Of Medicine and Life long learning

Friday, December 4, 2009

It is Friday once again and today concluded my second week of studentship in Prince Henry's Institute. Life as a student here is never mundane as everyday is different. You learn different things/techniques, you make different mistakes, you meet different people, you hear different codes(code blue/code red) and you attend different seminars. Quite variable. There is an explosion of knowledge in Prince Henry's itself and It makes it hard for me to digest and catch up.

I reckon it is fundamentally crucial for doctors or even medical students to keep themselves(or at least try to) updated with what is happening in the medical field from time to time. One of the best resources that I think is absolutely useful is Medscape. Just subscribe to their newsletters in various fields and you could get heaps and heaps of updates/advancements and even clinical trials that are currently being carried out in different parts of the world. There are videos on panel discussion on every single topic you can find not forgetting the chance to earn some CME points at the same time.

At this stage, year 2 medical students from Monash should probably be quite familiar with the drug Thiazolidinedione(TZD) which is used as one of the agent to control glycemia in T2DM patients. When I learnt about it last year, I was quite fascinated as this drug actually acts as an agonist to the nuclear receptor PPAR gamma to initiate transcription of insulin sensitizing genes. Interestingly, this is the same receptor that Simon and I are looking at right now in terms of tumorigenesis of granulosa cell tumor of the ovaries. However from a recent conversation with Jun, an endocrine fellow in MMC who is currently pursuing her Phd in PHI, I was told that one of the TZD, rosiglitazone was found to cause heart failure in patients by inducing water retention while messing up sodium balance. I then searched for this particular drug in Medscape and found an article written in 2001 claiming that Rosiglitazone could reduce cardiovascular mortality and morbidity in T2DM. I was confused for a while, wanting to know the real story behind this wonder drug. I then googled "Rosiglitazone FDA Heart Failure" and then a second article written in the year 2007 from Medscape appeared. Guess what? Roziglitazone really has an adverse effect and could precipitate heart failure, warned by the FDA. Pioglitazone which is widely used is currently being reviewed as well. I doubled checked, and It was valid. In a short duration of time, a drug can be known to cause harm, treatment strategies could be modified, guidelines are then being reviewed as frequent as possible. Frustrating huh?

In medicine, things are constantly changing. Thus, this serves as a good reason for us to instill the habit of keeping ourselves updated even at this stage itself. Even in undergraduate, why not? Many still could not accept that fact that medicine is really a life long learning process. It is not a course, it is not a job, it is not a career either. It is a life.

On another note, I attended a talk 2 days ago and was amused by the debate between the endocrinologists, diabetologist and the researchers. They were arguing about the use of insulin secretagogues in the management of T2DM. The researchers claim that insulin secretagogues like Sulphonylureas causes pancreatic beta cells exhaustion and on other hand, the endocrinologists softened their comments by saying that choices of medication is indeed limited. Was reading through Nature's Endocrinology review and there was an article saying that the current stereotyping of DM is oversimplified owing to the fact that the prevalence of "Double Diabetes" or better known as "Type 1.5 diabetes" has dramatically increased in both developed and developing countries. They argue that there is a need to review the current dichotomous classification of DM. Interesting isn't it, its never ending. New things come up every single day.

Managed to catch up with Prof Fuller this afternoon when all the staffs of the steroid biology receptor lab celebrated over the acceptance of Amanda's thesis on the role of mineralocorticoid receptors in the context of cardiac fibrosis and heart failure. She is now officially a post-doc research fellow in PHI, nicely done!

I expressed my intention of doing a BMedSc to Prof Fuller and we had a good chat about it. That concludes the day and I shall look forward to the endocrine ward rounds and journal club with Prof Fuller on Monday. A teaching session with the Endocrine Director of Southern Health without the presence of other medical students, how lucky. Hopefully the presence of inspiring figures like him will keep my passion for medicine burning.