Wednesday, December 07, 2011

Excellent Card Manipulation Magic

Performance by Yu Ho Jin, a Korean magician. I must say that this is one of the best card magic acts that I've seen, the elegance and creativity is truly outstanding.
Enjoy the show!

Monday, December 05, 2011

Love the Gift!

Received my wedding gift - a Nespresso coffee machine from my department colleagues. It's just a perfect gift to a coffee-lovers like us. Happy & thanks to them! ;)
Nespresso commercial starring George Clooney.

Sunday, November 20, 2011

The Storm has Come

Much warning has been given regarding the "Storm" in the country. For relevant articles you can read on a few of the following:
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

How to choose your Specialty?

(From doctorshangout)
Quite true..and absolutely hilarious! ;)

Friday, November 04, 2011

Help Cambodia

A physician friend of mine has sent me this email. With his permission, I'd like to share this out hoping to gather more help.

"Dear everyone,

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

Great Technology - VeinViewer

"VeinViewer uses near-infrared light to locate subcutaneous vasculature and projects its image in real time. It is clinically proven to reduce the nunber of attempts to start an IV by 50%, reduce the time to start an IV by 50%, and double patient satisfaction scores."


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!


Thursday, October 13, 2011

Can You Smell the Impending Disaster?

Though I'm currently out of the system, I do still pay attention to the healthcare news in my home country. I must say that I'm quite concerned, and this worry started long ago but analysing from the current situation, it is apparently not showing any good changes, and I think many of you will agree with me that, we're foreseeing more problems to emerge along the way.

Perhaps I'll just share this article posted on newspaper yesterday by S.A, followed by some evidence or views from others:
Young Doctors Mollycoddled

"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.
(Read: Quality first, not quantity)

-- 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?
(You'll understand how. Read: Corruption in Medical School)

-- Too many medical schools recognised overseas, with the standards, especially of Russian ones, being extremely low.
(This topic has been discussed far too many times, but we have not seen any measures taken. It was extensively debated long time ago, perhaps you can read: POTS I, II, III, IV. To be fair, I must say that not all Russian grads are substandard, I have worked with a few good ones.)

-- 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.
(I can understand why the words "very low" were used. You need to see to believe how incompetent a medical graduate can be. Read this: Unqualified doctors in medical practise)

-- We, the specialists, are forced to retrain and even reteach these incompetents.
(As result, significantly less time was spent for clinical work and eventually patients suffer the consequence.)

-- 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?
(I think everyone who cares for patients will agree to this. Medical error pays an extremely high price - it is life that we're talking about.)

-- 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."
My general advice is thus:
Before a decision to join medical school, make sure you're genuinely interested and have some ideas of doc's life. (Read: For future doctos - Part 1 & 2)
If you're already in the system (fortunately or otherwise), make sure you strive to be one of the best. When over-supply becomes a reality, only good ones will be employed. And that day will not be too long away from now!

Wednesday, October 05, 2011

Why date a doctor?

Saw this in facebook which was circulated around.
Some are bitter facts and some will just make you smile. ;)

Saturday, October 01, 2011

The Power of Human Touch

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

Charity: Water is 5 Years Old!

Charity water hits the 5th year anniversary!
Please watch it - and you can help by donating, starting a campaign or simply sharing the link!

Thursday, August 11, 2011

New Book Arrival

Fresh from One of the must-have references for renal medicine.
And brain cells-consuming as well.

Sunday, August 07, 2011

New Books for PACES

"Pacing the PACES"
"The Medical Short Case"
Good news for MRCP taker!
Dr. Lim TT (or Wuchereria on his blog) with his co-authors has come out with 2 books to aid the preparation for PACES examination. The books are now available in discounted rates for a limited time.
Anyone interested can have a look at his website.

Sunday, June 12, 2011

Interesting Imaging (3)

This patient came with an episode of seizure. He had similar episodes in the past and an intracranial intervention was done but he couldn't be sure what exactly it was.
A junior doc found the brain scan strange-looking and interpreted as "?Star effect".
What do you think it is and, what intervention was most likely done?

Tuesday, May 24, 2011

Some Medical Jokes

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

Charity: Water

Water Changes Everything. from charity: water on Vimeo.

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? ;)

Tuesday, April 19, 2011

Interesting CXR (9)

A man presented with acute onset of shortness of breath and clinical findings are of pneumothorax and an emergency chest tube insertion was done. However he remains in respiratory distress despite the procedure.
What do you think he is not improving and what does the CXR actually show?

Wednesday, April 13, 2011

Interesting ECG (7)

(Click to enlarge)
I have this interesting ECG sent to me by a postgraduate Medical Registrar from Kenya and we would like to share this for discussion.
What do you think it is?

Monday, April 11, 2011

Interesting Imaging (2)

A man with unknown comorbid was brought in with unresponsiveness. No history could be obtained from patient or family. Some of his clinical signs (Panel A, B):
And the CT Brain is shown in Panel C.
Correlating the CT Brain findings with the clinical signs, what would you highly suspect? Please give the complete diagnosis.

Saturday, April 02, 2011

Interesting Chest Xray (8)

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

Interesting Imaging

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

New Sarawak Handbook!

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

Need a Change

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

Interesting ECG (6)

Interesting ECG!
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?

Related posts:
Interesting ECG (5)
Interesting ECG (4)

Wednesday, February 23, 2011

Cardiac Arrhythmia?

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

Interesting Chest Xray (7)

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

New Card Collection

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

The Best Birthday Gift

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! ;)

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