Operation Twitter

Hi, general public. I'm sorry to ignore those who don't understand this issue. But clinical year students who don't have facebook should generally understand what this is all about. So UPM med students, I'm talking to you.


Regarding our twitter plan to have an impact on the Prime Minister starting next Wednesday:


To get to be the Trending Topic we have to have at least 5000+ tweets. I dunno how correct this estimation is. I really hope everyone will participate. I can't force you all, but I hope you all care enough about UPM to do it. 


Please start a twitter account. If you didn't join Pagoh/upcoming Pasir Gudang program, it's the least you can do!


1. Not welcomed at Serdang Hospital - tell yr experience of how doctors/nurses/MA at HSDG treat you (in a nice way 


pls)
2. Unable to review patient’s notes - lack of student ID
3. Competition - get teaching experience, OT exposure,
4. Teaching and student facilities used by others
5. Wasted travelling time - lecturers can't practice here


Just talk about HSDG is basically ours, build on our land, has a bridge to our faculty but it's not ours.


how to tweet
Register with yr email and log in
Go to PM’s account and follow @najibrazak
Tweet to @najibrazak regarding issues in previous slide
Use the hatch tag #HOSPITALUPM
FEEL FREE TO CREATE YR OWN HATCH TAGS AND GET YR FRIENDS TO USE IT


how not to tweet
Use vulgar/rude/defamatory words when tweeting
Incorrect spelling, unprofessional tweets
Repetitively tweeting the same thing
Talking about banal thing (i.e the weather, breakfast) or unrelated topics (i.e politics) with the hatch tag



The Facebook fanpage will be up soon. And a write up about this issue will hopefully be up soon.


Nazirah, 4thyr 2011/2012

Suggestions of books to read for clinical year students

So these are the books that I have used when I was a clinical phase student. The books that I used may be different from other people, and may not be what other people ‘prefer’, but u may use this list as a guide to know which books to refer to when studying

Medicine

1- Sarawak handbook of medical emergencies (This is a very useful book, esp for final years. Trust me)

2- Oxford handbook of clinical medicine (Again, very very useful)

3- Pocket clinical examination by Talley & o’connor

4- Case files Internal medicine by Lange publications

5- Making a neurological diagnosis at the bedside (UM press)

6- X’press revision in short cases (UM press)

7- Clinical examination by Talley & o’connor

8- The ECG made easy by Churchill Livingstone

9- 250 cases in clinical medicine (W.B.Saunders)

10- Hutchison’s clinical methods (Saunders)

11- Kumar & Clark clinical medicine

Surgery

1- Schwartz’s manual of surgery (Personally I prefer this book compared to Bailey & Love)

2- Bailey & Love’s short practice of surgery

3- Hamilton Bailey’s physical signs (Hodder Arnold)

4- Surgery at a glance

5- Churchill’s pocketbooks : Surgery

6- Browse’s introduction to the symptoms and signs of surgical disease

7- Lecture notes on General Surgery (Blackwell)

Orthopaedics

1- Physical examination in orthopaedic surgery (Longman)

2- Pocketbook of Orthopaedics and fractures by Ronald McRae

3- Clinical Orthopaedic examination by Ronald McRae

4- Apley’s system of orthopaedics and fractures (Hodder Arnold)

Paediatrics

1- Paediatric problems in Tropical Countries (Pelanduk publications)

2- Paediatric protocols for Malaysian Hospitals (KKM)

3- Illustrated textbook of Paediatrics (Mosby Elsevier)

Psychiatry

1- DSM criteria book (mine was DSM-1V-TR)

2- Pocket handbook of Clinical Psychiatry (Kaplan & Sadock’s- theres a bigger textbook version of this but this pocketbook should be sufficient)

3- Psychiatry (Oxford)

Obstetrics & Gynaecology

1- Obstetrics by ten teachers (Hodder Arnold)

2- Gynaecology by ten teachers (Hodder Arnold)

3- Essential obstetrics/essentials of obstetrics by Sabaratnam arulkumaran (Can't remember the title properly but go look for the guy mentioned above its his book.this book is a bit postgrad but I find it really useful and a joy to read)

4- Essential gynaecology/essentials of gynaecology also by the guy mentioned above

Ophthalmology

1- Lecture notes on Ophthalmology (Blackwell publishing)

2- Ophthalmology : an illustrated color text

ENT

1- Essential ENT practice (Rogan J Corbridge)

2- Ear, Nose and throat and head and neck surgery : an illustrated color text

Others

1- Physiological basis for explaining the signs and symptoms of endocrine disorders (UM press)

2- The little book of causes (Don’t let the name deceive you. It may read ‘little’ there but to remember the stuff inside is a pain in the ass. lol)

3- Churchill’s pocketbooks: Differential diagnosis

4- Pharmacotherapy handbook (McGraw Hill)

5- Review of Medical Physiology (Lange)

There are alot of other books I've used other than the ones stated above, e.g. textbooks, seniors's books etc so get your hands on them too! And when you go to year 5 you will have anaesthesiology and a&e so make sure you get some too concerning these topics. I just borrowed from the library since everything’s there. For those who are about to enter year 4 please please make your own notes. Suffer a bit during year4. Its OK, so that when you go to year 5 you have your notes with you and your life will be made much easier. Trust me, in year 5, you don’t have the time to make short notes and everything will seem so fast and you're expected to knw everything right from what's important in the history until the management.besides various management modalities available for that particular patient. Oh and I forgot one thing. Read CPGs (clinical practice guidelines) and hospital protocols since those are beneficial too. So goodluck guys! 

Syafeeq Faeez, 5thyr 2010/2011

Happy holidays, 3rd years!

Everyone passed the ENT and Ophthalmology posting! Congratulations and happy holidays! Hope we all achieve our goal in Pagoh!

Nazirah, 3rdyr 2010/2011

Laporan Hasil Lawatan Tinjau Ke Pagoh (6-7 Mei 2011) Sempena Program Juara Rakyat Pagoh

Program: Program Anak Angkat bermula dari 21-27 Mei 2011 diikuti oleh acara kemuncak iaitu Program Juara Rakyat pada 18-19 Jun 2011 yang akan dihadiri oleh Timbalan Perdana Menteri.

Objektif Program: 

Mendapatkan data bagi tahap kesihatan penduduk kampung di kawasan Pagoh serta memperbaiki tahap kesedaran dan pengetahuan tentang kesihatan penduduk kampung di kawasan Pagoh.

Tempat:

Pagoh, Johor

Melibatkan 2 dun  iaitu Dun Bukit Serampang dan Dun Jorak  (5 buah kampung dipilih dari setiap dun).

Dun Bukit Srampang: Kg. Parit Medan, Kg Parit Tepi, Kg Parit Simpang, Kg. Parit Tunggul, dan Kg Parit Sawah.

Dun Jorak: Kg. Parit Raja, Kg Parit Bengkok, Kg. Parit Pelampong, Kg. Bukit Rahmat dan Kg. Tiong Baru.

Anggaran purata bilangan rumah dalam setiap kampung ialah 63-65. Ini menjadikan responden dalam survey ini ialah > 3000 orang.

Pihak yang Terlibat:

Program ini melibatkan 150 pelajar daripada semua kursus FPSK UPM untuk dijadikan anak-anak angkat penduduk kampung manakala doktor-doktor pakar perubatan UPM daripada pelbagai bidang akan menyusul pada Program Juara Rakyat. Para pelajar yang terlibat akan dijadikan anak angkat untuk 5 buah rumah yang terpilih bagi bagi setiap kampong. Oleh itu setiap rumah akan mangambil minimum 2 dan maksimum 3 orang anak angkat.

Semasa lawatan tinjau yg berlangsung pada 7 Mei 2011, kami menemui ketua-ketua kampung yang terlibat untuk menerangkan serba sedikit tentang program ini, melangsungkan kerjasama bersama mereka serta mendapatkan informasi terbaru tentang keadaan terbaru kampung-kampung tersebut. Kami juga telah melawat tapak sekolah yang akan dijadikan tempat bagi Majlis Penyerahan anak Angkat bersama Penduduk Kampung pada 21 Mei 2011 ini dan juga pada acara kemuncak Juara Rakyat Pagoh bersama Timbalan Perdana Menteri.  Biik-bilik dajah, makmal dan juga kantin akan gunakan pada hari program bagi memudahkan doktor-doktor pakar membuat konsultasi percuma kepada orang kampung. Selain itu, kami melawat tempat-tempat tumpuan penduduk kampung iaitu masjid, dan kedai makan kerana ia penting dari aspek publisiti.

Gambar: Bersama Puan Hajah Istiqamah yang telah menumpangkan kami semalaman untuk lawatan tinjau ke Pagoh.

Gambar: Perbincangan bersama ketua Kampung Parit Bengkok/Pelampong, Tuan Hj. Emran B Hj. Hashim

Just thought you should know..

Ben from Flyfm blogged a bit about the event that the med students from UPM attended here.

Here's a bit about the history of It Begins With You.

And here's a bit of your seniors flash-mobbing.

More on the events later!

Nazirah, 3rdyr 2010/2011

Why medical students SHOULD get involved in extra-curricular activities

Many of you will know that a majority of us third years have been through an interview that will decide whether we can stay in college or not next year. Why are we going to these interviews in droves, you ask? Doesn't UPM medical students automatically get to stay in their hostels (K17) despite the level of extra-curricular involvement? A big reason this happened would be because we had previously thought there was no point in collecting merits as we had thought we would be staying in the KL Damai hostel next year when we have our postings in our 4th and 5th year. Because of politics and a lot of red tape, imagine the surprise, the slaps on our unsuspecting faces when we hear that there will be no KL Damai hostel and there might not even be a renewed contract with HKL as a teaching hospital for UPM anymore as of 2012. That's another story, and the issue is far more complex, but let's talk about the merits and staying in K17 part.

Medical students used to be priviliged enough to be able to stay in college without having to collect merits like other students, the cream of the cream syndrome if you ask me, so the few of us that do join these activities were seen as fools, and some were even advised by colleagues to quit medical school (with good intentions, of course) *ahem ahem*. Most of us won't even go out of the college to have a jog, preferring the creature comforts of our dorm rooms, let alone become chairperson of an event! So one wonders why should one get involved in these silly activities that nobody remembers in a few years time? I've heard of people saying medical students are so busy, they don't even go out to buy their own dinners! I've also read newsclippings relaying the opinion of some nerdy med student saying there is no enjoyment when studying medicine, only hard work and duty. Those "facts" are only true if you want it to be.

I have had the best time possible, and have learnt so much from being in UPM, and I've only gone through third year!  I never would've thought it would be possible since I honestly hadn't even known UPM existed before I searched it up to fill in my UPU form. I tell this to so many people, but it bears repeating: even if I could re-wind time, my first choice in the UPU form would still reflect that I want to be a medical student in UPM. Had I joined UM, UKM or USM I wouldn't have been able to join debate, I wouldn't have learnt the stuff I did, I wouldn't have been able to form the great relationships with the medical students, the staffs or the students from other courses. I would've never been able to gain working experience with my employers, some nasty, some nice. In short, I wouldn't be the person I am today .

Kem perkasa!

I think if I was to tell the kids about my time in UPM, the best thing would be about the fun I had joining the UPM debate team. (Of course, academically, clinical year was the best fun I've ever had learning.) It wasn't even hard to join debate because all you needed to be able to do was to speak "Yes" and "No" and you're in. Read the news and humanities journals? Learn economic/political/social theories? Um, yeah.. not really. I met with people I would've otherwise never did in K17, law students, fine art students, from Sabah, from Kyrgyztan, from other UPM colleges, previous medical graduates of UPM (hi Sooch!) Finally, it feels like I don't have to commit suicide by slitting my wrists with all my medical notes. I hadn't been able to join more tournaments since clinical year due to financial problems but I should hope that's about to change in 4th year.

Likewise, there are many seniors that's been vice president of the college MTM, MPP representatives, AIESEC members, thoose active in religious societies and so forth. Some can sing, dance, act, or all three and they do it well! Some have organized several big events and made it into the news! Some of them have their own side businesses and are able to afford cars on their part time jobs (hi Kak Ikin!). Some are married by their second, third, fourth year (hi, um.. nevermind). Don't think that a medical school limits you from having a life, because only you can decide that for yourself, not other folks propagating "truths" like to be a good doctor, one must study 24/7. Your life and how you balance it is up to you, so take control of it. People do ask, "How do you balance your studies?" I have no answer for this because I'm still not good at it even if I'm not active in extra-curricular activities, I make do with I have and I'm always improving my time-management.

Sports Medicine posting at Institut Sukan Negara, Bukit Jalil

I think it's better if I went by the format of what happened throughout the days since the posting is only a week long. But you learn so much, and it was quite fun, though it has to be said the only sport I enjoy participating in is sleeping, which I figure requires extreme stamina in order to be fully mastered.

Again, apparently UPM is the only medical school in Malaysia that offers this posting, according to Dr Jasmiza Khuzairi (a 3rd batch senior and also a sports medicine MO working at ISN). Sports medicine is pretty much what it says on the can, the practise of medicine pertaining to sports. No OTs or surgery here, kids, unless you're an orthopaedic surgeon wanting to sub-specialise in sports injuries, which incidentally is where Prof. Lim said the real money is! Nope, just intra-articular injections with hyaluronic acid (corticosteroid if we're lucky enough to see it) and a bunch of orthopaedic examinations to localise the athlete's problem.

The girls from group A2 with Datuk Lee Chong Wei

SO, here goes:

DAY 1: Prof Lim gives a lecture in the morning about acute and chronic sports injuries. Pretty much only three sticks in my head:

1. Muscles sTrain, Ligaments sPrain. Both mean the same thing, tears in muscles and ligament respectively. Beza t dengan p kena ingat ye. 
2. You use RICE as an acute management to sports injuries: Rest, Ice, Compression, Elevation.
3. Strains and Sprains are of three grades: Grade 1 =  microtears, Grade 2 = partial tear, Grade 3 = complete tear.

That's pretty much all I learnt for that day. They had a blackout lasting for two days at ISN so I spent much of the time sleeping in the comfortable pseudo-bed in the rehabilitation gym next to physiotherapy while everyone else worked out. Why bother since we had physical conditioning in the evening? In any case, because of the blackout, we couldn't use the gym to meet the famous athletes, no sauna, no hydrotherapy, no nothing. Then physical conditioning with Ms Ooi Swee Gaik was hell on Earth. According to her, we were doing the easy version. We did warm ups, co-ordination, balancing (for joint stability), core training and stretching all of which are not easy for a bunch of nerds like us to do. All of us suffered from DOMS (delayed onset muscle soreness) until Wednesday. I could feel it in my bones, my muscles, my ligaments. Everything. Hurts. Even going up the stairs or laughing the next day became a painful Herculean task. Today's lesson: Don't wait for sports medicine posting to work out. Get your ass moving!

DAY2: Dr Victor came and did a clinic session with us and gave an intra-articular injection for someone famous whom I can't seem to remember. Which is odd, because I was alone with her in the clinic for awhile, and I introduced myself and asked her for her name and the sport she plays, and had to be embarrassed later on when I told her I skip the sports section in the news. She's apparently the best Malaysian female badminton player on record, recently retired. She must've thought I was a complete moron.

Dr Victor (who reminded me of this 5th year named Hafiz because he looked like a Mat Salleh with a pekat Malay accent) took us to Bilik Kenanga to discuss INFLAMMATION. You might be laughing now, but it was a struggle in that room for all of us to remember first year pathology on chemokines, inflammatory cells, cardinal signs involved in inflammation. We barely scraped through alive. Learn from our mistakes, learn your inflammation WELL!  It's so easy, so trivial yet so important in every single discipline you go in. I've never been in a posting where the cardinal signs of inflammation was not asked. We had a Physiotherapy session later with Pn Faiza who showed us a bit about electrotherapy and taping. Pretty cool all in all. I remember Yog telling everyone he saw Azlan in the gym, the half Scottish squash player who posed half naked in CLEO; yes that one, I remember. Lesson today: Know this country's athletes, and hafal inflammation sampai muntah darah.

In the Medical Ward...

It has been a while since I wrote in proper English after my SPM exam until today. Seasoned by the experience of slightly more than half a year of clinical experience, I was asked to write an essay regarding internal medicine posting. The first thing that popped in my mind was just a repetition of three words- hectic, hectic and hectic. I wonder if there was anything rather more interesting than examining young female patients legally, with a yellow license clipped on my formal attire. Although it sounds interesting, I’m sure all medical students who were in my shoes will find it perplexing as most of the time, we are not sure what is exactly that we are examining.

Other than those “interesting” events in our clinical life, I can hardly scavenge fading memories regarding something particularly interesting that happened somewhere around October 2011. That was a fine day among hectic days, when all the year three medical students were so occupied with the preliminary tasks in their mind, mainly filling up their log books. My plan was to get at least 5 signatures of all the blood taking procedures from the hopefully kind MOs or HOs. And there is no free lunch here. I was prepared to be summoned here and there to help with this and that. The actual situation that happened that day surpassed my wildest dream. I haven’t enough cortisol or adrenaline to face the situation which has doomed to happen in this normal day. I was a medical student and today I deal with a real life!

It was 5 in the evening. This is always the time of day when we (some hard working student might disagree with me) doze off pretty easily. It was in Ward 7B, a ward with a number of acutely ill patients struggling to stay alive. During the day, most of my course mates were discussing what food to eat next and I wanted so much to join them. As always, I was not really feeling considerable to spare the patients with funny sounds in their lungs or hearts my time but I knew I had to do it anyway. My cold diaphragm of stethoscope was gently applied on their feverish chest. Of course, I asked for consent before I do so even though I realized that deep down in their heart they wish to left alone to breathe peacefully.  But what to do, I really wish to be a good doctor…

Initially I thought the few bizarre presentations from the patients would have made my day fantastic enough. When I was just about to happily leave the ward, I sensed something amiss at the corner. A few MOs and HOs were rushing towards a bed hastily with gloves and masks. It was not the first time to see situation in a medical ward. However, driven by curiosity, I approached the bed, trying to figure out what has actually gone wrong through the anxious expressions on those young doctors’ faces. From far away, the ringing of alarm from the machine seated at the bottom of the bed was clearly audible. Each wave of frantic alarm pervaded the atmosphere, stimulating adrenaline rush from everyone out there.

Slowly, some of the familiar faces started to appear in front of me. Then came Shafiq and Liyana (and also a few dudes I have forgotten who), who were still lingering around the hospital ward with unknown reasons (they are not ghost, they are good medical students…, just like me.). “Eh Pang, ape bende ni…” “Mane aku tau… Itu houseman macam tension gler…” “Nasib baik kita medical student je… Kita tengok je la…” We merely chuckled as we knew that was the only thing we managed to do at the moment.

Half an hour was gone, and we were still standing beside the bed. We realized that this patient was a TB patient. At first, we still could see the jerking of the leg of this patient whenever an intubation tube was inserted forcefully into his throat. “Ni mesti sakit gila…” Shafiq uttered this with chills and rigors. Then, a houseman started to surface mark the midinguinal point for femoral pulse. I assumed he wanted to dig some blood for ABG. He failed a few times to locate the arterial blood. Every time the large bore needle was pierced into the false area (I guess sometimes accidentally pierce the inguinal ligament, femoral vein or bla bla…), a clear brisk contraction of his quadriceps muscles was visible. After a few attempts, the houseman was happy. I could remember vividly Shafiq’s facial expression, as if he was the one lying on the bed.

Another half an hour was gone. This time, the MO in charge took a resuscitation bag and instructed the houseman to pump in air into the patient’s intubated throat. The resuscitation bag was blue in colour and looked soft to be pressed on. Therefore Shafiq was curious to ask me the following question, “Kenapa mereka mcam letih je tekan itu bag…” I could not answer him as I was having similar question mark in my heart. Therefore my answer to him was, “Pura-pura je mereka ni… Mau tukar shift awal kot…” My irresponsible answer was immediately replied with a bad karma, when the MO shouted at us. “Medical students right? Why are you guys standing there? Take a mask to come and help!!” That moment I knew my statement regarding the resuscitation bag is going to be justified as a FALSE statement.

All of us (the innocent medical students) bravely took a mask and a pair of rubber gloves, put them on, and tried to aid the resuscitation. At this point of time, we were all consuming glycogen store in the liver as all the glucose available in blood stream was all used up in the afternoon to examine patients. Perhaps God was trying to let me understand how hard resuscitation was. The first thing I was asked to do after fixing the patient’s leg immobile is to pump the air to supply oxygen to the patient. Oh god… I’ll bet you’ve never pressed such a hard rock stony dull bag in your life before. The perspiration drenched my formal shirt, my tie, my long pants, and my underwear, my everything… Now I realized the houseman was not hoping to end their shift earlier…  Shafiq was very clever. He stood beside the patient at the end of the bed, never wanted to approach the patient’s head… His duty was pretty easy, to hold the patient’s leg. I looked at him with an eye expressing vengeance. However, he dodged my eye. I can see his smiling mouth under the mask.

The patient SaO2 gradually fell. Then we have reached a moment to perform CPR on his chest. Again, I started the task as instructed. Now Shafiq has to take over my job. Once a while I look at him and I was happy to see him suffering now. Out of the blue, the patient vomited his blood. The blood spilled all over and onto his, her, their, your and not to forget, my face (here I exaggerate a bit to make it fantastic). The houseman was grateful that she was wearing an apron. I was pissed off that I was not wearing an apron. Shafiq was pissed off that he was not wearing an apron. Everyone there basically, was pissed off that they were not wearing an apron…

Now it was 7 pm. Oh god, I really could not stand this anymore and hence my question to Shafiq and subsequently to the houseman (after getting no answer from Shafiq), “We need to do this till bila ah Doctor?” The houseman, unsure with his answer, replied me “Until the ventilation machine arrives.” Then my next question will be “Bila itu machine boleh sampai?”… But before I throw my question, the houseman ran away to get some stuffs from the counter, probably he also did not know BILA.

Now it was 7.45 pm. An angel arrived (as if from the sky) in front of us and started plugging all the colourful wires to awaken the machine. Shafiq, with a BIG SMILE on his face, announced to me that we have rescued the patient successfully! WOOHOO… (I will skip this part for some reasons you will understand in the next paragraph.)

ENT posting (aka Easy No Tension posting).

Now, one of the things I never thought of would be this. I mean really people? Who would have thought I’d be writing an article on any posting. Then again, I suppose wonders or in this case, surprises never cease to exist. In either way, this is supposed to be an article about ENT posting.

Taken from Google Images

So, now, the question is where to start. The general consensus would say that that would be at the beginning itself. And I must warn you, I am a bit tedious when it comes to details and descriptions. Just kidding. It merits to be mentioned here that I literally did not know what posting I was going into the first day. All I knew was that the day before, we (Jay, Julia and I) had decided that we might as well go to the faculty at 8 in the morning and see what happens. So, the next morning, we had Julia coming into our room and telling me and Jay that she and I were in ENT while Jay got ophthalmology. It was a shocker and believe me when I say that I was whining in my heart.

Now, enough on all that personal stuff. It’s time to become professional. Again, just kidding! Not entirely. So, there we were at the tutorial room waiting for Mr. Yap and our briefing, which by the by was very informative and hilarious (you guys will experience it firsthand, and trust me, you will be glad I didn’t give you any spoilers) He managed to successfully make us look forward to the entire posting, despite the other shocker that we had to travel to HKL three days a week (that would be Tuesdays, Wednesdays and Thursdays). I suppose that you might want to know what made up the silver lining of that particular cloud. Truth be told, we realized it when he said the most important thing in that briefing; ‘WARDWORK = TIMES SQUARE TIME’. Not that we ever did it. Truly! Another thing about ENT is that the lectures are divided into 5 modules namely Laryngology (Dr. Subha), Otology (Dr. Khairul Shaharuddin), Rhinology (Ms. Narizan, who is actually an invited lecturer from HKL), Head and neck (Mr. Vincent, who is a new lecturer) and Allergy  with Mr. Yap himself). We also have another lecturer, Ms. Saraiza, who is an invited lecturer from HS. Okay, I see that I have handled the introductions to our doctors, I would believe now, I should give the limelight to our constant companions. And by that, I am in fact referring to our books.

Taken from shawnfeeney.com

For those who are going into ENT, the preferred reading material would be Lecture Notes on Otolaryngology by P.D Bull (not PItbull, as I initially thought. And I must admit, his name was one of the reasons I finished reading this particular book). Mr. Yap would tell us to finish this book by the first week (fret not, it is possible, even with a packed social calendar like ours) and then to move on to heavier materials such as P.L Dhingra’s Diseases of the Ear, Nose and Throat or even Logan Turner’s textbook who’s name escapes my memory at this point of time. But remember, whatever books you might read, it all tells us the same thing. Only difference is whether it is simple or convoluted.

After his briefing, we had the pleasure of meeting Ms. Subha in lecture. Later, we went to her clinic and learnt many things, the first one being that we did not know a lot of things. Hilarious isn’t it? Nonetheless, we had loads of fun in both clinic and her lectures. The next day off we went to HKL in the 6.30 am bus. I know it sounds not so fun but when you’re sleeping in the bus, all the animosity towards traffic jams for making us wake up so early to avoid it melts away in your dreams. In HKL, within the next few days, we would come to establish a routine, namely consisting of lectures, clinics and speech/audiology sessions (this is where we have to observe how audio testing is done by the audiologist and also speech therapy). Don’t get me wrong guys, these sessions are also available in HS but with fewer patients. An important note here would be regarding the BERA (Brainstem Evoked Response Audiometry) and also the allergy testing (which is done on Mondays and Thursdays in HKL and on Wednesdays in HS). BERA usually involves babies and requires them to fall asleep, so it is as you might be able to imagine, rather boring. So, when you go for that make sure you guys alternate. As for the allergy clinic, try to get it settled fo as soon as possible in the mornings because they usually finish up by 11 am. Then, we would also have bedside teachings in HKL, whereby each group gets two turns each, once with Mr. Vincent and another with Mr. Khairul. During our time there, Mr. Yap was away, so we didn’t get him for bedside or the opportunity to join his NPC clinic at the oncology clinic on Tuesdays. Hopefully, you guys will have better luck with that than we did. So, basically these are what you will be doing in the 3 weeks that you are here and in HKL.

Taken from geekologie.com

OW! Before I forget, we also had skills lab, where we got to play with all the ‘tools of the trade’, namely the otoscope, Thudicum (nasal) speculum and also mirrors that let us see your larynx. So, yea it was fun. Loads of it. Now, I can't imagine to tell you all that we experienced or learnt in ENT but I can endeavor to give u a sketchy idea of what it was like to be in this particular posting. Truth be told, it is actually a jam packed ride that is fun and scary at the same time.

Taken from onthebrinkofanewera.blogspot.com

Now, in a nutshell I believe I have told you as much as I can about what to expect in ENT posting, but truth be told, I feel like a spoiler already. Hopefully you guys would find this an interesting article that was helpful and funny (now, that’s the narcissist in me talking!) Now, for those who will be going into ENT, cherish every moment you get to spend in this posting. The main reason I am saying this is because 3 weeks has the tendency to just pass within a blink of an eye (I think that is the ophthalmology posting speaking). Anyways, have fun guys and hope you guys enjoyed this article.

P/S: There were no suicidal tendencies experienced!

Durga, 3rdyr 2010/2011

Geriatric Posting

Geriatric, based on Wikipedia is a sub-specialty in internal medicine that focuses on health care of the elderly.

So, in Malaysia. UPM je yang ade posting geriatric untuk medical students setakat ni. Jadi, kami yang third year ni kena la ikut sajaaa~ Sepatutnya dorang letak kat fourth year, tahun ni dorang pindahkan ke third year. Tapi bagus jugak, fourth year nanti kan dah major posting susah2 je semuanya, cam tak kena plak tetibe ade geriatric. Sebab geriatric ni, bagi aku minor posting je. Best je! Even though kena pegi HKL 3 minggu, awal-awal pagi. 6.30 bus dah jalan. Tapi, best!

Sebab posting ni je tak payah study banyak. Sebab kebanyakannya benda-benda yg dah study kat posting medicine mase 5th sem. :))

Basically, kitorang banyak jumpe case stroke la. Since ward 16 tu banyak accept elderly patient untuk rehab kan, jadi ramai patient yang dah kena stroke, and dorang admit sebab nak rehab. Rehab dari segi emotional and physical.

Kalau emotional, mcm dorang assess tahap depression orang-orang tua tu la. Mental state semua, nutritional pun ada. And for physical, dorg assess mcm mane orang-orang tua ni nak be independent after their traumatic event. Kan selalunya orang stroke, dorang ade weakness on either side kan? So, kat ward ni, physiotherapist, occupational therapist, the doctors and nurses akan berganding bahu untuk improvekan functional ability dorang. Kira yang tak boleh jalan tu, mula-mula pakai wheelchair, pastu walking frame, pastu quadropod then last-last pakai walking stick je! Lek je, dah bleh jalan. So bagus la. Lagi satu, kalau yg tak boleh uruskan diri sendiri, dorang akan ajar balik la care untuk jage diri. So, penjaga takde la susah sangat nak jage dorang kan.

Masalahnya, geriatrician kat Malaysia ni, sikit gilaaaa. Compared to geriatricians kat Singapore, memang boleh gelak je la. Kat sana berpuluh-puluh, sini tak sampai belas-belas pun. Aku pun tak tau, bila ikut posting ni, ade jugak tergerak nak jadi one of them kan. Tapi tak tau la, jauh lagi perjalanan untuk decide skang ni.

Mase posting geriatric tu, macam-macam belajar. Pasal healthy aging; and others;

• Balanced diet (same je ngan orang-orang muda punya, less salt, vegetables, 6-8 glasses of water, reduce white rice and pasta intake, better ambek brown rice. dairy products are important to avoid osteoporosis. And banyak lagi) cuma org tua selalunya takde selera nak makan, jadi dorang senang malnourished. Kitorang punya group project pun dapat identify more than 50% elderly are malnourished. Haih.
• Proper exercise for elderly is not jogging. Jogging akan cause problems to their knees. (Osteoarthritis) So, elderly harus practise safer exercise, macam walking and tai chi.
• Boleh retire, tapi jangan stop everything all of a sudden. nanti bole depressed. So, galakkan orang-orang tua buat keje, jangn bagi dorang boring kat rumah. Bagi otak dorg active walaupun dah retired. To avoid dementia too.
• Jangan neglect orang tua. Caregiver kene responsible.
• Avoid FALLS. And macam2 lagi

Senang cerita, posting ni banyak mengajar pasal life. And banyak jugak la aku terinfluence dgn lecture geriatricians pasal healthy aging. Harap-harap boleh praktikkan sampai mati. Pastu banyak jumpa orang-orang tua yang comel. Iaitu Aunty Maria yang pernah sama sekolah ngan aku. Sangat friendly and loving. Lebih 5 kali kena peluk ngan die, siap kena ciom2 lagi. :) Bagusnya orang tua mcm tu, sampai tak jumpa satu hari pun dah rase bersalah.

p/s: Nak avoid wrinkles, silalah pakai sunscreen SPF > 30 dan moisturizer yang secukupnya SETIAP HARI even though you claim that you don't get exposed to sunlight, just use it anyway. Saya syorkan Loreal UV perfect ya, dah gune lame and sgt bagosss. ;)

XOXO*, 3rdyr 2010/2011

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*bukan nama sebenar

Memory and Instinct

(Picture taken from Google Image)

I should probably write the first article to encourage more to come along.

I'll be the first to admit it. I feel I don't deserve to pass my professional exam. Not that I'm not grateful to lecturers or God, without them no way I would've been able to pass. No, rather, I feel like I lack the knowledge and thinking ability that I've always imagined a third year should have.

When I was a first year, I used to look at the third years as if they're the most amazing people ever and wonder how they ever passed their exams because I was struggling and had convinced myself that coming from Physics stream, I was more handicapped than most since I hardly studied in my years as a student. I remember every time we had a Problem Based Learning (PBL) class, a chief complaint was given, and we're supposed to give a rundown of differentials. And I remember saying to a mate of mine, "I can't wait until I'm a second year and we've gone through all these systems. Then, we can do this PBL thing properly. Time tu dah tau semua, baru boleh diagnose semua benda." Kononnya lah.

Now that I'm a third year, every day is PBL day, and every person in hospital is a PBL patient. And I'm still no better off than that first year girl who feels like she has no clue as to where to start diagnosing her patient. Now I think, "I can't wait until I'm a specialist. Then I can diagnose the patient intelligently." And then I'd wonder about how lost I'd feel like when I actually am a specialist...

Now and again, I have first years coming up to me, asking me, "How do you memorise all this stuff?!"

I wish I knew then memorising is a basic skill, and not even the most important skill, whereby the most important, the crux of a doctor's neurological software is the ability to think. Bak kata Mr. Gee, "Common sense is not so common."

How we used to memorise time tables from two to twelve to be able to do complex calculations properly until the ability to calculate 1897 x 789 becomes a basic function in us as a human being is exactly how we should treat medical knowledge. After being exposed to a certain problem, a brain's structure changes in a certain way so that the next couple of times we try to solve the problem again, the thought process that occurs in our brain is faster, almost automatic, as if by instinct. For example, monkeys solve true-false problems faster when they are taught the concept of one and zero!

Just like how log, calculus, etc is the next step in maths after learning how to multiply and divide, thinking and diagnosing is the next step after knowing all that medical jargon and information. Interpretation of signs and symptoms, prognosticating, treating, referring is the next step after knowing all your values, your facts, your texts. After all, you don't want to examine a sick patient infront of you and still be thinking mainly about whether you're doing the steps correct! It should be a given, and what you should be doing already is collecting clues.

It doesn't matter if you're from the Physics stream, if you're a monkey, you can learn medicine, anyone can. Don't think you're a better human being than most just because you're taking the medical course. (Yes, there are people who act like it!) It just takes unfailing will to continue to memorise and learn until it becomes instinctual on top of a powerful internal drive to be able to think, not just for your sake to pass exams, but for the patients you're facing in the future.

I hope first years remember that. That exams are just exams. That if you pass exams, viva, repeat papers, whatever it is, well done, no-one cares, no-one's looking at your pointer. I hope they know the things they're learning aren't for exams, but for that Holy Grail of a medical career: the development of a professional medical instinct. Here's to hoping that we all reach that point some day in our lives.

Nazirah, 3rdyr 2010/2011