What makes a good medical student?

In Manchester, we have to fill in the same form entitled 'What makes a good medical student?' every year, enlisting five virtues that makes a good medical student. It is to be filed in our portfolio so we can see the changes over the years.

My views have certainly changed especially since I started third year. I personally really like the self-directed learning approach the Manchester adopts, eventhough it really is like DIY medicine (which the medical school has denied time and again). They say they monitor our learning but I beg to differ. There is no one to tell me if I am going to the ward often enough. When tutors have to fill in feedback forms at the end of the firm attachment they just write a few generic positive words and the words are more or less the same with my other groupmates who goes to the ward not even nearly as often as I do. Those tutors who had filled in my forms had never really watched me talk to patient and observe my clinical skills. Student support, they say, is there. But getting an appointment with the dean last term is like having to beg for his time, so I just didn't bother. I hated that aspect of things.

Yet, I am happy. I get to spend as much time doing whatever I want. In a week, we generally have 2-3 days of spare time. I can play with sutures and airways in the skills lab, work in the ward (which is my favourite), go to theatre, sign up to clinics or sleep in bed. While most of my groupmates have always opted to have a lay in and leave at the earliest opportunity, I always make it a point to spend some time in the ward doing some 'self-directed learning'. Sometimes it's shit but at other times staying late is well worth it.

I'm a little uncomfortable with many of my groupmates who always expect to be 'taught' formally before trying to learn things themselves. ECG for example - almost every patient in my ward has one done as they are being admitted. But you would wonder why my groupmates, after four weeks being attached to the ward, still struggle with reporting a simple ECG. Whenever asked a interpret an ECG, the most typical response from my groupmates will be 'umm, we haven't been taught how to read ECG'. Everyday, when fazed with new things, all I hear is 'We haven't learnt neuro', 'We are not in the GI module', 'We haven't been taught cardiovascular examination' etc etc. It really gets on my nerves! Even with things that we've done for a thousand times already, I still hear them say 'We haven't been taught to interpret ABG' - O yes, you bloody well have! They would literally wait for a lecture or an teaching session to be arranged so they can be officially taught. That makes me feel nauseous. Why can't people be more resourceful themselves? Be curious, make mistakes, ask questions, read up and we wouldn't need any formal teaching at all. After all the learning resources are all around us - fantastic library (including electronic journals), friendly doctors, interesting patients - what more can you ask for?

I don't know why I always seem to not agree with the general attitude of my current and previous groups. I don't think I'm a bad group member. I am certainly a bit of a control freak, but I generally work well in a team. At the end of almost every nursing shift that I do, the sister/staff nurse would tell me to come back and work again. They must have found me helpful. And I seem to get along well with the doctors and other senior medical students on the ward. So I think I must have been ok.

I think I just can't accept the fact we, being a group of motivated high flyers would rely on such a ridiculous amount of spoonfeeding. It just made me think that these people aren't ready to be a student doctor yet - they are just a bunch of naive, immature teenage school kids.

Joke of the day

My sister Yee Leng told me 'My rats are toilet trained - they know how to go to the designated place to poo'...

Forgive my ignorance, I just can't help but to laugh!

Being judgemental

I had a great day yesterday at hospital. In fact most of the time spent on the Emergency Admission Unit (EAU) had been good. I've seen five lumbar puncture now (including two from my previous attachment) and the house officer said when the next one comes I can do it! I was in the ward from 0830 - 2100 yesterday. Saw amazing things: two LPs, ascites tap, elicited shifting dullness, SVC obstruction, and got my first ever successful blood gas! One of the lady which we did LP (whose CSF was a little yellow) on turn out to have subarachnoid haemorrhage, which was totally unexpected! So I got a free teaching on SAH since the house officer who did it was all too excited. The doctors kept telling me to go home but first it was raining outside all day and secondly there's so many interesting things to see how could it let such rare opportunity slip?

But I wasn't too happy about myself yesterday. This is kind of like a reflective thing. I clerked a patient who came in with collapse. He is a widower living alone who was just discharged from this ward yesterday morning and who reluctant to go home. The house officer was mourning about him suggesting that this must be an inappropriate referral. So, having the idea in my mind I did not really concentrate hard when I talked to him. And I thought his symptoms was so all over the place - non specific dizzyness, weakness, loss of balance, blurring of vision, tingling for a year or so. I quickly swept through the CV and resp examination which was nad in my opinion. I was reluctant to do a neurological examination because I can't do it properly yet, but the registrar insisted. So I did it. He kept telling me that there is weakness on the left side of his arms and legs but I thought the power was equal on both sides except for his hand grip on the left, and there was also a loss of sensation on the left foot. Finger to nose and heel to shin were ok but slow on the left. Visual field testing was so difficult with him because it was so grossly abnormal and I didn't want to repeat it because I just can't intepret the finding it all. So in the clerking sheet I wrote: 'Impression: I don't know, it's way out of my depth!'. In my mind, I thought he just can't cope living alone and trying to get attention by these psychologically induced signs. How wrong was I! When the registrar and consultant repeated the examination, they found clear cerebellar signs (nystagmus, buzzing noise in the left ear, abnormal left finger-to-nose and supination-pronation, left homonymous hemianopia, romberg positive). So he might have had a posterior circulation stroke or worse an intracranial lesion and would need a CT scan of the head. I was extremely ashame of myself. Not because I failed to elicit those signs (they were honestly out of my depth), but because I made a judgement of a patient even before I talked to him. I was already thinking that it must all have come from his mind. I didn't take his concerns seriously. And I thought he was faking the loss of sensation and stuff. All because he had just been discharged on the day itself, is a (miserable) widower and smells. How can I be a good doctor when I'm already such a judgemental person as a medical student? I found it difficult to believe that I'm actually this kind of person - ignorant and arrogant. If I have been a qualified doctor with the same attitude who clerked this patient, I could have let a man with an acute stroke go home with a 'heartsink' diagnosis. Why did I think that way? Partly it's me trying to conform to the views of the other doctors - you know how sometimes doctors would look at the patient's background and presenting complaint, and straight away say 'this must be a time waster' or something like that. But I cannot do that. I'm not experienced enough. And I mustn't ever do that even when I'm already well experienced. Judging someone from the surface is a dangerous thing to do. I should have know that.

Who would I be in the Harry Potter world?

I think I would be a cross between Dumbledore and Hermione. Those are my favourite characters anyway. I don't think I am born as intelligent as Dumbledore. And I don't think I will ever be as charming and as chilled he was. But I do like to make strategies alone and act in solitary. I have a lot of friends but hardly have any that I could trust with my weaknesses. I am definitely as hardworking as Hermione. Like me, she is always very resourceful and cares about her other friends. People say I am clever, but in fact I think I'm just a well read ordinary person (well, probably with a slightly good memory). And I don't take risk if I don't have to - always go for the logical and acceptable option. But I am not as popular and as pretty as Hermione.

The people's spoken - Loud and clear!

Malaysia had just had its general election yesterday and the result was shocking. For many years, the Barisan Nasional party (A coalition of parties representing the Malay, Chinese, Indians and other ethnic minorities) have been given very strong mandate to govern by the people. This time around, the BN did not even manage a 2/3 majority. It has only won by a simply majority (winning over 50% of the parlimentary seats) to form the government. Also BN lost five states to the opposition, the new states lost being Peneng, Perak, Selangor and Kedah.

This must have been far beyond BN's expectation. But if have they not see it coming at all, I'm glad that the truth has been smacked right on their faces. My initial prediction for this election was that BN would win but definitely by a reduced majority. I didn't expect not even a 2/3 majority.

What do I think? I think the people has really exercised their democratic rights and send the BN strong messeges. I always have a feeling that in the fifth prime minister reign, the government seemed to be always out of touch with what is actually happening in the country. Politicians from the government often saw it ok to brush off things that groups have to say. Things like 'if you don't like our policies you can leave' and '1000 people in the street protesting doesn't represent the general public and therefore has no relevance' etc had left people fuming in silence. And worse there is always these cocky politicians who would arogantly say rubbish like 'we have the people's support and what we do must be what the people wants'. I felt that they treated us, the public, like very simple beings who still thinks like the older uneducated generation giving undividing support to the party who brought Malaysia independence some 50 years ago. Certain people in the ruling party kept telling the mainstream media that no one in the country reads political blog on the internet, and would not hesitate to critisise bloggers as if bloggers are just a bunch of naughty school boys there to make trouble. They have clearly underestimated the power of internet as a mean to campaign. They need to realise that people (especially the urban, educated ones) are no longer so simple minded to hail whatever a minister/politician in the right wing says. We want our concerns to be taken seriously. And if they can't do that, then out they go.

One of the bloggers thought that many voters did not actually want the opposition candidate to win, but voted for the opposition candidate anyway because they did not want the BN to win. So many of the good BN candidates suffer as a result. And in fact if you scrutanise the results in detail in most constituencies, the winner only won by a tiny majority. That means people's view are still fairly splitted. It'll be interesting to see what the opposition can actually do for it's voters now that they have a stronger presence in the parliment.

Would Malaysia soon be in chaos? Malaysia have not faced such political situation ever in history. The last time the BN sustained such set back (which was not even as bad as the present election) in 1969, riots happened. There were violence between the different races. There were killings and a state of emergency had to be declared. Would it happen this time? We don't know but I don't think so. There is some issues of racial inequality but I think this time around the people didn't really voted for the benefit of their own race. The winners for this election (both from the government and opposition parties) are made up of quite a good mix of different races. The BN formula for power sharing is proven to bring stability, but it can't be the only thing that works. It's time for some social experimentation. This is history in making. Only with change can a civilisation progress. We'll see.