Friday, December 18, 2009
The next chapter of my journey will be a test to measure my own capability to cope with continuous daily stress at workplace. Working as a young doctor and at the same time managing your own family will be an exciting adventure. Hopefully I will be able to be a good doctor and a good husband at the same time.
I will upload my wedding card in my next entry. Till then, I am inviting all my blog readers to come to my wedding reception on 26th December 2009 and 2nd January 2010.
Wednesday, November 25, 2009
My grandmother passed away during my first semester exam. I was pretty close to her since she has been looking after me when I was little. I think the hardest bit when we are separated from someone is not having the chance to show how much we love that person. Occasionally, the memory comes back to haunt me since I've never got the chance to say goodbye to her. Al-Fatihah to her.
During my first summer holiday, my friends and I tried various jobs to earn a bit of cash. Initially we went all the way to Mildura looking for job. Mildura is right at the border of Victoria, roughly about 300km north from Melbourne. Having no luck looking for job overthere, we went to Cobram which is also along the state border. Alhamdullilah, after few days searching for job, we got a job in one of the big farms over there.
My first job was as a cherry picker, but I quit after few days. The salary was not that attractive compared to the workload. Next, we worked as strawberry pickers. This job is quite good but it won't be good for your back since you have to squat throughout the day to pick the strawberries. Again we quit from the job.
Next, we went home to Melbourne and try our luck looking for job at Yarra Valley, which is about 50km west from Melbourne. We managed to find a job as a cherry picker again and this time, we managed to persevere with the job until the end of cherry season (middle of January).
I've written a lot of posts about my working experience as a cherry and strawberry picker. Read these post below if you are interested to know more :)
From Cobram to...
Wandin East 1
Wandin East 2
Wandin East 3
Wandin East 4
Wandin East 5
p/s: I'm not sure whether I still have the talent to write that kind of post anymore.
I think that is a pretty good summary of my first year :)
Friday, November 20, 2009
OSCE stands for Objective Structured Clinical Examination. It means that you spend roughly 9 minutes either taking history from an actor or performing a brief but concise physical examination in front of an examiner or interpreting radiological images such as chest x-ray and answering several questions.
Long case means that you are given one hour with a patient in the hospital. In that one hour, you need to know why the patient is in the hospital and to perform relevant physical examination and at the same time, think of appropriate management plan for that patient. You then present your history and examination findings to two examiners. The examiners will be either a general surgeon, physician or a general practitioner. The examiners will asks several questions relevant to the patient and test the depth of your knowledge based on your answer.
I had two OSCE at two different location for two days. The first day OSCE was held at the medical faculty and the second OSCE was held at the hospital.
- Patient presented to you with dizzy spell. It was benign paroxysmal positional vertigo. I was not sure what else to ask in this station and was asking weird and random questions towards the end of the station.
- Interview patient who was referred from Emergency Department to Neurology Outpatient. The ED doctors felt that her epilepsy is not fully controlled. Again, I was not sure how should I approach this station. I have to read the question several times and in the end, running out of time to answer the questions from the examiner.
- Pregnant women who is vomiting. Take history and discuss the differential diagnosis and the relevant investigation. Hyperemesis gravidarum is the keyword for this station. I totally forgot about the intravenous fluid therapy.
- Interpret peak flow chart and teach good inhaler technique to asthmatic patient. Was running out of time in this station.
- Radiology station. CT Brain: Haemorrhagic Stroke. Chest X-ray: Tension Pneumothorax. Interpret lab result: Nephrotic syndrome. I don't have enough time in this station.
- Interview a patient who is feeling unwell. He had malaria. I think I did pretty alright in this station.
- Interview a patient who had recurrent abdominal pain. It turned out the patient had acute pancreatitis. Need to know the differential diagnosis and the relevant investigation. Despite memorising all the causes of acute pancreatitis before the exam, I forgot all the causes due to anxiety attack.
- Procedural skill station. Need to perform airway management and CPR.
- Perform cardiovascular examination on a patient who had a murmur. I think the murmur was mitral regurgitation. Not really sure about the murmur since I was pretty nervous thinking the differential diagnosis for both diastolic and systolic murmurs.
- Perform relevant examination for patient who had right hip pain. Need to do gait, Trendenlenburg test and hip joint examination. After that, need to interpret the hip X-Ray (Osteoarthritis) and discuss the appropriate management of osteoarthritis.
Hopefully all my friends and I could pass the final year exam and able to graduate together on 5th December 2009.
Thursday, November 05, 2009
Monday, October 26, 2009
Friday, October 09, 2009
Saturday, October 03, 2009
This rotation means that you are spending time with doctors at their own clinic and observing how the doctors managing their own patient. You will be given lots of opportunities to interview the patient on your own and then presenting your findings to the doctor. It is a good practice for my final year exam.
This rotation gives you an insight on what are the most common illnesses around the community. Sinusitis is more common than temporal arteritis. Otitis media is more common than croup. Pneumonia is quite common but it is not that severe to warrant the patient to be admitted to the hospital.
Having been spending few years in the hospital, it certainly give me a bias perception towards finding out what is the most likely diagnosis. If I were to see a patient in the hospital, I'm more inclined to think of rare or life-threatening conditions rather than to think of more safer illnesses.
I did my GP rotation in rural Victoria and there were several opportunities for procedural skills. I managed to excise a skin mole and suture the wound. After 6 years of studying medicine, I finally performed my first PR examination on a patient. It was an exciting experience to learn how normal and abnormal prostate gland feels like. I managed to deliver a baby in the hospital which is quite exciting considering that the last time I delivered a baby was almost 12 months ago.
It is certainly an interesting rotation and it certainly boosts my experience in managing the more common variety of medical illness.
p/s: Since I hardly been able to use the internet in the last 5 weeks, there are a lot that I need to catch up with. My google reader is already been filled with few thousands of unread items.
Tuesday, September 01, 2009
During winter holiday, the medical school asked us to choose 10 places for our GP placement. Unfortunately, since many medical students choose city placements, not many were able to get their place of choice. In my case, my placement was not even in my list. I was given rural GP placement which is quite far and close to the border of Victoria. I might be celebrating Eid over there as well. There won't be any Muslims within 50-70km radius from my GP placement.Now, that is something that I would call as celebrating Eid'ul Fitr in a foreign land.
I don't think I would be able to get free internet access over there. Hence, no more blogging or even facebook-ing in the next 5 weeks. As this will be my last post before going to my GP placement, please forgive for all my wrongdoings and Happy fasting. Happy Eid in advance too.
Saturday, August 29, 2009
6 years of studying medicine does not really teach you how to works as a doctor. There seems to be a big gap on how to put all your medical knowledge into practise. Doctors do lots of paper works and referral. Medical school won't teach you how to fill in those paper works. You are supposed to observe it from the interns during this semester and learned it by yourself.
Referring patients to the other specialty is not an easy task to do. Interns are supposed to refer any suitable patients to the specialist for further management. The most difficult part of this process is to answer questions from specialist on reason for referral. I've seen how interns were scared to death when referring to the specialist. If you are not able to answer the questions from the specialist, the referral won't be accepted and you have to tell this to your own consultant.
Many patients who are admitted to the hospital require lots of medical imaging such as chest X-ray, CT scan and MRI. Radiology department is always busy and it is not easy to get a slot for your own patient. Somehow, the young doctor has to plead or find convoluted ways to get permission from the radiologist. Asking for permission to do medical imaging for your patient will always be one of the most difficult tasks for an intern.
Drug chart is one of the most common tasks that every young doctor will do. Yet up to now, I have never been taught formally about all of the doses of the medication. The university asks us to learn it by doing online course.
In the last 5 weeks, I have learned more on how to do my future job more efficiently than learning anything on medical knowledge. Hopefully, my next two rotations will be interesting :)
Monday, August 24, 2009
وَيَتَّبِعْ غَيْرَ سَبِيلِ الْمُؤْمِنِينَ نُوَلِّهِ مَا تَوَلَّى وَنُصْلِهِ
جَهَنَّمَ وَسَاءتْ مَصِيرًا (4:115)
Sunday, August 23, 2009
Whenever I went to the ward, the average age of the patient would be around 75 years old. 26 years seems not a long period to me. I gained lots of reminder each time I met an elderly patient. Looking at their face and thinking of what sort of experience they have gained in the past, it helps me to re-orientate myself to the reality of this world.
Every time you reach an anniversary of your life, you are one step closer to the graveyard. It may seem far for now, yet sooner or later, you will meet the judgement day.
Sometimes, I'm a bit hesitant to celebrate my own birthday. Maybe unconsciously, I'm afraid that I will realise that all this while, I have been wasting my time. I hope that in the past 26 years, I have done enough good deeds and repent for all my sins to Allah and for any wrongdoings to any human being that I have met in the past. Insha-Allah, I will try my best to be a better person and controlling all my negative attitudes.
I'm grateful for all the birthday wishes that I received. I hope that everyone will remain steadfast in Islam. Happy Ramadan.
Saturday, August 15, 2009
This blog was started as a personal blog. A place for me to jot down all the ups and downs of my life as a medical student. The initial title of this blog was paradigmshift and the initial url was hafiz_238.blogspot.com. I chose paradigm shift to reflect my motivation to be a better person and to be brave to face all of the challenges in the future.
Later, I changed the blog title to 'kembara di bumi Melbourne'. I think I have to change the title of this blog at the end of this year since I won't be living at Melbourne. Not sure which title I should choose.
I used to be blogging frequently. However, in the last few years, especially when I started my clinical years, I haven't been able to blog as frequent as it used to be. Perhaps, life has been busy or I don't have any inspiration to put my mind into writing. Nevertheless, I hope that I would be able to maintain this blog for the next few years.
Thursday, August 13, 2009
Sunday, August 09, 2009
I usually arrived at the hospital around 8am and only came back to home around 10pm. I like to do my revision at hospital rather than studying at home since it can save me lots of electricity bills and prevent me from wasting my time doing unnecessary things.
There are lots of things that I need to revise for this semester. I am still trying to find time to revise my Obstetrics and Gynaecology and Paediatrics since those subjects will be part of my semester exam. Hopefully I can find time to blog and visit other blogs as much as possible in the next few months.
Ok, that's all for now.
Sunday, July 26, 2009
I am looking forward for this semester since it means that my 6 years of studying in Melbourne will end very soon. At the same time, I am feeling a bit anxious knowing that I will be working as a doctor in less than 6 months time. This will be my transition point from being a student to someone who will be looking after many sick people.
For GP rotation, we were instructed to choose 10 places that we would like to go and at least 3 of them have to be rural places. For this rotation, I was hoping to get somewhere close to home. Unfortunately, I got rural place for my GP rotation. It is so far that I don't think I would be able to return home every week. Hopefully, there will be internet access over there.
My first rotation will be medical rotation and it starts tomorrow. Despite being a final year student, I still believe that there are so many things that I didn't know and I am expecting a busy semester ahead. Hopefully I can survive this semester.
p/s: It is interesting to read what I have predicted 5 years ago. Read future predictions (In Malay)
Friday, July 17, 2009
p/s: The paragraph above was written in the format of formulating a psychiatry history. Usually, you need to mention 4P (Predisposing, Precipitating, Perpetuating and Protective factors) at the end of your presentation
Saturday, July 04, 2009
Up to 2nd July 2009, there have been 1691 cases in Victoria out of a total of 4568 cases in the whole Australia. Melbourne has among the highest swine flu cases per capita in the world.
However, this does mean that there is a widespread panic among people living here. Despite there were many school closed down and intensive media coverage, there were not many deaths associated with swine flu.
You should know that swine flu is not a dangerous disease. It is known to be extremely contagious but it is less likely to kill you. The normal seasonal influenza kills more people than the current swine flu.
Right now, I'm glad that the media has shifted their attention from swine flu and focus more on the death of an artist .
Wednesday, July 01, 2009
There were 5 OSCE stations.
- Take history from patient with symptoms of depression.
- Take history from patient with bulimia nervosa. Describe the management.
- Elderly women with Colles' fracture. Describe your findings in clinical examination and x-rays. Management of Colles' fracture.
- Patient with advanced lung cancer, want to die at home. Has several issues. Medication, feeding, EPOA.
- Elderly patient with side effects of medications (MS Contin and Naprosyn).
Bulimia nervosa again. This disorder has been featured in the previous written exams and I'm not sure why the medical faculty is so interested in asking medical students about eating disorders. During this station, I'm not sure what else to ask after eliciting all the DSM IV criteria for bulimia nervosa.
Colles' fracture. Hmm, I'm stumbled quite a lot in this station. When the examiner asked me to do physical examination of the wrist, I'm not sure how to neuro exam of the hand, so I quickly do a random examination of the hand. Hopefully, I can get enough points in this station to pass the ED station.
The last two OSCE stations were quite a puzzle. I'm not sure what else to say in patient with palliative care needs and not sure what are the side effects of those medication.
Overall , this semester which is made of RAPP (Rehabilitation, Aged Care, Palliative Care and Pyschiatry of Old Age), Rural rotation, Emergency Rotation and Psychiatry has been a frustating semester. Let us hope that all my friends and I could pass this semester exam.
p/s: Before the OSCE, we were given surveys for this semester to fill in. This was what I wrote for RAPP: The RAPP handbook is too painful to read.
Hopefully they will make significant improvement for RAPP :)
Sunday, June 28, 2009
While studying for this condition, I found out a nice claymation video showing Hallpike manouevre and Eppley's Manoeuvre.
Credit to Merck Manual
Saturday, June 27, 2009
- Side effects of haloperidol
- Football player hit at head. GCS 3. Describe assessment, initial management and investigation
- Key features of delirium
- Key features of obsessive-compulsive disorder
- Describe 3 risk factors of fall and give example for each factor.
- Elderly men with recent cognitive impairment. Given diazepam to treat his ‘nerve’ problem. Give comment on his diazepam usage.
- Elderly Italian lady with mental impairment. Lives in Shared Supported Accommodation. Unable to speak in English. Has diabetes, obesity and history of falls. List 5 issues in this lady. Describe your management.
- Men with paracetamol overdose and found with empty whisky. Slightly intoxicated. Describe initial management, investigation. Mechanism of paracetamol toxicity. Tool to assess paracetamol toxicity. Management of paracetamol toxicity and route of administration. [Guidelines for the management of paracetamol poisoning]
- Elderly women with advanced lung cancer. Want to die at home and family happy to support her. Describe your discharge planning.
- Women present to GP with symptoms of 8 years history of binge eating and purging. Normal physical exam. Describe management of this patient.
- 40 year old women with MS. Work as a telephonist and need to access computer as part of her job. Describe clinical features of MS that may interfere with her job (4 marks). Describe your assessment on finding out what are available at work to overcome this issue (4 marks). Recommendations on how to cope with work difficulty due to her MS-related disability (7 marks).
- Elderly men with long history of ischaemic heart disease and now presents with depressive symptoms. Describe the relationship between medical illness and depression.
Update 27/9/2009: Thanks to Intan for telling me the other questions.
5 marks questions
- List symptoms faced by an elderly widow, few weeks after the death of her husband.
- Describe the differences between vasovagal collapse and syncope.
- Describe anorexia nervosa
- 5 causes of constipation in bed-bound cancer patient
- 5 components of CBT in managing major depressive disorder
- A young boy falls on outstretched hand. Presents with pain in anatomical snuffbox. Normal plain X-ray. Diagnosis, management and complication.
- Differences between acute, chronic and cancer pain. Answer in table form
- 87 year old female, lives alone, presents with decline in function over the last 6 weeks. Has multiple co morbidities and lots of medications. Still driving. Has slightly reduced score in MMSE. Describe your management of this patient.
- A young tourist poisoned by bright-coloured octopus. Presents to ED. Which organism (blue-ringed octopus), what type of toxin and mechanism of toxin. Initial assessment and management. Treatment and expected outcome
- 38 year old women, previously well, presents to ED with back pain. Normal neuro exam and MRI. Has relationship problem with her partner but has resolved. 3 differential diagnosis. How to assess the different diagnosis in Hx and MSE.
- 40 year old train driver, presents with history of frequent alcohol drinking. In the last few weeks, he had panic attacks while driving the train and this is alleviated by drinking alcohol. DDx (6 marks). How to assess him in hx and MSE (9 marks)
- 40 year old policeman, presents with delusion and hallucination. He needs to do something to protect himself. Describe a thorough risk assessment (11 marks). Ethical principles faces by GP in this patient (4 marks)
Few of the questions were a bit difficult to answer. Those questions test the capacity of your memory.
The question on octopus was in a way interesting. I knew the type of the octopus but I didn't know the toxin nor its mechanism of action. In fact, I wrongly guessed the management in this question. There goes my 15 marks.
Friday, June 26, 2009
- Swine flu is now officially an epidemic. Malaysia currently has more 90 cases of swine flu and the reaction from the Malaysian newspapers has managed to over exaggerate the severity of the swine flu. In fact, many of my friends who are going back to Malaysia for winter holiday are quite worried that they will be under home quarantine too, since few cases of swine flu in Malaysia originate from here. Go read this; Swine flu's not that bad.
- Riot in Iran. I wonder what will happen to Iran in the next few months. Hopefully, if there is any chaos in the future, it won't lead to lots of unnecessary killing among the citizens and disrupting the petroleum production. Petrol prices has already been increasing and we don't need another riot to push up the petrol price.
- New operators for tram and train in Melbourne. Hopefully this will improve the quality of public transport in Melbourne in the future.
- Exams. I have finished two written exams and will be sitting for OSCE next week. Will write more about those written exam later.
- Firefox has released the third Firefox 3.5 release candidate. I am patiently waiting for the next version of Firefox . Read this; Firefox 3.5 memory usage, Top 10 features in Firefox 3.5
Thursday, June 11, 2009
At this time of the year, many medical students are busy applying for the intern job in Victoria or interstates. Most of my groupmates were having lots of stress and worries since it is not an easy process to apply for a job here in Victoria. They have to sit for many interviews and few of the interviews will be during the exam period. They have to balance between revising for the exam and preparing for the interviews.
As the only person in the group who is not applying to get a job in Australia, my role for the last few weeks has been to calm them down and help them with possible interview questions. Interestingly, we are doing psychiatry rotation and it has been useful to put all of those relaxation techniques into practice. I hope that all of my groupmates and my friends will get a job in Victoria.
In term of psychiatry rotation, I don't think it has been a useful rotation for me. It was not properly taught and most of the students are not really interested in choosing psychiatry as their future career.
Swine flu in Victoria has been infected many people in the last few weeks, and of last night, there has been at least 1011 persons infected in this state and the total number of swine flu cases in Australia is 1260. If the number of cases in Australia especially Victoria keeps on increasing, WHO might have to declare the swine flu as a pandemic.
Wednesday, June 03, 2009
Sunday, May 31, 2009
From ABC News via [Kevin MD.]
Bizarre radiology images.
Imagine your doctor being more anxious than you. How do you think that would affect the patient?
Saturday, May 30, 2009
VICTORIA has passed the point where the spread of swine flu can be prevented and should immediately close every school in the state for a week to slow the progress of the virus, a federal government influenza adviser has warned.
There were last night 209 confirmed cases of swine flu nationally, with 138 cases in Victoria.
Tasmania also reported its first case.
Although seven Victorian schools have been closed in steps to contain the virus and a further 27 identified as "affected", governments and health authorities insist the scale of the outbreak does not warrant wholesale school closures or cancellations of major public events. But Raina MacIntyre, an infections diseases expert and a member of Australia's Pandemic Influenza Advisory Group, said yesterday the time had come to consider more drastic steps.
"We're at the stage now in Victoria where a blanket closure of all schools and pre-schools should be on the agenda and a decision needs to be made quickly," Professor MacIntyre told The Weekend Australian.
Federal Health Minister Nicola Roxon conceded yesterday that the focus of Australia's pandemic response would invariably shift from trying to contain the virus to treating it.
It is interesting to see the number of schools that have been closed down around Victoria for the past few weeks. I have managed to mark all the schools that has been closed down (in red) and the schools that has been affected by swine flu but does need to be closed down (in blue).
Be sure we shall test you with something of fear and hunger, some loss in goods or lives or the fruits (of your toil), but give glad tidings to those who patiently persevere,
Who say, when afflicted with calamity: "To Allah We belong, and to Him is our return"
They are those on whom (Descend) blessings from Allah, and Mercy, and they are the ones that receive guidance.
Thursday, May 28, 2009
When a patient come to see a doctor, the patient will usually tell what is wrong with him/her such as having fever, short of breath or chest pain. These are what the health professionals called as symptoms. Symptoms are the observations made by the patient.
On the other hand, signs are the observations made by the health professionals. For example, a doctor might notice that there is an abnormal breath sound heard using stethoscope. The doctor might used various medical terms to describe the abnormal breath sound. This is a sign that may indicate that there is something wrong with the chest.
- Symptoms : any feature which is noticed by the patient
- Signs : any feature that is observed by any health professionals (Doctors, nurses, allied health professionals).
Wednesday, May 27, 2009
- major depression, resistant to medication
- bipolar disorder
- Need exists for rapid treatment response, such as in pregnancy
The relative contraindications are
- brain tumour
ECT was performed by putting two electrodes next to your head and seizure is induced by passing electrical current through those two electrodes. You can do ECT unilateral (only one side of the head) or bilateral (two side of the head).
If you are going to do unilateral ECT, you usually choose the non-dominant hemisphere. Usually, right-handed people have their left side of the brain as their dominant hemisphere. More info on cerebral dominance.
To reduce the effects of the induced seizure, muscle relaxants need to be given eg Succinylcholine (Suxamethonium Chloride). The patient need to be under general anaesthesia and a short acting general anaesthetic agent is used. The one I saw used Propofol.
Some trivia about ECT.
- It was initially used by Romans by using electric eels and currently ECT is no longer practised in Italy.
- In modern age, it was initially thought that having seizure can cure schizophrenia. So, that's how ECT was started :)
- After more than 70 years of using ECT in modern time, doctors are still not sure how ECT works inside the brain.
- ECT is one of the last resort to treat major depression. So, once you are having ECT, it is possible that you need to have ECT for lifetime.
Tuesday, May 26, 2009
All psychiatric disorders are classified according to their symptoms. Let's say if you have symptom A and symptom B together, that will be called as a disorder 1. If you have the third symptom, symptom C, A+B+C = disorder 2. To make it more confusing, many of these psychiatric disorders are overlapping and if the psychiatrist are not able to categorise the disorder, they will simply called it disorder not otherwise specified .
The classifications for psychiatric disorders keep changing over time, and any disorders were subjected to whether they were perceived as abnormal by society. If a certain psychiatric disorder was no longer perceived as abnormal and the society is able to accept the condition, this disorder will be removed from the classification.
Homosexual used to be classified as a psychiatric disorder. However, due to the increasing number of people who are practising homosexuality and the acceptance by some society, being homosexual is no longer treated as a mental illness.
We should treat the cause and not the symptoms. However, in psychiatry, many causes of mental illness still remain elusive and perhaps will take several centuries for it to be found. In the mean time, we have to depend on this classification based on symptoms, which is not accurate and can be confusing at times.
Tuesday, May 19, 2009
I have lots of free time in this rotation. Having lots of free time is a great blessing for me. I can now start to revise for my coming semester exam, although I’m not really sure what will come up in the exam.
After doing nearly two weeks of psychiatry, I still haven't found anything interesting in this rotation yet. I hope I can find something useful in this rotation. Otherwise, psychiatry will not be an option in my future career list.
Friday, May 15, 2009
lt starts at RM2.456.39 (Grade UD41, P1T6) as against those of other schemes of service. The initial salary takes into consideration the period of six years that an undergraduate takes to qualify as a medical officer.------------------------------------------------------------------------------
Furthermore, the total takehome pay for newly-appointed medical officers is RM4,058.39 when all the monthly allowances and Incentive Payment for Critical Service (the highest compared to those of other critical schemes) are factored in .
In addition, medical officers als o receive the following allowances:
> On-call allowance at the rate of RM150 per night;
> Locum at the rate of RM80 per hour; and
> Incentive payment for specialist ranging from RM1,600 to RM3,100 per month, depending on the grade of the officer.
The ruling that will entitle newly-appointed medical officers to receive RM6,000 per month will take affect in 2010, after the current batch of medical graduates have completed their internship at a local government hospital.
To further advance their career prospects, the Government has improved promotion opportunities of medical officers by creating more promotional posts. At the same time, the Government has increased the number of scholarships for the Masters programme to 600.
Will this be enough to lure Malaysia medical students to work in Malaysia public hospital? Personally, I don't think this will be enough to keep doctors in public health care system. There are various factors that need to be improved such as working environment, more opportunities to do specialist training at overseas, opportunity to work in private sector and the Ministry of Health should conduct more surveys from junior doctors to capture the suffering and burden among young doctors.
and lifted from thee the burden
that had weighed so heavily on thy back?
And [have We not] raised thee high in dignity?
And, behold, with every hardship comes ease:
verily, with every hardship comes ease!
Hence, when thou art freed [from distress], remain steadfast,
and unto thy Sustainer turn with love.
Wednesday, May 13, 2009
|CO2 emissions of an average daily newspaper (PDF) (100% recycled paper)||850|
|A glass of orange juice||1,050|
|One load of dishes in an EnergyStar dishwasher (PDF)||5,100|
|A five mile trip in the average U.S. automobile||10,000|
|Electricity consumed by the average U.S. household in one month||3,100,000|
p/s: I found it funny to compare the number of Google searches with a glass of orange juice
Sunday, May 10, 2009
After spending two weeks and a half at Heathcote, I personally think that rural rotation needs to be shorter in duration and Emergency rotation should be longer. There is not much to be learned during rural rotation.
You will be able to see how each health services are coping with limited resources in rural setting. Plus, you may be able to visit any interesting places around the town. If there are aborigines around, you can visit them and learn more about their culture and history.
Anyway, my three weeks of holiday in rural rotation has ended. Now, it is time for me to learn about psychiatry and hopefully my next rotation would be more interesting than RAPP and rural.
Wednesday, April 29, 2009
The population of Heathcote is around 2800 people and most of the people here are Anglo-Saxon. I hardly see any Asian people here . There are 2 doctors (GP) in the town and one small hospital. The hospital is run by one GP and that GP has resigned from the hospital last week. Now, the hospital is facing the dilemma of recruiting another GP.
This problem is a common scenario in any small town around Australia. There are not many doctors who like to work far away from major cities such as Melbourne and most of the doctors who work in rural, are being forced to work by the government.
Having said that, there are still doctors who love to work in a small community. There is one doctor, not far from Heathcote, who is still working to provide the necessary health care to the community, despite he is already 80 years old . It is something that amazes me.
Anyway, back to my rural rotation. I lived in a nice house next to my supervisor and it has wireless broadband internet connection. This place has a nice environment and I always saw kangaroos jumping around the neighbourhood. In fact, this morning, I already saw around 20 kangaroos alone .
Every medical student in University of Melbourne is required to spend 3 weeks in rural setting as part of their medical course. Rural rotations means that you are send to a small town, far away from your home and you have to learn what are the differences between rural and city health system. Some people were send to a place that is about 400km from Melbourne and close to the border of New South Wales. It is almost impossible for them to go back to Melbourne every weekend. Hence, they have to stay at that place for the next three weeks.
Not all accommodation has internet connection and I'm fortunate to be blessed with internet facility. Without internet, I would be stuck in rural doing nothing and getting bored.
This is my second week of rural rotation and I'm already looking forward for this rotation to end. There are not much that you can do here and I miss having superfast broadband connection at home .
Sunday, April 26, 2009
Aborigines in Australia have been abused for hundreds of years. They were isolated from their families and integrated into the white society to such an extent, they lose their own language. Australia has its own dark history.
There was an interactive session where the medical students were split up into two group and each group have to become a predefined culture group and follow all the rules. It was an interesting experience as each group culture is significantly different and each group has to find out what are the rules of the other cultures.
I find the session was useful to highlight the differences of cultures among human being. We are not that easy to accept any people who are different from us. Sometimes, deciding which one are good or bad rules in a community can be difficult since it is subject to various factors such as culture, faith and the global environment.
Saturday, April 25, 2009
At the end of the first day, we were given a tour on how to milk the cows. It was an interesting adventure for most of us since many of us were brought up in urban environment and hardly see any cows at a close range.
Seeing how the workers milk the cow was an exciting experience for all of us. Most of us took several pictures of the cow but at the same time, we have to beware of any unexpected things that could happen during milking.
The cows are milked from behind and the milking machine is attached to the udder. The machine will automatically stopped when it reaches a certain amount of milk. I'm not sure how much though.
Since we milked the cow from behind, the butt is facing our face and the cows can unexpectedly urinate or defecate at whim. There are two rows of cows during milking process and we stand in the middle. So, we have to be cautious on both sides .
On that day, several unfortunate people had the accident. It was not a nice experience to have that on your first day of your rural rotation.
Monday, April 20, 2009
After this, I will spend the rest of my rural rotation at Heathcote, which is about 155 km from Dookie and the journey will take another 2 hours from Dookie. The journey from Heathcote to my home will be another 107km (1hr 27 minute travelling time).
The map below will show the locations that I have written in the above paragraphs.
Friday, April 17, 2009
Tuesday, April 14, 2009
- Adblock Plus. I certainly recommend my reader to install this popular Firefox add-on. It blocks 95% of website advertisement and this also includes flash ads. It certainly helps me on having faster loading of any websites and have better internet surfing experience.
- DownThemAll. A useful download manager. It contains download accelerator and help me to organize all my downloads.
- IE Tab. I used this for any websites that stubbornly have to be displayed using Internet Explorer. This add-on is also useful if you are a web designer.
- Web Developer. It helps me whenever I'm designing this blog layout. It also help me to gain further understanding on how each website works.
Saturday, April 11, 2009
Hafiz took the istilah loghat perak yg anda faham quiz and the result is anda mmg perak piyor!
anda mempunyai pengetahuan luas dengan istilah2 yang digunakan diperak, anda mmg berasal dr perak kerana anda familiar dgn istilah2 yg sukar ini...dengan ini anda layak utk berkahwin dgn og paris, lambore dan kwsn2 yg sewaktu dgnnya!
Friday, April 10, 2009
Definition of time lapse video:
Time-lapse photography is a cinematography technique whereby each film frame is captured at a rate much slower than it will be played back. When replayed at normal speed, time appears to be moving faster and thus lapsing. Time-lapse photography can be considered to be the opposite of high speed photography.
Shlino lake sunset time lapse from Timelapser on Vimeo.
Spitzmeilen - Swiss winter mountains in time lapse from Michael Rissi on Vimeo.
My way from Per Erik Sviland on Vimeo.
Pixel's Revenge timelapse showreel from David Coiffier on Vimeo.
More time lapse video: 1, 2
I have managed to refreshed my knowledge on various acute life-threatening medical problems and able to perform few simple procedures such as putting a cannula into a vein, making plaster or back slab, practising Advanced Cardiac Life Support and observing how to manage various fractures.
Three weeks seems a long period for many but it seems to me that I prefer longer time in ED. Perhaps another week in ED will be good for me .
Overall, in this rotation, it is up to you whether you would like to be busy or just enjoying lots of free time available. You have to be very proactive in approaching doctors and nurses to get an opportunity to do lots of stuff. Most of the staffs here in the hospital I attached to, have been very nice and helpful.
My advice to my colleagues who will be doing ED after this:
- The best time to see lots of patients will be after 5 or 6 pm. If you are in the morning shift, there will be few new admissions except if there is any major trauma happening in the local vicinity.
- Fast Track, a section of ED which handles Category 3 t0 5 will be a good place to get your procedural skills done.
- Make sure you get to see lots of common presentation to ED [Chest pain, SOB, headache and fractures]
Tuesday, April 07, 2009
- Endocrine (diabetes, thyroid, parathyroid or adrenal dysfunction)
- Lung Disease (pneumonia, COPD, sleep apnoea)
- Infection (Encephalitis, meningitis, syphilis, HIV, septicaemia)
- Injury (Concussion, subdural, extradural haemorrhage, burns, general and cardiac surgery, #NOF)
- Intracranial (Tumour, raised ICP)
- Renal (acute and chronic end stage failure)
- Intestinal (Carcinoma, obstruction, ileus)
- Unstable circulation (Arrythmias, CCF, Myocardial infarction, Hypertensive encephalopathy, hypoperfusion, blood loss, shock)
- Metabolic (Hyponatremia, Hypokalaemia, Acidosis/alkalosis, hepatic failure, dehydration)
Adapted from Bloch and Singh, Foundation of Clinical Pyschiatry
In medicine, we learned many Latin and Greek words and this represent the fundamental vocabulary among health professionals.
a+verb(in Latin or Greek)+a = inability or loss of description of the verbExample
- apraxia - loss of the ability to execute or carry out learned purposeful movements
- agnosia - inability to smell
- agraphia - inability to write
- ataxia - inability to coordinate voluntary muscle movements; unsteady movements and staggering gait
- agnosia - inability to recognize and identify objects or persons despite having knowledge of the characteristics of those objects or persons
- alopecia - loss of scalp hair
- anaesthesia - Loss of feeling or awareness
- aphasia - loss of the ability to produce and/or comprehend language
More on acopia.
Tuesday, March 31, 2009
When physicians at an Alberta hospital asked why so many medical students and residents were using a faulty technique for inserting life-saving breathing tubes in patients, they received an unexpected answer: It's television's fault.
Many of the doctors in training said they had learned the procedure from watching medical dramas. And a subsequent analysis of the show ER revealed its fictional MDs and nurses performed intubations incorrectly almost every time.