Just graduated?

Choosen your hosp via E-placement?
.

But unsure what to #expect & prepare for the next posting, or HOship as general?
.

Enroll for #Departmental Welcoming session NOW at Medicorp’s Teachable school;
https://medicorp-class.teachable.com

You will learn;

✅ HO role in each posting,

✅ must-know #diseases for each posting; the common cases & #emergencies

✅ few case discussions as kickstart #revision for each posting!
.

It’s FREE & you can learn whenever you want!

List of books / guides for HOs

Here is a non-exhaustive list of guidebooks and references suitable for HOs:

🌻 Essential clinical calculators, sharings and 'survival kit' at www.notaperubatan.com (may install as app for offline use)

🌼 #Medical dept
- CPG from https://www.acadmed.org.my/index.cfm?%5C&menuid=67 (alternatively, download from Telegram bot t.me/CPG_malaysia_bot)
- Sarawak Handbook Of Medical Emergencies 4th ED
- Dr Hanif Arshad's series (Medical Notes & Sticky Notes for Houseman) https://hanifarshad.ordersini.com/hanifarshad

🌼 #O&G Department
- Handbook of Obstetrics Guideline 2024 (https://t.me/nota_perubatan/1508)
- Gynae protocol HTF (https://t.me/driliana9/6417)
- Sabah Women and Children Hospital (SWACH) Labour Room Protocol & Sabah Obstetric Shared Care Guidelines SOSCG (4th Ed June 2020) https://t.me/nota_perubatan/942?single
- HSA O&G Protocol https://t.me/driliana9/6571
- Kedah O&G Protocol https://t.me/driliana9/6569
- Sarawak General Hospital's Labour Ward Manual*

Note: for O&G it usually depends on which hospital you are working. Different hospitals have their respective O&G department protocol which could be slightly different from the others

🌼 #Orthopaedics
- Guidelines for House Officer Orthopaedic Department Hospital Melaka
- x-ray interpretation for orthopaedic HO

🌼 #Surgery
- Johor Bahru manual of surgery

🌼 #Paeds
- Paediatric Protocol
- Alia’s Illustrated Extra Notes to Neonatal Jaundice
- Alia's Illustrated Extra Notes to Total Fluid Intake
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🌼 Hospital Ampang HO Guide (for various departments)
- https://t.me/nota_perubatan/160 [download from original website https://myhow.wordpress.com/ho-guide/]

🌼 #Medicorp
https://medicorp.onpay.my/order/form/bookstore

(CPG Made Easy, HO Log Books Compilations, Clinical Skills Guidebook,  Nebulizer Pocket Book of Adult Dosages & Normal Values, workshops)

“Sorry, I dah try poke patient ni dua kali untuk blood C&S, tapi tak dapat. Boleh tolong tak?” 🥹
.

Saya macam nak #menangis dah bila minta tolong senior HO waktu tu!

Joblist lepas round pagi tadi pun banyak lagi nak settlekan,

& semua senior HOs busy sebab ward kami #active ie receiving admission hari tu.
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Saya yg baru tagging few days ni, first poster pulak tu, terkulat-kulatla try nak ambil blood C&S sendiri for the first time (dah observe senior HO sebelum ni), tapi tak dapat-dapat.
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#Stress betul! Rasa hopeless sangat sebab tengok senior HO buat sebelum ni nampak senang je, kenapa kita buat tak dapat pulak?
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“Owh, patient bed 12 yang ada underlying CA (cancer) tu ya?

Patient yg ada CA, memang vein susah nak nampak & very difficult blood taking. Takpe jom I tolong tengokkan” rilek je senior HO tu jawab 😅

Owh memang #difficult venous access ya! Patutla tak dapat 😅
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Lagipun memang tak berapa pandai sangat pun ambil darah waktu tu, sebab baru je start HO beberapa hari 😷
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Alhamdulillah, tak down sangat lepas dah tahu memang ada pesakit yg kita anticipate difficult venous access;

💉obese/#edematous patients (fluid overload, severe hypoproteinemia, long intubated & sedated patients esp in HDU/ICU)
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💉cancer patients, especially those who has started #chemotherapy
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- patients with #CKD ie chronic kidney diseases (be careful, most of them need to spare their left arm for AVF, so can try blood taking & branula at right arm only)
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- patient with history of intravenous drug user (#IVDU).
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So kalau kita HO baru, bila encounter patients macam ni, lebih baik minta #tolong senior HOs untuk ambilkan darah & ajarkan macam mana nak locate & detect vein patient tu.

Sebab kalau kita yg baru ni try jugak sendiri, chances nak dapat tu rendah, patients akan #sakit & kita end up bumpkan vein yg ada, jadi nanti orang lain akan lagi susah nak tolong ambilkan darah lepas tu!
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Thank you semua senior HOs yang sanggup ajar & guide saya dulu 😇

Mula-mula start tagging dulu memang #struggle sangat bab procedure ni sebab dekat Rusia mana ada peluang nak ambil darah, pasang branula, masuk Ryle’s tube & CBD semua.

Jadi sangat #takut nak belajar & try procedures atas real patients 😣

👆🏻more guide on difficult venous access ie blood taking 💉🩸 (I was in anaest posting, not ED sorry)


For working HOs, please aim to be branulogist (our informal term for expert in branula insertion😂 ) at 3rd posting, or after your Medical posting 💪🏻

Let’s brush up your blood taking & other clinical skills before HOship soon;

https://medicorp.onpay.my/order/form/clinicalskillsuturing_workshop

"Doktor, ini chest X ray post intubation patient katil 2 tadi"

What to look for in post intubation CXR?
- To look for complication, especially pneumothorax
- To confirm placement of endotracheal tube

The position of tip of ETT should be 5-7 cm above the carina in the neutral position of neck. When the carina is not visible, the tip of the ET tube should lie over the second to fourth thoracic vertebrae (T2-T4) or at the level of medial ends of the clavicles as carina is located between T5 and T7. 

Further reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173625

https://www.radiologymasterclass.co.uk/tutorials/chest/chest_tubes/chest_xray_et_tubes_anatomy#top_2nd_img

#ED
@nota_perubatan

Becoming a doctor is one thing. Choosing to stay in a public hospital is another.

There has been a growing culture of dissatisfaction surrounding work in the public service of healthcare system. The concerns of high workload, system pressures, career uncertainties, and the blurred expectations of covering multiple roles are real. Yet, the overall tone of the conversation has gradually shifted, where staying in MOH is sometimes framed less as an active choice and more as something one simply remains in.

And lately, there has been increasing discussion about recruitment from neighbouring countries, with doctors and paramedics drawn across the border by better pay and seemingly more efficient systems. It is understandable why many consider it.

But for some of us, the old saying still holds meaning: hujan emas di negeri orang, hujan batu di negeri sendiri lebih baik di negeri sendiri.

Yes. it is increasingly challenging with growing rate of burnout with overwhelming cases and tasks. But sometimes meaning is not measured solely by salary or system efficiency.
For some of us, we choose to be there…
I won’t say the doubts aren’t there. but for now.. here we are. Trying to make sense of it, trying to find footing within the system rather than stepping away from it

The public system offers something difficult to replicate elsewhere --- depth of clinical exposure, particularly in high-acuity and facilities, patients loads and complex cases. Nowhere else will you manage such a breadth of pathology, often at advanced stages, while carrying real responsibility early in career.
That high stake environment accelerates maturation not only technically, but in judgement, prioritisation, and resilience.

Beyond that, there is continuity in training and subspecialty development. MOH remains one of the few ecosystems where structured progression from HO to MO, through specialist be it parallel or MMED training, and onward to subspecialty and consultant level remains accessible without the fragmentation often seen in other pathways.

Then there is something less visible, but equally important: Purpose. Public healthcare places you at the centre of need. You treat patients because they require care. Can they afford options?. That by some means shapes a different kind of doctor.

Of course, many leave and for valid reasons. Better pay, improved work-life balance, or different career goals. These are legitimate decisions. But the fact that many still choose to join and stay should not be dismissed as a lack of options. More often, it reflects a different set of priorities.

Staying in MOH can mean choosing long-term growth over short-term comfort. It can mean valuing exposure, training, and impact over immediate financial gain. It can also mean believing that the system, despite its flaws, is still worth contributing to and improving from within.

Not every path needs to converge.
What matters is recognising that remaining is not passivity.
At the same time, we are not immune to the pressure. We hear the same conversations, we see the same frustrations, and there are moments when we question our own position.

But holding a firm decision does not mean closing all other doors.
"Keep he option open" sais my friend long time ago. Not because we are uncertain, but because we understand that circumstances can change.
A significant reason, a shift in priorities, or a new opportunity may alter the course.
For now, many of us remain because our reasons are still stronger than our doubts.
And perhaps that is the most honest place to stand not in blind loyalty, and not in reactionary escape, but in a conscious, ongoing decision base on calculated risk in every direction.

Staying isnt easy even until now continuing my journey in subspeciality training.

Public healthcare service in Malaysia, with all it’s imperfections, has given us something more valuable: our training, our exposure, our patients, and our growth. Not to forget with so many inspiring teachers who dedicate their expertise in public service.

The clinical depth here be it managing complex disease, late presentations, and resource-constrained decision-making has shaped who we are as clinicians. For some, that creates a deep sense of responsibility to continue contributing within the same system.

Not everyone will feel this way. Some will leave and grow in different systems, and that path deserves respect.
But choosing to work within the system and remain should also be respected.
Because staying is not about settle up.
It can reflect a belief that this country, despite its flaws, remains a place worth serving, worth improving, and worth building a future in.

And sometimes, it is simply recognising that what we already have here is enough to keep us established.

At the same time, as pressure continues to build across all levels… from HO to MO, specialists, and consultants. Thus, the stakeholders, our leaders.... should continue to review how to firmly supports and retains its healthcare workforce.

This also calls for addressing structural challenges within the system particularly bottlenecks in career progression at the specialist/consultant level, clearer role definition to prevent task spillover of other problematic supporting staffs and uneven workload distribution, and more meaningful opportunities for advancement into higher-paying roles that are appropriately benchmarked against comparable specialist/consultant positions elsewhere.

Perhaps it is also worth speaking directly to those at the beginning of this journey... to medical students, HO, and young MO navigating these early decisions.
It is understandable to feel uncertain in the current climate. The surrounding conversations can be intense, and at times, discouraging.
But before deciding too early, allow yourself the space to experience the system for what it is…
not only through what is said about it.

We definitely will encounter pressure, but also encounter room of growth. The exposure to complexity, the responsibility carried, and the pace of learning within the public system continue to offer a depth of experience.

Many who have trained within this environment recognise its role in shaping clinical judgement, resilience, and professional identity.
We do not have to commit to one path indefinitely. But giving yourself time to build a strong foundation as a doctor.
The decision to stay or leave will eventually take its own course. But the foundation built during this phase often becomes the reference point for whatever direction you eventually choose.

My humble opinion.
DrAnorHidayah