Friday, March 29, 2013


The more I learn new stuff, the less time I have to reflect on past.

One thing I've learnt and still am learning is a saying a band teacher taught me when I was still in primary school "It's not 'Practice makes perfect' but 'Perfect practice makes perfect'

Perfect practice... I think is fundamental. e.g. history taking.

You can forget even the smallest thing and boom your effort can go down the drain and miss a diagnosis e.g. asthma and pets!

Pathology is important in getting your head round pathophysiology of a disease. I regret not reading a pathology book before reading about presentations of a disease. Memories last longer when you understand pathology behind a disease.

For example, I was just reading about placenta abruption. How would you manage this patient? Well first of all you need to understand the pathology (placenta "rupture" from uterus before labour... so you get blood between placenta and uterus. Blood in uterus causes pain and has both maternal and fetal complications. Take note of key words there: blood, pain, mother, fetal)

Blood loss - IVF
Pain - painkillers
Maternal - short term (oxygen), long term (Anti-D)
Fetal - CTG

That reminds me of classification esp in O&G. Short, medium, long-term. Fetal and maternal. Obstetric or non-obstetric related...


There are 3 ways in managing a disease

Conservative, medical and surgical

I just thought of a joke so when next time a doctor asks, I'll say being David Cameron - e.g. doing nothing or simply himself being a Conservative...


So the recent facade is GMC validations. Henceforth, more and more medical schools are making reflections an informal or even formal piece which medical students have to write about...

I was a believer of quantity but now I am tending to think of quality i.e. reflections as well. Might as well start it now as reflections are something doctors have to do for the rest of their lives!

As always, there's a mnemonic for everything.. even for REFLECT

R = Research
E = Experience
F = Feelings
L = Learning
E = Evaluate
C = Continue
T = Teach

The steps in the model can be ascended or descended depending on the step the user feels most comfortable on. The steps are as follows:

Any task must be researched before being attempted. For example, there is little point in recording a blood pressure if the results mean nothing. Research may involve ascertaining best practice or performing a literature search. For non-medical prescribing this may mean researching a drug you wish to use or a piece of equipment.

This may involve repeating the task until competency is achieved or it may mean drawing on other people?s experience to achieve best practice. Do you need more research?

How did the task make you feel? Did you gain from it or did you feel that it made you feel uncomfortable and affected your confidence? Do you need more experience?

What have you learnt from the task? Do you feel confident about achieving results that will make you feel confident or do you need to re-examine your feelings?

When you have considered all of the above, are you able to carry out the task with a degree of confidence? Do you need to go back down the ladder?

Having completed all the steps, you should now feel able to complete the task without assistance. If you feel unsure, you need to decide which stage of the ladder to return to.

When you have reached this step, you should be skilled enough to teach the task.

reflect - research, experience, feeling, learning, evaluate, continue, teach

I'll keep my reflections i.e. blog short next time because I think short and sweet things make it better to absorb.

Friday, February 15, 2013

Psychiatry is hard

3 weeks of placement at an Eating disorder unit was an eye-opening experience. All had their own cause of this mental illness... biological, psychological and social.

And I think that is what makes psychiatry hard, especially history taking because you had to encompass all that - not only the causes, but also the consequences.

A long enduring experience for me because my history taking skills is not too good but I have learnt a lot in this process.... and found out that psych is definitely not for me.

I love Medicine!

Just had the urge to post this....

Studying medicine has its ups and downs... Becoming a doctor without having have the best of memories worries me; without sounding too nerdy though, sometimes there are times, especially little things that when they come together make sense, which make you light up and say "I love Medicine!!!" What a timely post on Valentines day...

For me today, it is heart murmurs and ECG!!!