Tuesday, April 27, 2010

Tip 6 : Facing Not So Good Result

Facing Not So Good Result (short form : NSGR)

Usually this is where the major problem is. Even before the result were out, some of us had already anticipated to get a NSGR. These are not healthy of course, but let’s not talk about that.

Most of the time, we say we can “feel” that our result would be NSG. But at the same time we haven’t prepare ourselves for this. That’s the big problem. When the result is really out, in our heart we can say “Oh shoots! I knew it…” some part of us may feel like “oh well, at least I have anticipated this, so I am not so crushed” well I say, oh really? I have been in that place, trust me, getting something bad that had been anticipated is not relieving at all. Even how much we anticipated it, its not a positive feeling when our initial feeling is not positive at all.

But what about those who never anticipate having a NSGR but it turns out the other way around. Most people would be very surprised and therefore will be very socked and therefore will be very depressed…. That’s a lot of “very”. Well, I have to say, yeah, it could be… But it could be different. This is how I found a way to get over my NSGR.

FYI, I NEVER anticipated to have to resit O&G in fact, I am VERY confident that I will pass. Ask Rahmah my housemate, she’ll testify to that statement :D… Luckily, by the time I receive the NSG news, I had already master some art of positive thinking skill.

The news about my result was sent to me in a form of a handphone call when I was on my way back home. It was Rahmah (as usual, hehe…), when she told me that I have to resit 1 posting, I ask, her “was it O&G”. Of course, even though I did not anticipate to have NSGR for O&G it was very unlikely to be surgery posting (surgery was the best 3rd year posting for me). She said, yes it was O&G. I don’t know why, but something in my heart, well actually I’m quite certain its something from the subconscious mind, a message from Allah, tell me to say ; “Alhamdulillah”. So I did, I say it, even though I don’t deny I was quite shocked. It was a weird response, I was not even sure if Rahmah heard it, I also feel that the word does not fit the situation. But the word “Alhamdulillah” itself, have its own power. The minute I say the word, what plays in my mind was “hey at least just one, I should be thankful”. The aura of the word “Alhamdulillah” is an aura of gratefulness. I guess its true after all that words are the follower of the heart (refer to link) not the other way around. Because I just say a word that mirrors the essence of gratefulness in the first reaction to the news, the subsequent responses were amazing. 

"Orang hebat akan sabar apabila diuji,syukur apabila diberi nikmat... Orang yang lebih hebat akan syukur apabila diuji, sabar apabila diberi nikmat" ~~My Quote

It was like a soft rain falling on my face. Every drop of thoughts falls down so peacefully; it was both relaxing and exhilarating. The thoughts that keep falling were the reasons why I was to resit. There were a lot of positive reasons; honestly these reasons are not reasons I made up to make me feel better. They are just thoughts flashing in my minds. Again, I’m convinced that this is the work of the subconscious mind. When we think positive, the door to happiness will open for us, we don’t need to search for it. That was the beauty of it.

There was one particular reason that I like the most;

Why do you have to resit? Before this you never resit in your whole life of a medical student even though your performance was worst before. It was because now you are ready to face it. Before this, you were weak, full of fear of other people perception, you are competitive, and you definitely can’t stand such a test from God. Now that you are more positive and stronger, this test is given to you so that you can improve on your study skills and your love for medicine.

This was the best reason that crosses my mind, other reasons were:

  • To be able to understand O&G more
  • To be able to spend time with Mar and Anis
  • To be able to experience life as a resitter
  • So that I will not be afraid of failing exams anymore
  • So that we can help each other during the resit posting
  • Spending time at KTDI is a life more disciplined
  • My skills wont be so rusty to be use when I enter 5th year

But the more time spent at KTDI in the resit posting week, I found out even more advantages of resitting. I am convinced that if I had face the news differently’ the door to happiness will not be open automatically. I will have to struggle to find ways to open that door. But positive thinking made all the difference. 

What determines a positive attitude and feelings is not how much we struggle to be positive, but its how much we let go to be positive. Being positive is all about letting go. Let go fears, anxiety, stress worries, be in peace and accepting. Listen to our subconscious, the message from Allah and the rest just leave to our subconscious, Allah message will find its way to our thinking and we will find it so easy to feel happy. 

But one particular tip that can easily be used here is the use of the word "Alhamdulillah". Allah's names have its own power, believe me, it can work wonders. When we leave it to Allah, Allah will give us His protection and security

Link: Follower of the words

Tip 5 : Facing Good Exam Result

Well, there is no tip needed to face a good result now is there? At least that what most people would think. Just because we pass with or without flying colors doesn’t mean we’re free as a bird… in fact, being able to pass with ease to me is even harder to face rather than failing. It is easy at first, but too much success can make us feel like we are better than those who are not. In our life, when we are studying together there are no winner or loser, we work together to win together. Passing the exam does not mean we win if we treat others like they are losers. I am not referring to anyone, just a thought… in my opinion those who had passed have an OBLIGATION to help their friends, not only giving moral support but if possible we should also offer help in terms of knowledge. If we are free from the burden to have to resit or repeat, we should never abandon our friend who experienced this “delayed in success”.

Some may welcome the help while others may feel intimidated. But that’s okay, when we offer something good to others, people reject, we could just smile and say it in our heart, “oh well, I am not the one at loss, my good deeds is already written and I have done my share of good deeds today”. We are never at loss when we help or even just offer to help; it all depends on our intention (niat).

There is nothing nobler than the sight of the students who have pass helping out their friends who are still in need of help, and also seniors helping out their juniors on their way up. Helping each others is very noble, but we don’t do it for the fame and to ask for favor in return. If we do good deeds without asking anything in return, that is exactly when our deeds will be returned.

Another challenge of facing good result would be how to spend the holidays. Usually at the end of end semester exam the break would be quite long. Without medic stuff to fill the head, our medical skills could be quite rusty. Not to mention some (especially me) who would have weight gain problem during the holidays due to the eat-sleep-tv-eat-sleep-tv schedule… so I guess, helping out our friends could help keeping in touch with our medic skills. Sometimes just studying because we don’t want our skills to be rusted is not a “good enough” reason to study during holidays, so how about helping our beloved friends then? Usually when our intention is for another person, our discipline would be better. (hopefully)

Anyway, just because I write it here doesn’t mean I ever made such a commitment before, hehe… but, insyaAllah I would be more helping in the future if I were to be given the chance.

Saturday, April 24, 2010

I Can't Wait to Finish This Exam!! :D

Oh I'm so happy!

I really can’t wait to finish this exam! No… not because I want to enjoy the freedom… are you kidding me? Medical student will never be free of the need to study. By the time we choose to be in the medic course we should have already anticipated that. But, that’s where life gets even better. Can you imagine how exciting this life is? I mean really, we are being rewarded to study, how can we NOT study! Every single thing we study is because we are going to save a life in the future, save a mother from losing a child, save a child from losing a mother, save a leg from being cut off, and most of all that I am very looking forward to is to save a soul and bring it to back to Allah’s road. Oh…. What a sweeeeeet life…… I can’t wait for all those things. The real reward is not JPA my friend… No, no, no… Yup, it’s the pahala from Allah…. Of course, provided that our niat is pure enough. So okay I missed a few years studying because I want to pass the exam, but hey, at least I realized it now, I got two more years to go. Let’s just focus on making those two years a happy happy time!

I really can’t wait to finish this exam! After this I am going to concentrate on my study plan for next year (year 4 insyaAllah). Oh yes! I am going to make it BIG this time, and I’m hoping to get the entire medic student’s of UKM to get involved. Any UKM medic students, who are reading this, get ready for that. I am planning to get all of us together to create a book. A book of mind maps and short notes. Hopefully, all students from all postings can get involved so that by the end of the first posting, there will a complete set of mind maps and short notes from all different postings. Rahmah have approved the idea, insyaAllah will be under the Zero Repeaters Campaign. I will post the details later.

I really can’t wait to finish this exam! I think my parents really misses me… huhu… My articles in Metamorphosis blog will be edited and will be published in the Lestari magazine, insyaAllah. My dad has read my articles, and he seems interested. I’m looking forward to concentrate on my book, but I’m pretty sure it won’t finish in the mean time. I’m not hoping to finish the book as soon as possible; I’m hoping that the content will be as meaningful as possible. If meaningful means I have to gain more experience, then bring it on!

I really can’t wait to finish this exam! I can’t wait to enter the next, “whatever year it would be”, I don’t care. After realizing the importance of studying during the medical student life, I am going to study, not harder but more sincere. Being sincere makes all the difference. If we respect knowledge, knowledge will be there. If we treat it like garbage, it will leave us behind. I’m looking forward to become a better student, more committed, more motivated, more motivating, more loved, more confidence and more of everything good! A good start is a start that actually started!

success is not the key to happiness, happiness is the key to success. If you love what you are doing you will be successful 

I just can't wait to finish this exam because I just can't wait to just move forward and forward! There are always great things waiting to happen tomorrow, there is no doubt that every single seconds of our life is a life lesson, something for us to gain, something good. When we leave it to Allah 100% we will find, life is so peaceful, beautiful and just…. Indescribable… 

Hoping for a beautiful tomorrow will make us happy today... Therefore everyday will be filled with happiness until there is no more tomorrow

Friday, April 23, 2010

Tip 3: Post Exam

Right after exam

As Mar suggested (again,hehe..)

“kuar exam hall ngan tenang,elakkan berbincang ttg soklan yg telah dijawab,bykkan berdoa...keep praying...tawakal...”

Additional things to do

  • Do not talk too much, try to be in peace
  • Avoid going out to have some fun because we want to “release tension”, instead….
  • Take a short nap, before that nap, pray: 
  • “Ya Allah, as when I wake up, cleanse me out of my worries, fill me with syukur, armed me with sabar… Make me Your faithful servant that will always be under Your guidance and may peace fill my life always”
  • After that do sunat prayer (or during any solah), and thank Allah for the exam, regardless of how we do it


Sleeping is a good way to recharge the mind. After exams, our mind had been working in an unusual environment. It is in an acidic condition. The sleep will help the mind to let go, calm our mind back and bring it to our natural pH 7.5 state. This will also help to energize the body and the mind will be able to produce a healthy thinking throughout the day.

We should also avoid going out having fun because our mind is still in that acidic condition. Fun and enjoyment is also acidic. Anything more extreme than peace is acid, anything too low from peace (laziness) is alkaline to the mind. Therefore the mind will become more acidic if we straight away go out o have fun. After that we will find it more difficult to be find calmness.

Besides, if we go out to “release” the acid, if somehow we find it soothing, this is like teaching the mind, the exam is something to be release. This is very unhealthy. This is one of the reasons why sometimes we tend to treat ourselves to “study because of exam”. We should let the mind know, the exam is actually just one of the process of learning for the future. That way, we will study because of something nobler.

If we want to go out it’s okay, but make sure the mind knows that the exam is not something to be treated as such, to be released once it’s over. If we want to go out, it should be because we feel like rewarding ourselves because we manage to do the exam well. This way we will feel happy, our mind will be happy. Talk about happy things during that time.

What are other things we can do after exam?

First and foremost is tawakal. But did you know that we can still “usaha” even after the exam? This can only be done through prayers. Here’s how:

  • Pray that Allah will have mercy on us, gives us patience and feeling of gratefulness
  • Give and pray a fatihah for the examiner, before that pray this:
  • “Ya Allah, aku sampaikan fatihah ini kepada examiner yang akan menanda kertasku, semoga mereka berada dalam keadaan selamat, tenang, gembira dan murah hati. Nampakkanlah padanya apa yang baik untukku, palingkanlah dia pada apa yang tidak baik dariku… Sesungguhnya Engkau Yang Maha Kuasa lagi Maha Mengetahui, berikanlah apa yang baik disisiMu pada diriku, dan jadikanlah aku hambaMu yang sabar dan syukur”
  • Remember to always pray that Allah will gives us whatever that is “best” from His side not to pray that Allah pass us this exam. So anything we received will be the BEST for us. NEVER question otherwise, accept whatever happen with sabar and syukur. Belive that Allah had answered our prayer.
  • If we are still afraid that our prayer is not answered, fast for a day or two and pray. Prayers of those who fast will be granted. (But actually Allah really answer all our prayer, there is no need to worry)

The reason behind

The fact is, after the exam only Allah can do something. Therefore, as long as the result have not come out yet, there is still hope. Put our hope on the one that holds every soul in the Universe, Allah. He can manipulate His being. Anything can still happen, kun fa ya kun. Believe in Allah if we want Allah to love us.

p/s: anything written here is merely my point of view, there is no scientific evidence. But sleep really does recharge the mind :)

Thursday, April 22, 2010

Tip 2: 2nd-3rd/4th Day Before Exam

This is the method of studying I've been using since 2nd year. So far it had been showing to give good prognosis to my exam result. Just sharing the method, check it out!

2nd-4th days before exam is what I would like to call the climax zone. I forgot to mention in my previous post, 1 day before exam should be the anti-climax zone, where the environment to study in must be free of any seriousness or stress. A good place would be our own room, where we feel safe and we can have all the privacy we can have.

A climax zone does differ a little bit from the anti-climax zone. 2-3 days usually wouldn’t be enough to study new topics. This is the part where we recall our knowledge. Therefore we will also use the “study scan technique” but this time it is called the “serious study scan” technique.


  • Plan how much we want to read for that day, make sure there all of the topics is scanned in the 2-4 days time frame.
  • Divide that day into three compartments; morning, afternoon to noon, and night
  • Take3-5 hours of each compartment for study, the rest is for resting.
  • Plan to double scan if possible. Sometimes we are able to scan quite fast, so prepare 1-2 days to scan the same topic 2nd time
  • The more time we scan the better it will stay in our memory
  • Fasting is a good way to manage time during “study scan” because less time for food, less time for sleep (because sleeping during fasting is a waste of abundance of pahala), less distraction (usually we avoid wasting time doing useless things during our fast), less talking with friends (wasting precious saliva) and more prayers (prayers of fasting people is granted). The strength to keep on studying and to absorb knowledge will be given by Allah, insyaAllah, make sure our niat is good
  • Try to do qiam as much as possible
  • Al-Mathurat and Al-Mulk as the opening and closing of the day

Serious Scanning technique

  • Find a “serious” environment, such as the library, ibnu sina, surau and etc, try to avoid our room where the juicy bed will keep on saying “come to me…”
  • Prepare drinks if we are not fasting, yassin water is very good, plain or mineral water (avoid r.o water, I will explain why other time), avoid sugary drinks (unless its coco A+ then it’s ok…promote lak)
  • Sit in the most comfortable posture, get a good lightning, and prepare adequate stationary. Go buy if it’s not adequate, this is important.
  • Start with fatihah as usual and get into a calm but serious mood
  • Scan through the notes, but get deeper this time. Try to get the important points, if there are techniques used to remember the points, use it now, and make sure it is embedded in the mind.
  • Jot down important notes to get into more serious attitude
  • Have text book around to clarify missing or inadequate information
  • Go as detail but as fast as we can
  • Don’t cramp for too long, take 5 minutes break every 15-20 minutes. Do whatever to ease the mind.
  • If we manage to finish our goal for that day, reward ourselves. Usually I will treat myself to a nice dinner… if you prefer to go even more serious start reading tomorrow’s topic to make sure no time is wasted
  • If we fail to reach our goal, DO NOT forces to cramp it and sacrifice our sleep! Try to go faster the next day
  • If we still fail to cover all, that’s okay, do not take the “1 day before exam” time to cover this. You can take, but not too much, maybe just in the morning, the rest of the day is for last minute “study scan”
  • We can sleep late in the climax zone but not too late to effect the next day. The maximum could be 1.00 am.

The Science Behind

Usually, during the exam, most of the information that pops out from our memory so easily is the information gain during this 2nd-3rd/4th day before exam. This is why we need to be serious and make sure to go as detail as possible. But since the day is not very close to the exam, we don't get too many pressure.


The visualization technique should be used as early as we started posting. It should be repeated every day, every time we remember to visualize it.

Tip 1: 1 Day Before Exam

If we want to do the last minute "study scan"

Mulakan dgn doa “al-fatihah”, selepas ayat “iyya kana’ budu wa iyya kanas ta’in” , doa dalam hati “Ya Allah, jadikanlah ilmu ini meresap dalam mindaku dan berguna bagiku” pastu sambung the rest of the doa.
  1. Take a deep breath and tell ourselves that we are relaxed
  2. Take a second or two to breathe in and out
  3. With calmness and peace just go through mind maps and short notes
  4. Understand and don’t strain to remember all points, just focus on the important points.
  5. Try to scan as much, but don’t push ourselves
  6. Stay happy and calm throughout the day
  7. Increase the amount of solat sunat and pray longer to Allah. Pray to gain His help, not to pass exam. Pray that whatever we do for this exam will be useful in the future to help others. It’s all depending on our intention or “niat”
  8. Sleep early, maximum at 11-11.30pm

Before going to sleep

Imagine or visualize….
  • That tomorrow as we enter the exam hall, there was a big smile on our face, our friend’s faces and the lecturers.
  • As we open the question, we smile because we know the answers to the questions
  • In fact we, all of the questions were answerable as all of them had been read and discussed
  • We are going through the questions so easily and all of the answers were marked with confidence.
  • As the lecturer said, time is up; we put our pens down with a smile on our face because we have answer satisfactorily.
  • As we walked out the room, we smiled to the lecturers and thanked them for the exam, and they smiled back having faith that we will pass
  • Don’t forget to feel the emotions as we are visualising

The science behind it

When we are in a state of peace and calm, we will be intact with our subconscious. The subconscious mind will also take up the information we read as we go through the notes. The information is there, stored in the subconscious mind. During the exams, sometimes we know we read somewhere regarding the question. Don’t strain and try so hard to remember what it was. Take a deep breath, and stay calm, let the answer come naturally. The only way to get intact with the subconscious is to be calm. If we are taking too much time, go to the next question. Sometimes the answer will come later. If we have read it, it is there stored somewhere in our mind, we just have to retrieve it, to do that we have to be calm.

When we imagine that we can answer satisfactorily in the exam, the next day, we will be expecting that we can answer with calmness and peace. Therefore, our mindset is to answer the question a state where we will be calm. When we expect good things, good things will happen. During the real exam there may be some questions that we don’t know, just take a deep breath, and remember about all those other questions that we can answer without a problem. We can’t expect perfection of course. Just tawakal, pray that Allah will guide our hand and mind to the right answer and answer it. Just believe that the answer we choose is right. Believe me, after the exam we will feel satisfied and grateful. Even if we go back and check for the answers, if we got it wrong, just smile and say “hey, at least I learn something new…”

If we find it hard to be in a state of peace, try to do solat sunat hajat and solat sunat taubat to seek for forgiveness. Sometimes, it’s difficult to feel calm when we feel like we made a lot of sins. Cleanse ourselves to gain confidence that Allah will help us. If we put our faith 100% to Allah, that’s when Allah will sent His help…

Thursday, April 15, 2010

When the obstetric patient says "no"

Have you ever wonder what is going through the patient’s mind when they say no as we approach them to ask for a history or to do physical examination? Some of them are obviously really sick; in that case just look back on the term empathy. But this is a real life situation of one of the patient I manage to get very close to in orange ward during my resit posting and this is what she requested me to share with everyone.

Praise to Allah The Almighty, Who had planned all the wonderful things in life in its many forms. Again, I say, resitting O&G could be the best thing ever as I manage to gain a lot of new information regarding the posting. Not only that the theory part of medicine was fed, but the PPD part was also filled with new experience. I manage to get close to one of the patient in orange ward. She was admitted due to cervical incompetence post cervical cerclage that apparently had loosened. She was diagnosed with threatened preterm labour. Because of this, she was one of those patients where the ward is their 2nd home as she was not allowed to go home and had to be on bed rest until delivery. After more than 2 weeks, they changed her bed (as always) and she was put together among all those patients who are also “at home” in the ward, usually the patient with placenta praevia.

Madam L was used to entertaining the students and answering questions when she was at her previous bed but when she moved to the other bed, the environment become different. We know that most patients with PP don’t usually entertain students as they had probably seen us more than 10 times a day. Therefore, entertaining students had become an abnormality to them. In fact, words are circulating around that apparently these students, or us students were meant to be forgotten. When Madam L routinely welcome students to take history, the other patient asked her “kenapa dilayan budak-budak tu, lain kali jangan dilayan…” what on earth?? Thus, madam L feels like she was caught in the middle between the students and her friends. So the ward really is a place like home to patients and they have neighbors around. Whatever is going around in the ward, the story is circulating around like what neighbours normally do when they are living in a functional society. I thought… this is something quite new to me. I think it’s normal to think that patients can get bored entertaining students, but to think that they are circulating around a stigma against us? I was quite sad, at the same time happy as I managed to gain this information. If I were to write a case report…..hah!its going to be way spicy (I like my reflective writing spicy)

Luckily, I did not waste the chance to correct the stigma. In fact, not just to madam L, there are also some other patient that usually don’t like students especially guys to mingle with their tummies, asked the same question. Apparently, not all patients understand the function of us students the lowest being (and greatest in number) in the “ward pyramid”. Sure some make us feel like we are the parasites feeding on patient’s sympathy to gain something so that we can live today, but come on people, thou some of the lecturer like to condemn us and send us way down to rock bottom (the name of the lowest most darkest city in the cartoon spongebob squarepants), but believe me, we are much more than that. These are some of the points I told her

  1. We are medical students that will surely become doctors, without us there will be no doctors to treat our children and the future generations
  2. Your problem will be faced by us again in the near future, if we learn from you, and you let us learn a lot from your problems, it is the same like you are saving the patient in the future too. Take the credit.
  3. Even though there are guys, but don’t see them as guys, see them as doctors. Just as much as girls need to learn, they need to learn as much. Please give them support as they find it very hard to get the O&G patient’s consent
  4. We did not come just to ask question, palpate the stomach and go home empty handed, you, the patients are our best teachers and we learn a lot just from one patient
  5. When patients welcomed us, it will be our most beautiful day and we will be very very happy. Making others happy is very good for the soul
  6. We really need patient’s support, sometimes lecturers shouts at our faces, obviously we will be crushed if patient’s also turn away their faces to us
  7. Don't worry much about what other people want to say, if whatever we do for others makes us feel good then just continue doing it. Let Allah be the Judge of our doings
  8. Patient’s is our sun in this dark life of medicine, you make us happy, gives us hope, information, company and we are so grateful for that (well I did not exactly say this, but she get the point)

What can be done

This is what the patient suggested...

When patients are admitted, they will have sort of an orientation of the ward. During this time, they will be briefed regarding the do’s and the don’ts of the ward. Maybe entertaining student should be put under the do’s so that they will anticipate our presence. So anyone got a suggestion where should we raise this issues? (if we want to raise it that is)

The patient’s right to say no.

Of course don’t forget about this. All patients have their own rights. We don’t force the patient, but it is not us only that benefited from the patient, they also benefited from us. We need to make them see that and we also need to feel that in order to gain confidence to approach the patient.

As Mar suggested…

When approaching a patient makes it clear to them that we are students, learning to become doctors and we need their help in order to gain much knowledge (something like that). So what if our introduction is too long, if we can destroy the negative stigma against us, I say it’s definitely worth it.

Treat patient as a whole, become a better student so that we will become better doctors. UKM can produce many doctors that are intelligent, but how many of them are holistic doctors?? Lets us make it so that all of us are…

This article is made in hope that student-patient relationship will strengthen and students (especially to myself) will gain more confident to approach the patients.

Wednesday, April 14, 2010

Presenting Gynae Case

Plz refer to presenting obs case note also

Scenario: presenting new case

Opening statement:

This is madam__a __ years old, --occupation --,para __ post menopausal for ___(registrar selalu mention not breastfeeding,not on OCP,not on HRT,tp dulu ada studnt present cam2 kena marah lak,so x sure la kena ckp ke x) known case of ___ for __ years ago,admitted when due to what and planned for what

Pas2 masuk when did d problem started n go on mcm biasa.rasanya xde masalah sgt la gynae case yg biasa camni...dont forget 2 mention LMP.tgk tiket cam biasa utk tau flow

Scenario 2: Gynae onco case

Haaaa….yg ne yg slalunya bila kena kat bed kta rasa macam,aduuuhhhhh…….tiket de plak,wouuuuu…….tebal…..yg itu baru volume 2,pe jadi pd volume 1?ntah lar…meh,sy kongsi camne nk present together with contoh,which happens to be my long case assessment…
Opening statement as above,tapi ada certain patient 2 known case dia panjaaaaaaannnnnggg pnah tgk presentation yg mcm ne;

Madam so n so,a 70 yrs old housewife..bla..bla..with a known case ovrian cancer stage 2a since 10 years ago. she was 1st presented 10 years ago complain of what,n then she go to see gp,n then refer ke hosp,n then scan found cancer
>>refer ke PPUKM,must state why,nape x wat kat sana je,usually logistic problem
>>ca125 asalnya berapa
>>buat debulking how long after that,what was d intraoperative findings during dat time (yg penting jela,jgn la citer mcm baru smlm de wat debulking),n what was d HPE result
>>ca125 after debulking bape
>>followed by chemo,what kind of chemo,how many cycle ,any comp from d chemo,time cycle keberape,what was done back then
>>what was d trend of d ca125,increasing or decreasing, is she responding well to the treatment,selak onco report ye,xpun study tiket betul2
>>barulah masuk,she is admitted yesterday for the 2nd cycle of what chemo,currently day 1 of chemo…

Tu dia…pas2 sambung

Second problem…
She had hypertension since how many years ago,on what medication,any comp such as stroke

Third problem…
She is asthmatic since when on what medication,last exacerbation was when

Fourth proble….begitulah seadanya…

Pastu baru sambung history lain if dr nk dgr gak…As long as Nampak teratur je,boleh la 2…
Kat sini xde specific guide,yg penting,follow d flow,on how they first presented,what was d investigation done,what was found,what treatment modalities was done,how was d response on treatment,any issues in between,sampailah ke today…tgk tiket,usually flow de ade.

This is d contoh of d case I presented during my rounds,time ne Prof Hatta xde,so xtau la menepati citarasa de ke x,tapi prof Shu n Dr Natasha x komen much on d flow(ok la 2 agaknya)…Cuma ada la technical problem yg kena marah gak

My patient Madam W.S a 72 years old para 4 post menopausal for 21 years with a known case of cervical cancer stage 2b diagnose 7 month ago, and currently today post day 6 of simple vulvectomy, due to verrucous cancer @ d vulvular region which was diagnose 2 months ago.

This is d opening statement,if u guys realize,there are 2 main problems,n problems ne very closely related,n may have relationship,so start with the 1st big problem cervical cancer. But during d presentation,dr xnk dgr pasal cerita ne,because pt da bnyk kali di present.but if I were 2 present,I present it this way

She was first presented 8 month ago with 1 day history of painless per vaginal bleed,3 pads fully soaked. She went to Hospital Petani to get it checked. Patient claimed that the doctors told her that there was a mass at the cervix clinically 8cm in size, but there was no report. A biopsy(or was it a pap smear??) was done confirming cervical cancer and she was diagnosed with cervical ca stage 3b.she was subsequently started on chemotherapy (where and when) and completed when.she had also undergo radiotherapy 48.6 GY/27F and 3 HDR brachytherapy (when) under oncology here(where)

Dis is d summary of d previous case followed by d problem she is having now

2 months after that,she notices that there was small multiple, nodular lesion @ d vulva region while she was urinating. There was no dysuria, bleeding, discharge, itchiness, or any other urinary problem (if ada differential diagnosis lain,ckp all d relevant negatives here). It was rapidly growing and started to fused together, subsequently,it gets bigger,and because of the friction during walkin,there was minimal bleeds n it becomes painful.She came to PPUKM and a biopsy was examination under anesthesia followed by cystoscopy was also done at 3/11/09 (if da banyak sgt event xpe kot nk guna dates). EUA findings:

There was multiple wart like mass over both vulva region,ranging around 1x1 to 3x2 cm.firm in consistency, irregular margin, well define border and bleed to touch. biopsy was taken and HPE findings was consistent with verrucous cancer (tp kena tau gak detail HPE ne,ada dlm tiket)
cystoscopy found small 0.5x0.5 cm soft nodule over opening,no curuncle,urethera was normal.

D nxt day,ultrasound was done to assess d upper tract and it was normal. She was scheduled for simple vulvectomy and it was done 1 week ago.intrapoeratively ….tgk dlm notes ya(plz summarize dis if possible,but don’t miss any detail)

So currently pt is well,had started ambulating since day 4, wound was clean and healthy, there was no discharge from d wound (sy x tgk pun time 2,but if u want 2 present make an effort to go see also,don’t juz copy from d notes,kang kena tnya karang…)

She is planned to keep d perineal dry, continue subcutaneous heparin, tablet Arcoxia, continue physio and allow ambulation. Currently we are waiting for HPE result from biopsy (time intraoperative amek lagi biopsy)

Basically 2 je la…for Onco,make sure tau d term neo adjuvant,post adjuvant treatment,conservative management,debulking surgery,all the relevant tumour markers if ada…yg radiotherapy atas 2 tadi, 48.6 GY/27F and 3 HDR brachytherapy,in case jumpa dlm tiket n nk present kena sebut betul la kan. nak pronounced mcm ne:

48.6 Gray with 27 fraction (ini lebih kurang mcm dose la) and 3 high dose rate brachytherapy

Post Natal Presentation

Unlike antenatal case,post obs case flow de mmg akan go back still flow kena cantik

Scenario 1:pt yg masuk2 dari PAC trus ke LR n undergo SVD,selalunya pt ne xde antenatal problem sgt

Opening statement:

Madam who,a (age n occupation,x silap kalo de known case problem time antenatal kn mention here jgk),para what,currently day what post SVD (if de ada vaccum assisted ke o forceps mention here,n why was it assisted,poor progress?CPD?) at what POA(SVD 2 at what POA,EDD ke,post date maybe).trus sambung,she came to PAC when because complain of what.

Pas2 at PAC…tgk no 7 blk,n sambung>>
She reached d LR at what time(kdg2 dr xnk tau pun,n if bagi dlm bentuk how many hours ago lagi cantik),with Os dilatation of what,n progress to active phase of labour within how many hours,if de dtg da active phase of labour ckp she reached to LR already in active phase pf labour with Os…if ada something happen in between PAC n labour,cthnya ARM,augmentation,antibiotic administration,jgn lupe mention,yg ne tgk partogram.if da ckp ARM kena la ckp liquor de camne kan,n kalo ckp antiobiotic kena la bgtau naper,if augment pun kn bgtau nape,always have reason for everything that is done.yg ne lebih kpd mcm nk summarizekan partogram.

>>so diikuti dgn,1st stage bape lame,2nd stage bape lame,baby boy or girl,weight,apgar score,EBL…n ikut la skema yg slalu guna.da abis 2 trus pegi ke step 10,currently patient camne

>>kat sini da maybe ada yg miss,correct me if I’m wrong,cakap pasal:
Pt is well,with no acute complain
Tolerating orally,ambulating well,had passed urine n bowel (more to ceasar case)
Lochia is normal
Any other complain if ada
Establish breast feeding?
Baby is well?
Family size?
Pap smear?
P.E? uterus contracted?at how many weeks?
If ada pape investigation yg dibuat berkaitan dgn labour 2 mention,cthnya,baby 2 ada G6PD,bilirubin level n pape la.tgk tiket.
Followed by plan,selalunya plan for discharge la.xpun awaiting peads..

Pas2 if dr tanya antenatally???jgn la xtau,go back to step 2,seriously,I’ve been there,phew!serius panjang…most of d time dr is interested to know jgk,sbb de x kenal dgn pt most of d time kes camni,antenatal history de straight forward je

Scenario 2: pt yg dulu pernah present antenatal skang ne present post natal lak,cthnya pt yg electivly admitted n had undergo SVD

Sama je opening statement,Cuma xde part came to PAC to la,ganti dgn electively admitted for xpernah present pt IOL,tp If ikut logic I would start off,after ckp electively admitted for IOL,trus masuk,berofe labour,Bishop score was assessed and it was ( favorauble o not),if not,how many prostin was inserted,after how many prostin become favourable,how much was the Bishop’s score dat time,pas2 trus sambung reached to LR n ikut di atas

Scenario 3: elective caesarean

Opening statement mcm sy ckp kat atas.pas2 trus p intaoperatively.lagi senang

Scenario 4: emergency caesarean

Opening statement maybe sama mcm scenario 1 or 2 tp bila time reached to LR 2 pandai2 la citer knp de sampai kena ceasar…poor progress after how long,or maybe CTG show fetal distress,yg ne tgk tiket pun bole…y len kira sama la

O&G ward round presentation (Obs case,new case)

Since ada yg request guideline ne n memandangkan 3rd year resit 2nd bash da nk masuk,i juz like 2 share guideline ne utk mereka yg bakal presenting utk memudahakan urusan.mngkin ada yg da lupe or yg belum tau lagi (2nd yr yg bakal masuk 3rd yr).walaupun tulis atas 2 “green style” doesn’t mean ada style lain,Cuma ada certain ward yg x kesah how we present.but 2 be safe,n for those nk masuk 5th yr better present better kan…green style 2 juz nk highlight style present ward green yg mmg “wajib” tip top.3rd yr,5th yr n registrar xde perbezaan when it comes to presenting at green ward, dats how d doctors at green ward treat us like adults,(n sometimes dat make us feel proud 2 be treated as such)..mintak2 sgt,pliz pliz pliz,tambah2 mana x cukup,dis is 4 d good of ourselves (bakal 5th yr),those who will b reassessed, 4th yr yg nk ke 5th yr,n juniors to contribute as much,we live to serve others.

Scenario 1: pt yg dtg from PAC,bkn electively admitted

Opening statement
1-This is _(1)_ with a _(2)_ currently at _(3)_ came to PAC due to _(4)_ with/without sign n symptoms of labour (such as??) admitted for_(5)_

  1. name,age,occupation,gravida n para
  2. known case of GDM on diet control,known case of what diagnose at what POA,previous hx of what,basically background history yg significant
  3. POA/EDD/EDD+?days
  4. d problem yg mmbawa de ke PAC,cthnya rupture membrane,reduced fetal movement,contraction pain,referred patient pun kn crita… If mmg da ada diagnosis,ckp je la,cthnya asymptomatic PPtype II,kn cakap at what weeks it was diagnose/due to latent phase of labour(tp nnt dr tanya lak,apa mmbuatkan kita ckp de latent phase of labor,if tau pepandai jawab,jgn ckp benda yg kita tatau)
  5. what was d plan yg de masuk ne IOL?ceaser?kena make sure plan 2 selari dgn pe complain de,kalo x dr akan tnye knp nk buat tu??sometimes pt masuk juz for observation or monitoring je,utk PP maybe for expectant management.

Followed by…
Her LMP was on the___ therefore EDD is on the ___


2-this is a planned n wanted pregnancy

3-she had +ve UPT test at (weeks of POA) / she knew she was pregnant when she missed period for (POA?) and had +ve UPT at __ . bole tmbah If he ada pg jmpa GP had another UPT test n a scan

4-dating scan?first booking?booking at PPUKM?

5-Antenatal screening—yg ne tgk tiket or buku pink 2 je,if ada MGTT yg dibuat bole ckp now.
If MGTT must be followed by—BSP—HbA1c and/or fructosamine.
BSP:how many times done,how many are abnormal or are all of them normal?if abnormal how abnormal was it,at what POA was it,what was d latest BSP result,was was done,insulin or diet control???yg ne pepandai la simplified,tgk tiket n tnya registrar if ragu2
HbA1c/fructosamine:if no HbA1c result,kn ckp HbA1c was not done,penting sbb ne yg determine control of sugar.1 poin penting yg blajar time ward round:if HbA1c is is high/slightly high but fructosamine is normal dis is previously very high sugar level but getting better control becoz hba1c is control selama 3 month dikumpulkan,if dalam 3 weeks 2 normal,tp HbA1c 2 tinggi sket,maknanya sblum 3 weeks 2 sugar de sangat tinggi sampai 3 weeks yg normal ne x dpt cover level sebelumnya.if dua2 normal,baru kita kata good control.kalo nk present nmpak sedap skit,she have good compliance to diet control,d blood glucose level was in good control as her HbA1c was normal,5.0%...barulah nmpak mcm kita ne berfikir bak kata most of d doctors la kan…

6-ANC eventful or not?if uneventful kena cakap : she had regular antenatal checkups and all of her ANC were uneventful.she had 12 ANC altogether (contohnya…)Eventful:her antenatal checkups was uneventful until at 16 weeks of POA she had UTI where she presented with suprapubic pain n bla..bla..bla..a UFEME and culture was done to confirm and it was positive for GBS,she was treated with what for how long…kat sini if pt 2 mmg known case of GDM,kn highlight glucose control,kalo PIH kn higllight BP control,if PP kn crita psl bleeding n scan,if IUGR kn crita psl serial scan n growth chart.dis is where we need to use our clinical knowledge….n look at d tickets..hihi…ingat,to present is not just to ask d patient blindly,always look at d tickets too.kan,x pasal2 dapat 1 quote

6.5-d event dat got her admitted at PPUKM,maybe bcause sign n symptom of labour.cthnya,at 37 weeks of POA she complained of contraction pain,n sudden gush of fluid,she came to PAC immediately

7-what happen at PAC—ne kn tgk tiket betul2,cari these points:
b)per abdomen
c)pelvic examination which consist of speculum n bimanual,n kira sekali ngan V/E la,tapi time present xyah la ckp pelvic examination show…mcm pelik je,ckp speculum examination found…V/E found…
d)CTG—reactive or not,ada pape abnormality x?

8-on admission…what was done,slalunya buat investigation,what was d result

9-during admission/at d ward…ada pape jadi x??bleeding?monitoring CTG?monitoring BP?yg ne pun kena ikut clinical knowledge n tgk tiket.if patient 2 duk lama,tgk dari day 1 sampai today,ada pape jadi x??if ada masalah cthnya UTI,bleeding,fever,how was she presented?what was done?investigations ape?treat dgn ape?outcome?ckp yg penting je la,slalunya ada dlm tiket…sekali lagi,rajin2 tgk tiket.nk lagi mudah tnya patient,selama duk wad ada pape jadi x,bape kali amek darah,penah demam ke,ada de bagi pape ubat,ada buat pape investigation,pas2 cari dlm tiket.

10-barulah masuk,and currently…patient is well with no acute complain,vitals are stable (ckp la result vitals de),if de on treatment pape,currently dis is day-3 of antibiotic treatment,pape la yg tgh current skang ne,if ada pape investigation yg penting,latest what what was what..tgk tiket.:P

11-haaa….kalo sampai kat sini,mmg knfem dr 2 berpuas ati dgn presentation anda,dis is d part where we say,so she is planned for,,,,,yg ne pun tgk tiket jer…kan ada tulis apa plan de kat ujung after every review…sometimes dr akan Tanya la,so what is your plan??so get ready with d plan,jgn xtau pt kita plan for what..
12-selalunya,kalo present camni,dr de jarang nk tnya pasal history lain,tapi kdg2 dr akan tanya,what are other relevant history,or what are other history u want to tell me,so kena tau gak.seqeunce de mcm biasa la kan, past obs>>gynea hx(include menstrual,pap smear n contraception)>>past med>>past surg>>drug>>allergy>>social

Scenario 2:pt yg electively admitted

Opening statement 2 jadi lain la kan,de jadi electively admitted for what n trus plan.Yg len sama je,Cuma selalunya xde part no (7) n part no (8) kadang2 2 de dtg with complain gak,so kn mention.investigation 2 selalunya ada,cari investigation apa yg de buat time de first admitted n compare dgn now or after treatment.cthnya,she was electively admitted 1 week ago at 36 weeks of POA for expectant management of PP.during dat timeshe complains of signs and symptoms of anemia, (such as…),where her Hb was found to be low,7.9,she was then transfused with 2 pints of packed red cells for the subsequent 2 days and post transfusion Hb was 9.0,overall,her Hb had been improving at the ward..n trus ke steps 9 n strusnya

Scenario 3:pt yg da pernah di present n dr ask for summary,short n sweet,katanya…

Opening statement sama,n terus ke steps 8(bukan terus 10 tau) tapi di summarized kan…

Scenario 4:pt yg mmg terlampau banyak kali di present,n dr ask for update

Opening statement n trus ke step 10,tapi if ada benda baru yg terjadi n dr xtau lagi,kiranya last present bnda 2 xjadi lagi,kena go back 2 step 8 utk dat particular problem

Scenario 5:dr 2 tatau langsung pasal pt 2,tp de nk dgr summary je,cthnya time consultant ward round (especially dgn prof har)

Opening statement,plus steps 8-11 disimplifiedkan. cthnya,on admission,she had sgn n symptoms of anemia,Hb was 7.9 n she was transfused with 2 pints of packed cells,post transfusion Hb was 9.0, otherwise her Hb at d ward had been improving. She also had UTI n was treated with T.Penglobe for 1 week currently she is on day 7 antibiotic treatment.

Guideline ne x rigid tau,if ada benda yg rasa mcm penting,nk masukkan,masukkan je..nk selit mana 2 sy suggest ikut timeline de.if u realize d beauty of d presentation is to make sure d listener can imagine d flow without having to go back n front again.use POA n how many days/weeks/years ago instead of dates,to make sure mmg nampak flow 2 cantiiikkk je…