Wednesday, December 07, 2011
Monday, December 05, 2011
Sunday, November 20, 2011
1. "The Storm is coming..."
2. "Storm is coming" for medical profession
3. The Standard of Medical education
4. The Impending Disaster
With the reference to articles above, I think "storm" is the common word now to be used to describe this disaster. Perhaps the incidences below will give you more idea on the severity of the matter.
Heard these from various sources:
1. Intern referred a case to cardio for chest pain TRO ACS. ECG showed "giant Q waves" (new invented term) and patient's "stable". It was found out later patient was actually having Ventricular Tachycardia and just left in yellow zone and nothing was done.
2. After being commented on mistakes, intern became emotionally unstable and pointing the needle to the senior's throat and asked him to "shut up". Just dramatic like in a movie.
3. Intern was found to take ABG from patient's carotid artery.
4. Intern was asked to serve IV Dextrose to a hypoglycemic patient. Later the nurse found that the patient actually had no branula. The patient next bed, witnessed that the intern actually shot all the dextrose into waste bin.
There are many more. These are just the complication of chasing "cheap & fast" med graduates, and patients are the one who ultimately suffer. Instead of advancing, the system is actually driven to the totally opposite direction - and very near to the other end.
To any laymen/non-medical ppl, pls view the stories as fictions. The ppl & location is very non-specific, or even nonexistent.
p.s: I'm not trying to be harsh, everyone of us made mistakes when we were new, but the bottomline is even before any benefit you're going to offer, DO NO HARM. This is the first medical ethic that we learnt. You don't have to be the smartest, but you must be a safe doc - at least you know what not to do!
Sunday, November 06, 2011
Friday, November 04, 2011
We had planned months ago to go to Cambodia on Nov 6-10, to visit the temples in Angkor. Today, we found out that there has been flooding since August 2011. This made us hesitate slightly, but we've now decided to go ahead anyway. Instead of seeing Angkor however, we will volunteer with the flood relief efforts in Battambang.
We will help DCO and CWARS with medical/logistics in Battambang, for the entire five days of our trip. Battambang is the rice capital of Cambodia, where 170,000 hectares is now destroyed. The city has a lot of flood-displaced people now, given that it's on relatively higher ground, and is the biggest city in the province. I have spoken to DCO, CWARS and a New York Times journalist to find out more about the situation on the ground.
The floods in Cambodia are little-publicised, mostly due to the concurrent (and “popular”) floods in Thailand/Bangkok. Devastatingly, the Cambodian floods have hit 75% of the country since August 2011, and there have been at least 60 deaths so far (the fewer people die in natural disasters = the more survivors you have to care for). The water is receding, and now "the tips of ruined rice stalks peek above the surface". In Battambang, we're looking at upwards of 6000 displaced people managed by the two NGOs, facing hunger, diarrhoea and water-borne illnesses.
1.2 million people are displaced (8% of the population), and the young government is incapable of rendering aid, leaving NGOs to fill the gap. The Thailand government is richer and more stable, and they have activated their military – these options are unavailable to Cambodia.
Therefore, we'd like to plead for your help, during this difficult time for an already-unlucky country. Please consider donating any amount that you'd like to the flood relief efforts in Cambodia. One option is to donate directly to any flood relief appeals in your country.
Alternatively, please pledge any amount you'd like to us, and any pledges we receive by email/text message before we fly off from Singapore on 6 Nov, will be converted into cash and brought to Cambodia for the NGOs we are working with. The cash will be used to purchase medicines, food and water. Clean water is the obvious need, and I aim to have a long-term practical solution to this problem, and will concentrate resources to this end. A preliminary idea is to use Lifestraw as a short-to-medium term answer. Longer-term plans will be to engage the government/raise media awareness to have proper piping systems, but this is multi-stakeholder challenge.
For transparency, all pledges will be made public, unless you opt out of this arrangement. Receipts and acknowledgements from the NGO/flood appeals will be provided wherever possible.
Many best wishes,
Kar Yee and Swee Kheng"
Let's do something to help the unlucky ones. Anyone who wishes to make the donation can contact Swee Kheng here.
Wednesday, October 19, 2011
The product was designed for healthcare workers especially those working in pediatrics, oncology, emergency & vein clinics.
I'm sure they will find this a good helper!
Tuesday, October 18, 2011
"Based in Silicon Valley, Physician Nexus network is the fastest growing social network dedicated exclusively to physicians.
This global communications platform was developed with a vision to transform the field of medicine, allowing physicians to connect with each other in ways that were not possible before."
I would like to encourage all physicians to join this network.
And I'd like to thank the committee for inviting me to join the Nexus Medical Advisory Board. It's certainly my honour and I hope I can contribute to it.
Thursday, October 13, 2011
Perhaps I'll just share this article posted on newspaper yesterday by S.A, followed by some evidence or views from others:
"I REFER to “Overworked housemen” (Letters, Oct 5) and other grouses that increasingly make their way into our media by Generation Y housemen. As a specialist in a government hospital in Selangor, I feel that instead of silence that may be misconstrued as guilt, there is a need to reply.
We are now at a crossroads in our health system. The high standards that were maintained through the years have fallen by the wayside. This is especially evident from the constant complaints of the younger generation, although the system and the government are bending over backwards to accommodate them. The reasons:
-- An overload of new housemen/doctors – 500 a year in 1998 and 7,500 in 2011, with the number estimated to rise to 10,000 in coming years.
-- Too many medical schools in the country – 42 at the last count, with some having very low standards. Indonesia with a population of about 300 million has half the number. How did these colleges come to be recognised?
-- Too many medical schools recognised overseas, with the standards, especially of Russian ones, being extremely low.
-- So we are now inundated with housemen to train, wherein 60% are of very low standard – meaning not even fit to pass the finals in a medical school exam, let alone to treat patients.
-- We, the specialists, are forced to retrain and even reteach these incompetents.
-- There are only so many times you can give advice to a person who doesn’t listen – sometimes when a patient’s life is at stake, voices have to be raised! Don’t you agree?
-- Increasingly, our politicians get involved when some VIP’s son or daughter who can’t cope, just wants to float through. Many specialists have been given letters of warning, when all they were doing was enforcing appropriate disciplinary action in respect of housemen who had gone AWOL.
-- The number of litigation cases against the Health Ministry due to housemen is at an all-time high. (And do you think this will further increase?)
-- The shift system was opposed by all senior faculty in the ministry, vis a vis all senior specialists, but it was forced on us. Who is going to monitor all these housemen under the shift system – the specialists?
-- When these housemen become medical officers and specialists, are they also going to go on shift?
-- We have better things to do than mollycoddle a tsunami of sub-standard doctors. If we are not careful, there will be a great exodus of specialists from the public health system in the next few years. (Read: Unhealthy growth of medical schools)
All you see in government hospital nowadays are the poor and the illegals – everyone else has an insurance card! So to the powers that be, wake up and smell the coffee."
Wednesday, October 05, 2011
Saturday, October 01, 2011
From TED: Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.
This is definitely worth spreading and I strongly think all doctors should see this. Came across this from MMR.
Friday, August 26, 2011
Thursday, August 11, 2011
Sunday, August 07, 2011
Sunday, July 17, 2011
Ever wonder how is the process of manufacturing playing cards like? The fine quality Bicycle decks, produced by US Playing Card company (USPS), are always cardicians' best partners. Over the years, its quality and art design excel in card industry consistently.
Check out the amazing video how playing cards are made inside the USPS factory!
Sunday, June 12, 2011
Tuesday, May 24, 2011
Just came across an old book of mine, and found some good jokes worth sharing I think..
Nurse: "Doctor, doctor - the man you just treated collapsed on the front step! What should I do?"
Doctor: "Turn him around so it looks like he was just arriving!"
A patient called his dentist to inquire about the price of extracting a tooth.
"250 dollars," The dentist said.
The patient was shocked, "What? 250 dollars for just a few minutes work?"
"I can extract it very slowly if you like."
A patient complained to his doctor, "I've been to 3 other doctors and none of them agreed with your diagnosis."
The doctor calmly replied, "Just wait until the autopsy. Then they'll see that I was right."
Harold complained to his doc that he was no longer able to do all the things around the house that he used to do.
His doc ran the usual tests. When the examination was complete, Harold said, "Now, Doc, give it to me straight. I can take it. Just tell me, in plain English, what is wrong with me?"
"Well, in plain English," his doctor replied, "you're just plain lazy."
Harold paused. "Okay," he said. "Now give me the medical term so I can tell my wife."
#5 (My favourite!)
Three doctors were in a duck blind and a bird flew overhead. The general practitioner looked at it and said, "Looks like a duck. Flies like a duck. It's probably a duck." He shot at it, but missed.
The next bird flew overhead. The pathologist looked at it, then consulted the pages of a bird manual. "Hmm," he said. "Green wings, yellow bill, quacking sound...might be a duck." He raised his gun to shoot it, but the bird was long gone.
A third bird flew over. The surgeon raised his gun and shot the bird without even looking. He turned to the pathologist and said, "Go see if that was a duck."
- extracted from "The Life of a Doctor".
Wednesday, May 18, 2011
Time flies! It's been almost 4 months since my birthday campaign for the Charity: Water. Just watched their latest video - the same message - to gather everyone's effort to bring safe and clean water to those who most need it.
I just donated again. You? ;)
Sunday, May 15, 2011
Specialist is giving bedside teaching to a group of medical students.
At a patient's bedside,
Specialist: "This patient has very interesting heart murmur. You all can take turn to listen to it," He then put his stethoscope diaphragm at the valve area, and passes the earpiece to one of the students.
So the students took turn to listen to it. The last student, after listening, took out an alcohol swab from his pocket and started to clean the earpiece.
The specialist was impressed, "Among all the group students, you're the only one who has the courtesy to clean it before returning to me."
The student replied, "Oh you're welcome. In fact I'm having otitis media and the pus discharge just can't be stopped. But don't worry, I'll clean it for you."
Tuesday, April 19, 2011
Wednesday, April 13, 2011
Monday, April 11, 2011
Saturday, April 02, 2011
A 40 year-old lady presented with intermittent hemoptysis for 2 days and was referred from a district clinic with impression of possible tuberculosis. She denies any fever or TB contact, though she noted hoarseness of voice for the past 3 weeks but she thought it was just URTI. Further history revealed that she has feeling of palpitation for many months but she did not seek any treatment. After looking at the chest Xray, what do you think is the abnormality and possible full diagnosis? (Click image to enlarge)
Saturday, March 26, 2011
A young girl presented with increasing abdominal distension with pain, septic-looking and she's lethargic to give further history. US abdomen showed some "suspicious shadows" and she's proceeded with urgent CT abdomen.
What do you think is the diagnosis?
(Click image to enlarge)
Wednesday, March 16, 2011
Just received my copy of new edition of Sarawak Handbook of Medical Emergencies today, freshly posted by Dr Soo from Kuching. The feeling is just great! I remember that I purchased the last edition in '06 when I was just about to start my Housemanship - and it has been a great and practical companion not only for my HOship, but throughout the period as a medical officer in Medical department! And I'm sure many other MOs will agree with me that this is an indispensable "survival book" for the on-calls.
Thanks to Dr Lim TT's help, I have the chance to get this new edition early, and it's exciting to see that there are new chapters added, and others being revised and updated. Thanks to the good work of Dr Soo with his co-authors! ;)
Saturday, March 12, 2011
I'm not sure whether any of you read the news - a sad news actually. Everyone in the department has a depressed mood after reading it.
Everyone works hard...but the outcome of this is really unexpected, and all our effort are pretty much wasted.
I remember I wrote a post "Morning 'Live Show'" few months ago, the message is "to respect others". No matter you are a HO, MO, specialist or even consultant, the respect to patients, team members, working colleagues etc - should always be there.
I believe many people will agree with me that, in the practice of modern medicine nowadays, the doctor-patient relationship is no longer the "I say, you only listen" type. Mutual communication and understanding plays a very important role, no doubt.
And the article also mentioned about "emotional quality" - which is very true, and like what I said before, you definitely need more EQ than IQ in this field, as you're dealing with people everyday, and how do you manage patients if you can't even manage your own emotion?
I just hope people can understand that one incident does not apply to all. Like I said, everyone here works hard and strives to provide better service!
Thursday, March 03, 2011
A 40 year-old man who was seen in clinic for history of syncopal attack. He was seen by GP but told to have a "normal heart rhythm". He is worried because he has an uncle who had a sudden death after a syncope. (Enough clues!)
And the diagnosis is?
Interesting ECG (5)
Interesting ECG (4)
Wednesday, February 23, 2011
I really can't believe that I got such referral in clinic today.
This is a young teenager who was seen in district clinic and somehow had an ECG done. The clinic MO described it as "P waves present, but R-R interval irregular" and referred for "cardiac arrhythmia".
I'm sure you get the diagnosis by one look at the ECG. And I believe it's fair to say that this can be interpretated by an undergraduate.
But I just feel sorry for the patient that he has to come from so far away, missed a day of his school, waited for sometime in the clinic to be seen - for no reason! All due to the poor ECG knowledge, so unfair for the patient, isn't it?
Sunday, February 13, 2011
A patient came with 1-month history of low back pain, and progressive lower limb weakness and numbness. Examination showed presence of neurological deficit, a MRI spine was done and shown as below.
Her chest Xray was like this:
Now you can link them and come to the diagnosis?
(Answer will be in comment)
Sunday, January 30, 2011
The Arcane deck preview. It was described as the "most epic trailer" for a playing card - I do agree!
My newly-added members to my card collection. 1st row from left: Shadow Master, Master Bicycle, Tally-HO Viper (Fan & Circle), and got myself a JoePorper card clip;
2nd row from left: Bicycle Ghost, Arcane White & Black edition.
Wanted to get Arcane for looong time, but due to that it is not available locally, and I was busy with exam last year - I didn't get it until now! Quite a bit of delay - but it's all worthy for sure! :)
Sunday, January 23, 2011
I was fortunate enough to come across Charity Water - an organization aiming to bring clean, safe water to people in developing nations by building wells. I saw this in Nov 10, and I can still remember the impact I've got from the concept. It inspires me to do something, and without further thought, I started my own campaign.
I first wrote a post introducing the Charity Water, and started telling friends and sending messages in Facebook. I was telling people that my birthday wish this year is not for more gifts I don't need; it's to give clean and safe drinking water to some of the billion living without it. I want to make my birthday matter this year. The response that I received was encouraging. I have support from family members, friends, working colleagues and from some people that I've not even met. For this, I'm truly grateful.
So I had my birthday yesterday, and guess what, the campaign goal was achieved!
The campaign's goal was set at raising USD1000 and I'm very very glad that we've made it. The chart shows where will the fund go to. I know that the fund raised may only help a small group of people, but I think this is a good start, and we have at least done something - which I believe will make changes to their lives.
To me, this is just the best birthday gift, ever. A big, big thanks to everyone! ;)