Getting to Know Housemanship in Malaysia

It has been 8 months since I Landed in a district hospital that I have never been before...

It was pretty exciting initially, but now, I felt exhausted most of the time hahaha....due to sleep deprivation sometimes.

Our Working Hours & Shift System
Housemen in Malaysia need to work at least 66 hours per week, with only 1 off day per week, 2 days of paid leaves (Cuti Rehat aka CR) per month. Although it is written as minimum working hours of 66hours, most of the time we are required to work for at least 70-72 hours, or even more than that when we need to work overtime to finish up ward works 😅 so earning the rm5.1k per month is not that easy at all.. haha

In my hospital, every department has its own working schedule for housemen, some adapted the latest TDS shift system, while some is still implementing the previous BD shift system.

BD shift: 2 shifts per day, i.e AM & PM shifts,
- AM is usually from 7am till 8pm,
- PM is from 7pm to 7am the next day.

TDS Shift: 3 shifts per day, i.e AM, EAM (extended AM shift) & PM shifts.
- AM shift is usually 7am to 5pm,
- EAM can be 7am to 9pm or 10pm,
- PM is 7pm to 11am the next day.

I personally preferred tds shift system as i will have more quality time for myself whenever I’m in AM shift 😁

What to put in Our Whitecoats 

1. Pens: preferably black ballpens, at least 2 as pens are easily MIA haha
2. Pen Torch: important to check pupils reflexes, injected throat (especially important in surgical based postings as part of preop assessment)
3. Pulse Oximetry: it’s always a hassle to search for a functioning pulse oximetry in the ward whenever patient c/o SOB or trying to wean off oxygen supply. So it’s highly recommended to bring along one all the time!
4. Snacks: although there are quite a no. of HOs in every department now, there are still times when you have no time to eat & develop hypoglycemic symptoms
5.  Carbon paper & empty stickers (if working in non computerised hospital): there’s a lot of forms that need double copies, and stickers are to label specimens as not all hospitals provide printed stickers of patient’s details.
6. Tendon hammer: particularly important in asessing patients with spinal of intracranial injuries! As some wards might not hv temdon hammers 😓
7. Frank Shann drug dose
8. Our smartphones with following apps: Whatsapp, Malaysian Blue book formulary, calculator, MDcalc (provides various formulae or scoring systems eg serum osmolarity, corrected Calcium, eGFR)
9. Small notebooks to jot down notes during rounds, or CME (alternatively can straightaway type in your smartphone too)

Our Duties As Housemen

1. OD or tds r/v. (TDS r/v is mandatory in surgery, paediatrics & selected patients in other departments). Preferably our Housemen rounds were done before our MOs come for r/v.
2. Carry out ward works: requesting USG/CT/MRI, taking bloods, referrals, posting cases to anaests for emergency surgeries (only applicable in surgical based postings), doing simple procedures in ward (eg in ortho we get to do T&S, skeletal traction pin insertions, wound desloughing, vacuum dressing etc)
3. First liners in attending emergencies in ward, eg drop in GCS, desaturation, cardiac arrest etc. As a general rule of thumb, we need to attend to patient STAT, assess clinically & take vital signs, and necessary relevant  bedside tests like ECG and take bloods ,provide basic treatments like oxygen and run fluids , have a rough idea of what’s going on, possible differential diagnoses and inform our MOs asap. 
4. Communicate with patients & their families. Since we are the only ones left in the ward most of the time, we should know what’s going on with the patients, and explain to them correctly whenever questions are raised. However if you think you can’t handle it properly eg explaining on treatment options available, do ask help from senior housemens or MOs. 🙂
5. Attending CMEs, in which we need to present for at least 2 times during each posting. 
6. Help in clinics, seeing patients together with MOs or specialists. 

That’s all for today. 🙃