Sunday, August 14, 2011

I JUST WANT TO BE ME

I'm not a star. I don't wanna be a star. I don't have a great name, the media have never heard of me. No public, no cheerleaders. It's not about winning or losing, it's about reaching your limits. Going as far as you can go and then going further!!. I don't collect titles, I collect hours, hours of hard work, hours of pain. As just me, I'm playing for the ultimate victory, the victory of yourself.This is a way of life, there's no finish line, becoming the best that you can be, there's nothing else that matters. Beating the odds, fulfilling your destiny. I don't wanna be a superstar, i want to be better than that, just want to be me, just wanna be ME.

Monday, February 21, 2011

i'm the pocket rocket man

Here's the thing that makes life so interesting: The Theory of Evolution claims that "only the strong shall survive." Maybe so, maybe so. But the Theory of Competition says "just because they're the strong doesn't mean they can't get their a***s kicked." That's right.

See, what every long-shot, come-from-behind underdog will tell you is this: The other guy may in fact be the favorite; the odds may be stacked against you. Fair enough ...

But what the odds don't know is this isn't a math test. This is a completely different kind of test. One where passion has a funny way of trumping logic. So before you step up to the starting line, before the whistle blows and the clock starts ticking, just remember: out here, the results don't always add up.

No matter what the stats may say and the experts may think and the commentators may have predicted, when the race is on, all bets are off. Don't be surprised if someone decides to flip the script and take a pass on yelling "uncle". And then suddenly, as the old saying goes, "We got ourselves a game."

Friday, July 9, 2010

Arrogant

This is a fear and a paradox of doing work that's important.

A fear because so many of us are raised to avoid appearing arrogant. Being called arrogant is a terrible slur, it means that you're not only a failure, but a poser as well.

It's a paradox, though, because the confidence and attitude that goes with bringing a new idea into the world ("hey, listen to this,") is a hair's breadth away, or at least sometimes it feels that way, from being arrogant.

And so we keep our head down. Better, they say, to be invisible and non-contributing than risk being arrogant.

That feels like a selfish, cowardly cop out to me. Better, I think, to make a difference and run the risk of failing sometimes, of being made fun of, and yes, appearing arrogant. It's far better than the alternative.

Tuesday, July 6, 2010

who you want to please???

Who is your action or your gesture or your effort or even your career choice trying to please? is it your boss, your family or just yourself?

Every man that I've ever seen fail has failed for precisely the same reason: they pleases the wrong person. Think about it... lets take advertising champaign for examples.It wouldn't have launched if it hadn't pleased the boss or the client, right? Pleasing the wrong person meant failure.

The same thing is true on a deeper level in your career choice or what you write or what you say or what you sell or how you sell it: if you are working hard to please the wrong people, you'll fail.I witnessed many smart & intelligent people (depends on how you define intelligent) fail to live up to their capabilities because they not try (or even try) to please the most important people: their own self !!

Does that critic or that buyer or that spouse or that girlfriend or that investor really matter as much as you think they do? i don't.... serve yourself 1st.. but don't be arrogance to not take wisdom from others..

Article on Housemanship in Malaysia

From TheStar.

Sunday December 7, 2008

Young docs walk a

tightrope

By RASHVINJEET S. BEDI and HARIATI AZIZAN

After completing a gruelling course, young doctors have another challenge to face – a demanding two-year housemanship where they rely on lots of coffee, cope with very little sleep and put up with public chastisements.

SHE had always wanted to be a doctor but six months into her housemanship, she snapped and just couldn’t take the stress anymore.

*Kavitha found the workload and endless hours on call a real burden, sapping her energy and spirit. Today, says her concerned father *Gurdave, she is close to having a nervous breakdown and is seeing a psychiatrist for counselling.

“The work load was too heavy and the hours too long. When she was on call, she sometimes had to work for up to 36 hours straight. She wants to be transferred to another hospital but every hospital is just as bad.

“But I don’t want her to walk away from the profession. I have spent close to RM400,000 on her education. I don’t want anything back but just for her to get through this,” says Gurdave.

Unfortunately, housemanship is taking its toll on many young doctors like Kavitha. Statistically, she is one of at least five housemen a month who is found to be suffering from mental illness.

Health Ministry director-general Tan Sri Dr Ismail Merican revealed last week that many of the medical graduates are unable to cope with their housemanship.

“The mental cases range from psychotic to neurotic. Psychotic cases include delusions and hallucinations, and neurotic behaviour includes anxiety, fear and anger due to the competitive environment.’’

On-call system

The term houseman refers to an advanced student or graduate in medicine gaining supervised practical experience. In Malaysia, it is compulsory for doctors to undergo housemanship for two years after completing their medical degree. During housemanship, they are rotated among six departments – emergency department, medical, paediatric, general surgery, orthopaedic, and obstetrics and gynaecology – where they are attached to for four months each.

Over the years, those undergoing housemanship have been voicing their unhappiness but these complaints have generally fallen on deaf ears. The biggest grouse housemen have seems to be the on-call system, where they are sometimes subjected to work 36 hours at a stretch.

*Pedro, who is into his sixth month of housemanship, says he has on occasion worked 38 hours straight with only one hour rest in-between.

“In some hospitals, the patient load is non-stop as they have to accept referrals from other hospitals,” says Pedro, adding that this is more apparent at hospitals in Johor Baru and Klang which are the busiest in the country.

Housemen are provided facilities such as beds and they can sleep if they have no cases to attend to. However, this is rarely the case and the most sleep they get is about two to three hours. And that is only when the housemen take turns to sleep, says *Lalitha whose housemanship stint ended recently.

“We force ourselves to carry on. What keeps us going is coffee and tea. It is only after we are no longer on call that we can go back and crash until the next day,” she says. Depending on the department and the hospital they are serving in, housemen could be on-call for up to 15 days a month. Lalitha says that during her first posting, she would work from 6am to midnight every day.

“We go home, have a bath and sleep for five hours before the cycle is repeated. They are preparing us for the on-call,” she says.

Shortage of doctors

Dr Kuljit Singh, president of the Malaysian Society of Otorhinolaryngology and Head Neck Surgeons (MSO- HNS), believes that one factor that can cause high pressure for trainee doctors is the shortage of doctors at some hospitals.

“Some hospitals have a lower doctor to patient ratio, so the housemen, being the lowest category in the medical fraternity, have to take on a lot of the work and responsibility, especially the lousy tasks, in the name of training,” he says.

Universiti Kebangsaan Malaysia Medical Centre (PPUKM) dean and director Prof Datuk Dr Lokman Saim agrees, saying that pressure from their heavy workload can push some doctors to the brink of breaking down.

“It is normal for a doctor to be on duty for more than 36 hours with on-call duties. In Europe, this has been recognised as a problem and they have passed a law to state that doctors cannot work more than 12 hours straight. Maybe we need laws like that if we want to improve our doctors’ welfare,” he opines.

Under the European Working Time Directive in 2004, junior doctors can work no more than 56 hours a week. They can work up to 13 hours a day but then have to have an 11-hour break.

Acknowledging that the number of doctors in Malaysia may still be too low for such a ruling, Dr Lokman nevertheless thinks it is a possible solution for the future.

Dr Lokman thinks that the problem of housemen suffering from mental problems can be prevented at the entry point of the profession.

“Currently, for public universities, students are selected by the Higher Education Ministry based on their exam results and co-curriculum activities. No interviews are conducted, so there is no way for the individual medical schools to assess their attitude and character. If we get the right candidates for the programme, we can be sure of the doctors we produce,” he argues.

However, he admits that it is not a foolproof method but he believes that it will help weed out the obviously unsuitable candidates.

“Many students are forced by their parents to take up medicine and these students end up very stressed because the course is difficult and they are not motivated. It will help us ascertain if a candidate has the right attitude and disposition to be a doctor,” he adds.

He highlights that a majority of students who fail and drop out of medicine are those who are forced by their parents into the field.

Bullying

But for those who successfully completed their degree, the challenge is dealing with the hospital environment.

They may have to contend with a handful of senior medical officers with the “Napoleon” complex who make the lives of the housemen difficult, says Dr Kuljit Singh who had served in government hospitals before branching out into private service.

“There is sometimes an element of bullying and high-handedness in the way some senior medical officers and consultants treat their junior house officers. They become Little Napoleons and are dictatorial. They say they went through the same regiment and that made them good doctors, so the newbies need to go through the same process,” says Dr Kuljit.

A senior doctor in the Johor Baru hospital, *Zul is also not happy with the treatment dished out to housemen.

“I have seen the degrading treatment given to medical officers, even after they have finished their housemanship,” he says. Zul himself was a houseman in the same hospital a few years ago and he says nothing has changed.

“If they talk about your work then it’s all right, but then they go into character assassination,” he says.

The housemen are usually screamed at by their specialists in the wards and in the clinics, he adds.

“The words used in front of patients are sometimes so degrading that in my opinion, it is these specialists who are the ones suffering from ‘mental woes’,” says Zul.

Those who fought back would be referred to the head of department who would either try to rectify the situation or extend the posting of the houseman, adds Zul.

A few of the housemen say there have been times when they were threatened with extensions in the department by medical officers.

Zul says that three of his friends quit the medical profession during their housemanship, with one of them ending up as a housewife.

“One of them would get anxiety attacks whenever she came to the ward. The thing is she was an excellent student,” says Zul.

*Maniam was barely a week into his housemanship when a specialist yelled at him in front of a patient.

“He asked me if I paid to pass my exams and also said I was the worst doctor he had ever come across. How can he say such a thing when I was there for only a week? They tend to look down on us as if we don’t know anything,” says Maniam.

However, Dr Kuljit, who taught at Universiti Malaya, shares that many students today are more pampered and have led a sheltered life, and thus cannot stand the pressure. Many come from a protected family environment, so when they are reprimanded, they get stressed and depressed. He believes that medical schools need to instil more soft skills, particularly interpersonal skills, in their students.

“We have many top scorers taking up medicine but many of them lack people skills. These students can manage with their studies but when they start working, they don’t know how to deal with their superiors, especially when they get scolded by them,” he says.

Pedro, on the other hand, does not have problems with any of the senior doctors he has to work with and says they are gems.

“I have no complaints because they teach us a lot. They offer us the opportunity to learn complicated procedures. They are willing to teach you even if there are possible complications. Even the specialists take time to teach you,” he adds.

President of the Malaysian Medical Association Datuk Khoo Kar Lin is unsure about the cause of mental problems faced by the doctors although he says the finding by the Health Ministry is a concern. He says a survey should be done on housemen to find out the causes.

“We have not received any complaints (about housemanship). I went through the system myself and from my impression it is not different from say 30 years ago. They are not being more overworked than yesterday,” says Khoo, adding that he enjoyed his housemanship.

“Every profession will have its challenges. We have to be cautious because people will always think that they are victimised and work longer hours compared to others,” adds Khoo.

President of the Malaysian Mental Health Association Datin Dr Ang Kim Teng says that housemanship could be a contributing factor to mental problems.

“It is not the job that causes it but the underlying susceptibility. Some people are more prone to this and the job stress could be a triggering factor. Factory workers, policemen and teachers can also face the same problem.

“It all depends on the individual’s ability to cope with stress. A lot of housemen go through their stints without any problems,” says Dr Ang.

Lalitha enjoyed her housemanship despite the many challenges in the different departments.

“We know this awaits us in the field. When I first started, I asked myself what I was doing here. The doctors pick on your mistakes and are not bothered if you have enough rest,” says Lalitha who got used to housemanship by her third posting.

She believes adaptation is the hardest and those who studied in foreign universities may have it tougher as they may not understand some of the terms used.

For *Tan, her social life took the backstage and she had to cut down on spending time with her family and friends.

“Those were the times when I thought of quitting but the feeling passed very quickly,” she says.

Tan didn’t really encounter any problems with the staff but has friends who have had books thrown at them and senior staff nurses giving them a hard time.

“At the end of the day, I am satisfied that I have somehow made a difference in a patient’s life. I don’t have any regrets getting into this line,” she says.

For Pedro, the only time he feels discouraged is when he has to get up at 5.30am for work.

“Once you get there it’s over in a snap,” he shares, adding that he feels really good when patients come out of life-threatening situations.

Pedro also says with all the running around they have to do, housemanship is the best weight loss programme.

“I can now fit into pants which I wore in Form Five!” he quips.

Prevention at entry

Dr Lokman Saim thinks that the problem can be prevented at the entry point of the profession, which is the medical course.

“Currently, for the public university, students are selected by the Higher Education Ministry based on their exam results and co-curriculum activities.

“No interviews are conducted, so there is no way for the individual medical schools to asses their attitude and character. If we get the right candidates for the programme, we can be sure of the doctors we produce,” Dr Lokman argues.

He admits that it is not a foolproof method but he believes that it will help.

He highlights that the majority of students who fail and drop out of medicine are those who are forced by their parents into the field.

Names have been changed to protect identities

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Clinical skills

Physical Exam Modules

Upper Extremities Module
Vital Signs and Chest Module
HEENT Module
Cardiac Exam Module
Abdomen Module
Lower Extremities Exam Module
Neurlogical Exam Module
Complete history and physical module

above are links to instructional modules and videos demonstrating physical exam techniques. The videos require Quicktime version 7 or higher. The video files are large

For useful medical websites http://mediconet.blogspot.com/

LEARNING AND TEACHING AT BEDSIDE

Skill Modules

Heart Sounds & Murmurs
Liver and Ascites
Neck Veins
Pulmonary
Thyroid

Dedicated to helping develop the skills of trainees (students and residents) in advanced physical diagnosis techniques and their application to patient care by demonstrating how to conduct attending rounds that include bedside teaching.

Linda E. Pinsky, MD

Assistant Professor of Medicine
Adjunct Assistant Professor of Medical Education
UWMC Director of Resident Ambulatory Training

Joyce E. Wipf, MD
Associate Professor of Medicine
Associate Director, Medicine Residency Program
University of Washington and Seattle VA

For useful medical websites http://mediconet.blogspot.com/

Neuro exam learning module

http://missinglink.ucsf.edu/lm/IDS_104_neuro_exam/NeuroExam.html

The learning module Components of the Neuro Exam was created by Jeremy Fields (MS2) and Wade Smith, MD, PhD

For useful medical websites http://mediconet.blogspot.com/

Neurologic Examination, University of Toronto

http://neuroexam.med.utoronto.ca/
Excellent collection of videos and text describing all aspects of the basic neuro exam.

short audiovisual tutorials that describe cranial, motor, and sensory examination technique. The explanations progress slowly through each procedure and are excellent for students. The continuity of presenter and simulate patient induce a relaxed pedantic experience. The author & narrator is Marika Hohol MD FRCP(C), Staff-Neurologist, St. Michael's Hospital, Assistant Professor of Neurology, Faculty of Medicine, University of Toronto, and the model is her niece. The videos are accompanied by notes on right side of video screen page for easy reference. ...

For useful medical websites http://mediconet.blogspot.com/

A Practical Guide to Clinical Medicine

A comprehensive physical examination and clinical education site for medical students and other health care professionals

Introduction	Breast Exam
History of Present Illness	Male Genital/Rectal Exam
The Rest of the History	The Upper Extremities
Vital Signs	The Lower Extremities
The Eye Exam	Musculo-Skeletal Exam
Head and Neck Exam	The Mental Status Exam
The Lung Exam	The Neurological Exam
Exam of the Heart	Putting It All Together
Exam of the Abdomen	Medical Links

source: the University of California.

For useful medical websites http://mediconet.blogspot.com/

PEDIATRIC NEUROLOGIC EXAM

"PEDIATRIC NEUROLOGIC EXAM: A NEURODEVELOPMENTAL APPROACH"

uses over 145 video demonstrations and narrative descriptions in an online tutorial. It presents the neurological examination of the pediatric patient as couched within the context of neurodevelopmental milestones for Newborns, 3 month-olds, 6 month-olds, 12 month-olds, 18 month-olds, and 2-and-a-half year-olds. Use the Table of Contents on the left to access these tutorials.

In assessing the child’s developmental level, the examiner must know the age when key social, motor, and language skills are normally acquired. The normal neurological findings one would expect for a newborn are certainly different than a 2, 6 or 12-month-old infant.

Obtaining developmental milestones is an important reflection of the maturation of the child’s nervous system, and assessing development is an essential part of the pediatric neurological examination. Delay in obtaining developmental milestones and abnormal patterns of development are important indicators of underlying neurological disease.

This "Internet Accessible Tutorial for Medical Neuroscience in the Pediatric Neurologic Examination" is authored by the University of Utah School of Medicine (Suzanne S. Stensaas, PhD), and the University of Nebraska Medical Center (Paul D. Larsen, MD).

A companion website to the Pediatric Neurological Examination is the Adult Neurologic Exam: An Anatomical Approach, where the anatomical foundations of the neurologic exam are presented and examples of both normal and abnormal patient conditions are exhibited.

http://mediconet.blogspot.com/

Neurologic examination

neuroexam.com is an interactive online guide to the neurologic examination, with video demonstrations. It is a companion to 'The NeuroExam Video' and 'Neuroanatomy Through Clinical Cases', both by Hal Blumenfeld
CONTENTS

INTRODUCTION

http://mediconet.blogspot.com/

CNS EXAMINATION

NEUROLOGIC EXAM AN ANATOMICAL APPROACH. Clinical Dissection of the Nervous System: An Internet Accessible Tutorial for Medical Neuroscience from the University of Utah School of Medicine (Suzanne S. Stensaas, PhD), University of Nebraska Medical Center (Paul D. Larsen, MD), and the Fundación Stern, Buenos Aires, Argentina (Alejandro Stern). Interweaves the neurological examination with neuroanatomy. This online tutorial lays the foundation for clinical problem solving by first, establishing the anatomical concept; second, demonstrating the problem solving method; then third, allowing active participation in applying the method. The tutorial combines the use of anatomical diagrams, live patient exam, video patient cases and self-evaluation tools to accomplish its educational goals. It also repurposes clinical video patient cases on streaming video for use in the tutorials as well as being available for use on demand. Anatomy and pathology of the nervous system is understood

http://mediconet.blogspot.com/

The Clinical Skills Online

The Clinical Skills Online (CSO) is a project aimed at providing online videos demonstrating core clinical skills common to a wide range of medical and health-based courses. This project has been funded by the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine.

http://www.youtube.com/sgulcso