医护人员的无奈

最近在星洲日报的沟通平台，有连贯性的评论，由药剂师开始，延伸至牙医，然后医生，再病人。。我稍微做了点整理，故事是这样开始的。。

溝通平台: 致衛生部長的公開信 2008-12-01 09:34
藥劑師根本就不獲重視。這就是為甚麼許多華裔藥劑師都在與政府的4年服務合約屆滿後都不願留在政府醫院。被醫生無理取鬧的罵，甚至被“老油條”的護士罵和 病人罵。幾個星期前，她因看不懂醫生寫甚麼字，一橫畫過去就是藥名，打電話去詢問那醫生，那名醫生二話不說就破口大罵。她還面對上司的種族偏見和無禮對待。。。

溝通平台: 回應Tan Boon 2008-12-10 09:14
陳君不懂程序，難道陳君的女友也不懂嗎？身為一個專業人士兼大學畢業生，如果這種普通常識也不懂的話，我為本地大學栽培出這種藥劑師感到悲哀。這種“以為”的想法也是本地大學生只會死讀書的最佳證明。。。

溝通平台: 藥劑師的無奈2008-12-15 08:38
事實往往不是這樣。北馬的人，卻被派到南馬；南馬人，卻派去北馬。更甚者，還有為數不少的東馬人拿著數目可觀的外州津貼在西馬各大城市就職，反之每年卻有無數西馬人被派到東馬。這樣的調動，試問可有任何標準、制度可言？藥劑師往往連申請的門兒都沒有。醫生卻被強制遷入醫院宿舍。有不少配予醫生護士的醫院宿舍是轉租承讓給無處蔽身的藥劑師。。。

溝通平台: 無病呻吟2008-12-16 08:40
醫生、護士和藥劑師肯定有差別，醫生、護士有宿舍是因為要值夜班。在大學沒租過房子嗎？出來工作還要替他大小姐準備宿舍？還沒工作便耍大牌，這算甚麼態 度？被醫生和護士罵有甚麼大不了？沒有工作經驗，罵罵兩下不就有經驗了嗎？在外工作可不是享清福，沒讀過比爾．蓋茨的書嗎？比爾老兄說要多吃苦才能成功，挨老闆罵沒甚麼。。

溝通平台: 給衛長的另一封信 2008-12-17 08:43
雖然配藥看起來很普通，很簡單的一份工作，可是我們接觸的都是病人的生命，畢竟不能拿病人的生命開玩笑。就拿個例子來說，一個24小時沒睡覺的醫生，你放心讓他替你看病、開藥方、甚至動手術嗎？我們藥劑師也一樣，你放心讓一個24小時沒睡覺的藥劑師替你檢查藥單、幫你配藥嗎？

溝通平台: 回應《給衛長的另一封信》2008-12-19 09:16
衛生部的政策是避免醫務人員長時間工作，他們必須獲得足夠的休息，因此我已經指示所有醫院，必須在值夜班過後讓待命醫務人員適當休假，以讓他們補充精神。我們強調，衛生部並沒有忽略藥劑師的問題，我們持續改善藥劑師的福利。衛生部已經調整了藥劑師的薪金制，使他們享有更好的待遇，例如新進藥劑師已經從P1T1，調整至P1T4。隨著這項調整加上津貼，使得政府醫院藥劑師職位更具吸引力。

溝通平台: 牙醫也很無奈2008-12-21 09:51
其實牙醫的待遇並沒有亦凡君所說得那麼理想，事實上是跟藥劑師一樣，同樣要守著U41直到服務期滿為止。醫生目前的遷升路線，首兩年的實習期為U41，後 三年的服務期為U44。而牙醫雖然同樣也有分第一年的實習期，和後兩年的服務期，但卻一直都是停留在U41，並沒有遷升至U44的機會。。。

溝通平台: 醫生更無奈2008-12-24 08:41
實習醫生一週至少會輪值一次晚班，而該晚班是緊接著白天的巡房工作開始的，每一次值晚班之後，醫生就得開始隔天的日常巡房工作，也就是說連續不斷的工作 36個小時對醫生來說根本就是家常便飯。雖然說當值的晚班醫生有oncall room可以休息，但試問究竟有多少的時間能讓醫生好好的坐下來合一下眼？

溝通平台: 病人才是最無奈2008-12-27 10:14
如果不 跟有動手術的外科醫生相比，一般上牙醫的染病風險，肯定比普通門診醫生還要來得高出許多。醫生、牙醫和藥劑師，雖然這三個科系至今都還是馬來西亞政府大學的前三甲熱門科系，可是如今有亦凡君，筆者以及陳君在此申訴藥劑師、牙醫和醫生的無奈，實為無病呻吟。最無奈的，也許是正在閱讀著我們文章的病人吧！

溝通平台: 我們當自強2008-12-28 09:44
也因為是在大醫院，人事關係也更為複雜，尤其是那令人生厭的階級制度。許多實習醫生都被大、中醫生視為下人，不斷得被施於最勞累的工作。尤有甚者，被護士或護士長欺負的事也時有所聞，就因為他們是最低下的菜鳥。資源有限，僧多粥少，滿足不了所有人。不必比較誰更苦楚，其實大家都是同一條船的人。不如互相扶持、同心協力，聚合起來才有力量。我們國家的決策人若不儘早處理這些問題，更多的無奈還會發生，更多的人才還會流失。。。

你又有什么看法呢？

什么是PCM?

什么是PCM？不是paracetamol（俗称panadol）哦！在这指的是Primary Care Medicine。

在马大医院常听到人提起去RUKA看病，其实是马来文翻译，全名是Rawatan Utama & Klinik Am，英文的Primary Care变成Rawatan Utama，服了吗？呵呵！

刚进PCM(Primary care medicine)一周，其实只上了三天，过后就自己放假了:) 在Klang时已经上了四周的PCM(Klinik Kesihatan Bukit Kuda)，在Final year时将会再到Banting的诊所进行课程。所以接触时间也算不少。


PCM就是在外面clinic的百科医生，他们都叫General Practitioner(GP)，毕业做完实习医生，再跟政府服务完，就可到外头当GP。在医院就称Primary Care，老师常说，他们是医院的把门员(gate keeper)，除了常看些头痛发烧咳嗽之外，最重要是提早发现严重问题，懂得何时把何人refer去相关部门，愈早发现治疗效果就越好。

同时，病人的教育也相当重要。Ideally，医生该花些时间跟病人沟通，灌输有关方面的知识，除了可达到预防效果之外，病人在了解病情的根本之后，才会信赖医生，会依照指示定时吃药等，减少non-compliance（没依照指示吃药）的问题，达到最好效果。

现实是残酷的，在Bukit Kuda时，医生看病只有少过五分钟，房间拥挤吵喳，根本没有时间和私人空间跟病人好好谈。而且很多时候病人来是因为depression或anxiety，往往主诉是其他问题如头痛背痛等，所以需要时间让病人把问题说出来。

不是所有门诊都需开药方，
吃药也未必是最好的疗方，
越少药方就越少副作用，
没有药方的治疗，用得正确，病人会安全噢！

这里介绍一下我们在PCM看病时应有的策略,叫做Murtagh's Strategy:

1. Probable Diagnosis （最可能的诊断，通常是常见的问题如伤寒）
   
2. Important/Serious diagnosis not to be missed （不可错过且严重的，如肺结核，癌症，心脏病等）
   
3. Frequent pitfalls （常被忽略的，多是较罕见的问题如infectious mononucleosis,leptopspirosis）
   
4. Masquerades - Depression, Diabetes, Drugs, Spinal dysfunction, Anxiety, Thyroid abnormalities, Urinary tract infection (3D SATU) （要scan过这些可能性）
   
5. Hidden agenda (病人有潜在的问题，如家庭纠纷，索取MC等）

有了这个策略，就能做出更准确的判断。

然后要以Patient centered的approach，做出一个Whole person diagnosis，也就是以病人的人（不是对病disease centered），做出全方位的诊断：

1. Physical
   
2. Psychological
   
3. Social
4. Behavioural
   
5. Effect on function

如此就能对病人在各方面的影响进行探索，在处理(manage)病人时有极大的帮助。

最后在病人处理方面，可以Scott & Davis model来manage：

• A - Acute management （如止痛，退烧，给antibiotic）
• B - Behaviour alteration （如停止抽烟）
• C - Chronic problem （如糖尿病，高血压）
• D - Disease Prevention （如皮肤敏感要少吃海鲜类）

PCM的医生，肩负着重大的责任站在最前线，不该被金钱利益蒙盖了眼，一切决定都应以病人的利益为出发点，这样就可大大减少antibiotic resistance,昂贵医疗费，门诊商业化等问题。

Jusco Member Day

Yesterday was the Jusco member day at the new Aeon Jusco at Bukit Mertajam. In KL, it is a grand shopping day for the ppl coz all brands will mark down the price, 70% are everywhere, or even more.

In Midvalley, the Jusco used to only permit 2 person per card to enter, ppl waiting to enter in early morning, grabbing the clothes like craze, queue long for trying, it is the day for the J members. With RM100 spent, can get RM10 voucher, sounds nice isnt it?

But these were sometime ago...


We arrived in the late afternoon, it was not as many ppl as expected. I went staright to do a member card RM12 on the spot, because afraid of long queue later. After shopping and purchasing, only i realised everyone can go in to enjoy the discount, not only for member, zzz...

The voucher redemption for member is only RM5 per RM100 expenditure (General merchandise, excluding food). I think this is the new rate, will be the same in all Jusco.

Anyway, the items were all marked down at lower-than usual price. The hottest spot was the ladies handbags. So many 70%, and in the centre there was a happy hour event sale, discount at 80%! Someone was using loud speaker to shout about the super sale, really very local (haha!) like in market..bet u wont see this in KL or in Penang Queensbay Jusco..

But it worked! many ppl outside rushing in to grab and choose, the bags were selling fast, with new stocks kept throwing into the war zone.


I bought some clothes and other things, all at least 50% :) In the shoe department, I asked the promoter about the price, some shoe like camel active are 30% during this Xmas n New Year sales, yesterday was increased to 50%. So if u are planning to get one, wait for this time!

But it was not as crowded in KL, maybe it is new in BM Penang, but i think it is mostly due to the economical crisis, everyone is saving hard for their pocket. So, only buy something if needed, dun get influenced by the discounts. I always remind myself about this, but still... hehe :p

Once per year, in each local Jusco, see u next year!

Merry X'mas & Happy New Year!

This is a pic taken not long ago at the new Aeon Jusco at Penang. The place was nicely decorated with X'mas & New Year atmosphere. Walking in the building reminds me of Klang Aeon Jusco, because the design, the shops, the cinema, they are all the same! Secret recipe, then got Black Canyon opposite the Big Apple donuts, looks so Klanged, miss the days at Klang oo..

Sales were everywhere, and the Jusco Member day is on this Friday! (tomorrow). Perhaps i will go to look for my stuff coz the discount is much more, and i believe Jusco in Bukit Mertajam wont be as crowded as KL kua (need to take long queue jz to test a cloth!).

Again, we went to Big Canyon to eat, the place where we (with classmates) used to celebrate Dr. Chuah (Paediatric lecturer) farewell. The food there was nice with its famous coffee, leaving me good impression. There was some kind of promotion set so was nice!

Actually i went there last weekend, then back KL for few days, and came back yesterday with Tatt's car. Sounds free huh? haha! Dont want to miss this festival season mah! Lagi i'm in Primary Care Medicine posting now, so i'm relatively free :)

Having a bit running nose n post-nasal drip causing a bit sore throat, hopefully it is abit n will recover very soon, cause i'm going for buffet lunch with family later at Golden Sand Resort. We went there long time ago when i was small, n my parents like it cause the food very nice and varied. Hopefully the award-winning restaurant will colour the day of Christmas!

Wish all my dear friends a lovely christmas day and a Happy New Year! Relax and enjoy this festival season :)

The Return: New Komtar, Pacific

Today I went to new Komtar with family, to have a look of the newly opened Pacific supermarket in Komtar, Georegetown. Coming back to this place was full of memory.

Looking 10-15 years back, my parents used to bring us here to shopping in the weekends. During that time, Komtar was the most happening place, crowded, full of people everywhere. Throughout the years, Komtar became quiet, worsened and finally stopped business for many years. This was mostly due to the opening of new shopping places like Gurney Plaza, Queensbay, Tesco etc.

Now the new Komtar comes back, opens right before the festival season and chinese new year, can it shines bright like before? we will see :)

The entrance at groundfloor facing main road

'GeorgeTown' white coffee, opens beside the main entrance

Pacific Bakery, offering variety of choices for customers

The beautiful christmas decoration outside the supermarket

Walking down the corridor reminds me of the olden days..
the floor has been renovated

Remember the McDonald at the corner?
Used to be the busiest restaurant, before it was closed..

Looks familiar? the center of the Komtar outlets

Used to sit here when eating McD ice-cream :)

The door, the wall, still telling us the story throughout the years..

Let KOMTAR returns like before, shining bright as the tallest building in Penang!

国产车，亲情，知足，快乐！

国产车新的Proton Saga在路上越来越多，我朋友就有好多个家里都买了辆，我家也跟进‘大队’，排了好多个月才拿到车。妈妈在今年四月底订，原本说三个多月就可拿车，结果等了半年才踏进我家，可见反应热烈哦！我朋友AK家在五月酱订，我去台湾前问他（那时十一月），还在等呢！

款式新颖，潮流感，马力小，最重要价钱不贵，是它的卖点哦！不是什么有钱人，有辆代步工具，坐得舒适，省油，麻烦少，那已经是满足了。什么八秒半到达100km/hr，什么超大cc马力，钱太多不如去做慈善哦！

最近看了部钱不够用2，相信很多人都看过了吧。当人到山穷水尽时，守护在你身边的才是最爱你的人。人心不如蛇吞象，人起了贪念，虽然物质上可能比人富有，但失去的可是无价的亲情，友情和爱情。有颗知足的心，生命会更灿烂！

浪漫一定要驾豪华车，用烛光晚餐，在KL Tower看烟花赏月吗？一起等巴士搭地铁，一起寻找道地的大排挡，一起在溪边海边谈天说地，无拘无束的，也很开心的哦！

当人有了太多的方便，就会失去过程的宝贵经验，那是生命的一点一滴，是一起吃苦的幸福啊！

不知怎么本来想到国产车的，却说到这里来，呵呵！夜深了较多感触吧。。

这使我想起了几年前一段Petronas的广告，我看了很多次，那信息还是那么强，感触还是那么深。这里和大家再回味一下吧！



婆婆的儿子驾着国产车进来那一刻，永远留在我脑海中，
知足常乐，孝亲敬老，无论将来如何，希望都能铭记我心。。

钱是万能的吗？我始终都不曾同意过。

我很幸运也有辆‘三手’Iswara在KL，92年国产车要加油哦！

醫協：2015年醫生過剩

（吉隆坡）大馬醫藥協會指出，大馬將在2015年以後，出現醫生供過於求的現象，因此有意攻讀醫科的學生必須做好應對壓力的心理準備。http://www.sinchew.com.my/node/94772?tid=1


目前大馬醫藥理事會需要處理至少5宗新晉醫生面對壓力、情緒及行為改變的問題；一些新醫生則無法應付長時間的工作。

Doctors now so cham have to work so much till get psy.. when the houseman are enough in future, i believe the problem will be lesser.

However, by looking at the statistic, when my batch graduate at 2010, there is still lack of 9000 doctors, but the Dr:Patient ratio has improved from 1:1236 to 1:747, hopefully we will have a not-that-stress working load when come out.

Btw, publishing this statistic on papers, is more of telling students not to simply choose medicine lo.. an improvement in medical service & quality, but a much more competitive medical life in future, good news or bad news? i dono..

The Happy Story

Before there was Happy, there was confusion. Everyone wanted to outdo each other, offering large free concerts, celebrity endorsements, and all the little extras that simply added up to the cost.

Then, Happy was born. Happy cut where others didn't; so-called “free” calls to the Helpline, massive billboard celebrity advertisements, and especially “free” MMS sent to your mobile. What it gained was savings that was passed down to you:

That means you’ll only need to pay 1sen per second for a quick call. The most is 99sen maximum for a much longer conversation. If talking isn't your forte, then there's SMS. Send as many as you like for only 10sen per SMS.

You'll even get 60 days' validity with every reload, no matter the value. So you can top-up with RM5 and still get 60 days of talktime.

And that, my friends, is the story of Happy.

http://www.happy.com.my

SO,if you are the one 'bou zhok' everyday, for sure there is no better plan as this in the market. Talking 45min with 99cent, gives u only RM0.02/min! BUT, u need to have 2 phones, coz this plan only for calling. Just get one old phone for calling ba~

Reload only RM5 can extend 60 days, making calls with RM0.02/min to all phones, including fixed lines and even sabah or sarawak!

For couples calling everyday, for students calling back hometown once in a while, its still an ideal plan.

I have been using it since early this year, its cool! think about it :)

周杰伦的中学，[不能说的秘密]拍摄点-淡江中学！（淡水）

前天是在台湾最后一天罗，我们早上去了故宫后，就打算去淡水。台湾MRT捷运非常方便，几乎台北的所有旅游景点都可由捷运到达，或在捷运站坐个公车就可到达，旅游手册都解释的相当清楚。

淡水是红线捷运终站。我们乘搭公车去渔人码头的方向，沿途有经过真理大学（要问问才懂淡江中学下这站），下车后就往斜坡上走。斜坡路口是间什么红毛纪念馆的，像是古时西方人占领时留下的建筑物。没多余时间，我们赶紧向上走，一路上好多像学生又向旅客的年轻人，情侣也不少哦！

经过的建筑物，有点像戏中的建筑物，所以拍了下来。

经过真理大学，不远就到达了‘私立淡江高级中学’。名字有点夸张，中学还有分超级不超级的？哈哈！不过应该是这间吧！问一问守卫，他很明白的就说旅客可进入，看来已有很多人慕名而来过了。

学校门口

开始经过一些古老建筑物，它是所基督教建立的学校，包括淡江中学和真理大学。然后有几座新校舍，最后来到旧校舍。我们一到就有‘感觉’了，似曾相识的感觉，好像电影内的某个角落！我觉得走廊有点像，但还是不肯定，最后问了那里的学生，才知道在不远处，取景多在课室旁的走廊。

这是学生说的走廊，戏中男女主角在此相见的哦！

这里也有点像。。

不过他们说不是所有景点都在此校，比如戏中的琴房等都是在别处，有幕黄秋生在草场旁与女主角对话，他们说是在真理大学草场，于是我们过去看了下，但觉得不很像，反而中学草场有点feel，大家看看吧！

淡江中学草场旁，个人觉得有点印象

真理大学草场，四处都是树而已。。

顺便分享些周杰伦母校的照片哦！学校非常美丽，花草树木，下去路口面对就是大海，非常特别的地方。

该校的橄榄球似乎有很好的成绩和历史

有个大钟楼，让我想起母校钟灵哦！

校内的大楼，很优美哦！

校内的学生都很会打扮 :p

真理大学，就在淡江中学旁。

不能说的秘密这部戏我没收藏，无法对照一下，不如大家帮忙看一看吧！无论如何，来到周董的中学，感觉还挺不错的！

Finally i'm back!

After a one week trip around Taiwan, i'm back to my hometown again :)

Taiwan is a great place to go, we able to go quite alot of places within one week, with minimal expenditure.

For many days i hvnt update my blog, so thinking of 'summarizing' my 'diary' here..lolz! So here is the trip n places we went:

Friday: Finish half day class at TsuChi, took train to BanCiao(板桥，near Taipei) stay one night. (plus Stephan n SuHuan)

Sat: Taipei 101, 西门町

Sun: Took train to Jiayi (嘉义）then took bus to 阿里山. The special train to 阿里山 stopped service, no chance to experience it. 阿里山森林游乐区. Stay one night. (student package)

Mon: 玉山看日出. Too bad the sunrise wasnt the perfect one, coz the sun was blocked by cloud. The place was very cold, nearly 0 celcius, luckily we wore few layers :p. Aftern back to 嘉义 and straight to Kao-Hsiung. Went to 六合夜市.

Tues: Kao-Hsiung （高雄）- 佛光山，旗津，西子湾（爱河）， 六合夜市, then took high speed rail (高铁）back to BanCiao

Wed: Taipei (台北) - 二二八纪念馆(meaningful), 总统府(place where president works), 中正纪念堂

Thurs: Taipei Zoo, 国父纪念馆

Fri: 故宫(nice, many historical things to learn n see)，淡水(went to JayChow's secondary school where the movie '不能说的秘密' was taken, also went to 渔人码头, a nice seaside with great scenery). At night went to 士林夜市, it was superb crowded!

Sat: which is yesterday, took early flight back to M'sia, arrived in late aftern. Came back to Penang at night.

Before this during the 3 weeks in HuaLien, we went to places like Taroko national park 太鲁阁, 慕谷慕鱼，鲤鱼池，七星潭，宜兰，焦溪泡温泉，慈济精舍etc. These are place where one can go during the attachment time in Tsu Chi Hospital in HuaLien.

Take note that if possible dun buy things at 7-eleven coz they are expensive! haha!

新奇古怪之台湾篇

猜猜看上图是什么车子？是不是很眼熟？快抢答！
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国产车Wira?！眼力不错，但不是哦，哈哈！
其实是。。。

Mitsubishi Lancer!这是旧款的Lancer，Wira买它造型，所以非常相似。台湾没国产车，到处都是进口车，以日本车如Toyota,Mazda,Nissan居多。路上到处都是豪华房车，连德士都Vios或Camry，难怪台湾在个人机车排烟量冠全球第三！

想要靠近它吗？

这是台湾的电插头哦！有时只有两个头，都没有开关挚的，小心走电:p

中医的Cupping，亲身体验感觉挺刺激的，要不要试试？皮肤都浮了起来罗。（外国朋友背后）

All about Taiwan! 宜蘭溫泉

I hvnt got the chance to online until today. Last week was busy for chinese medicine test (simple n cincai..haha) then saturday went to YiLan and Sunday went to Jing She & attended a chinese medicine course at hospital.

YiLan is a nice place. Famous for Hot Spring water, traditional cultural centre and night market. Besides that, also got wine factory n museum, lots of local food, new shopping complex, prison and cultural village. Lets share some photos here while i can explain a bit about the places :)

This is called Rou Geng Fan. The pork is made into small pieces, abit like meatballs but is handmade, taste delicious, recommended!

Outside cultural village, tell the history of YiLan, the culture & tradition of the people.

Look at the scooters here! The transparent plastic fixed on it is used to prevent cold air from blowing directly on the face. There is even wiper fixed on it, very cute :p

The road outside railway station. Be careful when crossing.. cars are coming at your left.

Restroom in chinese: make-up room

Dou Fu Fa, in flavours of peanut, yam, barley n red beans, thanks to senior for 'belanja' us.

A nice corner beside the Luo Dong night market, like a cafe/stall/restaurant/bar..whatever u want it to be!

Taiwan railway trains, can be superfast, fast, normal speed or local (pic above), jz like our LRT. The trains depart at the same station.

Many people enjoying hot spring water at the public hot spring garden. This site is strictly for leg only! you can jump into it if u want to :)

Night market at Luo Dong. So many stalls to eat and many things to buy n play.. some stalls hv to queue for very long to buy it.

Once arrived at the Jiao Xi station, can see many banners promoting Hot Spring water.

Seen at the wine factory, "If you never drink YiLan beer, means u hvnt come to YiLan!"

Taken together with my camera placing on a wall. 2 lovely seniors at the left, they are couple :)

In cultural centre, paper folding skills is extraordinary.

Street of the cultural centre, each building has its unique tradition. Spend more time here as the place is so huge, and its getting dark at 5 smth!

The entrance of the public hot spring, NT60 for student, but need to bring own towel. BTW, naked is compulsory in it!!

I'm doing my last week attachment is Tsu Chi, which is internal medicine in cardiology. Quite free here actually, as told by senior, but if want to attend all classed, then it is different story :) Learned about threadmill jz now from Dr Liu, a nice physician whois knowlegable. We will start our 'trip' after Friday. Probably going Alisan, Kao Hsiung and Taipei :)