Sunday, October 31, 2010

Another year has zoomed past and we are almost at the end of third year medical training. Time flies as they say. The end of another year is always the time when one looks back and reviews our achievements, what we did well, what we did not do so well and then look forward to set goals to rectify them.

Year 3 has been uneventful to me so far in the sense that life practically revolves around texts and patients. With the end of year exam approaching soon, I am starting to spend more time hitting the books instead of roaming around the wards acting like a house officer. Now don’t get me wrong, it’s not that I am better or comparable to them, it’s just the method of learning that I have adopted since the beginning of the year. Osler once said: To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.

A few things that I’ve learnt to appreciate over 12 months being posted in different departments:

Respect patients

All students should ask yourself, “Who taught me medicine?”

“Prof A is really good, he taught me this and that. He even printed notes for us!” one of my colleagues answered. At the end of the year, most students will be going around, knocking the doors of their lecturers to thank them for making them a better doctor. But how many actually pondered whether these individuals really taught us the art of medicine? Did they develop heart failure to teach us what an elevated JVP looks like? Did they suffer from cyanotic congenital heart disease just to show us clubbing of the fingers?

Then who taught us medicine? Obviously the patients.

Patient came in with wheezing to show us the signs of asthma.

Patient came in with a myocardial infarct taught us what are the ECG changes that you could pick up in an acute coronary syndrome. Without these patients we would never have learnt. Yet there are students who are capable of performing examination without even obtaining consent just to satisfy their hunger for good physical signs. They come, they strip, they auscultate and they leave.

Our parents taught us to always respect our teachers. That’s the reason why we should have utmost respect for our patients-Our great teachers. And not treating them like dummies for you to practise on.

To wish

Make it a habit to wish the patients and their family members when you clerk them. You’ll be surprised to see how cooperative and pleasant the patients become when you wish them. Always be polite to patients irrespective of their socioeconomic status, education level, ethnicity, language, culture and religion. I’ve learnt tremendously from drug abusers, inmates, people from the lower socioeconomic background throughout the year. They never fail to make me realise that I am indeed so lucky and blessed to be living in such a comfortable life and to pursue what I like in life.

"Healing occurs when you let another human being know that his suffering and fears matter to you"-Anonymous

Choose your friends by their character. Choose your socks by their colour. Choosing your socks by their character makes no sense and choosing your friends by their colour is unthinkable-Anonymous

Be less intimidating

Always stand or sit at the same level with patients when you clerk a new patient. If you are standing and patients are lying down, it can be very intimidating for them. Pull up a chair and sit beside the bed if necessary. Try to calm them down especially during bedside teaching sessions. I learnt to routinely shake/hold their hands while introducing them to my colleagues and teacher before each session starts. Trust me, this will ease their nervousness tremendously. Thank them before you leave, not because they have been cooperative but for the fact that they have imparted some knowledge in you.

Refer to them by their names, and not “cases”. They are not experimental subjects and don’t you think it’s rather dehumanizing to be referred as such?


Never do things half heartedly. What you do now will definitely reflect who you are going to be next time. Clerking without examination is unacceptable and it just shows that you are not interested in learning. It sucks to be the group leader in the sense that you are directly responsible for the group’s learning progress. Inevitably you will meet people who clerk a patient 15 minutes before bedside and expect the tutor to show them the clinical signs and to finish up all the remnants. Excuses like “The patient was eating when I wanted to examine” or “ Patient was not in bed when I wanted to examine” are commonly given as they fail to step up to their responsibilities. Be responsible when you carry out your duties. If you don’t know or haven’t done it, just admit it and remember to do it properly next time. You must be responsible towards yourself and your colleagues.

However, I’ve learnt to accept and adapt. Confucius once said: If I am walking with two other men, each of them will serve as my teacher. I will pick out the good points of the one and imitate them, and the bad points of the other and correct them in myself.

And finally Attitude

“Attitude , not aptitude determines altitude”. It is the attitude in learning that makes all the difference. Although you can argue that why take things so seriously? You'll get the same degree anyway, since you still call the person who ended up last in medical school -Doctor. It is up to us to decide whether or not to be a 99% doctor or a 50% doctor.

Spot Diagnosis?

Wednesday, October 20, 2010

A few of the patients that I've seen over the week..

The mad house

Friday, October 15, 2010

Just some random thoughts for the day

1) The medical ward in hospital Sultanah Aminah is indeed a mad house. You'll have patients screaming, yelling, crying even swearing from time to time. It's stressful to work in such environment, the workload is unreasonable with tonnes of blood to take, lab investigations to review, cannulae to be inserted. Worse still when you have a 10 year old dengue patient who is afraid of needle being admitted...tds FBC..argh...

2) I entered the ward when the sun has not yet risen and I went back home when the day has gone dark. Extremely exhausted to the extend that I lost my appetite for dinner.

3)I poked an elderly man 3 times, one for an ABG, inserted a branula and withdrew blood and lastly a blood CNS under strict aseptic technique. I'm sorry.

4)I love the ECG machine in D2, it is printed in A4 size, no more long messy ECG strips laying around.

5)The hospital is so poor that they ran out of reagents for TROP T, creatinine and serum calcium. This is a tertiary referral center and I believe the patients should receive tertiary specialist care.

6)My fasting blood sugar after morning round is about 3.2 mmol/L. This is the value after going around looking at 40 patients without taking a single sip of water or breakfast.

7)Lung cancer and PTB is so prevalent in this region.

8)Ascultated my first carotid bruit, and realized that clinical examination is way more superior as compared to sophisticated imaging investigations.

9)Every complaint from the patient is genuine.

10) And in medicine, what ever that happens after 5 actually makes you better.