. In the end, I completed all my work and went home at 9:45AM.

Thursday 26 May 2022

第一站 The First Stop

Moving forward along the track,
Bergerak ke hadapan atas landasan ini,
moving, moving,
bergerak, bergerak,
where am I going to?
ke mana akan kupergi?
I am a heavy train,
Aku keretapi berat,
moving forward carrying my dream?
bergerak ke hadapan dengan misiku?

Nobody knows the outcome of this dream,
Tiada sesiapapun yang tahu kesudahan misi ini,
除非是 头上的青天和湖里的水。 
apart from, the sky above me and the water in the lake.
kecuali, langit atasku dan air dalam tasik.
I know, the end of this track is the sea,
Kutahu, penghujung landasan ini ialah lautan,
but how about the end of the sea?
bagaimana pula dengan penghujung lautan?

Moving forward along the track,
Bergerak ke hadapan atas landasan ini,
moving, moving,
bergerak, bergerak,
where am I going to?
ke mana akan kupergi?
The sea is the home to all rivers,
Lautan ialah rumah segala sungai,
let it be the first stop of this train.
biarkanlahnya menjadi perhentian pertama keretapi ini.

Saturday 23 April 2022

Why I chose to do Medicine?

I had my first ambition when I was 4 years old. I wanted to become an architect, simply because my father is an architect and I thought it was natural for me to follow the footsteps of my father. However, I had absolutely no idea how the job of an architect is like.

When I was a child, I would fall sick every few months, where my grandparents would bring me to see our family GP. As time went on, I began to get fascinated with the job of a doctor, particularly on how a doctor could just ask some questions and do some examination and then determine the diagnosis and prescribe the medications. I was also curious to know how sicknesses arise and how medications treat sicknesses. I often read the labels of medications to learn more about them. Unlike many other children, I generally wasn't afraid of taking medications, in fact I loved the taste of some medications. 

With that, I started having some interest in Medicine. Over time, I began thinking, perhaps I should become a doctor. From my observation of our family GP, his job was quite relaxing, as he just had to sit in an air-conditioned room, wait for patients to come to him and he would make a lot of money every month.

Meanwhile, as I began to know about how the job of an architect is like, I wasn't impressed with it. An architect has to visit construction sites a lot. On a few occasions, I followed my father to his construction sites and I felt quite uncomfortable being there. Just like Anakin Skywalker in Star Wars, I don't like sand because it's coarse, rough, irritating and it gets everywhere. Construction sites certainly have a lot of sand and other sand-like materials. I also observed that my father's job of an architect is very stressful. He had to work very long hours everyday and he looked so tired every time he returned home from work. His mood was often bad because of his stress from work. I could tell his job wasn't enjoyable at all.

Architects need to be creative and good at designing. I was very poor at the Arts subject in school. There were so many things I didn't know how to draw and I had essentially zero interest in learning it. That being said, architects generally do technical drawings which is quite different from the Arts we learnt in school. As a matter of fact, I wasn't bad at technical drawings and I even had some interest in it. Sometimes when I had free time, I would draw maps of roads and plans of buildings. My father was quite impressed with my work. Once, I drew a map of a major road interchange in Subang Jaya, which my father said was so accurate that even many of the architects in his office couldn't have drawn it so well. Despite that, I was well aware that being an architect involves so much more than just drawing maps and building plans.

The perceived stress of the job as well as the need to routinely visit construction sites made me stay away from becoming an architect. Instead, I felt that a doctor is a much better job. In school, I had been learning that doctors are there to save people's lives which makes them so noble. I could appreciate that this is what makes the job of a doctor so great, rather than how much money a doctor earns. Meanwhile, architects were almost never mentioned in the school books, and most of my classmates didn't even know what it is.

My family had also been saying that to be a successful architect, I would have to work in a big city like Kuala Lumpur. Having lived in Kulim for so many years, I really didn't want to leave the place. But if I were to become a doctor, I could just stay in Kulim and open up a clinic there. That made the job of a doctor even more attractive for me. When I was 10 years old, I decided to change my ambition from becoming an architect to becoming a doctor. When I told my friends in school that I wanted to be a doctor, some gave me their encouragement, while others questioned whether I could be a good doctor.

In the following years, I watched several drama series from Taiwan and Hong Kong. While those drama series weren't primarily about doctors, they did occasionally feature scenes in hospitals. That gave me some insights on the job of doctors working at hospitals, especially when I had never visited a hospital up to that point in life. From what I observed, a hospital is a nice work environment with air-conditioning and nice furnishings, and doctors are constantly going around saving the lives of their patients which seemed so interesting. In contrast, working in construction sites felt so terrible compared to working in hospitals.

2009 was a pivotal year for me, as three significant events happened that year. The first was the global economic recession known as the Great Recession. So many people all over the world lost their jobs because of that, and some even committed suicide. While my family wasn't affected, I felt bad for all those people affected, especially when many of them hadn't done anything wrong in their jobs. The Great Recession started all because the United States government failed to manage their country's economy properly, and the whole world had to live with the consequences of that.

The Great Recession made me realise that a lot of jobs aren't secure, as employees can be laid off at anytime, but being a doctor is different. A doctor will never be jobless as they can always operate their own clinic and there will always be patients. If I become a doctor and I hear news about an economic recession, I would be thinking about how I could offer cheaper treatment to my patients who are affected by the recession, rather than worrying about whether I would lose my job and whether I could get food on my table. I liked the fact that doctors always have a stable income, which further strengthened my desire to become a doctor.

The second significant event in 2009 was the H1N1 pandemic. In August 2009, the H1N1 was spreading widely in Kulim. One day, I felt lethargic and feverish. My grandparents immediately brought me to see our family GP. I felt that my fever was just low grade, but the GP said I had a high fever of 39°C after measuring my temperature with a forehead strip. He said that my lungs were clear which meant that it was quite unlikely I had H1N1. I was so relieved to hear that. However, he then said he wanted me to be quarantined at home, emphasising that I mustn't visit my friends or let my friends visit me.

My grandfather was extremely worried after hearing that, as he felt that the GP was still suspecting I had H1N1 despite saying otherwise. All the time, my grandfather was worried that my condition could deteriorate. Whenever my grandmother told him not to worry so much, he would brush it off, insisting that we must prepare for the worst. My sickness was already giving me a hard time, and the excessive worrying by my grandfather made my experience even more miserable. Worse still, I was having a school examination at that time and my preparation for it was greatly affected. In the end, I performed poorly in that examination, and my ranking dropped from 2nd to 64th.

I blamed the family GP to be the cause of my grandfather's excessive worrying and thus my misery. He used a forehead strip which is known to be not very accurate, which might have overestimated my temperature. His statement that I was unlikely to have H1N1 seemed contradictory to his instruction for me to be quarantined, which he failed to properly explain the reason. I felt that the contradictory statements indicated only two possibilities, either the family GP was unsure whether I had H1N1, or he had poor communication skills. Either way, it meant the family GP wasn't a good doctor, and I was reluctant to consult him again if I fall sick in the future.

2 months later in October 2009, it was the third and most significant event in 2009. The H1N1 pandemic had ended at that time. One day, my grandfather had haematuria. He immediately went to consult our family GP. As it turned out, the GP just tried to keep quiet as far as he could, avoiding the questions asked by my grandfather about his sickness. It was very clear that he couldn't make a diagnosis at all, despite haematuria being a common presenting complaint. He didn't even attempt to refer my grandfather to a hospital or a specialist clinic. My grandfather then travelled to Bukit Mertajam to consult a specialist physician. He was a bit worried about how much the consultation would cost. I, being so naive, reassured him that I was sure it wouldn't be too expensive as doctors are there to help people rather than make money.

The specialist physician diagnosed him with urinary tract infection and prescribed him with antibiotics and paracetamol. Much to our surprise, the bill totalled up to almost RM1000! That was a financial burden for my family. My grandfather started taking the antibiotics after returning home. On that night, he started experiencing tachycardia. He telephoned the specialist clinic to ask about it, and he was told to go back to the clinic immediately. We had to rush to the clinic in Bukit Mertajam at night. The specialist physician then said my grandfather was allergic to the antibiotics and decided to switch to another type of antibiotics. Guess what? He charged another few hundred ringgits for that. My grandfather hadn't brought so much money with him as we left home in a hurry. However, the specialist physician insisted on the payment. We had to travel to the specialist clinic once again on the next morning to pay the few hundred ringgits, only then my grandfather was given the new antibiotics.

For quite some time after he started taking the new antibiotics, his symptoms still didn't improve. He was so worried that it could indicate something more serious. However, he chose not to see a doctor once more, knowing that the family GP wouldn't be able to diagnose him while the specialist physician would charge him a high price again. My grandfather certainly was going through a very difficult time and I felt so bad for him. I blamed it on our family GP who lacked the necessary knowledge to be a doctor, and even more so on the specialist physician who was too money-minded to the extent of completely disregarding the wellbeing of his patients. It took a few weeks for my grandfather's symptoms to resolve. The whole incident, as well as the previous incident, made me realise that there are so many bad doctors out there and they bring a lot of sufferings to their patients. I felt that this definitely had to change, and I wanted to bring about the change.

I told myself that I must become a good doctor, who will equip myself with the necessary knowledge for treating my patients and focus on helping people rather than earning money. If I become a specialist, I would still charge my patients the same price as that of an ordinary GP. I firmly believed that the decision to become a specialist should be motivated by the desire the explore further in an area of medicine that we have a particular interest in, not to make more money. I wouldn't hesitate to offer cheaper treatment or even free treatment to my patients who can't afford it. I was sure that the amount of money a doctor earns is way more than enough to live a good life, so there should be no excuses not to help patients in need with the excess money. With that, I firmly decided on doing Medicine.

In upper secondary school, I chose to take the subject of Biology. I knew very well that Biology is required for getting into medicine. In Biology, I could learn even more about the human body, and for the first time, I learnt a bit about some diseases. I found it really interesting and I wished I could explore further. I did find Biology a bit challenging as the examination questions weren't straightforward and often required long answers, but in terms of learning the subject, I really enjoyed it. At that point, I had another strong reason for doing Medicine, which was my interest in learning the subject.

I had always excelled in the Mathematics and Additional Mathematics subjects in school. However, I wasn't keen to study a degree in Mathematics as I didn't really have an interest in Mathematics and I was concerned about the job prospects of a Mathematics degree. I was quite interested in computers, which was why I chose to take ICT in upper secondary school. While I enjoyed the subject a lot initially, once I started learning about coding and programming, I began finding it a bit tedious. As a degree in Computer Science or IT would surely involve a lot of coding and programming, I decided that it isn't for me. Therefore, I set my mind on Medicine.

After completing secondary school, I studied A Level at Taylor's College. In A Level Biology, I had the opportunity to learn even more about various diseases, especially through the topics of Gaseous Exchange, Infectious Diseases and Immunity. Learning about human diseases fascinated me. I was so sure that there was no other course than Medicine that I would be more interested in studying. Knowing that I want to become a doctor, my Taylor's College friends kept telling me about the qualities that a good doctor should have, including good communication and practical skills. I was aware that I lacked communication and practical skills, but I was confident that I could improve on them through the training I would get in medical school.

At that time, I heard for the first time from my friends and family that after completing medical school, all doctors will have to do housemanship for 2 years before they can practice Medicine independently. My initial reaction was highly supportive of it, thinking that housemanship would enable me to gain more experience to become a better doctor. Later, I began hearing some scary stories about housemanship, especially on how house officers are bullied by their superiors, being required to work very long hours and not being given time to eat.

However, I simply dismissed them as rare and isolated incidents. My thoughts was that doctors have a lot of knowledge and are highly respected by the society so they surely would be able to speak up and defend themselves against any bad working conditions. In April 2014, I joined a field trip to IMU. There, a lecturer said it was very likely that housemanship in Malaysia would be shortened to 1 year in the near future. I strongly believed what he said, and I thought, no matter how housemanship is like, 1 year is just a short time and I would get to do what I like thereafter.

I was primarily interested in opening up my own clinic, although I was also considering working at public hospitals. On the other hand, working at private hospitals or private clinics not owned by me would be an absolute no, as that would go against my principle of becoming a doctor to help people rather than make money. I didn't want to make a decision on what I would like to specialise in at that point. I felt that every area of Medicine is great in its own way and I would like to explore them first before deciding which is best for me. I also didn't think specialisation is very important, as I would be content with being an ordinary GP.

Finally, I started studying MBBS at NUMed in September 2014. I really looked forward to becoming a good doctor, still oblivious about the challenges that I would be facing.

Friday 25 March 2022

22 September 2021: An extremely stressful day

22 September 2021 has to be my most stressful day in 2021 and my most stressful day throughout my housemanship so far. It was during the 3rd week after I started working as a House Officer (HO).

A day earlier on 21 September, I had failed the off-tag assessment which made me very upset. Not only was that quite embarrassing for me, it also meant I had to continue working the tagging hours from 7AM to 10PM every day, which is significantly longer than the normal work hours.

On 22 September, I was in charge of the acute cubicle in the Medical ward. Patients in that cubicle were generally very ill and they required morning, afternoon and evening reviews every day. At that time, I was still really bad at blood taking, where more than 80% of my blood taking attempts failed. A specialist ordered a blood culture for a patient whose blood was very difficult to get, even though another specialist had decided that it wasn't necessary earlier.

Taking a blood culture is a complicated procedure as it requires a large amount of blood and has to be done in a sterile manner. I couldn't even get a single drop of blood from that patient, how could I possibly get the large amount of blood needed? My colleagues and the MOs couldn't help me as they were so busy, so I gave up on the blood culture entirely. Shortly afterwards, the patient had to be admitted to the ICU. As he was intubated, I was required to accompany him there.

After arriving the ICU, an MO there asked me several questions regarding the patient's history and I couldn't answer at all. The patient's notes was several hundreds of pages long and I didn't know how I should read them. The MO was very nice and didn't scold me, but he emphasised the need for me to know the full history of a patient before accompanying them to the ICU in the future. Right after that, I had to accompany another intubated patient for a CT scan. Accompanying the 2 patients used up 2 hours of my time, while I still had a lot of pending work in the ward.

When I returned to the ward, an MO was doing the afternoon review of my patients and I had to join her. Although the MO is very nice, she was really thorough in her reviews which took a very long time. Later, a nurse was chasing me to complete the domiciliary care form for a patient who had been discharged a few days ago. The form had to be filled up in 3 copies. Then, one of the patients had a fever and I had to review him. After that, I could finally start doing the work which had been pending for a long time. Before I was done with all the work, it was time for me to do the evening review of my patients.

Suddenly, an MO came and scolded me for not arranging a Covid RTK-Ag test for a patient's wife who would be coming to learn nursing care. I had no idea that the RTK-Ag test was required. Then, a nurse told me that a patient required an IV cannula. Soon afterwards, I had to join the evening ward rounds by the specialist which lasted more than an hour. Much to my dismay, the specialist ordered a blood culture for a patient. The night-shift HO had arrived at that time, but blood cultures cannot be passed over to night-shift HOs which meant that I had to take it.

Seeing that I was so stressed, a senior HO helped me prepare all the equipment for taking the blood culture. I tried taking the blood culture but I wasn't successful. Then, I tried inserting the IV cannula for the patient who required it but I failed in that as well. The senior HO agreed to help me take the blood culture and insert the IV cannula, while emphasising that I needed to practice more and improve. I still had quite some work pending and my colleagues gave me some help.

I managed to finish all the work only at 10:45PM. That was the first time where I had to work overtime and I was truly exhausted. Combined with my failure in the off-tag assessment just a day earlier, I surely was having a very difficult time. At that time, the only thoughts in my mind was that I wanted to quit housemanship. I had applied for UK Foundation Programme 2022 as a backup option, and I felt that I really should go for it.

On the next day 23 September, I travelled to Johor Bahru to receive my 2nd dose of AstraZeneca Covid vaccine. I used that opportunity to go to EcoBotanic to taste some of the food there which I missed so much. At EcoBotanic, I kept reminiscing the good times in the past when I was working as a Teaching Fellow, where I truly enjoyed work and had so little stress. I really wished I could just keep working as a Teaching Fellow for the rest of my life.

On that night after returning to Kluang, I started feeling very tired which was a side effect of the vaccine. I had to take 2 days of sick leave, which gave me a much needed break from work. Thankfully, on 26 September I was allowed to off-tag and start working the normal work hours, which was 2 days of 7AM to 5PM shifts, 2 days of 7AM to 9PM shifts and 1 day of night shift every week.

After working my first night shift, my blood taking skills improved by a lot. Since then, I have been coping well with my housemanship. I am glad that I persevered and didn't actually quit housemanship.