Saturday, June 25, 2011

#58

Some people can really get on my nerves multiple times in a day. And all I can do is be patient because regret is something I don't want to feel when I say the wrong things at the wrong time. If I deliberately get back at them, it would make me one of them but what can be done when it's the final straw? Do you just let it go as always? The advice 'Don't care about them' is easier said than done when the person giving the advice is in the shoes of the person being adviced.

Sunday, June 19, 2011

#57

Just yesterday, I was thinking about why I need to come up with learning issues and find sources to write about it. Who knew we would have to do this someday when we were in clinical school? I had no idea. :S

I mean, when in Phase 1, we had to come up with at least 8 learning issues. The fewer the issues, the happier we were because that meant less work and that the session would end faster but thinking about it now, when we had a lot of time, it should have been used properly so that those sessions would end up sticking in our heads until Phase 2. If you ask me, I have not a clue about what I learnt. I might have a bit of basics but when it comes to molecular level, there is no way would I be able to recall lectures on differences between acute and chronic inflammation or perhaps the processes of cell formation and antibodies, process of inflammation etc.

Now, I find it taxing, but only to a certain extent because there are marks for it and there are lecturers who have a certain amount of expectations. I do not like writing learning issues because I am unable to find answers from journals to the question I have posed as an issue. It is not as simple as picking something off the internet like a newspaper article or from a forum discussion. Another reason is because of the time constraint and the amount of ideas that should be generated. Sure, we have 5 weeks to come up with 9 learning issues. 2 learning issues for 4 summaries and 1 for report. But what actually happens during a 5 week posting?

Week 1: Familiarising to a new posting. New schedule. New environment. New style of clerking. New techniques to learn. Basically, everything is NEW!

Week 2: Getting started. Well this should have been done in week 1 actually but it almost never happen unless the mind can be trained in a way to learn and cramp everything in advanced. So we start clerking in pairs. We make mistakes almost all the time. There would always be a piece of missing information.

Week 3: Getting the hang of it. So, this is the time when I would start looking for cases to write on and usually not very successful. This is also the time when I realise that it is rather difficult to look for suitable learning issues. This is the week where I learn to make issues out of things. :)

Week 4: Getting somewhere. This is the week when we are familiarised with the curriculum. I know I am heading somewhere. I know now what this posting is about. But, oh snap, exam is in week 5! This is the week when case summaries and reports should be finished but still, it doesn't happen. Mugging starts here.

Week 5: Exam time. Case summaries/report deadline. Stress.

This cycle repeated itself 3 times during this semester and I am about to go through it the 4th time. Lucky for me, some postings allow us to hand in our assignments on the Monday of a new posting and that would be tomorrow. I still have one more learning issue and one case formulation to complete. *Sigh*

Friday, June 17, 2011

#56

This is an experience I thought of sharing. The reason why I am writing about this is because I believe that obsessive compulsive personality discorder is not a laughing matter when it could be for some. OCPD is different from OCD (Obsessive compulsive disorder) in many ways yet similar in some. In OCD, the patient would be aware of it but this is not so in OCPD.

During my posting in psychiatry, I met a patient. It is amazing by how much you can learn by just observing a person's actions and this is not something that someone would normally do unless you have a lot of free time in the world. Well, I had that free time. At first, it was a bit odd because this person also has schizophrenia and so there were stories which my friends and I heard. After awhile, I noticed that this person would ask the same question at least 2 - 3 times even though an answer was given after a few minutes each time. Everything had to be proper it seemed. Arrangement of the things brought along, sitting posture, properly structured English sentences.

Initially, a few people laughed because it was weird to ask a question over and over again after being told the answer multiple times. But then later, I noticed that it was not weird at all and this person, I felt, was actually anxious and required reassurance. And I was right, this person did have OCPD. I felt that this was an amazing experience because it is sort of like getting a diagnosis right without being told. It is sort of like being able to pick up something just by observing and not just that, by listening to what patients have to say, they make the best teachers.

This is also one of the reasons why we are advised to spend more time in the hospital than to study books because everyone comes with a different presentation. One matter can overlap with another. One matter may predispose a person to another disease/problem. I guess what I am also trying to say is that mental illnesses is not something to joke about. Sure, it can be joked about among a circle of friends but not in front of a patient or stranger because it is a sensitive issue and that does not mean these patients do not deserve the care. I feel that they are the ones who deserve more care.

I met many doctors who inspired me and taught me these lessons of caring for a patient. Child psychiatry (Autism, Down's, learning disabilities etc) and neuropsychiatry (dealing with behavioural changes in Parkinson's, Alzheimer's etc) were two fields which caught my attention. It's not that doctors in other postings do not care about their patients but I suppose it is because in psychiatry, there just had to be extra attention to the patient's wellbeing.

At this point, how many are there who actually care for the patients? Back in Phase 1, we knew nothing about empathy. We were excited over cases, not patients. The more severe, serious and rare it was, the more excited we would be. But now, it is different. Sometimes, I find it depressing. I am yet to be able to deal with death well. I cried a lot when 2 patients whom I have been following up with since their admission passed away because I got to know what went wrong, how their lives have been and the suffering at the end. And I know that crying was normal.

Thursday, June 16, 2011

#55

The end of psychiatry posting means a beginning of a new one - orthopedics. I've been through paediatrics, obstetrics, family medicine, internal medicine and surgery. What do I like best?

I like the time I get in psychiatry. It is not as hectic as the others. Well, the time I have is similar to family medicine.

I like surgery because it is straightforward unlike in internal medicine wherby one thing can be caused by this and be affected by that etc. I find that surgery is similar to obstetrics because it is fixed. There is a problem, fix the problem, and it's settled. This is also a reason why I like obstetrics but only from the theoretical point of view.

I like the variety seen in both paediatrics and internal medicine but the scope is really wide. This makes me wonder if I would someday be competent in these fields if I chose to stick to either one. Nevertheless, speaking about psychiatry, it really is not too bad. I enjoyed my posting. I have learnt to empathize. Just because someone is mentally ill does not necessarily mean that they would be forever. With motivation, a person can make a difference in his/her own life.

For me, I am lucky to have motivation and support from a few friends. :) So, what's next? Well, there is another long case (practical which lasts for about 1 1/2 hours) in 5 weeks, OBA on psychiatry and orthopedics in 5 weeks, and one major exam (4 days in 2 weeks) in 7 weeks. Confusing, isn't it? This also kind of means that I probably may not have the time to update the blog as usual.