Why i want to become a doctor.

This is NOT my story.,

I found it when rearranging my documents in my lappy. Read all the files that were not needed. I saved this article few years ago during my KTT years.Hope you will be inspired by this story.Author unknown.

My mother often recounts a story about me following around my father, our small town’s internist, on a certain home visit. Upon finding a woman with a swollen, painful belly, he began palpating her abdomen -- when he noticed two tiny hands of a toddler, emulating his own. I cannot remember a time when I was not interested in health care. As I finished high school and entered college, however, I had my doubts. I grew up watching my father suffer the hardships of his career, from long hours and disappointments to the difficulty of providing adequate care under insurance regulations. Additionally, I wondered whether I was genuinely dedicated to medicine or whether I was simply infatuated with the idea of imitating the extraordinary individual that is my father. Indeed, with three members of my immediate family in medicine, I felt as though I was simply falling into the occupation. Today, however, I have come to realize that I did not merely fall into medicine -- I fell in love with the profession on my own accord.

One notable memory often reminds me that when I am providing any type of patient care, no matter how minor, I have the feeling that I am at home. As a lifeguard, I had the chance to provide first aid on several occasions, and I recall one such event very clearly. During the summer after a particularly difficult sophomore year in college, I was left with many questions, including whether medicine truly offered the best career path for me. Then, one afternoon I was watching the pool when a young girl, slipping from the waterslide, collided with another swimmer. She struggled out of the water in a panic, fearing a broken leg. Rushing over, as I calmed her and assessed her right leg, I suddenly had that familiar feeling: this was my calling. To date, nothing in my life has felt more natural than when I was caring for Marie by the pool that day. Consequently, in the past two years I have only sought to expand on my opportunities to participate in and provide medical care to others. Last year I completed my training and gained certification as an emergency medical technician, and only recently, I began volunteering with the Orange County Rescue Squad. Finally getting the chance to participate actively in patient care has proven tremendously fulfilling and has further solidified my commitment to the medical field.

Hoping to learn more about health care within hospitals, I volunteered at the University of North Carolina’s Resident OB/GYN Clinic in the Women’s Hospital. Here, the nurses and residents have taken extra time to explain their procedures and courses of treatment, while I have also actively taken part in the care of the patients. In the past year I have gained experience taking blood pressures, weights, and patient histories. I also spent a memorable night following Dr. Lois Aronson in the labor and delivery ward. During this period, I observed two deliveries and two surgeries, and I also learned to perform pelvic exams and find fetal heartbeats. My favorite part of the whole volunteering experience, however, must have been the chance to witness Dr. Aronson’s thoughtful and compassionate interaction with patients during normal prenatal checkups. While observing her careful communication skills, I developed my own approach to conversing honestly and caringly with patients.
To complement my hands-on experience preparing for my career as a physician, I have devoted my energy to preparing for the rigorous scientific education that must preface the training of any thoughtful and capable physician. When reflecting on my college career, one experience stands out as the most enjoyable learning experience of all: teaching an introductory biology lab at UNC for two semesters. This endeavor allowed me to assume the role of a mentor and an instructor. As I was responsible for the laboratory education of 25 students each semester, this undertaking taught me to become a communicative leader who can guide others in their educational development. Moreover, the sheer amount of pleasure I received from helping my students achieve their goals reflects my commitment to a career of service.
My mother always said, “Don’t be a doctor unless you have to.” I feel that I am truly beginning to understand what she means. I know that becoming a physician is a long, difficult path. I have witnessed the realities of medicine in my own home and have spoken with an exhausted medical student on the thirtieth hour of her shift. I also know that for me it is worth it. Nothing would make me happier than devoting my life to becoming a physician and delivering quality, compassionate health care. To achieve my goals, I look forward to medical school as the next necessary and welcome step.

When a pod of 55 pilot whales recently beached themselves on a stretch of Cape Cod, vacationers and beach-goers came to the rescue. By high tide, they managed to save 46 whales. In explaining his motivation for jumping in to help, one volunteer simply answered, “Life.” The same purpose inspires my ambition to become a physician.

Medicine appeals to my deep appreciation for human life, inculcated by studying man as both a human being and biological machine. The decision to practice stems from a perpetual fascination with science combined with this basic love for life. I grew up capturing insects and watching PBS, always questioning the complexities of how the body works. Through academics and medical research, I have begun to answer this question.

My passion for knowledge of the inner workings of the human body led to proactive involvement in medical research, enriching my view of medicine as well as nurturing the desire to continue research endeavors throughout my medical career. For the past two years, I have studied the relationship between structural damage and preserved clinical function in multiple sclerosis patients through functional MRI, under the tutelage of Drs. Cranston and Mahoney. Although unsure how these two factors correlate, we hypothesize that a critical period exists when the brain undergoes reorganization. In a concurrent study, I am investigating the role of the pelvic veins in cryptogenic stroke, funded through a grant awarded by the American Heart Association. The objective is to determine, via MRV, whether the pelvic veins are the source of thrombolytic emboli in cryptogenic stroke patients who also harbor a patent foramen ovale. The results of these studies not only will contribute to the advancement of medicine, but may also hold therapeutic benefits for those afflicted with such neurological damage.

The rewards of medical research lie in its practical application, and there is no better place to observe the miracle of life than in the NICU. Each day, newborns struggle to survive, illustrating the inherent advancements and limitations of medicine. I have witnessed preemies, from 24 weeks of gestation and on, live and die. Exposure to patients revealed that people are much more than collections of cells and organs -- we all share the special gift of life. My role in helping to care for them abounded with both challenge and joy.

My first patient, Baby S, arrived nine weeks prematurely and spent the first month of life in the NICU. Due to the presence of an extrachromosomal fragment, he suffered slight mental retardation. His mother, who had the same condition, visited infrequently during his hospital stay. When she did, her visits were brief and inattentive. I grew quite fond of Baby S, often watching him snuggle into the blankets like a small burrito. Although his sky blue eyes moved in a spastic manner, they gave life to his somewhat immobile body. He rarely showed signs of discomfort, whether hungry or needing a change. I tried to give him the extra attention he lacked. At times, he rewarded my efforts to interact with a smile; other times, he gave me a dirty diaper.

Reflecting on my experiences, I realize that the practice of medicine entails more than remembering and dispensing scientific facts. It requires exercising both mind and heart, along with a genuine respect for life. Baby S and my other NICU patients instilled in me a sense of how precious life is, and I am certain that my current EMT training and planned medical mission to southeast Asia will reaffirm my conviction to improve the lives of others.

The career of a physician will allow me to balance an intellectual curiosity with my desire to help those in need. By helping man at his best and his worst, combining a passion for life with the pursuit of scientific knowledge, I can help heal and comfort others. I eagerly anticipate a vocation in which my patients fuel my search for knowledge, and that search embodies reciprocal benefits to my patients. When asked why I have chosen a medical career, I can confidently respond, “Life.”

To this day, the very thought of red oak bark tea nauseates me; my mouth still retains that bitter flavor. As a child in a rural community in the foothills of the Rocky Mountains, even the threat of home remedies like red oak bark tea was usually sufficient to scare the sickness out of me. Once, when my mother administered powdered alum to my sore throat, I concluded that my family must have had enough of me. They assured me, however, that alum was not supposed to make you gag quite that much.

I never considered becoming a doctor as a child. My family could rarely afford the luxury of proper medical treatment. Thus, unpleasant home remedies were my earliest experiences of healthcare, and I cannot say that they were exactly prepossessing. Nor was my opinion unusual in my environment: in my rural farming town, doctors were the people you went to when all your family remedies had failed, and you couldn’t get out of bed to go to work anymore. Medicine was seen less as a way to improve your quality of life than as an expensive method of postponing the inevitable.

I could not point to a specific date as the day I decided that I wanted to commit my life to medicine. Rather, it was a gradual realization that grew out of my love for biology and my sense that the path I was taking was not meant for me.

Merely attending junior college was an enormous achievement for me, as none of my family had ever graduated from high school. Initially, I intended to earn my associate's degree in biology. Unfortunately, my family’s difficult financial situation prevented me from following my interest in this field, for I soon had to find a full-time job to help out at home. I continued taking classes at night, but unfortunately, no lab courses were offered in the evening. Finally, after four years, I completed the requirements for an associate’s degree in economics. That was when I realized that I wanted to explore biology further. At moments, I even began to think of attending medical school, only to dismiss these daydreams as no more plausible than winning the lottery.
I soon married and entered a very difficult period in my life. Trying to keep my husband happy and my marriage together, after earning my associate's degree I quit the job I had enjoyed since high school graduation. I proceeded to change jobs every six months or so for the next two years before separating from my husband. When I knew there would be no reconciliation, I decided to follow the dream I had put on hold, and I applied to the institution I now attend to study biology. Being a doctor may not have been a lifelong dream for me, but it is my calling.

The first time I met Carla, she was sitting on the floor alone in the middle of the lunchroom while the rest of her cabin played outside. Carla was a frizzy-haired 11-year-old girl with autism. It was her first time away from home, and she was struggling to adjust to the new patterns, people, and places. At the same time, as her camp counselor, I was trying desperately to figure out her needs. Carla could not communicate spontaneously, and she responded to my questions only by repeating them. It was difficult helping her transition from one activity to the next, because whenever a game ended, Carla would just flop down on the ground and refuse to budge. I tried singing songs, dancing, and playing "follow the leader, " but nothing uprooted Carla. Then suddenly, after a few days of working with her, I noticed that Carla was fascinated with hands. Although she would not hold people’s hands, she liked to touch them and look at them, and I soon discovered that I could use her interest to motivate her to participate in life around her. For the next two weeks, I transformed my hands into butterfly wings, and the two of us flew around camp together. Although we could not communicate verbally, we found a connection more powerful than conversation, and I discovered how deeply satisfying it is to help other people, particularly those who cannot speak for themselves.

I have dreamed of becoming a physician since childhood, because medicine offers the rare opportunity to combine science and humanism to make a real difference in other people’s lives. I have a longstanding love of science, which led me to major in engineering in college because I enjoyed working on applied scientific questions. Most of my course work and extracurricular activities were science-related, but my interest in medicine solidified, ironically, during the summer when I took my first break from science. During the fall semester of my junior year, I began to feel overwhelmed by conflicting responsibilities in my course work, part-time employment, and various extracurricular activities. I realized that I had spent most of the previous decade enrolled in academic, research, and community service projects to prepare myself for the challenge of medical school, but I had not yet confirmed that aspiration. I tried to focus on what made me happy at the time, and I realized my most beloved experiences occurred while I volunteered at a pre-school with disabled children. Whether I spent my time helping the children swim, reading to them, or simply chasing after them, I always left with the feeling that I had made a small impact on their lives.
I researched camps for children with special needs, and after talking with directors and former counselors at numerous programs, I chose to become a counselor at the Frost Valley YMCA Mainstreaming at Camp program. I started that summer both excited and daunted by what lay ahead. The counselors and directors warned me that the job would be emotionally, mentally, and physically exhausting, but I had no idea what I would encounter. That summer became the hardest and most rewarding time of my life. Every two weeks a new group of children with a wide range of developmental disabilities entered my life and became dependent upon me for almost all of their care. I quickly realized how different each child was and tried to adjust my counseling style to fit their individual needs. Motivating and communicating with children who cannot -- or will not -- reciprocate your efforts requires a great deal of patience and creativity. Working with this special group of children tested me greatly, but I found that the hardest part was saying goodbye at the end of each two-week session.

During my last weeks at Frost Valley, one of my campers, a 19-year-old girl with mental retardation, began having seizures. I recognized her symptoms, but one night her seizures became continuous. We called an ambulance, and I jumped on board so that I could spend the night with her, holding her hand and acting as her medical advocate. Because she looked quite “normal, ” it was difficult for the medical staff to understand that she had the communication skills of a 9-year-old. After I explained her condition several times, however, the staff realized that although Jackie looked “normal, ” she required special care. After a long and scary night, Jackie was released from the hospital and sent back to camp. Fortunately, she recovered completely and was happy and healthy for the rest of her time at camp.

I am sure she will never remember how frightened she was that night -- or even my holding her hand -- but I know I will never forget it. That summer, particularly that night, reaffirmed my desire to become a doctor. I realized how critical it is for medical professional to understand the needs of special populations, to work directly with them and their families. I also understood that I could join my two loves by working as a pediatrician for children with special needs. Caring for a child who cannot tell you what is wrong requires a person with patience, skill, and compassion; it is my dream to become one of those people.

OBG : OT Day

Day 2.



Its OT day.

Today, we had seen the common.
A known case of ovarian cancer, its seromucinous type which produces ascitic-like fluid in the peritoneum. From tip-toeing behind Dr N and Dr L, i could see grain-like thingy scattered all over the bowel. They decided to do colonoscopy and sent us all out. Instead Dr L asked one of the unfortunate PG to take a class on ovarian tumour. As expected,she taught us whatever she knew,and let us go early.

Pheww,

Today,it is so much like a pasar malam or a kindergarten. There are people screaming,some runs,some frowns,some giggling at the corner and so on.

It is going to be alternate days of pure boredomeness in OT in which much better than having class in OPD.Why? Coz it is so boring and most importantly NO AIRCOND!





Bring flip flops!

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OBG: The womenhood and maternity world

DAY-1 9th term

Instead of watching educational videos..try this!

Heheh..that one is a korean drama. Do watch the drama. I haven't seen it yet.I found it in Youtube asi was trying to search for antenatal examination.

Hihih...

End of Paediatrics Posting

I will miss these kids!

She had thalasemia major with hepatospleenomegaly.

Classic clinical presentations of Nephrotic syndrome.Aged 4 years old.

In theory class.

My lovely friends trying to console this baby. ughh!


Bye-bye...See you again kids next year!!!

21st century patients end era of ‘doctor knows best’

Source: here.

March 12, 2012

FMT LETTER: From M Saravanabavan, via e-mail

There has been a sharp increase in the number of medical negligence claims mounted in the courts in Malaysia throughout the years and as a result, the Courts have granted sizeable awards to victims of medical negligence.

In 2011, the High Court in Penang awarded RM150,000 in damages to a former salesman who had been wrongly diagnosed as being HIV positive by a private hospital. In the same year, on another instance, the High Court awarded RM100,000 in damages to a deceased woman’s family for failure of a private hospital to investigate and diagnose that the deceased suffered from colon cancer.

Recently, on Jan 21, 2012, the High Court in Johor awarded a couple a total of RM870,000 due to medical negligence by two hospitals and the Government during the child’s birth.

These cases do not indicate a healthy trend for the country. Neither the doctor nor the patient would want to undergo the painful process of litigation. Large awards will probably deter future omissions and negligence but it will also damage the reputation of the healthcare system.

Perhaps a greater understanding of the law in relation to medical negligence may do some good. Given the growing demands of accountability by the society, it is imperative that medical service providers are made knowledgeable about the legal issues affecting them in their daily practice.

A good starting point would be to define negligence. Negligence is defined in law as the breach of a duty to use reasonable care as a result of which there is damage to another. In simple terms, this means fault.

Indeed it is trite law that a doctor owes a duty of care to his patients. Therefore, medical negligence will occur if a medical practitioner has in some way harmed a patient or caused harmed to patient due to the fault of his own. He will be considered to be in breach of his duty of care and in turn as negligent.

Of course, the law does not simply attach negligent liability to a medical practitioner by default, proof of negligent conduct is required and it will not be easy to show that a particular medical practitioner had been negligent. Who proves the negligent act? Under the law, the person claiming that he had been negligently treated bears the burden of proving medical negligence. There are two stages to prove this, firstly, the plaintiff must establish that there was a professional standard of care owed to him by the doctor and secondly, the plaintiff must prove the fact that the doctor has abandoned that professional standard.

The most commonly accepted manner of proof of the professional standard of care is another doctor’s testimony. This is where the Bolam principle is applied. This principle was established in the 1957 case of Bolam v Friern Hospital Management Committee. According to this authority, if the doctor manages to prove that what he did is accepted as a standard practice by even one responsible body of medical opinion, he will not be held liable for negligence. This is even so when there are other responsible bodies of medical opinion that take a stand to the contrary.

The Bolam principle allows the doctor to rely upon a body of responsible peer professional opinion to absolve him of professional medical negligence. The popular idiom ‘One man’s meat is another man’s poison’ is of relevance here in that whilst doctors are relieved that the law allows them to be judged by their own peers, the Bolam principle had clearly made it difficult for the patient to prove that the doctor had positively breached a standard of care owed in the circumstances. As a result, for the patients, the existence of the Bolam principle hinders them from getting justice and the fair trial that they deserve.

The Bolam principle was then subject to considerable scrutiny in the 1997 decision of Bolitho v City and Hackney H.A. In this case, the courts qualified the Bolam principle and formed a view that a doctor could be held negligent notwithstanding peer professional opinion which purportedly represents evidence of responsible medical practice if that opinion is determined by the court to be “not capable of withstanding logical analysis”, or is otherwise “unreasonable” or “irresponsible”.

Professor Rachael Mulheron explains the impact of the Bolitho case in her 2010 paper ‘Trumping Bolam: A critical legal analysis of Bolitho’. She states that the judiciary has pointed out that Bolithoturned Bolam on its axis, in that the court, and not the medical profession, became the final arbiter of medical breach. Since then, it has become a challenging legal question as to what features particularly characterise a peer professional opinion as one that is “illogical”, “irresponsible”, and “indefensible”.

Apart from Bolam principle and its subsequent qualification in Bolitho, there is another principle commonly applied in medical negligence cases. This principle is derived from the Australian case ofRogers v Whitaker. In this case, it was accepted that the doctor’s negligent act cannot be conclusively determined by “any profession or group in the community” but it should be determined upon consideration of complex factors, namely, “the nature of the negligent act; the nature of the treatment; the desire of the patient for information; the temperament and health of the patient; and the general surrounding circumstances.”

This is an obvious departure from the Bolam principle explained above. Under the Rogers principle, the Courts had the license to scrutinise professional practices to ensure that they accord with the standard of reasonableness imposed by the law. The ultimate question is not whether the defendant’s conduct accords with the practices of his profession or some part of it, but whether it conforms to the standard of care demanded by the law.  In short, the Courts will decide whether the doctors’ have been negligent or not. This will not depend wholly on the practices of the profession or opinion of the doctors’ peers.

Which of these approaches have been followed in Malaysia? Since the 1960s, the Bolam principle has been routinely applied by the Malaysian courts to medical negligence cases . Traditionally Malaysia has taken the classic doctor-centric approach. The court will not examine the reasonableness of the treatment. Malaysian Courts have uncompromisingly followed Lord Denning’s words in the 1954 case ofRoe v Minister of Health where he states:

“But we should be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong. Doctors would be led to think more of their own safety than of the good of their patients. Initiative would be stifled and confidence shaken. A proper sense of proportion requires us to have regard to the conditions in which hospitals and doctors have to work. We must insist on due care for the patient at every point, but we must not condemn as negligence that which is only a misadventure.”

However, a 2007 Federal Court decision, Foo Fio Na v Hospital Assunta & Anor expunged the Bolamprinciple. The Courts applied the Rogers principle in preference to the Bolam principle to decide whether a doctor was negligent in failing to inform the patient of the risk of paralysis that is inherent in a spinal cord operation.

The Courts held that the test enunciated in Rogers would be “a more appropriate and a viable test of this millennium.” They concluded that the Bolam principle has no relevance in the determination of medical negligence.

The Federal Court has clearly made a policy statement in regard to the Bolam principle and put a potentially onerous task for the medical practitioners. The rejection of the Bolam principle means that evidence of medical practice is just another factor that the courts should take into account in determining medical negligence. Professor Dr Puteri Nemie in her paper Medical Negligence Litigation in Malaysia argues that professional practice and opinion will still be relevant and not denied in setting the standard of care. What will be denied is its conclusiveness.

It appears from the above that the traditional approach of “doctors know best” has been discarded. It is not the medical men but the courts who decide whether a doctor was negligent towards the patient.

Such is the position of the law in relation to medical negligence in Malaysia today. Professor Dr Puteri Nieme argues that this position can be attributed to the trend nowadays that patients no longer want to be treated as passive recipients of medical care. Instead, they want to be treated as co-producers or partners able to manage their illnesses.

This sentiment is not new. It was already echoed two decades ago by the Honourable Justice Michael Kirby, the former President of New South Wales Court of Appeal in his 1983 paper Informed Consent: What does it mean. In his concluding remarks, he states:

“… the days of paternalistic medicine are numbered. The days of unquestioning trust of the patient also appear numbered. The days of complete consent to anything a doctor cared to do appear numbered. Nowadays, doctors out of respect for themselves and their patients must increasingly face the obligation of securing informed consent from the patient for the kind of therapeutic treatment proposed…”

To state the obvious, 21st century patients expect more from their doctors. Patients are better informed and more aware of their legal rights.

Therefore, it is pertinent for medical practitioners to have a strong grasp of the law in relation to medical negligence and conduct themselves in ways to ensure the highest standards of medical practice.

The writer is an advocate and solicit

Paediatric: Its time to play!

With kids lah, but don't play-play. They are cute, lovely, induces mothers instinct like feeling compelled to carry them on your shoulder, wanting to cuddle them, play cikk-boooboo ,yada yada.

But, once they cry with highly shrieking voice,and demanding attitude, they aint cute or cuddly anymore.

But still have to think how to get the measurements.

The circumferences, the rates the sounds,the reflexes, the power and tones, and the developments.

These kids are sick,irritable and suspicious.

Hah! They tend to cry and hug their amma and appa upon seeing strangers.

In wards,these kids dont see us as medical guy, but rather apparent to them as ALIENS. Yes!

Aliens in white coats,with spectacles covering the eyes, with 'scary' instruments dangling around their neck and pockets, who were trying so hard at making a stable contact. To them,we are aliens trying to figure out how to communicate with them using keys,coins,phones and anything that is available in the wide wards.

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OBG

Medicine Posting Story : Language Barrier

 Fuhhh..fuhhh..!!! Its dusty here!

 

Its Saturday and i just finished making my bed. I've been waiting so long to update my story during my medicine posting.


In our 9th term posting, we had 6 weeks of medicine posting. Never thought that weeks gone by in a blink and suddenly the time to shift from Unit 2 to Unit 1 will come so soon. Head Unit 2(HOD) ,Dr A was so nice and very helpful. He always smiles       and treat us well. No hard hitting questions asked and always gives very detailed explanation in regard of the case presented.

It had been 3 weeks in the unit 2 and i find myself finding cases that i really want to see. This time we had 3 cases of ascites which i find very difficult to deal with during junior times. Now, that i have mastered the history taking skills as well as the physical examination part, all went well and i was lucky enough to get such a cooperative patient. Why is it important to get co operative patient?

Well, imagine if you were a poor and absolutely incapable of financial support. You were so sick and had to take a leave from work for a very long time. You had no choice but to go to either a government funded hospital or a charitable hospital so as not to worry about the money when you were so sick to pay for the bills. Our hospital is a charitable hospital in which the hospital reduce the doctor's charge, and medications were so cheap. However, since this is a teaching hospital, all patients in huge wards have to be willing to be inspected and used as subject during class( if they want more privacy, pay the tenth fold price of a private deluxe room).

At least, all patients who are well enough are expected to co operate with the students learning in this hospital. If the patient does not give their consent, even if the case filled with interesting positive findings, you can't force them to be palpated by so many students and at the same time give you detailed history of their sickness.I heard from my friends living in Egypt, as well as in hospitals where majority of the patient came from a very financially capable background were so reluctant to cooperate with the students. Yeah, it is well understood.You were sick and sensitive, you had to pay high bills and you want to be treated well and you expect no one bothering you every hour asking the same questions and touch your body for so many different reasons.

Sometimes, i do respect and amazed of the poor people who came to our hospital and become so cooperative to us. Thank You anna! Thank you amma! Thank you for being such a lovely understanding patient! I've learnt a lot from you guys!



You know what?In Indian culture, patients regardless of financial background were so respectful towards doctors that when they came to to the out patient clinic, they would open their snickers/slippers/chappals outside the door cubicle! They did that in spite of knowing the floor was not carpeted and dusty and we were all wearing our shoes inside. It shows how respectful they were towards the doctors! Not to mention towards the doctors-to-be too! In Malaysia, i think no one will give themselves to be examined or less getting an advice from a medical student. I think , all well educated patients are highly suspicious to doctors and would never see quack doctor for treatment. Nowadays, patients are willing to trust the internet rather than doctors advice and prescription. Thank you God for sending me to India instead of Poland. I hoped that my choice of staying in India instead of Malaysia were the best. Yes, it did in terms of clinical cases and as well as polishing my skills. Read How i end up in India.




Ehem,back to track. What we do exactly in medicine posting? Posting are divided to two. The wards and the out patient department(OPD) also known as clinics in Malaysia. On Tuesday and Saturday we had OPD and the other days we had to go to wards and take cases to be presented at the end of 3 hour class.

In OPD, we went there by 9.30am. Divided ourselves and go to respective doctors in charge at different cubicles. Lagi bagus kalau pegi kat head unit lah. Banyak cabaran!Heheh, dirang suka ajar dan tanya soalan. Kalau anak-anak buah dia, buat kerja dia je. Malas nak layan kitorang. Lagipun ramai patient nak layan lagi. 

Me and my unit friends in OPD!

We stood there and wait till the Dr say something.This time, HOD want do some inspection on how well i took blood pressure. With so many patients during OPD, i doubt that my skills will go rusty. Do everything the way it should be. The beginners way. No shortcut to take blood pressure. It took me twice or thrice the time needed to take blood pressure compared to him. Dr A said, as time goes by you will get your way to find the blood pressure in a short time. You have to find your way. If one day a doctor have 50 patients at evening, how much time does he need to ask the history,examine the patient and give the diagnosis? Practice! Practice!Practice! Be fast and save your and patient's precious time!

Other than taking blood pressure, we had to auscultate the heart and lung sounds if there is a case with positive findings. If the interns we busy clerking, and the doctors were busy talking to patient, he would ask us to take the height,weight and find the BMI.To all readers aspiring to study in India, please learn a bit of their language if you don't want to be blurry and spaced out in class. Majority of the patients here in Mangalore  spoke Kannada and Malayalam. Only few well educated Mangaloreans speak Hindi. Some patient also speak other language like Tulu and Bangla in which we had to us our God-given limbs to try to communicate through sign language although we looked like clowns at circus.

Language barrier is a problem if you don't have the initiative to learn basic orders and common words used in wards and OPD. At least learn how to say : here,there,pain here?,flex you leg,extend your arm etc... I tell you, it will be useful during examination where no translators are provided for us foreign students as well as the non-local students. Haha! Believe it or not, only locals speaks their language. 40 % of Indian students coming from other state like the northern area only speaks Hindi. Most of our patients don't speak Hindi which puts my fellow Northern Indian friends in the same shoes as mine.

Be friendly and ask nicely!

In ward, we came early at 9am and started to take history from the patients. We looked through the patients files lied on the bed which were meant for doctors doing rounds. We looked through each and every files to see whether it is worthy of being presented or not and it must be adequate with findings. Once we did, we jot down the name,age,place of the patient. Read the history ,findings and impressions in advance.Never believe what is written in there. The history could be wrong and doctors expect you to take the history yourselves. They want to know the history in  detail and expect you examine the patient before presenting the case. Wrong moves could sent you to bottom of self-mood-destroying-mode.

So, the challenge here is how to take the history in detail if you don't even speak their language? How do i do it? Easy! Even though you don't ask the questions directly, you can at least prompt the questions to you fellow friend. He or she might be submerged in the conversation especially when talking to old folks. So, your  job is to bring them on track by asking questions pertinent to the case. Involve more in conversation and remember the details translated. Doctors expect us to present the case without looking at the case sheet. Most of them will took the case sheet away anyway.Be prepared of the investigations and treatments needed by the patient. Find the differential diagnosis if you have more spare time. In the end, doctors will ask other diseases that comes with the same sign and symptoms and teach you how to rule out each one to come down the real diagnosis.

Fuhhh...

Its a long essay for now. I should stop here or else my arms won't move at all.

Da!

So, which one are you?

Choose wisely! 

Surgery : End Posting 9th term

Surgery end posting will soon come around the corner. What will i do?

Again, i'd like to write what i have to prepare for end posting which consist of viva  as well as case presentation.What shall i do?

First, prepare all the proforma for important topics based on Dass Surgery Clinical Manual. Reading proforma is much easier than reading right off the book.Read all the little notes you wrote.

Next, read the differential diagnosis part. You always left that particular part behind! Don't leave any SMALL printed words. It may come back to you some day somehow.

Prepare a bunch of viva questions in your mind. Don't slack off at the very last minute. Come On!! You can do it!

Practice the examination part and please remember all the test names! Don't confuse Brodie's-trendelenburgh test , Swartz and Perthe's test!

Last but not least, prepare the materials needed for physical examination. Don't forget to buy the AAA Batery for torch light!



P/S: Please read some theory part from Manipal Manual Of Surgery and SRB!!