Saturday, January 10, 2009

Wednesday, December 31, 2008

new year...looking back in time..

Today is 01.01.2009..time's been 8 years now that I'm breaking my bones, flexing my spines and tearing up muscles..all the sleepless nights..sweats n tears.. to bring life to the world! OBGYN is deemed to be a rather hectic at times but to me, its very fulfilling and rewarding..there were dissapointments of course, but looking at those little ones, cry of joy from parents and a simple thank you already made my day.. for me, I do get these more than those complaints or shouts or bad outcome event..surely once in a while it happens.

Looking back in time, I was never much into Internal Medicine or any medical related works for that neurons are not capable of handling many synapses of all those differential diagnoses that one has to come up with when dealing with a medical patient..eversince my medical school postings, I usually ran out of my DDx even before my turn came up to answer..LOL

In my clinical years, I thoroughly enjoyed my Surgical postings, Mr.Boyle whom I did my residency surgical attachment, included me in the team, I clerked patient, prepped them up for surgery, scrubbed in and he taught us a lot during those long hours of AP resection. The team itself was very enegertic and nice, Guan the intern (read:HO), Bernadette the SHO, Ravi the most wonderful senior Registrar, whom I had the opportunity to work under him during my intern year. My partner in crime was Peter Branaggan, a lovely northern Irish lad, together we came up with tricks and tactics to evade another classmate of ours (suffice to say bout him to this point only..hehe) who was also in the same team but different aspiration shall I say.

My O&G posting in the Coombe Women Hospital was cut short by the nationwide nurses boycott then, for one whole week we did not have to go to wards simply because nothing was going on, hardly any patient, no surgery, no nurses except in critical areas like labour room with minimal number, SHOs had to do more, medical students were told to stay away..we gladly left and spent time at the movies.. but later I did sit in few of Dr. Patricia Crowley's clinic, with her (because other people simply didn't want to, she could be pretty hard n strict), surprisingly I enjoyed her clinic the most, yess she could be very intimidating but she was a very passionate consultant and a very good teacher, provided she saw your determination to learn.. We had great time during evening classes with Dr.Eric Bartel, I think he's German, very nice and coached us a lot for viva and osces..The gorgeous Dr.Deidre Murphy and another goodlooking consultant whose name I forgot took us for gynae surgery in St.James's Hospital.. unlike in Malaysia, here we could do internal(pelvic ) examination unless in OT, after the patient is under anaesthesia, just before painting begin, with consent from patient prior to going in, well..most of them didnot consent.. therefore, it's left to our imagination.. the same goes with conducting labour, we werenot allowed to do VE, mainly due to no consent, up to only when the baby was crowning with many hands of midwivs gotten your hands mangled in between.. I'd only manage to get 3 vaginal deliveries during my 1 week of night shifs in labour room.

I did compensate for the lack of above by doing my elective posting in labour room, HUSM during summer holiday..I et a bunch of nice people that made me thinking working in Malaysia wouldn't be so bad. My supervisor, Dr.Nik Hazlina (Assoc Prof now) who just graduated then, was the nicest, soft spoken and taught me thru O&G services in Msia. I counducted quite a number of patients, clerked those coming in, inserted IV cannula, took blood, washed all the equipments, was working as HO and enjoying it. My LR Registrar, K.Intan was also once from Dublin, so the bonding was stronger, I followed her everywhere, she let me assisted her during LSCS, with no HO around, she is now a private consultant OBGYN in Seremban,met her again recently,after all those years. She inspired me to excel in O&G and now she still is.. There was
also K.Murizah who was the MO incharge of labour room, who used any spare time she has to teach us, HOs n students, I followed her around during oncall, she is now in Alor Setar and an ART consultant. There was Dr.Siew and Dr. Rosilawati who allowed me to hold u/s probe during scan session and let me currette the uterus during D+C with him, very much to the envy of his medical students..huhu.. wonder where they are now.. My 1 month posting was a memory to be remembered always, Prof. Nik , Kak Intan and K.Muri we do meet up at courses and they're still very nice and friendly towards me and remembered me as their one month student!

Naturally, I did better in Surgical-based exams in the final year, Dr. Crowley called me for viva and she was waiting for me when our final results were out at the dean's office. She pulled me to the front of the board and said," Nasuha, look here, this is the gift from the department to you..", she was smiling away as I looked up at the board, there was PASS in Medicine, Surgery and 2nd CLASS HONOURS in Obstetrics!! I was speechless, we hugged and I thanked her profusely. That was the last time I saw her..

Saturday, December 27, 2008

everyone who aspires to be a doctor should read this..also to those who have just started working as doctors..

This was published in The Star on Thursday December 25, 2008

Not easy being a doc

I WOULD like to refer to the recent letters about housemen and sick doctors. The job of a medical officer is very demanding and carries a heavy responsibility, especially now, as patients are more aware of their rights, have high expectations, are medically more knowledgeable and more litigations conscious. Housemen, their parents and those who aspire to be doctors should realise this.

Housemanship requires psychological and physical endurance. If one is unable to cope with the demands during this period, then one may succumb to stress, and the possibility of making medical errors is higher.

Many want to be doctors without realising that they have to make a lot of sacrifices.

A medical student is responsible only for himself, but once he graduates and becomes a doctor, he is responsible for the life of his patients.

The medical profession is rather unique in that although a doctor may have obtained a medical degree, he still cannot practise because he still has a lot to learn especially the practical skills of medical management.

In fact, the medical degree is just a licence for them to start learning how to practise medicine. Medical doctors will not be given full registration unless they pass their housemanship training. Housemanship is the time when newly-graduated doctors are trained not only to manage and administer the medical management under supervision to patients but to withstand the endurance of working long hours, day and night, weekdays and weekend.

There was an incident when a new doctor entered the ward for the first time, and a paediatric patient collapsed in front of her. She was stunned and unable to respond whereas the nurses tried to revive the child. Unfortunately, the child died.

The doctor did not come to work for three days. On the fourth day, she came to see me and said that she had chosen the wrong profession, and subsequently left the hospital. As mentioned in your papers, there are doctors who get “sick”.

A doctor can be held liable in an action of negligence if he fails to exercise that degree of care and skill which is expected of him. Medical errors do happen when doctors misdiagnose, delay treatment or administer the wrong dosage.

As such, a houseman who examines more patients, spends longer hours in the wards and handles more procedures will become a better and more confident doctor.

Housemen should not complain about the long working hours and being scolded by their seniors and specialists. Teachers and lectures have been scolding students since ages because they want their students to succeed and be better than them.

As part of their training, housemen have to report for work long before the official hours and work through lunch and dinner if need be, and know every detail of their patients.

They should love their work and enjoy the satisfaction of seeing patients under their care recover. No patient should die because of a houseman’s incompetence. Inexperience is not a defence.

So housemen should go to work with the right attitude and acquire knowledge, skills, stamina and patience so that they can be confident of working alone anywhere in the country.


Pengarah Kesihatan Negeri, Perak

6 Habits of Highly Respected Physicians

  1. Ask permission to enter the room; wait for answer
  2. Introduce yourself, show your ID badge
  3. Shake hands whenever feasible
  4. Sit down, smile if appropriate
  5. Explain your role in the health care team
  6. Ask patients how they feel about being in the hospital
mmm...definitely good points to ponder many of us actually do these on regular basis, as a second nature?

pharma freebies...we need pens?

I came across this today ...reminds me of us..err..most of us if not all..we are after all ordinary human beings.. when visiting booths, attending conferences

A few weeks ago, one of my patients offered me a coupon for our local office supply store. "Doc," he said, "you're going to need this come January."

He mentioned a story he had heard on the news about how doctors would no longer be able to receive free pens from drug companies. What a stupid idea, I thought. Who cares about free pens? Then I recalled my experience at the Pri-Med West conference a few years back.

In many ways, it was like any physician conference. It was barely past Easter, and the exhibition hall in Anaheim, California, rippled with the excitement of another scavenger hunt—only these weren't kiddies seeking brightly colored eggs. They were primary care physicians of all shapes, colors, and sizes scampering about like hamsters in a maze, scooping up every freebie in sight and hurriedly stuffing them into their large drug-name-embossed tote bags. Walk out with the heaviest bag, and you're our winner for the day.

The aisles were lined with innumerable booths: There was office-testing equipment, opportunities to boost income by learning cosmetic surgical procedures, competing EHR and e-prescribing programs, insurance companies, and medical societies, as well as numerous non-medical exhibitors. And all of them were giving away something: snacks, candy, pens, penlights, laser pointers, leather organizers—the list was as long as the line of scavengers waiting to scoop it all up. And within the first five minutes, some booths were completely cleaned out.

There are two categories of scavenger-hunt participant at any conference: physicians and their spouses. They are divided into two-person teams easily distinguishable by the color of their oversized drug-company bags—the first acquisition for any serious conference scavenger. Anything not nailed down is fair game. At one point, I observed a woman making off with a stapler.

Techniques vary. Perhaps the boldest of them is what pharmaceutical reps call "the swoop." The physician suddenly appears from out of nowhere and quickly sweeps all of the display items (pens, treats, notepads, stickers) into his bag. And then, in a flash, he is gone without a trace, presumably back home to restock his penless office.

(And those pens go fast. I watched reps place boxes of them on a table, and as soon as they turned away, one doc took an entire box! One can only imagine what goes through the minds of airport security screeners as they scrutinize the oddball contents of these freebie bags.)

More artful are the magician wannabes, those who employ their skills of misdirection and sleight of hand in the hope of netting perhaps two additional writing utensils. They strike up a conversation with the booth rep, then in a moment of inattention, shoot their hands across the table, grasping whatever handouts they can hold and sticking them into the waiting bag before the rep returns. One particularly enterprising physician deposited an entire bowl of mints into her bag, after first scanning the room to ensure that no one was watching.

Observers of this phenomenon know that nothing reveals the seamy underbelly of medicine like an exhibit booth that's run out of freebies. Tempers flare, indignation soars, and retribution awaits at the adjacent table that still has a few refrigerator magnets left.

Which brings us to one small point of note: Exhibition reps do not have special powers. When an item runs out, there is nothing they can do to create more. Not even your yelling and screaming can alter this fact. I know; I have seen it firsthand.

Of course, not all that I've taken from my conference experiences has left me so discouraged. For one thing, I did come away with some really cool pens. And I hear they'll have to last me for a while...

Jeffrey K. Pearson, DO, practices family and sports medicine in San Marcos, California.

Friday, December 26, 2008

reminiscent of the good old days...

This picture was taken just before I left Dublin in August 2001, at Arman's house if I remembered correctly.. front row from left was Razi, Khairin, Mazlin. Mid row was Abg Mail, Fauzey Pokcik, Kak Iwa n baby, myself, Ong. Back row: Bai n Arman.. Missed them lots..