:: my little box ::

Saturday, September 29

I've been having quite a nice time doing SIP for the past 2 weeks at NUH surgery... Although the HO i'm following is on leave the other 2 HOs in the colorectal team have kindly adopted us...

The 1st week (tues to thurs) was a mad mad rush. I was so busy and tired... We didn't have that many patients but somehow our patients were pretty complicated and not very stable so we had to call alot of pple, arrange alot of stuff and the discharge summaries were also very complicated. And it didn't help that we were still new so naturally we didn't know how to plan in advance, what to do first, how to speed things up... So quite shi bei gong ban like that...

The earliest I went home was 7pm! Still, i felt very satisfied. Its cool to be rushing around and i'm happy that I'm putting in my best for my patients. Although it takes more out of me and i go home later i feel contented.

I hope i'm doing the "thinking house officer" job... Most of the time we act as scribes, taking down the vitals and writing down stuff the Drs tell patients, but there are times we can make a difference!

Sometimes I feel like i'm each patient's personal secretary, cos i need to keep track of their various appointments and make sure that they don't miss out on any. I had 1 patient who was supposed to be arranged to see ID in 1/52, but the ward clerk wasn't around so the SN said she'd take note. I went down the following monday and she still wasn't around and the appointment wasn't done! So i got the staff nurse to note it down again and checked 2 days later... Phew, thankfully they managed to get the date.

I wish the system was less confusing. Sometimes patients miss out on things because they're not being followed up properly and i get upset when i realise such things are happening. Its so easy to miss out things, especially when the patient has SO many appointments.

Maybe every patient should have their own card, and be updated on who they're supposed to see so that they can remind Drs if they forget anything.

Another problem is that because we refer patients to so many people, the management is all split up! We had a patient who's OHGA/insulin was discontinued, and they referred endocrine for outpt mgmt. His aspirin was also stopped cos he had PR bleeding at the time.

I really do hope that his physician remembers to restart his aspirin and that the endocrine appt is up and that he goes for it or his DM control will go out of hand again! (He can't afford it cos he already has DM nephropathy!) Which reminds me i'm supposed to ask why a renal pt is given aspirin.

Thankfully our patient load isn't that high because if it is I'll be totally flustered looking after all these bonus aspects of our patients.

But i think its necessary because we cannot treat just the condition the patient presented to us with, but rather the patient as a whole. In this aspect i feel that we should communicate with the patient's family Dr to organise care, but singapore has not reached that standard yet, and i think HOs will kill me if I suggest they print an extra summary for the GP to read so that they can further manage the patient.

But this is needed esp in those pts who aren't that well educated and don't understand what's going on!

I will bring this matter up to the neuro team next week. (Or whichever dr i feel is nice and willing to listen) I'm sure alot of pts have such problems and i don't understand why no one has though about resolving this earlier.

Ok, memo to self to refer senior Dr.

I think alot of pple don't really know what i"m talking about but its ok! This is for my own reference. haha... But i'm sure my classmates know what i'm talking about.

Repeat point: Do NOT treat the patient's condition! Treat them as a whole! I'm not sure how other pple work, but i have a feeling that alot of them just want to treat the problem, then quickly d/c the pt out of their hands and refer them to other pple to settle the rest of their problems. I can't blame them because they must be very busy and they have so many pts, unlike the SIP student (like me) who can take time to really sit down and sort things out. But i think its for the patient's good if we treat everything together.

Note to self: Be a THINKING house officer. Don't act on spinal level. (at least not for all things)

I had a pt who was referred to colorectal who's HCTZ was taken off cos she had hyponatremia. After that her BP was persistently high (150 +) and no one did anything about it. On discharge (it was only our 2nd day taking over her case) i could've ignored it but i decided it wasn't good and called our Reg to ask if he wanted to do anything. Thankfully he didn't say "refer cardio" haha... and upped the atenolol dose.

I feel that its a small thing, but it makes a whole lot of difference, because when the patient gets discharged, the pharmacist will tell her what sort of medication to take based on the prescription. So her BP control may remain high for the rest of her life if no one picks it up!

Which is bad of course. :(

Ok, enough about patients. Now for the team - i've enjoyed the past 2 weeks. I like the colorectal team alot (Especially one of the senior consultants) cos he makes me feel just like a part of the team and I feel very happy on ward rounds. There is less of the hierachy sort of "you are the HO, the lowest life form, i don't talk to you except to give orders".

:) haha, i'm happy! If all my HO postings were like that I'll be really happy to go to work everyday! But of course i don't expect such luck lah.

Ok, these are all my thoughts. Sorry they're so jumbled up. Will try to sort them out.

Till next time!

*Me to You*
Tatter teddy posted at 11:53 am

Sunday, September 23

Haha, this sounds like a very cheem post but its actually a silly one..

Sometimes i think too deep into things and i end up bringing myself onto the wrong track...

Last week's paeds OSCEs had a question showing this fat girl with central obesity... I was already writing supraclavicular fat pads cos it was Cushing's syndrome when i started questioning how come there wasn't any acne or purple striae...

Then i saw that she had a low hairline and it occured to me it must be Turner's syndrome.

Sigh. Big mistake... I'm such a stupid idiot... It was such an easy question! If i went ahead and answered it I would've gotten almost full marks. bleargh... And now i got the whole thing wrong. SIGH.

Should've calmed myself down before the test... Dunno why I was so nervous also... Haha.... the adverts say drink driving kills. I say nervousness kills too.. haha....

Anyway i remained upset with myself for like the whole day! I know its only 1 question but in cases like this its not about the marks but rather 'how can i be so foolish/stupid/idiotic/whatever???!!!' Grrrrrrrrr....

Thankfully we went vivo and had a nice lunch after the playhouse meeting and i had a nice dinner with Derrick so that made me feel better! :)

And I felt better the next day after having a good night's sleep! Set things aside man!

Till next time,

Cheesie

*Me to You*
Tatter teddy posted at 12:35 pm

Tuesday, September 11

Oh, and by the way i realised that today is 911!Maybe that's why i'm in low spirits? A bad day when alot of ppl died when i was in J1 (6 years ago)...

Oh dear, has it really been so long? Oh dear, MBBS is coming soon... Oh dear... That's terrible... I like being a medical student. Sigh... I SO don't want to work as a HO. But of course i would like to pass my MBBS the 1st time. So what to do, must become HO loh. Sigh... If only the work wasn't that tough I would probably enjoy it more...

*Me to You*
Tatter teddy posted at 7:09 pm

I'm into my 2nd week of ortho posting... Unfortunately I haven't been mugging much cos i've been studying paeds more... What makes it worse is that for the 1st week i felt really tired upon reaching home and started dozing almost immediately upon touching my notes... ARGH... I can't understand why i'm so tired!!!

What's worse, i fell sick on Sunday night and was sniffing really badly for the whole day yesterday... Now I'm better but i've still got a blocked nose... Sigh... My health hasn't been too good... its my 2nd URTI in 1 month! (I got a URTI during the 1st week of study break b4 ortho started) Darn...

Ok i'll stop whining because my Small Small URTI is peanuts compared to what other people are suffering... Its just irritating to feel sick if you know what I mean...Not being able to run well/smell well/eat well without feeling discomfort...

I wonder how those patients with chronic pain feel? Will the pain really go away after some time? I really wonder... I hope I won't have such problems in future, cos feeling sick makes me irritable and I'm not exactly a very tolerant person.

Was discussing with Ah Ma today about DM risk... haha she was saying Dr XX at TTSH was telling her he sure "kena" cos both his parents have diabetes... I think my chances aren't exactly low either cos my grandad and grandma (paternal and maternal respectively) have diabetes too... But if given a choice we would both rather have dyslipidemia cos it seems easier to control... haha... DM and Hypertension are really no joke... Seeing so many patients with foot ulcers and my own grandpa with a ray amputation I think DM is a terrible thing to have... And i also read somewhere that it takes away 13 years of life... (I think its 13)

Sigh... In not exactly high spirits... :(

*Me to You*
Tatter teddy posted at 6:57 pm

__Archives__

Archives