DAY 1661-1669

Mar 21 - 29

1) And just like that, our group is done with Emergency Medicine! It has been a hectic week, doing morning shifts and evening shifts for the past week, but we definitely learnt a lot. Throughout the rotation, we were attached to different "zones" within the department. Essentially, patients presenting to the Emergency Department (ED) can be classified into trauma vs non-trauma cases. Most trauma cases would involve road traffic accidents, although falls are quite common too. Trauma cases need to be assessed for severity, and priority is given to the patients that are in the most critical state, followed by those in semi-critical condition, and finally those that are in stable (non-critical) condition. Patients in the most critical state are sent to the "red zone", those in semi-critical state to the "yellow zone", and finally stable patients to the "green zone" - this is the definition of triage. 

2) In addition to the three "zones", the ED houses an observation ward, where patients are monitored quite similarly as in a medical ward, before being discharged. Finally, unique to the hospital we were attached to (Seberang Jaya Hospital), there is also a Medical Emergency Coordination Centre (MECC), where emergency calls are handled. I was attached there for a day, and I learnt a lot about how emergencies are coordinated by region. For example, Seberang Jaya Hospital is the only public hospital that handles emergency calls throughout Penang. So if anyone dials "999", the call is transferred to this centre, where the operator confirms the details and the nature of the emergency.

3) An important point to note (which I suspect not many are aware of) is that the call taker and the ambulance dispatcher are not the same person. Sometimes, callers may be worried the longer they continue talking with the operator, the longer the time taken for help to arrive. This is not the case. Immediately after an emergency call is answered and the location confirmed, an ambulance is dispatched from the nearest available hospital or health clinic. The reason the operator continues asking further questions is to ascertain the extent and severity of the injury/condition, to check if more than one person is involved, and whether there are other hazards in the vicinity. Also, certain procedures can actually be taught over the call, for example how to perform CPR, or how to tie a wound to stop bleeding, or even how to perform or assist an emergency delivery!

4) I really enjoyed my time in emergency medicine. We managed to sit in on two CME (continuous medical education) sessions, where we learnt about primary and secondary surveys (done on patients presenting with polytrauma), as well as stroke management. CME sessions are intended for house officers and medical officers alike, as a means to keep up to date with the latest guidelines. Furthermore, I noticed that everyone in this department worked very well together, like a well-oiled machine. We would see medical assistants, nurses, house officers, and medical officers work together, each doing separate tasks, all working to stabilise and monitor the patients in each zone. What struck me the most was how relaxed these people were - they were doing things that would in any other setting cause a lot of chaos and panic, but instead they remained calm and collected. 

5) Next week onwards, we will be switching to the department of radiology, also in Seberang Jaya Hospital. I hope that radiology will be just as interesting as emergency medicine has been. Until then, I'm just going to enjoy whatever "free time" I have left haha. Thanks for visiting my blog as always, and have a great week ahead. Cheers! 

Post-rotation dinner @ Saigon Bowl

(l-r: Myself, Sharifah, Rachel, Siti, Jinny)

Pho (Vietnamese noodle soup) with a very unique drink - egg coffee!

(a Vietnamese drink traditionally prepared with egg yolks, sugar, condensed milk, and robusta coffee)

All smiles after being told to go have breakfast first XD

DAY 1652-1660

Mar 12 - 20

1) Finally, after several delays due to extension of the movement control order (MCO), our group (Group B) has completed the family medicine rotation! This means there are two more major rotations to go - the so-called "multispecialty rotation" (consisting of emergency medicine, radiology, ophthalmology, and otorhinolaryngology), and obstetrics and gynecology. After that, we have a week of written papers and a soul-draining 20 station OSCE. For each station, we get 1 minute to read the question, then 6 minutes to perform whatever task needs to be performed. The task could be anything from history taking (asking patients about what brought them here), communication (breaking bad news to patients, or educating patients about certain medications/procedures), physical examination, or practical skills procedures. Bottom line is none of us are really looking forward to it...

2) Reflecting on the current rotation, I have found family medicine to be a unique experience. This is due to a few reasons. Firstly, the opportunity to compare and contrast both the public and private aspects of medical practice. During our time in family medicine, we got a chance to visit a different clinic each day. This meant that some days we were attached to the public community health clinics, and on other days we went to private GP practices. Some of the main differences between the private and public settings include the availability of medications, continuity of care, and cost. For instance, government health clinics would usually have certain types of medication only, while in the private setting, the only limiting factor would be whether the patient could afford the medication. In terms of continuity of care, in a private setting, the patient would see the same doctor/specialist, which means they would develop good rapport over time, while in the government setting, they might not see the same doctor each time for follow up. Finally, the most important factor - cost! While a private GP does have a set consultation fee, this is still many times more expensive than the equivalent government health clinic, where each consultation costs a mere RM1. 

3) Another reason I found family medicine to be unique is that we had the opportunity to see a patient managed from start to finish i.e. from the moment they walk in until they leave. Whereas in other settings, such as the medical or surgical wards in hospitals, we only see patients at a particular time, perhaps before their surgery, or after their surgery. In the GP setting, we learnt how to take a history of the patients' complaints, perform necessary physical examinations, order relevant investigations/blood tests, prescribe them the appropriate medications, and follow them up as required. This made me realise how important the primary care consultation is for patients. The primary care physician is the first point of contact for patients, and they see undifferentiated cases (meaning patients which have not been seen by any other healthcare professionals before this). Their duty, among other things, is to ensure that no "warning signs" are missed. As an example, for every 100 patients who come in with the common cold, perhaps 95 of them do indeed have the common cold which will resolve by itself, while another 5 may have more serious underlying medical conditions that require further investigating. By looking for warning signs, the physician avoids misdiagnosing these five patients with a simple common cold.

4) Throughout the rotation, I found all the doctors (in both private and public settings) to be phenomenally nice and helpful. Each of them had their unique style of teaching, for example, by asking us to examine patients in the waiting room before presenting it to them, or by testing our book knowledge about common medical conditions encountered in this department. Generally, we would see a lot of patients with a history of diabetes, hypertension (high blood pressure), and dyslipidemia (high cholesterol). Others would present with more acute conditions, such as diarrhoea, rash, joint pains, or headaches. Regardless, we saw our fair share of cases during our time here.

5) Having finished our exam today, we have two days of "free time" before our next rotation (emergency medicine) starts on Monday. For both emergency medicine and radiology, our clinical attachment will be at Seberang Jaya Hospital (not the usual Penang General Hospital). I look forward to a fruitful and enriching experience in the coming rotations. And on that positive note, I'll end my blog post here. Thanks so much for visiting as always, and have a nice day. Take care and stay safe, cheers! 

Look who I bumped into post-exam @ Gurney Plaza - Melvin and Melissa! :D

Lunch with friends on the day we had practical skills session at the Clinical Skills Unit

(l-r: Afifah, Jia Min, Jinny, Myself)

Practising those suture skills XD

Initially I took these pictures for study purposes, 

but now I see they can also be used as blog material XD

(this is the medication given to patients presenting with sudden breathlessness due to an asthma attack)

That's how you measure the amount of medication needed

That's normal saline solution (basically it's 0.9% sodium chloride)

That's how you measure out the required volume of normal saline

This is the nebuliser machine

(it converts the liquid medication from just now into a fine mist for easy inhalation into the lungs via the face mask below)

That's a nebuliser face mask 

(the patient with an asthma attack may need to breathe through this 

to relieve their symptoms of breathless)

Got my haircut two days before our exam :)

DAY 1637-1651

Feb 25 - Mar 11

Night has arrived, 

Another day survived,

The medical student returns late.

Dinner has gone to waste,

For they only long to taste, 

That warm embrace of their own bed.

In stress they thrive,

In sickness they strive,

For attendance equates to proficiency,

From dawn to dusk, 

They put on a mask,

To shield others from their own deficiency.

Exams are a priority, 

So say the majority,

The mindset of a student is resolute,

Like modulus in mathematics,

Or temperature in thermodynamics,

Their conviction is thus absolute.

From students to doctors in a flash,

From scratching their heads, to treating the rash,

Repeating to themselves that old lie,

That this will all be worth it before they die.

Years of stress have taken their toll,

The once bubbly figures have lost their soul,

The cost of their dreams was their own health,

Have they never learnt that health is wealth?

Pre exam week lunch with my friends @ Baby Sumo Restaurant

(l-r: Rachel, Myself, Sharifah, Afifah)

Dinner with my cousin Eo @ Arashi, Gurney Plaza

Thanks so much for the wonderful meal!!