Resources one should have in Orthopaedics posting as a HO in Malaysia

I think this might be a little important. Unlike Paeds and Medicine, for which there are the Paeds Protocol and various CPGs, there aren't any official guidelines for Orthopaedic management in this country. Apart from the following, I would suggest a small notebook in which you can jot down the common management seen in your hospital.

Look through your HO logbook and aim to complete it quickly. Some procedures are hard to come by and may not come by at all by the time you finish your posting!

As always, the following is based on my personal but honest opinion.

Books/Printed Documents:

Print This - A highly useful PDF document made by a great team. Has all the important fracture classifications, some important angles (to accept check x-rays), common dressings, implants and in the final page some important ortho emergencies to watch out for, amongst others. Try to memorize this by the end of the posting. To be The Ultimate HO, memorize the entire thing before the beginning of the posting!

'UIA Ortho Book' - It's actually titled 'Basic Fracture Management for Students and Housemans [sic]'.I don't know where you can officially get this, but since UIA/IIUM grads are everywhere, try asking them. This book came highly recommended by one of my specialists and a few MOs. The book is usually found photocopied. It is concise and has almost everything you need to know regarding some of the most common management points in the posting. If anyone has a means to get the original form or a way to contribute to the authors, I'd greatly appreciate you dropping me a line.

Netter's Concise Orthopaedic Anatomy - A great book for a quick look through important anatomical points, and concise information on some important injuries. It even shows x-ray techniques. This book saved my life (okay, more like reputation) quite a few times. Small enough to carry around (and lose :( ) in the hospital.

Apley's Concise System of Orthopaedics & Fractures - Get the concise version if the big one is too costly. Mind you, your specialist might tell you it's 'not enough'. It's more than enough for a HO not very keen on furthering in Orthopaedics (or too broke to afford the bigger book).

Websites:

1. Orthobullets - Concise as the name, and highly useful for some accurate high-yield facts and management points.

2. Wheeless' Textbook of Orthopaedics - Another highly recommended site.

Both of the above are more than adequate, and best of all they're absolutely free. And amazing.
God bless the contributors.

If you're not keen on getting the books suggested in the previous list, access to internet and the above sites, as well as the PDF document in the previous list, is more than enough most of the time.

Tools

1. Measuring tape

2. Goniometer

3. Tendon hammer

4. Don't forget your stets! And other basic HO stuff. Just because it's Ortho doesn't mean you don't review the patient holistically ;)

Actually these can be found- most of the time, anyway- in your clinics and wards. But it's better to have them handy. The goniometer? I've survived without one, but I could distinctly remember some MOs running around like headless chickens trying to find one in the clinic.

Conclusion

Some Orthopaedic departments are known to be the most chill departments in the hospital.
Some are known to be the most malignant.

Either way, it is always better to equip yourself in this posting, same as other postings. It may not be a major posting like medical or surgery, but once you become an MO, you may - MAY- be thrown into this department, and have no say in it. Furthermore, some basic management of orthopaedics is still important when you're the frontliners in medicine, working in a health clinic or the emergency department. So don't take this posting for granted!

Important topics?
Kindly ask your bosses. I might go into it later, if I have the time and motivation.

Counting down to the end of this posting...

Some Days

Some days,

it's enough for a fellow colleague to thank you and say they trust you.

That you can be relied upon.

That when you're in their shift, they feel less burdened.

Bosses aside,

we know each other (HOs) most.

We are the ones who have to cope with one another, we are our own support system.

So what if your bosses constantly pick on you?

If their advice is useful, then improve on that which you're lacking in.

If not, keep your chin high. Don't be rude, and if it's too horrendous, vent to the proper channels.

Your colleagues, your friends, will be there for you as long as you're not entirely useless.

Entirely useless pun colleagues mostly takkan abandon kan...

Sebab tak nak kerja diorang pun susah.

Rojak sikit.

Love yourself, reward yourself.

And sometimes, be a little more proud of your effort. But not too cocky, mind. It's a thin line to tread. What's important is that you realize there is no way on Earth or in this life in which you can please everyone. The majority is enough.

Your intentions, your niat- set them right. God willing, everything else will follow through splendidly.

And study lah homework2 yang diberi MO/Boss, kalau tak saja cari nahas hahaha!

New Year's Eve~

So much has happened this past year.

I got a job and subsequently felt the advantages of working life- buying myself shiny things, being able to give my parents money and treat my family to meals for a change, and learned how to sort myself out better.

I'm pretty sure I had something more insightful planned for this post, but my postcall state is preventing optimal recall. So, sleep it is.

Happy new year to all, and may 2017 be better than 2016 for all of us :)

Counting Work aka Berkira Kerja

No lah I'm not going to write about some vague friend here.

I'm writing about myself.

I have caught myself, time and again, 'counting work' - literal translation from the Malay saying berkira kerja. Or berkira tulang urat- counting bones & veins. Hey, that may be more relevant now.

I entered the posting with several other people.
And I found myself to be the pioneer among them.

First to get more patients to review.
First to get more acute patients.
First to present cases in the morning passover.
First to... well you get the drift.

I started bemoaning my tragic life:
Why am I the chosen one? Why do I have more patients to review than them, they are also taggers? Why do I have to go into the OT with the known malignant MO EACH time he covers EM OT? Why do I have to present two times in a row? Why me, why me, why me?

You see, hearing about this likely made you a little (or a lot) uneasy around me.
But that's the reality- I am far from perfect.
I forget so often that nowadays I have much less patients to review and the workload is so much more manageable. Although there are definitely other added stressors in this posting, I can definitely say this is a posting with minimal workload compared to my two previous postings.

I easily forget that I still have a stable job and am able to live on my own, rather comfortably, while others may be suffering from unemployment, and also countless other real tragedies.

How selfish of me to bemoan a difficult relative, or the fact that yet another patient got into an accident, and yet many others still have to be referred to my department due to whatever reason, even if they were direct results of their own mistakes.

...

I wanted this job.

No one put a gun on my temple and threatened to pull the trigger unless I took up this vocation.
I recall multiple attempts to persuade other people that I am worthy of this course. Letters, essays, interviews...

Oh God.
Why am I so weak when tested?

Yes, I am human, but I am capable of much more than this.
My lips are too fast, my temper too easily roused.

Sometimes in my head I think "Why must this patient be assigned to me? Such a difficult patient, to present to such a difficult boss..."
And almost in that same second, I rescind my thoughts. Forgive me, my patient. Forgive me, God. Forgive me, my past teachers and lecturers and colleagues- my selfishness has overstepped boundaries! Even if I don't vocalize most of my thoughts, their toxic energy permeates my psyche and results in actions that are less than pleasant. At its simplest, a distasteful expression. At its most complex, hurtful words.

It's so easy to snap at a colleague when I can feel the boss getting mad at me over the phone- "Get me the BHT for Bed 01 STAT" I would say- nay, snap- to the newer poster who was a little overwhelmed and could not answer my question.
I catch myself almost immediately and try to smile and lighten my tone, thinking that no matter how I act if my boss is already mad, his temper is hardly going to improve... But by then the damage has been done.

So easily do we hurt others while we try to proclaim that we care, that we're in this profession for noble intentions.
While we try to act our best and smile to our patients, do we extend the same gesture to our colleagues; our supporting staff; our bosses? Never mind that they're not doing the same to us.

I'm not even at my counting work topic yet, not fully.

...

"Eh AA look lah, why must I do this twice? BB hasn't even done it once! And look I got a difficult topic some more! Why is this distribution so unfair?"

Never mind that BB is a first poster who takes more time to learn the ropes compared to his fellow batchmate, CC. CC is more proactive and learns quickly, volunteering to do work where BB prefers to hide in the shadows. But do I understand BB's motives? Do I help him more than I talk about him?

Sadly, no.

A new case comes in.
I just did a procedure, and prior to that I already clerked the last case that came in.
I looked at BB, whose gaze shifted around uneasily.
"You go clerk that new case," I said. More a command than a request.
He needed the experience anyway, I reasoned to myself.

My senior already left to do an emergency operation- 'No doubt to avoid the wardwork and just chill with a rather cool MO', I thought bitterly. This senior also gave me OT time with a more malignant MO, repeatedly, while he/she goes into OT with cooler MOs without even asking any of us if we wanted more OT experience, being new and all.

Astaghfirullah.
What devious thoughts.
So easily does the mind come to conclusions that are less savoury.

I got up and went to BB.
"Okay tak?" I asked.
He nodded, and went to clerk the patient.
Full of trepidation, no doubt, but rising to the occasion- because his senior told him to. Perhaps he realized that there was no other option.

I could have been nicer.
I could have offered to clerk the case right as I returned from doing the procedure in another ward, and offered for him to stand by and watch- but this wasn't going to help him in the long run.
In conclusion, I could have been nicer. Could have had more noble intentions. But as I commanded him to clerk the case, all I was thinking about was how tired I felt.

And I shouldn't be, because come on, what did I do the entire day?

*slaps self*

This is just one simple example of berkira tulang urat.

It happens to most of us.

Some of us are just more noble, more patient, and thus more pleasant.

...

I've been told in older postings that I was a hardworker.
A good senior.
Sometimes I scoff at those remarks.
I also get snagged by selfishness and impatience.

It's just... I try to make up for it later.

I seek forgiveness from God.
Try to be more patient with those around me.
Try to be more mindful of what I say to people, even if those people agree with my complaints.

If my toxic environment affects me, my toxicity added to the environment will not improve anything in any way.

So,

I have to be more mindful.

Actively try to quash any negative thoughts- no matter how numerous. Counter them with good memories and vibes, with humility. Repeatedly tell myself why I wanted this job so much. That I can, and I will, make a difference in this system. That I will be better than my toxic bosses. That I will not treat my juniors the same.

And for that to happen, I have to start now- with my colleagues, with my patients.
If I could be impatient to a colleague who's my junior only by a few months, what's to say I won't be a malignant MO to my HOs in the future- who are my juniors by years?

If one case makes so much of a workload difference, what's to stop me from being an utter devil when people refer cases to me in the future non-stop, just because it's one of those 'J' days?

I will break the negative cycle within me before I could break the negative cycle outside.
I have to stop thinking about what I want, and more of what I need.

Patience. Resilience.
More (even more!) humility.
Knowledge- no matter how tired I may be, I can always squeeze in some quick facts. ALWAYS.

Because my patients entrusted themselves to me.
Entrusted their most embarrassing histories, body parts, habits, to me.
So I can make them feel better.
So I can heal them.

And more often than not, I spit in their faces by being lazy and impatient.
Assuming stuff about the more difficult ones.
Wishing they never came during my shift, to my hospital.

The nerve of me.

Do I know how difficult I can be if I were the one in their shoes?
I don't.
So why do I judge them so easily?

What is one more presentation, when I can learn from it?
What is one more patient, when I have the opportunity to make more people happy?
What is a kind word, when it can change the mood for an entire day?



Everybody needs to be reminded at some point.
I'm almost halfway there.
Right now is a good time for a reminder.

I'm sorry for disappointing you with this.
Perhaps later, more positive stories! :)

WOOOOO

Just as you thought you had it worst,

Welcome to...

A New Posting! 

*party streamers* *vuvuzela noises*

Where everything is ALWAYS worse the first few days in.

Ahaha.

No seriously I just, I dunno.
I feel stupid.
And humiliated.

Some postings just have a more generous share of, let's just say, vocal bosses.

This posting is one of them.

If I continue to not let their loud comments slide, I'll be beaten by the end of the day. I usually am.

NEED TO SLEEP STILL TAGGING BYE