Second and third class patients

Depending on your social status and income, you might be admitted to first or second or third class ward in Malaysia's hospital. The different ward class could mean that your stay at hospital either be comfortable or staying in a crowded cubicle.

If I'm not mistaken, being in third class means that you have to pay for every blood test but you pay less for admission fee whereas in second class, you don't need to pay for any test/investigations since that is being covered under admission fee. Please correct me if I'm wrong.

In Australia, there is no such thing as second, third or even first class. Every patient received the same standard of medical care. The only different perhaps whether you are in a single room or in a room with 4 people. Back in Malaysia, being in third class could mean that one cubicle containing around 10 patients.

I think in Australia, they have quite large amount of resources such that they could afford to provide one television per bed and every hospital has air-conds. In Malaysia, there is only one television per ward and a ward might have between fourty to sixty patients. I guess if you are admitted to public hospital in Malaysia, you might get bored easily and don't have the luxury to see any form of entertainment.

I'm not sure the needs of segregating patients in different ward class since I thought the provision of health care towards Malaysian citizens should be universal and be standardised regardless of your social status or income. At least for those who come from higher social status, they can afford to go to private sector.

Why am I writing about this matter? This might be one of the potential improvements that could be implemented in the future, provided that the government has enough staff, resources and facilities.

News: Public unhappy with government medical services

Medical Abbreviations in Malaysia

After four weeks doing elective in Malaysia, these are some of the common medical abbreviations used in the hospital.

AFNT – Anterior Fontanelle NormoTensive
AGE – Acute Gastro Enteritis
ARF – Acute Renal Failure
BE – Base Excess
CBD – Continuous Bladder Drainage (Fancy phrase of saying putting up a urinary catheter)
CBS – Capillary Blood Sugar
CKD – Chronic Kidney Disease
CLD – Chronic Liver Disease
DFU – Diabetic Foot Ulcers
DIL – Death In Line
DRNM – Dual Rhythm No Murmur (This is used to describe cardiovascular examination findings)
EES - Erythromycin ethyl succinate
EMCS – Emergency Caesarean Section
FTSVD – Full Term Spontaneous Vaginal Delivery
JE – Japanese Encephalitis [PDF]
KIV – Keep In View
NNJ – Neonatal Jaundice
OA – Orang Asli
PCM – Paracetamol
PD – Peritoneal Dialysis
SCR – Subcostal Recession
SGOT - Serum Glutamic Oxaloacetic Transaminase. Another name for AST (Aspartate aminotransferase)
TCA – To Come Again. Example TCA eye clinic 6/52
TRO – To Rule Out
UFEME – Urine Full Examination Microscopic Examination
UGIB - Upper Gastrointestinal Bleeding

p/s: Most of these abbreviations are quite different from the one we used in Australia.

The Coat of Professionalism

The person with the stethoscope is coming closer. The fear starts to build up. The pain gradually become more painful as that person is getting closer to them. The pain from needle is too much to bear with. The fear is too intense for them to handle. Then out of nowhere, they start to cry and try to run away from that person.

This was a common situation that I faced everyday while doing my elective in paediatrics back in Malaysia. Children are too afraid of anyone wearing stethoscope and will always associate them with needles. Any attempt of even touching them or putting the stethoscope on their chest will result in an endless crying and this may lead to futile effort to examine them.

Sometimes, we have to struggle with the children while the parent holding them down for us to check their heart and lung function. An outsider may saws this act as quite cruel but it was necessary for their own health.

Every doctor working in Malaysia has to wear white coat. The main reason behind this is to show the so-called professionalism. Every male doctor has to wear tie as well and this is certainly not suitable in hot humid environment in Malaysia.

The only department in the hospital that does not follow this code of conduct is paediatrics (a branch of medicine that looks after kids). White coat is the main source of fear to the patients. At least by not wearing white coat on the ward, this may help to reduce their anxiety. Nevertheless, any doctors or nurses for that matter, will always be associated with needles injection and most of the kids will developed intense fear towards the health professionals.

As a medical student who is trained in Australia, it was quite amusing for me to see everyone working in the hospital to wear white coats. Doctors, nurses and medical assistants have to wear white coat every day. I would not argue with this regulation if all the hospitals in Malaysia is fully air-conditioned but this was not the case.

In Australia, doctors are not required to wear white coat and it is not compulsory for male doctors to wear tie. Nurses have their own uniform but it is not white in colour . I guess we can be professional even without the white coat.

According to google, professionalism is defined as

• the expertness characteristic of a professional person
• professionalist - A person or organisation that supports a professional attitude
• an occupation, vocation or high-status career, usually involving prolonged academic training, formal qualifications and membership of a professional or regulatory body

Manglish

I spend two weeks of medical rotation and two weeks of paediatrics as part of my elective in Hospital Ipoh, Perak. This hospital is roughly about 40km from my home and I was driving to and fro everyday.

This post I would be writing on the language used among doctors in Malaysia. Manglish, that is the mixture of Malay and English; is the most widespread language spoken by doctors.

After four weeks spending time in Ipoh, I never able to speak in Manglish. I was the only medical student who are doing elective in each department and thus, every doctor questioned which university I was from since I don't speak in Manglish.

I find it quite difficult to speak in Manglish. It is akin of breaking up the language and mixes it with another language. For someone like me who has been striving to improve my English, this is a step backward.

I am planning to work in Malaysia next year. I believe that within few years of working as a doctor in Malaysia, I would be able to master Manglish but my aim of improving my English will be diminished slowly.