Here is a non-exhaustive list of guidebooks and references suitable for HOs that I know of. I read many of them during my HOship.

🌼 Medical Department

• CPG from https://www.acadmed.org.my/index.cfm?%5C&menuid=67 (alternatively, download from Telegram bot @CPG_malaysia_bot)
• Sarawak Handbook Of Medical Emergencies 4Th ED*
• Dr Hanif Arshad’s series (Medical Notes & Sticky Notes for Houseman) https://hanifarshad.ordersini.com/hanifarshad

🌼 O&G Department

• Handbook of Obstetrics Guideline 2024 (https://t.me/nota_perubatan/1508)
• Gynae protocol HTF (https://t.me/driliana9/6417)
• Sabah Women and Children Hospital (SWACH) Labour Room Protocol & Sabah Obstetric Shared Care Guidelines SOSCG (4th Ed June 2020) https://t.me/nota_perubatan/942
• HSA O&G Protocol https://t.me/driliana9/6571
• Kedah O&G Protocol https://t.me/driliana9/6569
• Sarawak General Hospital’s Labour Ward Manual*

Note: for O&G it usually depends on which hospital you are working. Different hospitals have their respective O&G department protocol which could be slightly different from the others

🌼 Orthopaedics

• Guidelines for House Officer Orthopaedic Department Hospital Melaka*
• x-ray interpretation for orthopaedic house officer*

🌼 Surgery

• Johor Bahru manual of surgery*

🌼 Paediatric Department

• Paediatric Protocol 4th ED 2019 (https://t.me/nota_perubatan/709)
• Alia’s Illustrated Extra Notes to Neonatal Jaundice*
• Alia’s Illustrated Extra Notes to Total Fluid Intake*

🌼 Emergency Department

• Guide to Essentials in Emergency Medicine, 3rd Edition* (By Shirley Ooi et al)
• Dengue in emergencies* (by HKL Emergency & Tramatology Department)
• ETD protocol / Medication dilution protocol in respective ETD
• Tintinalli’S Emergency Medicine Manual, Eighth Edition* (for those who would like to study deeper in Emergency Medicine)

🌼 Anesthetic

• Basic Anaesthesia Handbook (UiTM Press)*

🌼 Primary care (Klinik Kesihatan)

• Common Clinical Problems In Primary Care: A Quick Guide (2022)*

🌼 Hospital Ampang HO Guide (for various departments)

• https://t.me/nota_perubatan/160

🌼 Medicorp

https://medicorp.onpay.my/order/form/bookstore (CPG Made Easy, HO Log Books Compilations, Clinical Skills Guidebook, Nebulizer Pocket Book of Adult Dosages & Normal Values)

Clinical Skills, Episiotomy Repair & Suturing Workshop
https://medicorp.onpay.my/order/form/clinicalskillsuturing_workshop

I’m not sure whether there is still online courses for various departments like last time. I think can contact Dr @DrIlianaMohamad for enquiries

🌼 Others

• Alia’s Illustrated Extra Notes to Performing Physical* (for those who are not familiar with proper physical examinations — important for end posting examination short cases)

*Book titles that can be searched at Shopee / bookstores

❗️The rules of tracing investigations (for newbies)❗️

1. Learn to trace

• Which system to open? What is the ID / password? Where to trace?
• Where to write the results? (typically in an investigation chart in respective wards)
• Every investigation that you / other have sent need to be traced, to check whether the results are normal or abnornal

2. Trace with knowledge

• Need to know the normal values of each investigation (esp the basic investigations), which one is significant
• Give priority to tracing investigation results for patients who are relatively unwell or unstable / post-surgery (e.g. severe or active bleeding, dehydrated, tachycardic, hypotensive)

3. Trace with action

• Do not shy away / do nothing / ignore if the result is abnornal
• You can
  • Inform to MO or ward specialist for further management
  • Correct first, then inform your MO (e.g. hyperkalaemia, hypokalaemia)
  • Inform your plan to MO first, then take subsequent action accordingly
• Urgency to inform – immediately? tomorrow morning? later during afternoon round?
  • Some repeated investigations if remains normal, no urgency to inform unless

That’s all that I can think of.

Conclusion: Trace every investigation sent, and take appropriate action on the result traced

We are definitely not a clerk, doing all the paperworks, but this is our responsibility to our patients

Importance of tracing investigation results – it will guide us what to do next for the patients

One of the most important task / responsibility of a House Officer is to TRACE samples sent.
(to further clarify my statement – tracing investigation results is the responsibility of every doctor who is treating his / her patients, regardless of whether you are an HO, MO or specialist)

We are not decision maker; while still in training, we cannot make final decision for patients most of the time.

HO’s job is to trace and update results once available, for the specialist / MO to make appropriate clinical decision.

For example, “Patient X admitted for community acquired pneumonia. On day 4 of admission, he was clinically well and planned for discharge by specialist during ward round.” During the ward round, you highlighted that the blood C&S aerobic day 2 shows Gram Positive Cocci in clusters.

Will this change the management? Yes

• Because of this pending culture result, the patient will not be discharged, and the antibiotics will be continued until the final culture result is available.
  

Understand the system in your hospital

Different hospitals or even different departments have different systems.
Some departments/ Unit, you need to refer to specialist oncall (not because they don’t have MO but maybe because it’s a subspecialised case). Usually our MOs can help to do this kind of referrals.

Some departments have MO oncall for the whole day from AM today till AM next day

• the same MO will accept referrals during and after office hours

Some departments have MO peri (peripheral) – i.e. they will see all the referral cases from their peripheral wards.

Sometimes, operator has only MO oncall number. Then how to find the MO who previously reviewed your patient? Ask your friends in the hospital/department HO chat groups anyone has number of that MO.

In some departments, MO oncall will see all new and old cases referred to that department. So you can call operator to ask who is the MO referral from that department on that day

In some departments, the same MO in charge will only see the patients that they are in charge / the patients initially referred to their teams.
For example, patient A and patient B were both previously referred to department X, but reviewed by different teams in the same department. So you would need to call back MOs from different teams to review patient A and patient B.

From time to time, you will understand about this system.
So that your referral can go through smoothly. This saves your time, just need to refer to the correct MO referral to see your case.

Introduction

Clerking patient is a routine job for any doctor. Inpatient clerking is not simply copying the entries from ED or OPD notes. Once the patients are in the ward we should ask further detailed history and do further physical examination or laboratory tests to rule out or rule in other diagnosis.

Miscellaneous

For certain comorbidities, patients should have a record book with them. Remember to have a look if necessary:

• Patients on regular warfarin under INR clinic / MTAC follow-up would have an INR book, where the usual INR range and adjustment of warfarin doses are recorded
• Patients with diabetes mellitus would have a diabetes mellitus follow-up book, where certain information such as HbA1c, weight, medication list are recorded
• Patients with ESRF on CAPD would have a CAPD record book, where you can get information regarding the input and output of the peritoneal dialysis fluid
• Patients with TB would have a TB treatment book which gives you information regarding weight, anti-TB treatment regime, medication administration record, and follow-up date

Perhaps there are many other record books with patients. Always ask from patients regarding these books, so you can have rough idea how patient and the control of those chronic illnesses.

Requesting imaging from ROTD is bread and butter for HOs. Here are some simple tips for successful radiology request:

1. Know your patient history & progress, and some relevant investigations in relation to the imaging that you are requesting (must be confident enough to present your case / request to ROTD)
2. Clear indication
3. Clear urgency (confirm the urgency of scan from your superiors)
   • Urgent means to be done today
   • Early: how early? next week? next 2 weeks? next month?
   • Outpatient: how many months? where is patient’s appointment? (SOPD? MOPD? Ortho clinic? etc.), so that the Radiology department will know where to dispatch the imaging results & films
4. When requesting for CT scan, don’t forget to bring X ray films (especially if you are working in a place where physical films are still being used)
5. When requesting for CT scan (e.g. for malignancy), try look for and bring patient’s relevant previous imaging formal report e.g. previous USG neck report / previous HRCT or CTPA report and films etc.
   • If this is the 2nd CT scan (e.g. 2nd time CT brain) for that patient during current / recent admission, it would helpful to the radiologist to COMPARE findings if you can attach together the formal report as well as film / CD
6. CECT requires consent for contrast, please don’t forget to sign and then attach together with the imaging request form to avoid rejection.
7. For outpatient imaging, make sure you get patient’s valid phone number beforehand, for appointment counter purpose

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Actually if you are not sure of the indication, you can always CLARIFY with your MO / specialist (most of the time they are the best people who know what they want to see / plan based on the imaging requested)

For example, your superior said “Plan: request USG Abdomen”

Then, these questions should come in your mind:

1. “Why we request this imaging?”
2. “Should I request as urgent or to get early date as inpatient?”

🎾 Because radiologist will also want to know about this from you / the primary team!

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Sometimes your bosses will tell you the important points to be presented to ROTD, to make the imaging request to be granted easier
So it is important to ASK if you are unsure.

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When you are getting more senior, hopefully you will be somehow more experienced and know how to deal with certain situations better 😊