According to strict local and religious customs in certain Asian countries, male doctors are only allowed to "see" his lady patients covered by full-length veil. Being a doctor myself, I have more than once ruminated on how it can be done. I think for the thousandth time how lucky I am here and don't have to see my patients behind the curtain.
What we seem not to recognize is that, much to our chagrin, we're carrying out such behind-the-curtain consultation every now and then. Many a time while running into another doctor on the corridor, we have a quick conversation about a patient's condition and then offer our expert opinion. We also give order after hearing few words from our nurses at the other end of the telephone. Truth be told, some of us had trouble with this – me, too.
Once upon a time – just one week ago really – my nurse consulted me because his mum got painful tummy. He didn't bring his mum to see me but described the whereabouts of her pain, "Pain at the right side of her tummy, lasting for two days. She went to see a doc at the government clinic, and then was given a referral letter asking for surgical opinion."
I tried to collect my thoughts. "Did she ever mention problem with taking fatty meals?" We agreed that it could have been coming from gallstones, those little pebbles of cholesterol that plague the gallbladder. Behind the story, nevertheless, lurks one of her mum's uterus cancer, which was operated five years ago. That means her mum's belly had a surgical cut made before. When the muscles become weak over that area, the internal organs can bulge through the scar. The nurse thought that this was a very good suggestion. He actually believed that his mum (and the doctor at the government clinic) felt a lump over the belly. I nodded. "Let's get an ultrasound for your mum and see."
A lot of times I get it right and pride myself on my know-it-all diagnosis. Not always, though. Two days later, the nurse brought the ultrasound images and her mum to see me. His mum's ultrasound did show a few innocent gallstones. I couldn't see why that mattered. In fact, when I took a look – finally – at her belly, there was the telltale angry-looking rash of painful shingles on the right side. Ha, ha, ha.
Thursday, July 30, 2009
Saturday, July 25, 2009
Parents
"I made quite a few mistakes last night," one of our new doctors confided to her friends in the Facebook, "but I'll learn. By heart."
I was silent for a moment, nodded to myself, and wrote a few words of encouragement.
How could one begin a new job without making mistakes? I couldn't fathom it. The credo of learning from mistakes is never new, not the least for someone, myself included, who is reading a lot about parenthood. New parents, as I was told, can be very much like new doctors; they all make mistakes in order to learn and survive their first few months.
"You know the only people who are always sure about the proper way to raise children?" Bill Cosby had reminded us. "Those who've never had any."
I was silent for a moment, nodded to myself, and wrote a few words of encouragement.
How could one begin a new job without making mistakes? I couldn't fathom it. The credo of learning from mistakes is never new, not the least for someone, myself included, who is reading a lot about parenthood. New parents, as I was told, can be very much like new doctors; they all make mistakes in order to learn and survive their first few months.
"You know the only people who are always sure about the proper way to raise children?" Bill Cosby had reminded us. "Those who've never had any."
Thursday, July 16, 2009
Novice
If there is any similarity between novice medical interns and new parents, chances are that they all make lots of mistakes.
There is so much we don't know about when we become new parents. The same is true for new interns. Of course, they must learn their trade on the job.
As a father-to-be, I haven't the foggiest idea what a parent's life would be. Then I sit back and pat myself, trying to learn the dos and don’ts from the parents' bible, What to Expect: The First Year.
Which brings me to one of the lessons I learned as a medical intern: the way to become a doctor could never have been learned during my medical student's days of reading.
There is so much we don't know about when we become new parents. The same is true for new interns. Of course, they must learn their trade on the job.
As a father-to-be, I haven't the foggiest idea what a parent's life would be. Then I sit back and pat myself, trying to learn the dos and don’ts from the parents' bible, What to Expect: The First Year.
Which brings me to one of the lessons I learned as a medical intern: the way to become a doctor could never have been learned during my medical student's days of reading.
Wednesday, July 15, 2009
Cookie Cutter
With computer being a must for patient care nowadays, our new medical interns scurried off to learn all the electronic survival skills before they started their job this month. Many times, senior and junior doctors alike aren't immune from the trend of electronic medicine. My consultant, to take but one example, asked us about the computer keyboard shortcut keys yesterday. These shortcut keys, in a nutshell, help us to navigate the computer keyboard efficiently. To cut and paste a paragraph, you can do so by simply hitting two keystrokes such as "Ctrl + C." Yeah!
I see no reason for objecting such ways to increase our productivity. I'm simply uncomfortable. Don't ask me why. In a rush to finish the task of writing discharge summary for patients, many of us champion the good news of going electronic. Presto! A few keystrokes would miraculously cut and paste from the old notes, filling the new medical notes with large blocks of texts verbatim. Same size, same order, same sentence, line after line.
Perfect? Yes and no. Simple, perhaps, but much more than that.
Whining about all these paragraph-clones (with copying and pasting identical number of sentences paragraph after paragraph) makes me sound like a stubborn Luddite who bemoans the stem cell cloning technology. Am I? The truth is… new technology is exciting, but not always. Once we doctors let this computerized cookie-cutter do the "cut and paste" job, we've seen the identical (and sometimes meaningless) repetition of patient notes during our rounds and in our clinics. A patient who has had his diabetes mellitus first diagnosed years ago will then persist, in this era of "cut and paste" cloning, to be called "fifty-year-old, newly diagnosed diabetes on dietary control" for each and every of his subsequent clinic visits.
That really bothered me. Still does.
I see no reason for objecting such ways to increase our productivity. I'm simply uncomfortable. Don't ask me why. In a rush to finish the task of writing discharge summary for patients, many of us champion the good news of going electronic. Presto! A few keystrokes would miraculously cut and paste from the old notes, filling the new medical notes with large blocks of texts verbatim. Same size, same order, same sentence, line after line.
Perfect? Yes and no. Simple, perhaps, but much more than that.
Whining about all these paragraph-clones (with copying and pasting identical number of sentences paragraph after paragraph) makes me sound like a stubborn Luddite who bemoans the stem cell cloning technology. Am I? The truth is… new technology is exciting, but not always. Once we doctors let this computerized cookie-cutter do the "cut and paste" job, we've seen the identical (and sometimes meaningless) repetition of patient notes during our rounds and in our clinics. A patient who has had his diabetes mellitus first diagnosed years ago will then persist, in this era of "cut and paste" cloning, to be called "fifty-year-old, newly diagnosed diabetes on dietary control" for each and every of his subsequent clinic visits.
That really bothered me. Still does.
Sunday, July 5, 2009
Verify
We live in an age of mistrust, and perhaps one of the greatest mistrust is felt by those of us with busy lives at work.
This idea began to dawn on me during recent conversation among our medical colleagues who complained bitterly about urgent consultation to see patients outside our department. It can be somewhat frightening to think about the mushrooming consultations within a hospital nowadays. Never in the past were doctors confronted with endless consultation to see patients from other departments (which, mind you, keep increasing in number and variety). The consultations come in many guises. Some of them are darn real urgent, some less so, the others being trivial and almost meaningless.
One of the most difficult tasks is to find out which is which.
Last week, my nephrology trainee brought me to see a patient who had just undergone a surgery of cancer at his neck; he has kidney disease and is on dialysis. "It should be a straightforward case," I thought.
Not until I met the patient did I realize that he had a metallic heart valve. Which means he needs to take anti-clotting medication to stop his metal valve from getting blood clots and hence damaged. Alas! His usual oral anticoagulant (or blood-thinner) medication was simply discontinued without any bridging anti-clotting medication like heparin for almost one week. In case you're wondering whether the surgeons had consulted the cardiologist for opinion, here is the answer: Yes, they did. The consultation letter asked for opinion about the medication before and after the surgery, but never mentioned that the patient has a metallic heart valve. The medical doctor then turned down the request to see the patient and wrote back to the surgeons, asking them to refer this patient for opinion at the outpatient clinic.
In no sense do I mean to say who's right and who's wrong. Difficult to grasp as it might seem, I have always had difficulty in turning down a consultation without either seeing the patient or talking directly to the doctor who makes the consultation request.
My colleagues are no doubt tired of my favorite quotations, including that signature phrase from Ronald Reagan. To which may I add here, "Mistrust, but verify."
This idea began to dawn on me during recent conversation among our medical colleagues who complained bitterly about urgent consultation to see patients outside our department. It can be somewhat frightening to think about the mushrooming consultations within a hospital nowadays. Never in the past were doctors confronted with endless consultation to see patients from other departments (which, mind you, keep increasing in number and variety). The consultations come in many guises. Some of them are darn real urgent, some less so, the others being trivial and almost meaningless.
One of the most difficult tasks is to find out which is which.
Last week, my nephrology trainee brought me to see a patient who had just undergone a surgery of cancer at his neck; he has kidney disease and is on dialysis. "It should be a straightforward case," I thought.
Not until I met the patient did I realize that he had a metallic heart valve. Which means he needs to take anti-clotting medication to stop his metal valve from getting blood clots and hence damaged. Alas! His usual oral anticoagulant (or blood-thinner) medication was simply discontinued without any bridging anti-clotting medication like heparin for almost one week. In case you're wondering whether the surgeons had consulted the cardiologist for opinion, here is the answer: Yes, they did. The consultation letter asked for opinion about the medication before and after the surgery, but never mentioned that the patient has a metallic heart valve. The medical doctor then turned down the request to see the patient and wrote back to the surgeons, asking them to refer this patient for opinion at the outpatient clinic.
In no sense do I mean to say who's right and who's wrong. Difficult to grasp as it might seem, I have always had difficulty in turning down a consultation without either seeing the patient or talking directly to the doctor who makes the consultation request.
My colleagues are no doubt tired of my favorite quotations, including that signature phrase from Ronald Reagan. To which may I add here, "Mistrust, but verify."
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