Sunday, May 31, 2009

Disturbing radiology images

Warning: Viewer discretion is advised.

From ABC News via [Kevin MD.]

Bizarre radiology images.

Part of being a medical student is the ability to be calm whenever facing a major trauma. Hence, we have been shown weird and traumatic images since first year. The ability to calm down is important since it can have a direct effect towards the patient.

Imagine your doctor being more anxious than you. How do you think that would affect the patient?

Saturday, May 30, 2009

Swine Flu in Melbourne

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.

Read more

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).

The hospital that I'm attached to is right in the middle of the epidemic area. I might add that there is one railway line that is passing through all of those schools.

p/s: Having said that, I don't think we should be panic with the increasing number of swine flu in Australia.

Trials and Tribulations

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.

[Al-Baqarah: 155-157]

Thursday, May 28, 2009

Signs versus Symptoms

This post is written to clarify the difference between symptoms and signs.

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.

In summary,
  • Symptoms : any feature which is noticed by the patient
  • Signs : any feature that is observed by any health professionals (Doctors, nurses, allied health professionals).
p/s: Sometimes, signs and symptoms are used interchangeably cool.

Wednesday, May 27, 2009

Electroconvulsive Therapy

I had the opportunity to observe Electro Convulsive Therapy (ECT) today. The indications for ECT are
  • major depression, resistant to medication
  • bipolar disorder
  • mania
  • schizophrenia
  • Need exists for rapid treatment response, such as in pregnancy

The relative contraindications are

  • brain tumour
  • dementia
  • delirium

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


If you are ever had the chance to know how the psychiatric disorders are classified, you will be utterly shocked.

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 mrgreen.

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.

Read more.

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


Doing psychiatry as my last rotation seems to be the right rotation for me smile. There were not many lectures/tutorial that I need to attend every week and each person has their own individualised timetables. At first, the individualised timetable seems a bit complicated to understand. However, after reading it several times, it seems easy to comprehend.

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

How much a young doctor earns?

Taken from The Star

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.

Any opinion?
HAVE WE NOT opened up thy heart,
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.

[Al-Syarh: 1-8]

Wednesday, May 13, 2009

Energy efficient of Google search

Taken from Google Blog

ActivityGoogle Searches
CO2 emissions of an average daily newspaper (PDF) (100% recycled paper) 850
A glass of orange juice1,050
One load of dishes in an EnergyStar dishwasher (PDF)
A five mile trip in the average U.S. automobile10,000
A cheeseburger15,000
Electricity consumed by the average U.S. household in one month3,100,000

read more

p/s: I found it funny to compare the number of Google searches with a glass of orange juice mrgreen

Sunday, May 10, 2009

End of rural

I finished my rural rotation last friday. For the last three weeks, I have been away from Melbourne.

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.