The Normal Days

6.45 am – Getting of from bed. Or trying, for the very least.

7.00 am – Breakfast (Carman’s anyone?) and a quick shower.

7.20 am – Towards the bus stop, which is conveniently located below my block.

7.35 am – Bus arrives. Taps the EZ-link card after getting on.

7.45 am – Arrives at bus interchange. Taps out. 70 cents deducted. Starts walking towards the clinic.

7.50 am – Reaches the clinic. Powers up the pc.

8.00 am – Ding. The first patient being called.

9.00 am- Work work work.

10.00 am – Work work work.

10.15 am – 10 minutes breather for a quick snack. And to pee.

10.25 am – Work work work.

11.00 am – Work work work.

12.00 am – Oh my God. I’m hungry. Work work work.

1.00 pm – Lunch with friends! 5 dollars a meal. May go up to 15 since there’s a mall nearby.

2.00 pm – Bah. Back to work.

3.00 pm – You know the drill.

4.00 pm – Getting excited that it’s gonna end soon.

4.30 pm – “Why are there still patients?!” Everyone starts getting really edgy.

5.00 pm – Done! Takes a slow stroll back with wifey. (Oh yes, she works at the same place as me.)

5.10 pm – Hops on the bus.

5.30 pm – Buys dinner from the the nearby kopitiam. Spends about 10 dollars for both.

6:00 pm – Chilek time. Movies, dramas, studies, gaming, music and housework all the way till 10.30pm.

10.30 pm – Catch up on some news using Flipboard (fantastic app by the way).

11.00 pm – Nite guys!

p/s. Oh, and if you’re wondering what about the not-so-normal days a.k.a syok days, those are the times when I’m back in KL! 😉

When RM12,000 a month isn’t enough.

Miraculously, an old post in The Malaysian Insider just got popular again. You can read the entire article below.

http://www.themalaysianinsider.com/malaysia/article/when-even-rm12000-a-month-isnt-enough-to-get-by-in-malaysia

Parts of the excerpt.

One of them is Caroline Wong, who believes her combined household income of RM 12,000 is not enough to sustain a living in Penang, famed for its beaches as much as it electronics manufacturing sector.

The 34-year-old clerk lives with her husband, a sales manager and their young daughter are starting to feel the pinch despite earning an income that was once sufficient to live comfortably.

“We are always eating in at home now and we can no longer afford to buy goods like branded clothing,” Wong told The Malaysian Insider in Penang’s capital city George Town.

According to Wong, every month the couple have to fork out RM 4,000 for the house and car, RM 1,500 on food and another RM 1,500 on daycare, baby food and milk for their child.

On top of that, there is RM 750 on insurance and a family medical card, RM 700 on petrol, RM 600 on phone bills, WiFi and broadband, RM 120 on Astro, RM 140 on water and electricity bills and RM 110 on a weekly housekeeper.

“We put aside RM 500 every month for road tax and car insurance. Come May next year, we will have to spend another RM1,500 a month on our second child when it arrives,” Wong said.

So is RM 12,000 enough for doctors to start a family?

I had previously written a post on how much was needed in general to be sustainable in Klang Valley here. However, that’s only applicable to a single person. One would require an estimated of RM 5,000 to be able to live comfortably. What if it’s for 2? Simple mathematics would tell you that it’s roughly gonna be about RM 10, 000. Family of 3? You do the maths.

Reading through the comments posted on The Malaysian Insider, many disagreed with the statement and justified that it was more than enough. I beg to differ. Now, of course to survive, you don’t really need that much but let’s talk about it from a comfortable (not lavishly) point of view. To have a family and to live in KL (or any where in the Klang Valley), you would probably have to get a condominium or a house, which ultimately takes up a chunk of your income. Houses in KL these days, at least within the KL vicinity, costs no less than RM 500,000. Staying further away would be cheaper, but it’ll be replaced with increased petrol cost and time vs. distance traveled. With that in mind, to service the loan itself will require you to fork out an estimated of Rm 3,000 a month. RM 1,000 left for the car loan is fair enough to get a decent car (excluding proton cars).

However, RM 700 for petrol and RM 600 for phone bills are rather excessive. Additional cost saving measures should be undertaken in those categories, which can be improved.

Therefore, a note to all future doctors out there, your starting income will hardly be enough for you live comfortably, let alone starting a family.

Here’s the salary of a house officer (Pegawai Perubatan UD41).

Base: Rm 2,778

Housing allowance: RM 250 (pathetic, can’t even rent a decent room)

Public service allowance: RM 300

Critical allowance: Rm 750

COLA: RM 100 – RM 300

A grand total of whooping Rm 4,378 (using max COLA), which is hardly even close to RM 5,000, or RM 12, 000 on combined income assuming your spouse (assuming a doctor too) is working too. What’s next? For those planning to do medicine, better be really prepared. And for those already in it, plan your finances in advance as it ain’t gonna be an easy road ahead.

Being Listeners

Doing medicine is not just about giving the best advice or the best drug. Myself at times tends to get hasty when the workload gets too hectic, and starts jumping to conclusions before the patient could even finish his/her sentences. At the end of the day, what the patient needs most may not be the advice you give, or the blood tests or x-rays you’ve ordered, or even the medication you’ll be giving. They just want some of your time, to have you listen to their troubles and that, easily be the best medicine you could ever give.

Come to think of it, I’ve talked about this before in one of my previous post. I can be a little cheong hei (long-winded). In person, I don’t really like to talk much and I’m not really a people person but when it comes to talking to patients, I can talk non-stop. The irony.

A couple of days ago, I saw an elderly gentleman who was in his late 60-s, complained of body aches. He had multiple issues like an excised kidney for renal cell carcinoma, underlying gastric reflux, osteoarthritis and all the yadda-yadda stuff. Funny part was I didn’t dwell much on his presenting complaint. After asking a few quick questions, he then started sharing about him having the initial thought of dying as soon as possible since he had so many medical problems at hand. However, since the coming of his new born grandson (which he described him as sooooo cute), he decided to live a little longer until at least he’s in school. And he asked, “Can right?”. Speechless moment with an awkward pause, which I replied with a smile. And of course he carried on sharing about his life stories for a while. In the end, he thanked me and left the room happily without having me to examine him (Fine. I admit I had totally forgotten about it). Somehow, after the conversation, it kinda brightened up my day, especially when you’re being bombarded relentlessly with tons of patients to see each day.

Just thought of sharing it with you guys as listening, is both therapeutic not only for the patients but for the receiving party as well.

Are you a good listener?

To X-ray or Not to X-ray

That is the question. Of course we’re no Prince Hamlet but we do have to make a wise decision on whether we should request an x-ray for a patient who has recently injured/sprained his foot, ankle or knee.

For feet or ankle joints. Quite simple. By Ottawa rules, as long as there is pain over these 4 areas when pressure is applied, do an x-ray.

  • Posterior part of lateral maleolus.
  • Posterior part of medial maleolus.
  • Base of 5th metatarsal bone.
  • Navicular bone.

If patient is unable to bear weight on the affected ankle joint, do an x-ray.

For knee joints. Only do an x-ray when:

  • Patient is above 55 years of age.
  • Tenderness over the patella and nothing else.
  • Tenderness over head of fibula.
  • Patient is unable to flex his knees to 90 degrees.
  • Patient is unable to bear weight despite limping.

Then again, rules are rules. And rules are meant to be broken, when your life is at stake. Things don’t usually go the way you want it to be.

Patient: Hi Doc, morning. I want an x-ray.

Me: Morning. Er. Huh? What’s the x-ray for?

Patient: It’s for my knees. Can I get it done today?

Me: Wait wait wait. What’s wrong with your knees?

Patient: I have this pain in my knees.

Me: And how long has the pain been? Months? Any falls or injuries?

Patient: Just yesterday. Had a twitching pain in the right knee for a couple of secs. No fall what-so-ever. Thought might as well I get both x-ray’d since I’m here.

Me: …

Me: I doubt you need an x-ray for that sort of ..

Patient: Why not? I personally took leave today so that I could come to have an x-ray done and you’re not giving it to me?! Are you going to be held responsible if anything happens to my knees?!

Just one of those daily nonsense I get during the usual jam-packed clinic sessions. Life ain’t as easy as you think it would be.

Generation Y

As usual, I get my daily dose of Malaysian news from the Malaysian Insider and came across this article about the Generation Y, or Echo Boomers.

Employers are becoming increasingly dismayed by Malaysian’s Generation Y job seekers who generally have a poor command of the English language and lack communication skills, are too spoiled to handle stress, and in a hurry to climb the corporate ladder yet indifferent to the need for experience.

These Gen Y recruits, when compared with previous generations, are also less impressed with job benefits such as medical insurance and bonuses, preferring instead immediate cash rewards for performance, surveys among employers and trade groups have revealed.

Graduates these days come from colleges and immediately want to become managers, without even any experience. You can’t scold them and they can’t handle stress.

Believe me, it’s happening in the medical world too. Young doctors are calling in their parents when they are unable to take leaves or cope with their on-call duties. Doctors who just go AWOL because he/she can’t stand the heat. Doctors who break down easily after “lectured” by the senior ones. Doctors who think quitting is the best option available. So on and so forth.

So why is this happening? I’ve got the slightest clue. Maybe the Generation Y are way too pampered? Over protective parents? Softies?

One of the favorite quotes: Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. As the day goes by, this phrase will most likely phase out. Should just change it to: Give a man a fish and you feed him for a day. Don’t stop giving, and you feed him for a lifetime.

Bear in mind that the Generation  Y doctors are going to grow older and eventually they’re the ones who will be treating you, whether you like it or not. However, without being able to handle the pressure, how far can one go? Only time will tell.

Where do I stand then? Come to think of it, this is rather amusing. By definition, I’m in the Generation Y category too since I’m born between 1977-1994. And yet, I can’t stand all this utter nonsense.

Work Place

Ever curious as to how a polyclinic in Singapore looks like? Here’s a shot for ya.

PC

Although I hate to admit it, it’s considered one of the more comfy clinics that I’ve worked in so far.

Nowadays, surviving as a general practitioner in Malaysia is gonna be tough, and it’s gonna get tougher by the end I get my stuff settled here. Has plans (more like thoughts) to get one going but seeing GPs back home can go bankrupt, I shudder at the thought starting one myself. The initiating cost itself will definitely be a very damaging start. And to start anew in a place with hundreds of other GPs competing with one another, it’s a race out there. Building rapport with patients, and to have them like you, will take time. And time, is of essence. Income will fluctuate, and may very well end up in the losing end. Despite that, I still have dreams of having a clinic of my own. It’s considered a joy, at least for me, to see some form of continuity in care of patients with chronic illness that improves through proper management. However, you don’t really see it (the continuity) in the government polyclinics as the load of patients are shared among different doctors. Seeing a patient and having a plan does not guarantee that the patient will see you again the next, and most likely the plans will change when another doctor sees him/her.

Have you got yours planned out yet?

Cost of Living in Klang Valley, Malaysia.

How much to live comfortably in the Klang Valley? Let’s do a break down.

Ultimately everyone wants to own a place of their own. So a property value of RM 250000 – RM 300000 (although I do believe a decent property in Klang Valley is double/triple of what I’ve stated), you’ll have to service a loan between Rm 1000 to RM 1500. If not, a rental around Klang Valley area would costs about the same. Utility bills about a RM 100. An average car value of RM 100000 , brands from Toyota, Honda, Mazda, etc. Estimated loan of RM 1000 to RM 1500. Of course if you’re a Proton fan, by all means. You can lower that value by half to about RM 500. Let’s take RM 1000 as of now. And when you have a car, you need to pay for petrol as well. Let’s put this at RM 250. Internet bills. Let’s take UniFi’s cheapest 5MB package which costs RM 150. Phone bills. RM 100 for calls and 3G. If you’re gonna be a cheapskate like me who uses prepaid, that’s fine too. Food wise, average of RM 5 per meal. Let’s assume you eat 3 times/day. So, RM 15 a day. In 30 days, RM 450. Eating the same food everyday would be kinda tedious, to add in some spice to life, probably additional RM 50 for each weekend, be it food or other entertainment purposes like movies, hang outs and stuff. So 4 weekends, that would tally up to RM 200. If you do take up an insurance scheme, maybe about RM 100 a month. Although it varies depending on which kinda scheme you’re getting.

Now let’s add them up. House loan/Rental (RM 1500) + Utilities (Rm 100) + Car loan (RM 1000) + Petrol (RM 250) + Broadband (RM 150) + Phone (RM 100) + Food (RM 450) + Entertainment (RM 200)  + Insurance (RM 100) = RM 3850. As you can see, an estimated monthly expenses incurred would be RM 3850. How about savings? Say you plan on saving RM 500 each month. That would be RM 4350. As this is the take home income, we’ve got to include the EPF (forced savings) and tax in too. So give and take, RM 5000 would be the figure.

Do take note though, this is calculated based on one person. If you have a family and other commitments, the figure itself would definitely be higher. Of course the amount can be pushed lower, by taking out the car loan and petrol expenses but I would not consider that as living comfortably. Unless you do not intend to move out from your parent’s place and stay in forever, probably you could remove the burden of a housing loan then.

Then again, is RM 5000 really enough? I wonder.