Tuesday, December 11, 2007
By Aishu, m4
After passing (enduring, some might say) our preclinical years, entry into the clinical years was one fraught with excitement and eagerness to finally experience what ‘medicine’ is all about. Or so we thought. There we all were, making our instrument purchases with much zest, debating on which stethoscope to buy from the type to the colour. “I shouldn’t get green, it will be very hard to coordinate with my clothes” said a friend. “Its more worthwhile to buy a Littman, it can be used for paediatrics as well” said another. “I really can hear even the faintest murmurs with this Welch Allen” concluded another. And so we went on preparing for that entry into the wards. Names to be printed on nametags were carefully worded after much consideration for their ease of pronounciation & recognition (or difficulty for some, if you didn’t want to be called upon to answer!). And when the day finally arrived it was grand. I remember enjoying the feeling of transversing the hospital corridors in my white coat, complete with all the formal regalia – stethoscope occupying prime position around my neck, tendon tapper, pen torch and the all important pen & notebook all perched in my pockets. And then there was the not-too-rare instance of patients addressing you as ‘lokun’ and thanking you profusely. So we went about talking to patients, privy to their most private of symptoms and touching them everywhere in the name of ‘physical examination’. It was all very grand indeed.
Slowly as the first few weeks passed and the excuse of ‘only my 1st month in the wards’ began to become outdated, the responsibilities of that white coat began to dawn. The impending arrival of clinical exams created a sense of general panic as now it just wasn’t about chit-chatting with patients. In about 20 minutes (which really seems like 2 minutes when you are in the hot seat) we were expected to convey the patient’s current, past and expected problems all at one go together with our best opinion on what to do for him/her to a senior doctor (their annoyed/frowning/bored looks didn’t help at all). Oh well, this was still manageable – it was only e-clinics and no one would fail, we told ourselves.
And then it all began in earnest – serious general medicine posting, daunting logbooks with an amazingly endless list of conditions which were ‘must see/must know’ and the horror of a looming clinical exam to top it all off. You see, this was probably the first time we had to deal with an unknown enemy in an exam – gone were the days of theory exams with a set range of topics and comforting ten-year series. Now we had to face a patient; a human being who could be of any size, colour and disease profile. He/she may not want to talk to you or worse tell you misleading information and may pretty much have just about any known (or unknown) disease in the world. And not forgetting the examiner who may be kind or fierce, easily mollified or demanding postgraduate standards, have a motherly expression or one of ‘Im out to get you’...point made. It took us pretty much half the posting for all of this to sink in. And it was only then that the immense range of general medicine dawned on me – there were so many cases to study, physical examination skills to hone and management to learn. Amidst all this was the part about enjoying yourself in the wards and feeling like a doctor. Anyone can be forgiven for forgetting this last bit!
As they surged past, clinical years were turning out to be much more than finally experiencing ‘real’ medicine. Your seniors wisely advise you to strike the balance between spending time in the hospital and with your (much less enthusing) textbooks. They tell you clinical exams are all about the 1/3rd rule: the patient determines a third of the outcome, the examiner another third and you the last third – so just focus on getting your third right and don’t worry about the rest they preach. Any of us will tell you however that, that is easier said than done. My examiner, ‘Dr WPK is very fierce, I m doomed’; ‘What if I get a difficult patient” and so on we moan. It just is not possible to pretend that these are not (very) valid concerns. And so there you are the poor medical student trying to pass your posting exams.
Soon you realize that wearing that white-coat gives you a lot of responsibility and that you owe a lot to your patient. You start taking active interest in their conditions, checking their management and saying hello to them everyday. You start to feel that your presence might indeed make a difference to that lonely, old Mdm Tan. And then I got a glimpse into the nuances of dealing with patients – do you treat them just like new friends, share hand phone numbers and even emails or maintain a ‘doctor – patient’ kind of relationship. I had to grapple with responding to a patient’s queries through hand phone communication – whether I should have even given her my number and to what extent I can act as a ‘medical adviser’ and just how and when do I say no and draw the line? These were an important part of my clinical training. I believe all of us have learnt from such experiences – all while dealing with the perennial haunt of exams and assessments of course!
Amidst all this, subtle dilemmas begin to emerge. Drawing the fine line between simply asking patients to talk to you and persuading them to do so for example. You know that a patient has been examined countless times and is not very keen to talk to you. But he has massive splenomegaly. What if you never get to examine an enlarged spleen? Or worse what if you get a similar patient for your exams? And so there are some who will try to get the patient to be examined one last time. It takes definite courage to walk away from that patient wishing him well and tell yourself there’ll be another time. The first time I did that, it was difficult. Subsequently, it was the obviously natural thing to do. Add to that coming across classmates who dont quite have the same principles as you when it comes to proper ‘medical student conduct’. They might leave curtains open (even if its by just 2 cm) or discuss histories in the lift or act like a stone to a crying patient (it could really be their way of consoling but still..). So you are confronted with endless possibilities – do you just put up with them or confront them with how you feel? Or simply avoid them and co-exist in separate ‘zones’ in peace? These are just some of the ‘situations’ we have to deal with. And so we learn, pass postings and on retrospect, grow.
Yes, 1 year on, I have realized that these experiences do allow (possibly force) one to mature in terms of learning how to deal with patients’ expectations as well as your friends and enter new realms of tactfulness in communication. Thankfully and joyfully, I’ve realized that it’s not just about the various stressors and dilemmas. The exams are merely meant to prepare you for the future – where we will be facing ‘exams’ everyday when managing your patients. In fact, it can all be summed up in a single episode: I was walking blissfully after the end of a long day when a person fainted outside the hospital canteen. Next thing I knew, a man said ‘Doctor Doctor, over there quick’ pointing to the fallen lady. I rushed to her side, heart pounding, willing myself to find just as strong a pulse in the lady’s wrist. I couldn’t. Abandoning the radial pulse, I turned to the carotid, mentally rehearsing the sequence of CPR and everything else that my emergency medicine doctor had calmly said the day before. Much to my relief, the carotid pulse was there – not pounding or bounding but there. Almost simultaneously a nurse appeared and I heaved a sigh of relief. Taking my place beside the nurse it just struck me – the magnitude of what I could have done and was expected to do. It was the patient in front of you who mattered at the end of it all.
I say now that one can still enjoy ‘real’ medicine as a clinical year student – it is after all a potpourri of all the above! From the thrill of that white coat to patient’s expectations to professional dilemmas to dealing with fellow classmates and exams: that’s what ‘real’ medicine encompasses. And realizing this will just make it all much easier and loads more enjoyable!
Thursday, November 01, 2007
Disclaimer: The editor has not edited the language to retain the original flavour of the article. The views stated here do not represent the views of pULSE. For the repulsed, take it with a pinch of salt and have a good laugh.
So, you have managed to lie through the medical interviews and have gotten the golden and much coveted disruption letter. People hail you now that you have gotten into the most prestigious course in Singapore and you don't have to see your sergeant's face anymore. You try to associate your life (and am not ashamed to do so) with medical stuff like putting up a stethoscope as your msn display picture or creating silly uncalled-for blog names like funkydoctor.wordpress or hugeblackperineum.blogspot and start having orgasmic dreams about partying all night with half-naked nurses. Sorry to burst your bubble, but take this from your senior: YOU'RE GOING TO HELL.
XLNH brings to you this in-your-face guide on how to survive M1. Remember, this is not a guide to get onto the Dean's List, so, use this wisely and with much caution. For the latter guide, please check with your friendly neighbourhood mugger toad.
1. ENVIRONMENT: The environment sucks. No doubts about it. The whole campus looks like a freaking African sanatorium. Drabbed in gray dull shades, the medical faculty is really the epitome of 100% functionality and 0% aesthetics. There are two entrances to NUS.One end, from the NUH side, you have all the geeky faculties with their bespectacled nerdy students like Science, Computing, Medicine, Dentistry etc and on the other end you have all the good-looking, smart, macho, witty faculties like Music, Real estate, Arts and Social Sciences. We already get enough BAD stereotype , but that's not all. While people from Yong Siew Toh Conservatory of Music get all the avant-garde architecture, all we get are dull dilapidated derelict blocks.
If you thought army food was bad, wait till you check out the Science Canteen, otherwise named "Frontier". It makes me wonder why they call this disgusting canteen frontier? The frontier of shit, the frontier of vomit or the frontier of shit plus vomit? The food here SUCKS CAMEL BALLS. For it to be named the best canteen is really too much of a joke. Sometimes I feel like scanning my 11B up the asses of all these vendors at the Frontier. Not just that, the canteen is so crowded with students (many of them foreign, math equations spewing )of other faculties that the wait for your food just gets exasperating and unbearable. If you wish for some kamikaze just go ahead and grab something from Bambino's. Nice name, right? Yeah I used to think so until I tried their COLD, and utterly unpalatable pasta. You're almost guaranteed to choke on your vomit. Spinelli , a cafe-styled outlet tucked into the far corner of frontier, sells good snacks, notable examples include Oxford Ginger (naked ginger girls from oxford).
The good news is that we've Enclave at the NUH side. Much better food, but horrendous queue for lunch, and it gets boring after a while. Nasi Padang there is oily and high in cholesterol( beware hyperlipedemia, get that, and soon you'll be having statins for lunch), tasty and superb but promises to clog up your arteries. But still, a wise choice over Frontier - and do check out the 20cents/drink machines along the stairways from the Dean's Office to Enclave. And you get a respite from checking out the ladies decked in office wear. No no, not those cleaners you sick perverts.
Here we arrive at a very sensitive and interesting part of medicine. Because the way Singapore teaches medicine is somewhat modelled after the primary school classroom system, the medical faculty is often like a family, a home, those idiots will tell you. BULLSHIT! Because the medical faculty is an enclosed area and people literally see each other almost everyday (no modular system), the medical faculty is the hell-spawn of all backstabbing, rumours and other what-nots. So how to avoid all these backstabbing? Well, really, the saying goes: If you can't hide from something, go ahead and make it worse.
2. STUDYING: So, are you depressed enough yet? Now let's make this even harder for you: Medicine is not about intelligence, no its not. Medicine is not about many things we normally consider the hallmark of intelligent studying. Medicine is about mugging the gargantuan amounts of information, piecing them together and then regurgiatating all of it onto your pieces of exam paper. Sad but true. Anatomy is going to spank your balls when you go for your first lecture, especially when the lecturers fail to whet your appetite by rantling off obscenely long names and their multiple functions. But don't let that discourage you, anatomy is by far the easiest (to pass) module ever in Medicine.
Biochemistry is a department where you can sit back & eat your popcorn NOT because they make it easy for you to understand concepts BUT because you will NOT understand a single thing they say.
Physiology, oh yes the great physio department. Efficient people but otherwise very strict and cruel. They murder people for exams. Physiology is more of understanding, many will say. BULLSHIT. How can anyone understand without mugging through the stack notes a few times over? Stop lying to yourself, yes, medicine is all about brainless mugging.
Now, let XLNH answer a few of the questions we KNOW m1s want ask...
Qns: Do I need SNELL/Lippincott/Guyton to pass my M1?
Ans: SNELL is for people who enjoy eating books. Go for baby moore. All text books for biochem are SHIT. Just use the notes. For physiology, get baby guyton, Papa guyton is going to spank your ass real hard as you will have problems swallowing all the chunky info together.
Qns: Do i need to go for histology prac?
Ans: NO! Just skip everything. Before SPOTS, just attend Prof Kaur's histology review and ask some hardworking friends to take all the pictures of her slides. Don't worry about histology, because during normal labs,all you would see are just heaps of stained mess anyway..
Qns: Do i need to go for anatomy lab lessons?
Ans: Yes! But please do not be so kiasu, hog teachers, crash slots and write down everything the doctor says. And DON'T PLAY YOUR GUITAR in the small rooms when people are having lessons in the main hall.
Qns: Should I attend Prof Voon's pre-lab lectures?
Ans: Maybe, if you are competitive. Well I did, but it didn't help me. The best thing to do is to simply to read your Snell once. Like i mentioned, SNELL/Baby Moore is vital to passing anatomy. You really will need one.
Qns: Do I need to study to pass?
Ans: Yes you need to study, a lot. But don't overstress yourself. Allow time for entertainment and rest.
Qns: Are there cute girls to spot in med library?
Ans: No, there aren't.
Qns: Are there cute boys to spot in med library?
Ans: No, there aren't.
Qns: Does being a mugger help me get onto dean's list?
Ans: I'm more concerned about helping people not get into the kicked-out list.
Qns: Do I need to attend tutorials?
Ans: I wasn't that enthusiastic and I still passed. So what do you think?
Qns: Do I need to suck up on my tutors?
Ans: Please don't.
Qns: How much do I need to study for exams?
Ans: Ah, here comes the perennial question. How much is enough? Study enough to pass, but don't bother going into details. Many smart-asses in medicine will try to read up little small details and spam them right in front of your face to get this "WOW YOU'RE SO SMART" response. But don't be fooled by them. Reserve your memory for the more important stuff. Asking around to know what's tested, and what's important will do you good.
Qns: If I get onto the dean's list this year, will I be a surgeon next time?
Ans: Maybe, but remember grades from M1 don't exactly factor into specialization. What's vital to get into top specialization are the final MBBS grades and also your ball-licking skills.
Qns: Is it true that medicine is a lot of ball-licking?
Ans: Not for M1. But you'll know soon enough.
Qns: O dear, after reading your guide, I feel like committing suicide!
Ans: Don't worry you're not too late to quit med school.
I hope this guide helps you to get a C at least for your pros (which means you will promote).
Good luck :)
Comments here
Thursday, November 01, 2007
By KB Kok
Brother KB Kok, a mystery clinical year student, believes we shouldn't let other people handle our $$$ while we're in medical school.
Most medical students know nuts about economics and finance. I must admit that I'm one of them too. How “appropriate” it must seem then, that we should be saddled with a debt of $17,520 every year till we faithfully complete our medical studies.
This, I'm sure you're aware my friends, has been thanks to the repeated fee hikes from slightly over $1,000 in the mid-80s. So much so that there is talk that a greater proportion of medical students nowadays are from more well to do families who can afford to absorb the hike.
If that is true, maybe that makes the people who proposed the fee hikes feel better. But its like professors turning a blind eye to students struggling at the bottom of the bell curve, justifying the difficulty of tests using the stellar grades of people who spoiled the market.
Fact is, we still have a sizeable number of medical students in the current batches that are working to pay off school fees now and their study debts quickly on or after graduation. But being full-tim students, the amount of time we can devote and money we can make is limited.
So recently, a friend told me I should approach a financial planner.
“Eh KB, why you save your money in the bank? Now the interest rate how low lah! Make better use of it, go get some financial planning advice!”
Ignoring the fact that I have no really regular or sizeable income to speak of, or that I have no idea what a financial planner does (aside from maybe being a commission kia), I decide that it might be a good idea. Surely, its also high-time I should find out what all this hype is about. So I gamely make an appointment to see a Financial Consultant (FC) from XX bank.
At XX bank, I meet my FC (who actually turns out to be a rather attractive lady).
“Hi Mr.Kok, how may I help you?”
“Oh, I've got a study loan, from your bank actually, and I'm looking to pay off quickly. I was wondering if you could recommend anything to help me?”
FC looks unimpressed and proceeds to lose me with her alien tongue about the same time as I got lost in her hazelnut eyes… But anyway, I shall attempt to translate our rough conversation:
FC: How much you want to get?
Me: How much do you have now?
FC: I would like to grow my savings more than what it would be if I just saved them this 3 years.
Me: Would you need any of this money?
FC: Hopefully not.
Me: How much are you willing to risk? I don't want to lose any money.
FC then explains the various plans to me but I get slightly perturbed when FC starts to guarantee returns without much substantiation on what some of the plans are actually investing in. I start to think that FC is like a real estate agent except that her client's house is somewhere in the US and she can only show me photos of it.
Being more cautious than greedy, (and having kept my dopamine, norepinehprine and serotinin levels in check), I walk out without committing any money.
Having now found out what a financial planner does, I decide to find out how all these structured deposits actually work. But in any case, the Government has been encouraging Singaporeans to shift our savings to deposits right, so whatever it is, cant be that bad right?
Economic textbooks, however, were worse to read than any patho, microB and pharmaco book put together. Like with FC, I was totally lost in their jungle of jargon. So when I heard through one of my grapevines that some bankers of interest frequented a certain pub, I jumped on the chance (my maiden visit to a pub… it helps they're now smoke-free)
Not to be disappointed, I spent the entire evening eavesdropping on almost all the conversations in the pub (sadly, I didn't get any good pick-up lines). But just as I was about to give up and try my hand at picking up a cute girl (in retrospect, I do regret), I happened to come across a lone figure sitting at a corner in the pub and decided to talk to him since I had nothing much to lose.
He turned out to be a senior staff member at a certain Singapore branch of a big investment bank. Probably a little high from the drinks he had, he acceded to my request to explain how he thought all these deposits actually work. Let me draw it out based on what I understand:
If the sketch is true, its no wonder the income gap is widening both within countries and between countries. Those buggers in the investment banks like Goldman Sachs are pocketing obscenely unfair proportions of the profits they make off money from commonfolk on the street! And yet, like the recent Bear Stearns subprime funds fiasco shows, its also going to be frigging hard to sue them even when they lose the investors' money. To be fair though, the smaller funds do collapse, but that's even worse for us!
To end all this off, the other day, I met a friend who had put his money in a certain structured deposit for 3 years already. He laments that he's been losing money all these 3 years and probably just expects to get back his principal deposit at the end of 5 years. Although he'd prefer to draw out the money now, the bank had shortened the penalty-free time for early redemption a while back.
Therefore, I believe we shouldn't let financial planners handle our money while we're still in medical school because:
• We don't have much more money to make anyway
• They don't really know how the money is going to be handled
But then again, KB Kok still does know nuts about economics. If you would like to correct what I have written here, please do feel free to respond below or liase with my pULSE friends to send your own article to rebut me. (Pulse.magazine@gmail.com)
