Thursday, September 29, 2005

Essay Time

Someone recently asked why I don't blog that regularly anymore. The answer is simple: NO TIME LAH! :)

This same person also mentioned something about blogs not accurately reflecting its author's true character / personality. I totally agree. Many people can't reconcile my quiet nature with what they read on this website. And one writer who seemed nice turned out to be a real jerk. So... give and take, I guess.

Lots of hullabaloo over the blog-o-sphere lately, with lawsuits, editorials and online discussions. I was approached for some advice on a case that wasn't publicized in the media, and which is, let's just say, more "within the realm of my expertise".

Suffice to say, my sympathy lies entirely with the defendant, and I think some people use Google for totally WRONG ( and slightly stalker-ish ) reasons, yeesh.

Obviously, I have strong opinions about blogging, especially in the medical circle. I know many fellow doctors who partake in this worthy pastime, with most preferring to write under the cloak of anonymity. I, on the other hand, started out with a very small audience before gaining some measure of prominence, then went through a couple of, um, tumultuous phases when certain entries "didn't sit well" with certain people.

I was fortunate for various reasons, the most important of which include (1) very tolerant seniors, (2) a few key figures who fought tooth and nail for my right to vent, and (3) refraining from testing the boundaries of the freedom I've been afforded.

Like me, this other person was censured for speaking his/her mind on "a sensitive issue", but with one major difference: the involvement of an extremely irate "third party" who kicked up a huge fuss. I've read this person's entry ( before it was removed ), and heck, it isn't anything I haven't heard before in conversations over meals with many colleagues. The only problem is, the "third party" found the post, and well, you can imagine how THAT turned out.

There're bound to be left and right wing proponents, and I am no doubt a leftie. However, the blogger has to exercise his/her own discretion, especially when it concerns medical subjects. Life isn't always fair, but there're ways to protect yourself.

Don't let this episode get you down.

Training Opportunities

Prompted by the 26 September entry on this blog.

I like this quote: "Yong Loo Lin, we have a problem." :)

FYI, my first month of housemanship was absolute hell. And after 4 months caring for pint-sized patients, I went through another month of torture in Internal Medicine before finally getting the hang of things. ( This, despite doing a month-long elective in Emergency Medicine during which I familiarized myself with most staple ward procedures. )

Way back then, I'd already realized how inadequately my med school education had prepared me for life in the real world. You waltz through 5 years of endless lectures and tutorials, set a couple of IV plugs, do maybe one urinary catheterization if you're lucky, and wake up to an EXTREMELY UNPLEASANT reality on the first day of housemanship.

Ward rounds! Urgent scans! Blue letters! Discharge summaries! Endless bloods! Family updates! New admissions! More bloods and other changes!

In paeds medicine, I learnt how to do heel-pricks for serum bilirubin levels the day I switched wards and landed in Jaundice Land. Worse, I had to prick 10 to 15 heels every morning before rounds even began. Sometimes, my fellow HO and I did this together like a well-oiled machine, with one pushing and pulling the cots in and out of the assigned procedure room, the other all ready with the capillary tube and Lancet. Mastering the technique was another challenge, 'cos you can't just stick the baby and expect good blood flow. Nooo, you have to find just the right spot, prick the skin deep enough, then MILK with everything you've got. Done correctly, you can complete the entire task - including unwrapping, positioning, blood-taking then rewrapping - within a minute.

I rotated through paediatrics at least twice during my clinical years, with each posting lasting a couple of months. Now WHY didn't they ever teach us how to do this? Did they think med students weren't qualified to perform heel-pricks, and totally inexperienced new interns ARE?!

Other things I wish I'd been taught in med school:

1) how to clerk patients intelligently
- I didn't find out what "premorbid state" meant till my Internal Medicine rotation
- they tell you everything about typical angina, but nothing about "atypical chest pain"

2) how to handle difficult patients and their relatives
- I understand there's a recently added Communication module in the university curriculum, but trust me, simulations don't even come close when you're faced with an angry clan or a demented patient who refuses to hold still when you set his/her IV plug after s/he yanks it out for the 20th time.

3) how to handle yourself
- we all know what bedside manners are, but no-one ever taught us what to say or how to say it. Breaking bad news, informing DIL, building rapport - I learnt it all ON THE JOB, FROM MY SENIORS, AFTER MAKING QUITE A FEW MISTAKES.

I wish I could talk more with the students who pass through my department, but there's never much time, and most of them shadow consultants rather than us registrars. But dinner with a fresh local HO the other night yielded disturbing insights.

"Oh yeah, we're SUPPOSED to spend a month carrying out official HO duties, but most of the time, the consultants just tell us to go to the library to study."

Sigh. Unacceptable.

Anyway, why don't I let you ponder that and move on to something less controversial.


The Cincinnati Pops

First time I've ever caught a concert 2 nights in a row, but the programme's completely different each evening and I just can't pass up the chance of hearing great film music played by such an illustrious group. Getting goosebumps just thinking about it. :)


A new blog set up by a new friend.

A VERY CEREBRAL new friend. :D

New TV Shows

The Amazing Race: Family Edition


Everyone spent the pilot 2-hour premiere running around the United States, and from what I can see of next week's trailer, the teams will be doing more of the same in the 2nd episode.

Don't feel like following up on this one.

Medical Investigation

New series on Starworld every Wednesday night at 9pm. Not too bad, but rather annoying at times.

The lead's bleached blond curls are distracting, his acting stiff and overdone.

There's WAY too much cell phone use.

Do they actually expect us to believe the paediatrician didn't consider the differential diagnosis of osteogenesis imperfecta in an infant with easy bruising and blue-tinged sclera?

They DC shock EVERYBODY, even when it's clearly asystole.

Suspected highly contagious disease, patients quarantined in an isolation ward, staff mostly clad in protective gear, and the lead saunters in WITHOUT A BLOODY MASK. Wow, he must've jabbed himself with prophylactic immuniglobulins or something.

Last Words

Seems I've unintentionally worked myself into a mildly agitated state, heh heh.

Let's end off with my views about the current "hot topic": service and the nasty Singaporean.

From a medical perspective, I'd just like to state, for the record, that the typical Singaporean patient is a real piece of work.

Impatient, demanding, confrontational, suspicious, neurotic, occasionally in serious denial, frequently rude, rarely appreciative.

Sales personnel are paid to be nice to the customer, but what about us doctors? Do patients care that we're exhausted, stressed and bogged down by numerous work commitments? Do they understand how overbooked the clinics are? How hard we're trying to clear the changes? How we can't discharge them RIGHT NOW because we're resuscitating someone, dammit?

There was a frightening emergence of the Singaporean Patient Who Bypasses Hospital Procedure And Submits Complaints Directly To A Very Receptive Newspaper Forum, but thank goodness we've put a stop to THAT.

More to follow ( including House quotes ) when I go on leave. 3 more days, 3 more days, 3 more days.

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