Saturday, November 27, 2010

TRIAD (ENT,OPthal,Anaesth) Posting!


Yesterday, I officially ended this three minor postings group all togather and called TRIAD posting. It was definitely tiring with so many things to catch up in such a little time. We also log book to fill in and case reports(case write up) to be made for each minor posting. Regardless all, it is indeed an intresting posting as I won't encounter it as houseman (HO) again.

We get 3 weeks for Ear, Nose & Throat (ENT) posting, 3 weeks for ophthalmology and 2 weeks for Anaesthesiology. So total duration like a major posting = 8 weeks !! oh ya, for this posting we need to have an otoscope and opthalmoscope that cost about RM600 altogather. The advantage is you can practice it at people anytime you want.

This is the last minor posting of triad which I am most intrested on. Anaesthetist are also known as perioperative doctor. They manage patient whenever a surgery is involved and will see the patient before. during and after surgery (during recovery). The triad of anesthesiology on the effect aimed during surgery is: anesthesia (unconscious), muscle relaxant and analgesia (no pain).

In this posting, knowledge about drugs & medication is vital. We need to know the types of drug, mechanism of action, effects, indication...all the pharmacology parts. I used to dislike memorizing pharmacology. However, since the posting teaches us the relation and importance of these drugs, it makes pharmacology interesting!

Anesthetist need to be skilled in inserting needles to patient and life saving procedures. We need to do 5 intravenous cannulation at Accident & emergency(OT)within 2 weeks for this posting and see general and regional anaesthesia procedures at Operation Theater(OT). We also took Basic Life course(BLS), learn about defibrillator and type of mask use during the last week(2nd week).
Source of picture :

Yup,maybe I want to be an anaesthetist...put people to sleep..and wake them up after the surgery..hehe :)

Ear,nose & throat (ENT)-Otolaryngology

From the name itself, you can guess which area it involves. It is the first minor posting frm TRIAD. SInce my supervisor is specialize in nose, i see a lot of cases related to nose. In this posting, we need to know how to use the otoscope to see the eardrum clearly. The most intresting thing I was able to see is the presence of Aspergillus Nigra inside the ear (looks like fungi at the bread). The doctor later clean it with the ear toilet (suction of the fungi out from the ear).

normal eardrum that can be viewed via otoscope

Source of picture :

An ear infected with Aspergillus Niger. Diagnosis : otomycosis

Source of picture:

Some common cases seen are allergic rhinitis. They have special clinic day called allergic clinic. Another intresting thing to see is the needle prick test. There will be about 20 antigens of common triggers of allergic like dust mite, prawn an nuts that will be tested. The staff will make a small pricked on the patient's forearm(palmar side) with a blunt pin without bleeding. It is painless. Although, it may cause anxiety to certain people...hehe

Your eyes do not see what your mind does not know!! It is all about eyes and everything related to it. So, the basic science of eyes needed to be revised. I am amzed to know that we can suspect a systemic disease by looking at the eyes. The eyes will effected in most systemic disease know especially diabetes mellitus. We have to learn to use opthalmoscope to see the retina (an area further behind, inside your eyeball) with the help of pupil dilator. We need to draw 20 significant findings of retinal disorder in our log book that needed doctor's sign.

It needs a lot of practice to get the skill of using a direct opthalmoscope. It can be tiring to us as we need to strain our eyes to see the area of retina and find if there's anye significant finding.

However, regardless all, i like the picture of retina..its' beautiful (subahanallah!)

Source of picture:

Next posting will be PSYCHIATRY(my LAST posting for year 4) and then I'll be a FINAL YEAR student after the final exam... (",)

Sunday, November 21, 2010

Sexually Healthy Youths!


What happen if you talk about sexuality issues?? Variety of respond will come out.The respond will range from openly discuss about it to stigmatized the topic and refuse to discuss it. It is not only about sex.It is about the relationship between men and women,XY with XX,mars & venus (you get the picture).

Islam is syumul(complete) that have guidelines in sexuality issues and on how we should behave among different genders. A sexually healty youth should feel safe with those who are known to be safe.

from An-Nur (24:30-31)
Tell the believing men to lower their gaze and be modest. That is purer for them. Lo! Allah is aware of what they do. (30)
And tell the believing women to lower their gaze and be modest, and to display of their adornment only that which is apparent, and to draw their veils over their bosoms, and not to reveal their adornment save to their own husbands or fathers or husbands' fathers, or their sons or their husbands' sons, or their brothers or their brothers' sons or sisters' sons, or their women, or their slaves, or male attendants who lack vigour, or children who know naught of women's nakedness. And let them not stamp their feet so as to reveal what they hide of their adornment. And turn unto Allah together, O believers, in order that ye may succeed. (31)

Who are the one who are known to be safe?? They are those who obeys these to verses in Al-Quran.. men who protect his and the womens' modesty..women who protects her modesty and cover her aurat (body)..Its all there in AL-quran the book of guidence for Muslims.

According to Mary Buxton,a certified sex therapist, A sexually healthy teen are those who appreciates their BODIES (even a non-muslim agrees on this). Appreciating your body in Islam is covering our body and also keep our modesty.

Sexually healthy teens are:

* those who take RESPONSIBILITY for their own BEHAVIOURS
-so,please be wise in any decision and do not blame others on your action because you are the one who is responsible for your own choice.
* COMMUNICATE effective and respectfully
-learn to say NO,protect and prevent yourself from being used.
* express love and intimacy in a way that is appropriate to their AGE
-choose SAVE sex instead of safe sex...SAVE it for the only one who already commit to you (husband/wife). Say NO to pre-marital sex!

remember this from An-Nur,24: 26...
Vile women are for vile men, and vile men for vile women. Good women are for good men, and good men for good women; such are innocent of that which people say: For them is pardon and a bountiful provision. (26)

Another issue related to medical profession...

you are a muslim doctor at a general private clinic. One day a Muslim colleage girl came and admit to you that she is sexually active and need you to prescribe her contraception pill. What will you do?

Some may say, I am a muslim, I am against this behaviour and I want to refer her to a colleague who agrees to do it.

However...what if she neglects it and take some other harmful medication or methods for her contraception needs? Who will be responsible if anything goes wrong?

The best thing to do is...

First, make a good rapport with her. Explain the consequences and advice her to get back to the right path. After that, give her the contraception as ethically it may prevent harm and provide beneficience to the patient. Pray that one day she will realize her mistakes and seek forgiveness form HIM (taubah)

Note: This issue was dicussed by Prof Harlina during her talk on Let's become sexually healthy youths! I just share what I got from her intresting talk.May it benefit me and you..Ameen :)

Thursday, November 4, 2010

Revised topic:Muslim Government Doctors Criteria

Salam...this is an entry written by a friend (also my batch mate) as a feedback on Malaysian GOvernment Doctors Criteria. It is something we all medical students should read and think of!!

1. There is life outside medicine. Who said so you can't have life outside medicine. That's ridiculous. Think! There is doctor who is married with doctor in the same hospital. Also, there is doctor who is dating with staff in the hospital, including nurses! Well, that's what I call dating. Sport? Walking, running in the hospital isn't that call sport? Don't be "closed-minded" Think! There is doctor who joins the Fitness First. Clubbing? A muslim should avoid this. You know that. Think! Can't do chores for your parents? Of course you can’t if you are not living with them in the same house. But wait, praying Dua’ for your parents isn’t that one’s must do? That’s one simple chore you can do for your parents. Think! Even, there are doctors who become a member of NGO of Islamic Society eg. IKRAM, KARISMA, JIM, others as to dakwah. Think! The is life outside medicine. It’s just you who make your life in such a cocoon. Think!

2. When you are in the working profession, you earn your own money. You have your own life. Still living with parents under one roof and being pampered by them? Of course not. And of course you can, if you want to. Well, not only doctors who are not living with their parents! Don't you think so? Think! Move out of the house ASAP because your parents wouldn’t understand your job? Please don’t follow this advice. Don’t run away from your parents. They wouldn’t understand your job? They’ve raised you up until you are able to stand on your own feet. They know you. They will know. They never come to hospital watching how a doctor working? I bet your mom had admitted to any Gynecology ward before this. Think!

3. Bila jodoh dah sampai seru dan berkemampuan, berkahwinlah. Sememangnya fitrah manusia ingin saling mencintai dan dikasihi. No need to wait until you have complete for the Govt compulsory services. There is medical student who married during study. There is houseman who married her registra. Think! There is life outside medicine.

4. Get baby as soon as possible after getting married. Well, depend on your luck. Rezeki Allah bg lain-lain. Fikir balik. Apekah tujuan berkahwin? Tak mau anak? Panjangkanlah zuriatmu yang baik-baik sementara nyawa masih ada. Think!

5. Follow the work protocols in your hospital. That what keeps you safe. Think!

6. 36 hours working non stop? Trust me, you can sleep in between. Yes, I’ve seen doctors doing it. Are you really sure non stop? Muslim has break for prayers. Isn’t that enough? How many doctors have died because of this? None. Think! Everybody can do it. Allah akan bagi ujian yang hanye setimpal dengan kemampuanmu.

7. Don’t drive if you know that you are drowsy or disoriented. Don’t be stupid. Get a taxi. Be smart, be safe. Think!

8. Coffee contain caffeine, and some how it can cause tolerance. If you are a coffee lover, of course you need constant supply of it. For coffee hater like me, better to avoid it. Find a better way to keep you fresh. Think!

9. Managing stress is very important. I’m sure you have had experienced any stressful event in your life. But yet, you managed to get over it. How? Nicotine patch? Definitely not. You are doctor. Don’t abuse drug. That’s why you learn psychiatry aren’t you? Think!

10. Don’t get over influenced by the media. That’s are all movies to be watched by the people all over the world. Of course the story line are all made up and making its much interesting. Don’t you think so? Do you think that the doctors’ life in the movies (House, Scrubs, Grey Anatomy) resembles its own doctors’ life in its country? Do you think so? Think! Do you think that you can get better life in other hospital than in Malaysia? How better is better? Think!

11. There are doctors who have gardens at their houses. Yes, they have maid. So?

12. Try to walk around with houseman in the hospital during your practical year. Don’t forget to smell them. Do they smelly? Never in my experience! They have time to take a break, and have bath. Think!

13. Fasting. Islam has trained you to stay empty stomach, right? Sacrificing yourself to save someone’s life isn’t that beautiful? Think!

14. Doctors do deserve MCs. Who says so that they’re not deserve to get one?! Remember, we are all human being and human gets sick when they get sick. Don’t you think so? Nobody is perfect. My supervisor had MC because she had sore throat. What?! Sore throat? Think!

15. Scolding, destructive criticism, racial bias, finger pointing from your supervisors are nothing. I am very sure you have trained to become resistant with all of these negative tortures during your practical years. Think! Why they do that? They love you. They want to make you a better doctor. They don’t want you to make mistakes. This profession involving lives. This is not a playground. Think! You want being pampered by them? Being nicely treated by them? This is not kindergarten anymore. Think! I love being scolded. That what keeps me moving on.

16. You think your life will be just confined to the hospital only? How many doctors having fun with families, travelling around the world, win noble prizes, etc, etc, etc………..? Think!

Never regret of what you are doing now, Medical Students…
Isn’t this your school-age AMBITION?Yer cikgu, saye nak jadi dokter. Saye nak bantu orang sakit.
Wasn’t that your kiddy answer?
Yes, you wanted to be here. Yes you are.Think! Think back.

Its not easy to get you here. Yes, here. How many years had you struggled to get you in this profession. You are now half-step distance to become a doctor. Never turn back.

I do believe that my life has been planned by Allah. Why am I here? Because Allah had planned for me to be here. Ouh, I need to find the hikmah behinds these. Allah knows what is the best for His servants.

Never let negative thought under estimate yourself, your capability. If other doctors who can do it, why not you? WHY NOT YOU? Of course there is NO SHORTCUT to be one. A consultant. You think it is easy to become one? They also had struggled through tough years to be one. Yes.

Every king was once a weak baby, and every awesome building was once just a drawing on a piece of paper. And you? THINK!

Jadi dokter, satu pekerjaan yang mulia. Yes, doctors playing God. But yet, everything happen dengan IzinNya. Saving lives, isn’t that mulia? Imagine you save someone’s life or making someone to have a better quality of life. And that person able to beribadat and do good things because you’ve helped that person. Don’t you think “saham pahala” gets to you? Allah knows.
What other profession yang the customer really trust the person? None can beat doctor profession. So, use this opportunity to dakwah as well.

Positive mind set will definitely deliver Positive attitude!

written by Muhd Izmeer