Anyways, lets stop digressing and get to the crux of the matter. I know (inevitably so) many of you are feeling depressed and worried about how Eastern European graduates are being looked down upon. Just relax and take a chill pill. It just so happens that a very few rotten apples make it look bad for everybody, and with the advent of social networks and social media, these isolated incidents are published far and wide making it look like a common occurrence. <\/p>\n
Let me put it to the rest, It doesn\u2019t matter where you graduate from, it only matters if you keep harping on it.<\/strong> In HTAR, the Dengue wards, and MOPD is practically run by a Ukraine Graduate M.O. I\u2019ve seen SPECIALISTS<\/strong> present cases to him to ask for his management opinion. When he is on off, another Ukraine Graduate M.O. runs the MOPD. Once, when both of them were on off, the MOPD was a mess, and when the usual 200 patients are seen by 12 p.m. went well into the afternoon.<\/p>\n Back to my first day, I knew that I knew shit, I knew that I\u2019m doomed, but I knew one thing for sure, the same shit my mom told me before starting med school, \u201cAny idiot can become a doctor.\u201d So it hit me, hey, you\u2019re an idiot, you can do this too.<\/p>\n On my very first day, I went through most of the tickets in the ward, to find out what were the common cases we were treating. Uncontrolled HPT, Uncontrolled DM, ACS, URTI, AEBA, AECOAD, ACUTE ON CKD, ARF, and the such. I went through the management of all these cases, and compared it to the Sarawak handbook, I wrote down my findings in a small pocket note book.<\/p>\n Blood Transfusion for patient \u2013Unknown!<\/p>\n Then, I started clerking cases, and since I am Jonah, getting new admissions is not a problem, at all. During my first few clerking attempts, it was really horrible, and I was not systematic. I was all over the place, it was a complete mess. Naturally, the MO reviewing the case gets so pissed, and says, \u201cThe fuck is this shit\u201d. Afterwards, I note all my mistakes, and try to understand what is expected and develop from there. Initially, considering the bad clerking, the MO will tell me to write a new entry and will dictate his findings and management.<\/p>\n Having learnt this, I will learn the proper management, and the reason why it is managed as such. I continued clerking as many cases as I could and continued presenting, and now the response is a bit better. Now they are fine with my clerking, and are okay with the management, but feel that it needs a bit more optimization, and they add\/omit\/modify whatever I\u2019ve started.<\/p>\n Continuing this path, I learnt what and how I could expect a drug to react. This eventually led to me experimenting with my own management style. Of course some were utter rubbish, but others were interesting to note, that they worked. To quote you an example, patient already on amlodipine 10mg OD, defaults for 1 month, comes back with bp skyrocketed at 180\/100. Common sense dictates, using the long acting amlo is not sufficient, and furthermore, just using one antihypertensive won\u2019t be enough either. So here I have literally a shitload of drugs I can add, but what to choose? Begin the experiment with alpha channel blockers, beta-blockers, ace-inhibitors and see what works best. Of course every patient is a subjective individual, but for the most part, everyone unless contraindicated respond as expected.<\/p>\n Finally, by the time I got off tag, reviews were now smoother, with most MO\u2019s simply saying, ok just write Seen By me. Usually meaning they completely agree with your management, and may choose to add\/omit some, or usually nothing. Boy does that do wonders for your confidence. It even got to the stage where I played with my own Insulin Sliding Scale, and conjure one from memory <\/p>\n The next big thing is procedures, and this was a big thing for me. I\u2019m not into the whole reading and gaining knowledge nonsense. I\u2019m hands on, and doing procedures was awesome, and as someone interested in surgery, it felt like the training I needed prior to getting to the good stuff. Personally, I only wrote down procedures I performed myself, assisted, or observed into the log book. This proved to be good, cause I could gauge which procedures I needed more exposure into and which I was confident enough to do whilst listening to music (true story bro).<\/p>\n As a first poster, you will come quick to notice that MO\u2019s will not trust you to do any procedures, and rightly so. Mainly because, if you screw up, and if something goes terribly wrong, the patient is going to be affected, and in the worse case scenario, might perish! The key here is persistence<\/strong> and confidence<\/strong> but don\u2019t be overconfident!<\/p>\n On my fourth day of tagging, there was an abdominal tap being done. Me, being na\u00efve and shit thought, hey, a rare procedure (needless to say, you\u2019ll be seeing at least 3 patients that need a tap every day in the ward) and quickly went to observe. I observed the procedure, and was keen to do the next available one. Surely enough, by the time I was done in medical, I had two pages of abdominal taps performed, so much so till the gastro MO noted, You must be hating me since I\u2019ve ordered most of these taps. I smiled and told her, I enjoy doing procedures boss, any other taps to do? Anyways, taps are pretty minor thing, there are other procedures that carry a higher risk.<\/p>\n![\"IMG_20120122_051755\"](\"http:\/\/hypog.net\/blog\/wp-content\/uploads\/2012\/02\/IMG_20120122_051755.jpg\" "\\"IMG_20120122_051755\\"")
<\/a><\/p>\n. Of course now a new specialist has tried to standardize the sliding scale, by distributing a more systematic one for the ward, but sometimes, its easier to just write down your own sliding scale than to look for the ward specialists version.<\/p>\n.<\/p>\n