Paeds Posting : Week 3

Another week in temerloh. Bagi aku hospital kuantan is far way alive than hospital temerloh for one reason. Dekat temerloh they put the patients in cubical, one small room dalam 8 patients while in kuantan open macam tu je. Takde room yang separating the patients except the langsir. So kalau budak bising satu ward boleh dengar but not in temerloh. Dekat kuantan masuk ward sorang-sorang tak rasa awkward takde rasa macam ada orang pandang kita nak makan pun. Walaupun maybe the parents are quite annoyed dengan us the medical students for asking repetitive questions again and again. Penat kot nak jawab. Sampai ada satu makcik tu kami datang-datang je ya dik nak tanya apa anak makcik ni dah ____ hari dekat hospital, makcik datang sebab _____. Sampai satu tahap dah tak payah tanya soalan pun makcik dah tau nak cerita apa.

But thats how we learn. Patients are our books. We learn from patients. You guys just need to bare with us lah. Nanti kang kata housemans nowadays are not competence. Itu tak reti ini tak reti. Kalau tak diberi peluang masa medstudents in bila lagi?

Bedside teaching with Dr Mai memang ya tohan nak menangis rasa. She's a good lecturer. Very strict yet very lovely. Comel je bila bercerita. The strict part of her is that selagi dia tak dapat jawapan yang dia nak jawapan salah entah apa-apa malas nak fikir malas nak mencari nak harapkan dia suap je selagi tu dia marah tak sudah. But she's a good teacher. She wants us the students to think. Mana orang tak cakap doctors are like robot. Sebab we have useless brain. Ada otak malas nak fikir. Macam robot. She's training us to be at the top of hierarchy.

Aku pun rasa aku suka menghafal tapi tak faham sangat pun. Lepastu lupa. That's not how I should learn. Kalau macam ni ilmu nak retain sampai mati pun takboleh. 6 weeks left je lagi till the first block exam. Takuttttttttttttttttttt :(

Ada senior cakap kitorang nampak gelabah sangat baru first posting dah beria pergi ward hari-hari clerk banyak patients satu hari tapi malam tak study. Memang betul apa yang senior cakap tu. Sehari clerk satu patient je dah cukup. Malam study disease tu from a-z. Tapi aku clerk sehari dalam 2/3 patient untuk dapatkan skills macam mana nak clerk patient. Ingat senang nak tanya soalan. Aku selalu krik krik depan patient. Lepas dah tanya sekali banyak soalan taktau dah nak tanya apa. Cara aku examine patient pun tak betul lagi. Kalau ikutkan dulu target sehari 5 patient. Tapi satu patient je kadang sampai sejam lebih campur examine badan dia. Pastu dah penatlah apa. Malam pun selalu aku tak study. Haritu sibuk siapkan case write up buat lagi last minute kan study pun entah ke mana :( Apalah. Pagi tu clerklah 2/3 orang. Malam pilih satu disease untuk study from a-z. Jangan malas sangat.

Jangan jadi macam apa yang senior cakap nanti tanya soalan basic pun taktau nak jawab apa. Mana boleh macamtu. Aigoo.

Nanti-nanti:)

Next week ke pekan pula.

Paeds Posting: Week 2

Week one itu hari introduction to paeds posting. Masuk minggu kedua dah start pergi hospital, clerk patient, examine patient punya jantung, paru-paru dan perut untuk case presentation, penuhkan logbook, case write up dan yang paling penting untuk kegunaan masa depan juga nanti. Medicine ni ialah pembelajaran sepanjang hayat. Sampai bila pun takkan pernah habis sebab medicine ialah satu bidang yang luas. Mana boleh lupa benda yang kita dah belajar sejak dari first year lagi. Tak boleh! Semua tu diguna pakai sampai mati.

Ahad itu hari sampai ke selasa ada dekat temerloh. Ward paeds hospital temerloh ya tohan cantik yang amat. Kalau aku jadi budak-budak mesti aku suka datang ward paeds hari-hari. Bapak cantik gila interior designnya. Nama pun ward kanak-kanak kan kenalah berseri berwarna warni sikit kan. Masuk hari jumaat ni adalah dalam 6/7 case juga yang aku dah clerk. Serius cakap aku takut patient. Aku tak reti nak approach patient. Tak reti nak mulakan perbualan.

First day sampailah ke harini pun hari ke lima mesti nak kena ada orang teman pastu nak orangtu mulakan dulu cakap dekat mak/ayah adik tu yang kita nak clerk anak dia. Aku takut pada rejection :( Padahal biasalah tu kadang parents patients ni nak privacy malas nak layan medical student tanya soalan yang sama berpuluh kali. Tapi bagusnya abang-abang akak-akak pakcik-pakcik makcik-makcik ni dia layan je orang tanya apa. Walaupun soalan tu dah ditanya banyak kali orang medical student yang berbeza.

Pastu kenalah terus terang kak/bang/cik/pakcik saya ni baru je bape hari kat sini. Tanya macam-macam ni sebab nak belajar kalau saya macam slow sikit tu maaflah ye heheheh buatlah muka semanis yang boleh. Yang bestnya dorang ni faham je tau. Tapi aku ni ha yang gelabah sangat takut nak approach.

Semalam nama aku naik untuk long case. Dokter nak case yang berkaitan dengan buah pinggang, down syndrome dengan sistem saraf. Aku pilih yang berkaitan dengan buah pinggang. Pagi rabu tu memula clerk 2 orang sorang ada jangkitan kuman pada saluran kencing sorang lagi ada nanah dekat buah pinggang. Serius masatu takde confident pun nak teruskan clerking sebab dah rasa krik krik taktau nak tanya apa. Aku masatu mengedeng je ikut kemana kawan aku pergi. Rasa bodoh gila boleh tak. Masuk ward taktau nak buat apa. Bukan taktau nak buat apa tapi takut nak approach patient. Haihhhh.

Pastu try clerk adik yang ada demam denggi, Dah confirm dah nak amik adik tu jadi case presentation. Sekaliiiii petang tu adik tu discharge dahhhh. Sedih gila boleh tak nak tak nak kena cari patient baru. So aku pun teruskanlah clerking juga adik yang ada nanah dekat buah pinggang tu. Siap berteman lagi sebab takuttttttt sangatt. Serius tak tipu :(

Tanya-tanya mak adik tu rasa macam tak cukup je rasa macam tak puas hati. Aku pun apa lagi bukalah bed tickets tengok file adik tu rupanya dia ada congenital anomalies. Buah pinggang belah kiri dia ada dua salur kencing (ureter) bahasa mediknya duplex kidney. Takpe kalau ada dua salur kencing dekat satu buah pinggang asalkan dia tak belit sesama sendiri. Ni adik ni saluran tu berbelit jadi tersumbatlah saluran kencingnya. Air kencing takboleh keluar terkumpul dekat buah pinggang. Apa lagi kalau air dah bertakung je macam tu senangnya nak dapat jangkitan. Tak kisahlah jangkitan kuman ke virus ke fungus ke.

So thats how adik tu ada nanah dekat buah pinggang dia. Selain tu dia ada demam, selsema dengan batuk. Juga mak perasan air kencing dia da sekali nanah. Jadi dia datang ke htaa untuk tebuk perut dia untuk alirkan nanah tu keluar. Lepas nanah tu dikeluarkan je barulah demam selsema dengan batuk dia tu surut.

Case yang aku buat untuk case write up ni pulak pasal jangkitan paru-paru.

Bila tengok adik-adik yang sakit ni aku rasa apa tau. Aku patut bersyukur diberi kesihatan. Kaya mana pun pandai mana pun kalau tak sihat susah juga. Bayangkanlah dengan badan kecik macam tu dah sakit-sakit. Hidup terperap je dalam hospital. Dalam ward to be specific.

Mana  yang asyik merungut Tuhan tak bagi apa yang kau nak tu tolonglah jangan. (cakap dekat diri sendiri juga ni). At least kita sihat. Boleh makan apa je yang kita nak. Boleh buat hobi kita luangkan masa lapang kita dengan benda yang best-best.

Bersyukurlahhhhhhhhhhhhhhhh.

Nanti-nanti :)

Paeds Posting : Day 1

Tak macam posting lain yang dah ada class dekat jalan hospital campus (jhc), dah start masuk ward dah pun (kot), kitorang yang posting paeds ni still dekat indera mahkota campus (imc). A week of introduction to paeds. Yelah paeds ni different from other posting pasal it is related to kids, while the others deal with adults. Daripada satu group besar yang consisted of 37 members dah pecah jadi tiga subgroup. Every week ada dua group akan ke temerloh dan se lagi ke pekan. Starting next weeklah. Last two weeks barulah ada dekat kuantan. Tapi macam mana pun tiap minggu (khamis) mana yang ada dekat temerloh tu kena balik ke kuantan pasal jumaat ada seminarlah conferencelah and so and so.

Tengok jadual pun dah rasa macam namateyyyy. Serius busy. Serius akan penat nanti. Serius this year is far wayyy more challenging than the previous two years. Ada 9 minggu of lecture, seminggu study week dan seminggu exam. Dalam 9 minggu lecture tu 2 minggu dekat kuantan, 2 minggu dekat pekan dan lagi 4 dekat temerloh.

40% continuous assessment dikira daripada attitude, attendance, seminar, case write up dengan log book. Untuk log book wajib clerk 20 patients, the more the better. Nak jadi a good doctor kan kenalah buat keje banyak sikitkan. Mana boleh sikit-sikit ni.

Kena perform at least 80 physical examination. 20 examination for each cardiovascular, respiratory, abdominal and neurological system. Campur clerking tu 100 ah. At least bukan at most. Tolonglah jangan malas sangat wahai diri sendiri. Aim for D kan kenalah perform dalam 150 ke? Aim high. Kita bukan lagi nak belajar for the sake of exam. Clerk patients pun bukan semata nak penuhkan log book. No! Letak dalam kepala semua ni untuk kegunaan masa depan kena masterkan bukan semata untuk nak penuhi requirement je. Okay?

60% lagi daripada exams; theory & clinical.

Orang kata jadi dokter ni lifeless pasal life dia banyak habis dekat hospital. Yeke? As long as kita enjoy apa yang kita buat everything will turn interesting (?) Sure kita takbolehlah nak jamin yang semuanya akan run smoothly but just keep on praying and work hard for that.

Nanti-nanti :)

For D

2 weeks of elementary classes before the clinical posting starts had just ended yesterday. The first week we learnt about how to take the history, some introduction to the postings; internal medicine, surgery, paediatrics and o&g, introduction to the operation theatre, how to build rapport (therapeutic relationship between doctor & patient), universal precaution that have to be taken seriously before examining the patients and so and so. The second week was all about the physical examination. How to perform cardiovascular, respiratory, abdominal and neurological examination.

History taking is the most important part as 70 percent of diagnosis rise from it. So it should be done correctly, precisely, accurately and so and so, followed by the physical examination and then the laboratory investigation. History taking looks like it is easy to be done. First, build the rapport. Then ask the patient what brings s/he comes to the hospital (the chief complaint). Based on the complaint we proceed to the history of presenting illness, past medical history, family history, drugs history, and social history plus menstrual and gynae history (for women). Looks easy, just talking-asking and listening to the patients. But actually for a beginner like me it is way difficult. Cause the time you heard the chief complaint, you must already have some differential diagnosis in your head so that you can ask the patients questions related to the diseases that you expect the patient have. One chief complaint leads to many possible diagnosis. 

Then look for positive findings and important negative findings to exclude some differential diagnosis. My basic medical sciences is suck. I think last two years I learnt only for the sake of passing the block exams & professional exam. And I used to study last minutes, a week before the exams. So that is why during the physical examination classes when the lecturers asked why this patient has this and this, if the abnormal finding is this what is the possible diagnosis, what is the pathophysiology of the symptoms, why? how? can you explain further? I CANNOT ANSWER IT and it is so frustrating. Yes, there's certain questions that i can answer but still it pissed me off. 

Now you see, this is the result for studying just for the sake of exam. As the exam ends, the knowledge starts to disappear as well. 

I will starts my paediatric posting this coming Monday (7th Sept). So now I needdd to clear my mind. Buka buku baru. All the things I am going to learn in paeds are what I will be encountering during my practice as a doctor. Learn by heart. Read, understand, remember and apply. Learn with all my heartttt. I am going to be a doctor. I am needed by the people to treat them. I need to be excellent in my study. I need to be persistent in my study. I need to. 

"If you want to be a doctor, be a good one"

Clerk patients at least 5 patients per day. Practice physical examination on them. Study the common cases in Malaysia first followed by uncommon one. Be positive. Always. If the lecturers get angry with me (obviously there is something wrong I have done) dont be disappointed. It means that there are many things that I have to learn, dont be depressed. Do not. Always be positive. Make a study group. Study! I am going to become a doctor and I have to be a good one. Let's work hard and smart for D (distinction)! 

I can do it.

Positive!

Sure things will become more challenging in clinical years. No more spoon feed. I have to be more independent. It is not easy to become a doctor. But it is not that difficult to be the one. Many have succeeded. And now it is my turn to be one of them.

I can do this.

I will become a doctor in 3 years time!

"Have courage & be kind" 

:)