Friday, October 31, 2008

Down again with URTI

I had 2 bedside teaching yesterday, in the morning with Dr Faizah and in the afternoon with Dr R. We did a few short cases with few patients in the ward.I had to examine a hyperactive girl and and who obviously not cooperative as one of my short cases.Gile stress.Dahla specialist garang and kuat membebel.
Went to the NICU again later in the evening(Baik jugak Dr R ni rupenye siap ajak pergi NICU lepas tu).Examined 2 babies.One with Patent Ductus Arteriosus.Examined him and found that he has Continuous murmur( aka Machinery heart murmur), best heard at the infraclavicular region with bounding pulse,exactly like in the textbook!Second baby had Acidotic breathing (aka Kussmaul breathing).He is critically ill.
I'm having sore throat with coryzal symptoms.The paediatric ward is full with viruses!

Thursday, October 30, 2008


It's only my 3rd week of posting but I am already suffering.Initially you thought that paediatrician are motherly and caring but in actgual fact they are totally the opposite.I know that u have a 16 yrs of experience of becoming a Dr and paediatrician.Jgn laa nk compare your ilmu with my ilmu.Baru 3 minggu in Paeds.
I had two bedside teaching today, one with Dr Faizah yg baik and another with Dr R yg kuat gile membebel.Has been selected randomly by her to present long case.I dont know why but she always makes me her target.My history was okay except for a few loop holes here and there.Normal lah kan? Didnt know that thee Feeding history as well as Child develpmental history must be THAT detail!!??? Kena tau how the mother prepare the milk, put the water first or the susu tepung later or vice versa,how many ounce, how many times per day, is it full of half-a bottle, when do you start to introduce formula milk, what brand, any allergic reaction,why that brand, when does the baby started to weened?If yes, wht kind of food,semi solid food?nestum? how many times per day? what do you give in the morning,afternoon and evening etc.Haish...blom masuk other history lagi...
Patients are so uncooperative.They will start to cry or run around once you approach them.Or they will start to make noise and monkey-ing around when you are doing the physical examination.Not to mention where there was this one episode when a baby started to sneeze right at my face while I was auscultating!It drains down all the energy and your patience.Seriously the Paediatric Clinic is just like any pasar malam in KL.

In short, Paediatrics is Kenerakaan dan sangat Leceh!I will never become a Paediatrician.A big NO NO

Tuesday, October 28, 2008

Link or Tagged or whatever you want to call it

I've been tag/linked to a few blogs.D* to write a more sensible posts from now onwards! It was never of my intention to write a proper 'blog'.I dont even edit my posts...gaaa

Monday, October 27, 2008


Sometimes we need to sacrifice in order to be good.I notice that I am still lacking in terms of my physical examination.Therefore, I sms-ed Dr Faizah and asked her whether I could join her ward round this Sunday.And she replied that I could join her.And so last Sunday I drove to Hopsital Serdang from my house in Cheras just to follow her ward rounds.It took 4 hours just to cover 2 wards; the 5A and 5B.I had to examined the babies and present my findings.No she didnt ask the houseman but me to do the examining.I was quite intimidated at first, sape lah aku hanyalah seorg medical student.But I improved later.Dats what I like about her.She will ask YOU to examine the patients for her.And she will teach you if you do wrong.I intend to do the same next weekend.

Some interesting cases
1. A child with acute Stridor
2.A child with measles- first time tgk

Saturday, October 25, 2008

Neonatal intensive care unit

Yesterday, me and my othe 2 group members had a bedside teaching in the neonatal intensive care unit with Dr Faizah, the specialist in-charge of the NICU in hospital serdang.We had to examined this one tiny preterm baby.It was awkward at first.This is my first time examining a tiny body.After doing physical examination on him,I presented my findings to her.This baby had pansystolic murmur of Grade 4,highest intensity at the tricuspid area.My colleague had to examined a neonate who is having bronchopneumonia.Apparently he had 2 out of 3 cardinal signs of heart failure.He had enlarged heart (cardiomegaly) and tachycardia.However, his liver was not enlarged.Dr Faizah had to break the bad news to the parents.It was really frightening after seeing the way the parents react.They were shocked and in denial.However, I admire Dr Faizah's way of handling the situation.She was straightforward and was being emphatatic at the same time.Life as a doctor is challenging.We still need to be able to handle all sorts of people.People,especially parents have high expectations on doctors.Its hard to be somebody who is a personafication of God's mercy

Monday, October 20, 2008


Today is like finally I got to know the difference between crepitations,ronchi,wheezing,vesicular breath sound and bronchial breath sound.It's really frustrating to just read from the book but unable to differentiate it in a real practice.Had a bedside teaching with one of the Paediatrician,Dr Faizah.I presented a long case to her just know.History taking was good, although I need to reorganize my points so that it make more sense.Did a few short cases as well on respiratory systems.I learned on how to present my findings for respiratory system in a a short but systematic way.Dr Faizah and us had to go from one patient to another patient because each patient had different signs.I am really really glad that finally I get to know the difference!Its hard to just read from the book.We also discuss the case and try to colerate it with chest X-ray findings.

I have another bedside teaching with her tomorrow morning.Need to do some reading.Not forgeting that my group have to give a lecture during our TBL session on the Development with Dr Rohaizah at 2.30pm.
Just checked my email and guess what I received 5 emails from my mentor Datuk Dr Musa Nordin...Why!!?? banyaknye kerja nk kena setel.Makan chocolate waffle je hari ni.I'm hungry

Saturday, October 18, 2008


Yes, today I wud like to talk about ringtones,particularly the ones that the specialists have.
In surgery, surgeons have been labeled as straightforward, no hanky-panky kind of person and will not hesitate to scold you.That's what I thought INTIALLY.I have encountered a few this type of surgeon during my previous clinical posting.They are more relax, cool in nature with non-radiating anger.They will scold you there and then and right after that, all is forgotten and forgiven.They might look stern,but all that image that you have for them were shattered once you listen to their ringtones.And so I have decided to judge them based on their ringtones! haha
Some of their bizarre ringtones are
Dr(Miss) A = A frog which sounded like he is about to puke.Its so funny and little bit annoying when you listen it during the operation.

Dr(Mr) H = A disco song! A cool and alim person with a disco kinda ringtone.Beats me!

In paediatrics...

Dr N = "Touch My Body" by Mariah carey.I mean like wow! I gaggle each time when her phone rings.She is in her 50's (so I persumed) but she certainly is berjiwa muda!Did I mention that she is using a new iPhone too???

Dr H = A song called 'My heart' by Acha Sep...whatever tu. She is garang and persistent PMS-ing.I never thought that she wud have this ringtone, its so contradictory with her personality!And yes, she uses a new iPhone too.Whats with the iPhones??? Apparently people in the paediatric department love iPhone so much.What they got a subsidy for it ar?

Anyway, dont get me wrong.All of them are nice, orelse they wont become a doctor in the first place.It takes a little bit of effort to get to know them.Know what to ask, how to ask and when to ask...

Friday, October 17, 2008

Those cute cuddly little babies

Yes, I just completed my first week of Paediatrics posting in Hospital Serdang.My impression: A bit boring compared to Surgery.URTI, Asthma, diarrhoea and a few other common illnesses.Thats it so far.Not too interesting for me I guess.
I like those little babies and kids.There were no problems in clerking their history from the parents.The parents are very helpful and will always try their very best to provide us with satisfactory answers.They are not too protective with their child and will assist us during physical examination.However, the tough part is when you actually want to do physical examination on babies.Kids are okay.But babies, phew, really a headache.Sometimes, they will start crying by just seeing the white coat that we wear.Occasionally I had to open my labcoat and not wearing it while in front of them.This is what we called "the white coat syndrome".Some countries like in the UK, it is highly discouraged to wear white coat while in the paediatric ward.It makes your life miserable when your patients starts to cry.
In paediatrics, we had to bring our own rattler, wood blocks and some soft toys.They are meant to attract attention but most importantly to assess development of the child.It is part of the history taking andphysical examination.The history taking and physical examination is significantly different from Surgery.In history taking, paediatric history is added.They consist things such as Antenatal,neonatal history,Immunization, Feeding and weening history,developmental history which consist of fine motor skills, gross motor skills, speech and vision and also social skill.I'm still learning in getting a good history.
I'm really missing Surgery so much!

Wednesday, October 8, 2008

Surgery Exam Week: Long case exam

Seriously, I didnot know whether I should be pissed off or be happy with my long case exam just now.
I am not happy because

1) I got a patient who does not know how to speak or even understand Malay or English.He is a Bangladeshi patient to be exact.Came with central abdominal pain of 1 day duration.I had to use a translator for history taking, and it was tough and time consuming.It took 1 and a half hours for everything-ie history taking, physical examination,summary,provisional and differential diagnosis,investigations and discussion.Most of the HOs and MOs in the ward were in disbelief when I got this patient for my exam.They themselves have difficulty in extracting the history from the patient.
The case was a difficult case and I was the only one in my batch to get him as patient!Anyway, I think I did allright, though it could have been better.I manage to come out with the correct final diagnosis.The diagnosis was " Subacute Intestinal Obstruction secondary to Adhesion colic" .My reall really strong point for supporting the diagnosis was " This patient have a right paramedian scar due to his previous abdominal surgery in Bangladesh.During the process of healing, there will be fibrous tissue formation which will make the gut to adhere to each other".Something like that. Initially my provisional diagnosis was "Strangulated Incisional Hernia" due to the presence of that surgical scar but however during the physical examination the cough impulse was negative.So I've decided to change my provisional diagnosis to that adhesion colic thingy.

2) We did not know when is our examination, as in the time.We always need to be ready, handphones must always be with us at all times.I received and SMS from Mr Ahmed the surgeon(my examiner) at 10.45 am while I was at the Surgical clinic.I need to be at the Surgical ward 3A in 30 minutes time for my Long case exam.I was anxious for one whole day yesterday because 7 of my friends had their long case exam already.

I was happy because:

1) I did not really clerked the patients prior to the exam.I did now even bother to know the diagnosis of the patient in the ward.This is to prevent bias in exam.We tend to be bias if we've already know the diagnosis .We tend to forget to ask other relevant symptoms which might be related to other differential diagnosis.Bias is really really really dangerous in any medical examination

Currently preparing for my Best case write up report, SWOT analysis, Reflective diary, Peer assessment, and for my Written examination.Argh!