Tuesday, September 13, 2011

Transformer

Hepi Eid...

Long silence.Sometimes we have to accept that we are incapable to do everything in this life.Allah created us with limitations.None is perfect except Him.

Being a 'transformer'.It is not easy to change to a new person with new environment.That news even though it comes like a thunder,IMAN acts as a guard,protecting emotions to keep in appropriate manner.

I do love orthopaedic very much, yet Allah wants to grant me more than that.Being as surgical medical officer in HKK has sharpened up my knowledge and skills.Supervised under a good, dedicated surgeon is a great chance.I do really appreciate the knowledge Allah has given to me throughout my attachment here.Until now...I do not know when I can turn back to my beloved orthopaedic posting.He knows.

I'm applying master in orthopaedic.Hopefully the path is smooth.

Altogether fasting 6 syawal.

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Friday, June 17, 2011

The Great Physician

Welcome to the Great Physician's
Office hours are as you come,
He's a specialist in all problems
And His day is never done.

He can heal a heart that's broken
He can mend the spirit too,
No matter what your ailment
He does have the cure for you.

His fee for service never alters
He serves rich and poor as well,
He's our one chance for salvation
He alone saves us from Hell.

There's no fee for services rendered
All He asks is we believe.
and do as He has commanded us
And His blessings we will receive.

Do you have a special problem
That is troubling you this hour?
Then just simply turn to Him
You can find no greater power.

Don't delay in seeking treatment
Please my friend don't hesitate,
For His office is soon closing
And He'll shut and lock the gate.

I wouldn't want for you to suffer
While the doctor's so close by,
Your whole life will be much better
If the physician you will try.

Saturday, June 4, 2011

MVA in Kuala Krai

Subhanallah...

2 days ago was my worst oncall since i'd been working in Hosp Kuala Krai.Five victims were referred to me on the same time.All those patients got open fracture.Upper limbs, lower limbs both we handled.Thanks to Allah they were all stable.

It was around 4 am in the morning while I was just rest my body on bed after doing debridement of one patient who had been assaulted on his leg.Pity to my houseman, he had to sacrifice all his 24 hours on that day to patients.May Allah bless you.

We managed to settle down everything until Subuh Azan was heard.Because of too tired, I slept for a while with my arms landed over the emergency table.My eyes were closed until I heard MA Razman's voice.He came to offer help doing the backslab.Oh...thanks a lot MA Razman.

Now...Alhamdulillah,I'm happy playing with my niece here.Weekend is a gift.


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Sunday, May 15, 2011

Sharing is caring

I have just came across a letter from public which has been published in Berita Harian recently.At least he/she has some values of empathy towards us, as a medical officer.

We..have been trained to be tough.As tough as a soldier, perhaps.Until we have no time to convey a letter to ministry, telling that we are tired, we have less time to sleep like other people, we got small little time with spouse and kids.We say nothing, we just do it.

And today, people outside start looking at us.They feel sympathy.They know we are really tired to work for 35 hours non stop.It happens sometimes, we involved in motorvehicle accident during driving 'postcall', just because we are sleepy.But we just keep quiet.

We have been trained that way, and somehow we accept it.When somebody share their feeling with us, we certainly appreciate it very much.Thanks a lot, brothers and sisters for your empathy and concern.....may He bless you.

SHARING IS CARING.

Friday, April 8, 2011

PryME

All praise to Allah..Alhamdulillah.

The only word that I could utter after attending Practical Rheumatology Made Easy Workshop at Renaissance Hotel today.Thank you Allah for giving me chance to upgrade my knowledge regarding joint disease, and their latest practice guidelines in Malaysia.

The programme started at 9 am and finished around 6pm involving 4 speakers who are all physician consultant in rheumatology.Thanks a lot Dr Asmahan, Dr Ainon, Dr Asmah and Dr Haselynn for your fantastic presentation.Now I feel more confident in managing [patient with gouty athritis, rheumatoid athritis, osteoathritis and SLE.Hopefully it will do better to our patients.

# There has been a new criteria to diagnose patient with rheumatoid athritis.Please do search for American Rheumatism (ACR), revised 2010


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Friday, April 1, 2011

Mushrooming medical schools

Malaysia, a country with about 26 million inhabitants, boasts of 24 medical schools now.

Just a few years ago, the number was less than 10. In fact, when my eldest son entered medical school 10 years back, I could count the medical schools with my fingers. Now even with my toes and my fingers, I can no longer. Some of the names are so new that I, as a doctor, did not even know they existed until I did some research for this article.

The list is below:
Public universities:

* University of Malaya, Faculty of Medicine
* Universiti Kebangsaan Malaysia, Faculty of Medicine
* Universiti Sains Malaysia, School of Medical Sciences
* Universiti Putra Malaysia, Faculty of Medicine and Health Sciences
* Universiti Malaysia Sabah, School of Medicine
* Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences
* International Islamic University Malaysia, Kulliyyah of Medicine
* Universiti Teknologi Mara, Faculty of Medicine
* Universiti Sains Islam Malaysia, Faculty of Medicine & Health Sciences
* Universiti Darul Iman, Faculty of Medicine

Private Universities and Colleges

* UCSI University, Faculty of Medical Sciences — School of Medicine
* Monash University Malaysia, School of Medicine and Health Sciences
* International Medical University, Faculty of Medicine
* AIMST University, Faculty of Medicine and Health Sciences
* Allianze College Of Medical Sciences, Faculty of Medicine
* Management and Science University, Faculty of Medicine
* Cyberjaya University College of Medical Sciences, Faculty of Medicine
* Royal College of Medicine Perak, School of Medicine
* Melaka Manipal Medical College, School of Medicine
* Penang Medical College, School of Medicine
* MAHSA University College, Faculty of Medicine
* Newcastle University Medicine Malaysia (NuMED)
* Taylor’s University College, School of Medicine
* Utar

These are the medical schools in Malaysia. These schools, when fully functional, will produce about 4,000 doctors a year. There will be thousands more Malaysian doctors being produced overseas, since many Malaysians are studying medicine in the UK, Australia, New Zealand, India, Indonesia, Russia, Taiwan and even Ukraine.

The sudden mushrooming of medical schools is apparently due to shortages of doctors in the public sectors. This is because most doctors in government service resign after their compulsory services and opt for the supposedly greener pasture in the private sector.

In most other countries, the logical thing to do to counter this brain drain of doctors to the private sector is to find out why doctors are resigning from government service, and then try to address the woes of the doctors, and hopefully, keep them in service. I call this common logic.

The Malaysian solution, like in many other instances, does not take common logic into account but rather uses the sledgehammer approach. After all, we do have Malaysian logic, which is different from common logic practised in most other countries. For example, if we cannot have spacecraft of our own, we can still produce astronauts by sending Malaysians into space, hitchhiking on other countries’ spacecraft.

In most other countries, the common logic will be to try to improve the working conditions in public sector so that doctors will stay back. But Malaysian logic is sledgehammer logic, and is very different.

If the doctors do not want to stay in government service, then Malaysia shall flood the market with doctors, so goes the Malaysian logic. Never mind that setting up of medical schools and training doctors are expensive businesses. We have petroleum and huge amount of development funds.

By building more buildings and buying expensive medical equipment to equip these medical schools, billions will have to be spent and, of course, in the Malaysian context, everyone will be happy, down from the planners, the contractors, the parents and all others involved, since the perception is that projects in Malaysia inevitably will have some leakages and wastages, and many people are very happy with these leakages and wastages.

Never mind that we may have the hardware but we may not have enough qualified people to man these medical schools.

The Malaysian logic seems to be like this: If enough doctors are produced, the market will be saturated with doctors, and thus, doctors will have nowhere to go but to stay in government service.

Well, the people may be clapping hands and rejoicing that, with more doctors than are needed, medical costs will come down.

Unfortunately, things do not function like this in medical education. Experience in some countries tells us that some doctors in private practice, when faced with too few patients, will charge higher and do more investigations, some of which may not be needed. So instead of medical cost going down, it will go up.

In any advanced nation, the setting up of a medical school requires a lot of planning and is not done on an ad hoc basis. Planning must include where to source for experienced and qualified teachers; where to build new or source for existing teaching hospitals, which are big enough for the placement of these medical students to do training.

Planning such as facilities, equipment, classrooms, curriculum. In the west, it takes many years of training for a medical school to be set up; whereas in Malaysia, we see more than 10 in the last five years.

In Malaysia, due to the sudden “exponential” increase in medical schools, we have medical schools pinching staff from each other, even the mediocre ones. With that number of qualified teachers only, it is unavoidable that many teachers may not have the experience and qualification to be medical lecturers.

The early birds (medical schools) are more fortunate. Their students are placed in bigger hospitals like the General Hospitals of Kuala Lumpur or Penang. Now, some of the medical schools just opened have to send their students to smaller district hospitals to do their training. The smaller hospitals are often manned by more junior doctors who are not qualified to be medical teachers, and these hospitals have only very basic facilities and equipment.

This is just the beginning of the problems. For a doctor, graduating from a medical school is the beginning of a life long journey, and the basic medical degree is more like a license to start to really learn how to manage and treat patients.

The most important year after a doctor graduates is the houseman-ship. If a doctor does not have proper houseman training, then he would face a lot of problems later on. He or she may know all the medical knowledge in the world (just for argument’s sake, since knowledge of medicine is so vast that no one can know everything), but without the proper houseman training, he or she will not get the hand-on experience so crucial and important to doctors.

A doctor without proper houseman training is not unlike a person who has only ever raced in arcade games, suddenly being asked to race in a real life race. He would not have the hands on experience to do well. A doctor without proper houseman training would be like a person given a license to kill, and a disaster waiting to happen.

Now, with 4,000 doctors being produced in a year, where do we find so many houseman positions for these young doctors?

Even now, with some of the medical schools just starting and not yet producing doctors, and the number of doctors being produced is much less than the 4,000, the wards in some of the bigger hospitals are filled with so many housemen that, in some wards, there are not enough patients for these housemen to learn management skills.

About a year back, I was told, in HKL some of the units have more than 20 housemen. Recently one doctor told me that in some units, it may have even more than that. I was aghast. Since with that many housemen in a single unit, and so few senior officers to guide them and so few patients for them to learn from, how are they going to learn the skill of doctoring?

When there is not enough training for these housemen, what do you think our policy planners do? In the typical Malaysian style, they increase the length of houseman-ship from a year to 2, hoping that the longer time will help to give better exposure to these doctors.

Compared to Australia, New Zealand, and United Kingdom, houseman-ship is still one year only. By increasing the length of the houseman-ship, it is a tacit admission that our one-year houseman training is not as good as the above mentioned countries.

A poorly trained houseman will become a mediocre medical officer, and since now most of the specialists are trained internally, it will be a matter of time before future specialists may not be as well trained as presently.

Many parents do not know about the actual situation and still encourage their children to take up medicine. They are not told of the actual situation. The day will come when there are simply so many doctors that none are adequately trained. There will come a day when a doctor graduating from a medical school cannot even be placed in a houseman position.

And that day is actually very near.


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# never ending story, I do realize it,and I pray to Allah may He protects me from doing harm to my patients.Hopefully, I'll grow up as a safe doctor,doing the best for my ummah !

Friday, March 4, 2011

Transferring Tendon..

Alhamdulillah...All praise to Allah.

It has been scheduled.InsyaAllah tomorrow morning I'll be joining my boss elective operation.Just finishing doing pre-op round today.One of the patient is a young lady with the congenital Erb's palsy.She is planned for right wrist tendon transfer KIV wrist fusion.


" who will join the OT tomorrow ? " Mr zairuddin, my ward specialist asked.

" Me, Mr zai.."

"..so you should have a look and read about tendon transfer " He encouraged while smiling.

Alhamdulillah...I just read about Principles of tendon transfer described by Roger Dee.Basically, there are 5 principles which have been outlined by Mayer, Steindler, Bunnell and Boyers.

Before that, what does it means by tendon transfer?

It is defined as " procedure in which the tendon of insertion or of origin of the functioning muscle is mobilized, detached, or divided, and reinserted into a bony part or into another tendon to supplement or substitute for the action of the recipient tendon "

Principles of Tendon Transfer

1. Correction of contractures

The joints must be freely movable, because a transferred tendon unit cannot overcome a fixed joint contracture.the skin and soft tissue must be supple and free of scarring.

2. Adequate power in the transfer

The muscle must be strong enough to perform the desired function.Thus, only muscles rated 4+, 5 or better should be considered acceptable donor.

3. Sufficient amplitude in the Transfer

The amplitude is a function of muscle sarcomere length.One should choose a donor with more than adequate amplitude for the desired function.The work capacity of a muscle is determined by the product of its power and amplitude.

4. Satisfactory Line of pull

The best course for a tendon transfer is a straigt line of pull througgh unscarred soft tissue.Each turn or bend in the transferred tendon can set up a point of friction, causing loss of effective power and amplitude.

5. Functional integrity

The transferred tendon cannot be expected to perform more than one function or to have separate amplitudes for different motions.The transferred muscle tendon unit must be expendable.For example, if both the FCR and FCU tendons are tranferred to the dorsum of the hand and wrist, active wrist flexion will be lost !


Hopefully we can learn something and may the operation tomorrow will be successful.May Allah bless.

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