Tuesday, August 26, 2008

Short form

In Malaysia, we are flooded with many unauthorized, self-invented short forms.There are many reasons of inventing these short forms.First, it is easier to write notes or jot down something really fast when we have short forms.Second, medical terms can be sometime become a tongue twister, especially when they are combined with few other medical jargons.Below are the short forms that I have learned so far during my Surgery posting.Correct me if I'm wrong, or you have anything to add.

TCA-To come again

AOI-At own risk

TDS- 3 times per day

BDS- Twice daily

Stat - Immediately

PRN - Only when necessary

Imp- impression

These short forms are usually used in writing notes during clerking patients, or being used in any forms that need to be written down by the nurses or doctors.

OGDS- Oesophagogastroduedenoscopy ( try to say it 10 times continuously.haha)

ERCP - Endoscopic Retrograde Cholangio Pancreatography

IND - Incision and Drainage

SNC- Suction and Curettage

DNC-Dilatation and curettage

In order to pronounce these words correctly, you have to be relax, take a deep breath and say it one syllable at a time.But, it is quite impossible to do that when you have to present in front of the Specialists, who are known to be bombarding you with lost of questions.Tak habis ckp lagi dah tanye next question.

What did I did today:

1) Ward rounds, clerk patients, do physical examination, prepare my short cases which I have to present this Friday to Dr ( Mr) Al-Amin.
Note: When a person is a surgeon, please do not call him/her 'Dr'.Instead, if he is a gentleman, call him 'Mr' or if she is a lady, call her 'Miss'.Pelikkan? Dah susah susah jadi Dr, tetibe nk kena panggil Mr and Miss balik.

2) Do Rectal examination on my long case patient in order to complete my abdominal examination

3) Perform ECG on a patient

4) Observe OGDS

5)Observe Colonoscopy with Punch biopsy

6) Observe insertion of Central Venous Pressure line (using Seldinger technique)

Monday, August 25, 2008

How long does it take to greet patients?

It saddened me to see that the specialists and other doctors in the Hospital Putrajaya to not to greet their patients well.This is usually seen during the ward rounds.You can hardly see them greet and aknowledge their patients.All they do is straight away discuss the problems, complications, treatment plan etc among themselves, although the patient is staring, waiting helplessly in front of them.Sometimes its quite funny to see that it is the patients who greet the specialists.There is no doubt that these specialists are brilliant and talented people.They are always busy due to their tight schedule.But, is it so difficult to say Hi, or give salam and say How are you today?How long would it take? 5 minutes?? No it only takes only a few seconds.I just would like to remind myself and to those future doctors out there that our job is not treating the diseases only, but treating the patient as a whole.I always here that the HOs mention the patient by their diseases."Hey Timah, boleh tak ko check kan patient yang ada paralytic ileus tu, aku busy la" .I mean like...helloo...tak payah laa sampai macam tu skali kan?
Few patients have actually asked me "Doktor ( altho I am not a doctor yet but they insist of calling me by the title 'Dr' ), saya ni sakit apa sebenarnye?" Can you believe that? The patients dont even know what they are suffering from.Where is the human touch? One of the ways of relieving the pain and the suffering of patients is actually verbally treating them well.Try to talk to them.Make them laugh.Listen to their stories about their family, their work ,their children, their hobbies etc. So far, it helped me in doing my task.I felt easier to clerk their history, do physical examination ( Per rectal examination included!) as they become more confident towards you.They trust you more.They know that you are there to help them.
I am currently doing my second Long case.It's about a 74 y.o Malay lady with the history of colon cancer.She was admitted to the ward due to epigastric pain with jaundiced.Due to the history, the doctors suspected of liver metastases and porta hepatis lymphadenopathy.It later confirmed with ultrasound and she will be referred to Hospital Selayang ( The Liver and Gallbladder specialist hospital).That makcik was very cheerful and comel( admitted by my other colleagues themselves)
I helped one of the HO to do wound dressing on an open book fracture of the pelvis due to motor vehicle accident.This patient had a big hole at his right upper buttock.The wound needs to be cleaned every other day.It was not easy as I had to wash the wound with saline, hydrogen peroxide and do suction.It was first my time and it was a good experience.Managed to assist in doing the Vacuum-assisted Closure(VAC).The surgical ward MO, Dr Zamaq asked me to learn and by next week, he wants me to do the dressing myself.Adeker????Dah gile ape?
Other than that, I clerked a few patients today and did some physical examination on them.I really like this one patient, where she was really cooperative.I totally respect her as she told us that she will helped us by telling her problems.She even let us to do PR to her.She work only as a cleaner.Why cant the doctors be as kind as her.
Hmm ok, gotta go.Long case under progress ...............

Friday, August 22, 2008


Just got back to home sweet home.Seriously, penat giler... Wards, Sick outpatient department, OT, Emergency department..you name it...clerked soo many patients, physical examinations ( no cincai cincai...must be thorough)...including breast examination, assist this, assist that, prepare shortcase...prepare and present long case for patient.Life is so hard

By 7.30 am, I have to be in the hospital, ward rounds is at 8am with the Surgeons and specialists, MOs, HOs.Then I will wither stay in the wards, or rush to the Clinics or Operation Theatre to see interesting surgeries, depends on my group rotation.Malam, ada on-call both in the Surgical wards or Emergency department.Balik pukul 12 am.Life is so demanding.

Wednesday, August 13, 2008

Surgery posting: Day 3

I did a procedure called "Per rectal (PR) examination" today.PR is actually a procedure where you insert your finger into the anus of your patient.It gives a wealth of information which helps in diagnosis and assess the patient's condition. You can say that I was lucky as I already had the opportunity to perform this procedure on my third day of posting.haha.Thanks to Dr Najma.Sungguh baik hati kerana mempercayai dgn skill saya yang tak seberapa ni.
Had my first TBL (Task based learning) session today with Dr Ahmed Ali..We discussed about a topic regarding 'Breast lump" . The session began with a lengthy presentation by Azrul and Benjow .It started off by doing some revision of our preclinicals knowledge about the types, the staging etc of breast tumour.Then we proceed to the signs and symptoms, risk factors, invstigation, diagnosis( triple assessment involving examination, imaging and cytology) and ultimately the physical examination of the breast.Seriously, didn't know that a proper and complete breast examination is that complex.
I clerked a few new patients today and presented my case to the doctor.Ward rounds? of course.Tomorrow I am going to follow my patient with left inguinal hernia to the OT.I am going to take him as my first Long case presentation.

Surgery Posting: Day 2

I am currently in the comp lab as I am unable to update this blog at the comfort of my newly rented house in Precint 9, Putrajaya.It's cold, I'm tired and exhausted, and I just done on my slides regarding the "Metabolic Response to Trauma & Surgery", which I have to present in the Seminar session tomorrow.By the way, today is my 3rd day of surgery posting and not the 2nd day.I am not able to update yesterday due to unforseen circumstances.You will know at the end of this post.

The second day started at 7.30 am.We waited for our Hepatobiliary surgeon Mr Al-Amin in the lobby of Hosp Putrajaya.Today was our first bed-side teaching and seriously it was interesting.We covered two cases of bed side teaching today.The first case was Dr M, who had a Paraumbilical hernia and the second one was Makcik S who had a Parathyroid Hyperplasia secondary to pr0longed and chronic haemodialisis as a result of renal failure.Azrul and Salwa, two fellow group members clerked the case respectively in front of Mr Al amin.They even did physical examination.Then after a few comments by Mr Al-Amin, we proceed with our activities.As for me, I clerked a few cases.I was a bit nervous as this was my first time to clerk case from a real patient.I am currently attached to the Surgical Ward 3A ( a Male ward).The cases that I manage to see were acute appendicitis, Intrauterine death and Mesenteric tumour.I like this one post-op mesenteric tumour pak cik.He is 73 year old and seriously was healthy.Despite of being a driver of jentera berat who has irregular working hours and had to work 24/7, he appeared to be healthy.He doesnt smoke,.He doesnt have DM or Hypertension.His other 14 children have those diseases instead.Both of him and his wife was really friendly.They even gave their phone number and home adress, asking me to visit them once he has been discharged.So sweet.There is this some feeling of satisfaction in me.

At 2 pm, we had an appointment with Sister Sabariah at the OT department.We had a lecture regarding " Scrubbing, Gowning and Gloving method".Seriously, I felt that going into the OT is not as easy as ABC.There are procedures and steps that we have to follow in order to ensure sterility in the OT.It shows how st*pid that show named Grey's Anatomy is.Haha.Nak jalan kat OT pun ada cara.Nak berus tangan and lengan pun kena ada teknik dan repetition tertentu.No wonder my surgeon told me that as a medical student, do not feel hampa when after finish scrubbing the operation has already ended.As a beginner, it will take quite a lengthy time to scrub in.

The highlight of the day is actually during my On-call hours.Yes, I already have on-call.It began at 7.30pm and ended at 12am.I rushed to the Ward once I have arrived at the hospital that evening.I met a few patients just to update their history.I had ward round at 8.30pm, along with H.O Dr Sufiani( sangat baik ), M.O Dr Zamaq ( Triple A's student masa dekat HUKM dulu, I think) and Endocrine surgeon, Mr Cheong and a few nurses.I was asked to do full abdominal examination to a Pakistani patient, suspected of having Pancreatic tail carcinoma.Doing a full physical examination in front of a specialist, MO and HO for the first time was not easy.I was pretty nervous at the beginning but later managed to maintain my composure.The only thing that I have done wrong was that I forgot to make sure that the patient is lying down 180 in supine position.The head of the patient was actually tilting 45 degress..huhu.Mr Cheong also asked me to feel the difference between the Left iliac fossa and right iliac fossa of this one patient who had just being admitted to the ward, suspected of having acute appendicitis.He said, the problem with medical students nowadays is that they do not know how to differentiate between guarding and tenderness.

Later, I proceed to the Emergency department(ED).Sumpah wallah ramai gile patient malam tu.The department was quite hectic and the staff were running around here and there.Me and my colleagues introduced ourselves to the doctors and nurses there.I was given the task to clerk a patient who had just went into the ED.I later presented the case to a Dr named Dr Hasanah ( sangat baik rupanya) and after a few questions, she gave me two thumbs up.Tak sangka.I occasionally went to the Radiology department and managed to see a few ECGs,X-rays and CT scan.I saw a patient with a multiple infarction of the brain in CT scan.Maybe that's the reason why he is being so restless and is having dementia.There was also a patient who have DM, Hypertension, Gout, history of MI, Left Bundle branch block(LBBB), and Parkinson's disease.Serious, a super combo for me that night.He already have akinesia, cog-wheel rigidity, pill-rolling tremor, slurred speech as a result of Parkinson's disease.He also have bilateral non-pitting oedema of the legs due to his congestive heart disease.However, the chief complaint was SOB (Shortness of breath) .Creps (Crepitations) was heard at the left lung on auscultation.Dind't have time to wait for the X-Ray becoz it was already late.Juru X-ray pun tengah keluar pegi makan masa tu.

One thing I learn today is that do not be shy.Be confident.Ask when you want something.The staff of Hospital Putrajaya is more than happy to assist you,seriously...

Monday, August 11, 2008

Day 1 : Surgery Posting

Bismillahirrahmaanirrahim, today 11 th August 2008 is the day I blog.Yes, this is the day where I started blogging, pouring out my feelings, views, vent my anger or "ketidakpuashatian' etc.

The day started off by clinical briefing by Prof Latiff at the auditorium.The session started at 9 am and me being the smart ass came late.It was completely unintentional.I began my journey from home and I was caught in a traffic jam.Hang ni pun satu Nabil pasaipa hang pi ikut jalan tu kalau dah tahu traffic light situ mcm siput.The late is not like really late.It was only like 2-3 minutes late! However, I admit my mistake to prof.I know well that 1 minute difference can save lives in clinical settings.And so, dapatlah penumbuk gaban Prof Latif kat bahu tadi.After the briefing, we had sessions according to our respective group.The surgery posting group consists of 16 people and we met 2 of our professors of whom are experienced surgeon.They are Mr Ahmad Awil Adam ( aka 'Triple A') and Dr Ahmed Ali Abdullah from Yemen.We were given our clinical logbook , guidelines and other books.I must say that clinicals is about self-directed learning.There is nomore clear cut stuff like you learned during pre-clinicals.In pre-clinicals you can read, discuss and do the exams and pass with flying colours.During clinicals we have to apply our basic knowledge, apply and improve our psychomotor skills and most importantly improve in our affective domain ( communication skills, verbal/non-verbal skills)

Later in the afternoon, we went to Hospital Putrajaya.I had lunch at the cafeteria.Hanan didnt eat becoz she is puasa-ing and Odi, my senior who is currently doing her O&G posting were there also.She basically told me all the things which made me a little bit worried and afraid.At 2 pm, we went to the surgery ward.I must say that all the H.Os , M.Os, nurses etc were seen to be perplexed.It was as if they were invaded by a group of aliens.Serious sh*t I tell you, it was written all over their faces.That made me a lil bit worried becoz the reception was not really encouraging.But I still think positively, as the old Malay saying goes "Tak kenal maka tak cinta". The we were introduced to 3 lady surgeons.Yes, LADY.One was baik, one was tak nak tengok muka kami lansung, and one was garang.Again, I am not going to judge them becoz "Tak kenal maka tak cinta".

At 3-4 pm, we all gerak to our resource centre in Precint 9 Putrajaya.We waited for our Prof to come.One thing I would like to say is that our teaching and assesment is very much different from our pre-clinical years.In preclinical for example, I had SCTL, PBL,Clinical correlation sessions, OSCE, OSPE etc. But in clinical years, I will have to be accustomed with many new ways of learning and assesment.I am going to have TBLs( Task Based Learning), Seminars, CCP( Combined Case Presentation) , CPC (Clinico-pathological conference), short case presentation, long case presentation etc .Not to mention the ward rounds ( general, pre-op, post-op), clinics hours, operation theatre, bed side teaching etc. I am still trying to digest these new stuff.

One word that can summarise me for today."MIX feeling".I am feeling excited and afraid/worried at the same time.Will I perform?Will I able to meet the expectations?Will I learn things that will benefit me and ultimately to my patients? Only time will tell...