Breath freshener overkill

Met a drug rep today who was trying to sell me an anticancer treatment for lung cancer. This first thing I noticed was an overwhelming smell of air freshener, as if he has emptied the entire content of the can into his oral cavity.

Poor soul, he was obviously trying very hard to mask that fact that he smokes. Afterall, trying to sell drugs to a lung oncologist and smoking like a chimney doesn’t go down well. Unfortunately it wasn’t working despite the probably near lethal dose of breath freshener in his system: I could still smell the cigarette breath.

All in the name

I wonder what it is like if your name is the same as that of a famous celebrity. There must be lots of incidents where the name is used as a joke or a means of humiliation.

I have treated quite a few patients with such names. I have treated Michael Jackson, Tom Jones, Kevin Costner, Joan Collins, Dean Martin, Paul O’Grady. and a few others.

No, I don’t make fun of their names, and treat them like everyone else

I am just very curious how they find living with such famous names but I feel it is too rude to ask them (obviously I’d be making conscious mention of that fact which is unprofessional given I am their consultant).
I wonder how many more celebrity names I will come across.

Just another rant at current medical school teaching

Unbeliveable. What a group of consultant colleagues said during lunch regarding the quality of training of junior doctors. Many universities are now using a problem based learning (PBL) approach Apparently studies suggest that it should  produce doctors who are more independent in their learning and thinking, putting them in the right path for the rest of their careers. There is much more emphasis on modules organised in systems (eg cardiovascular system; they are meant to study all about anatomy, physiology, pharmacology and pathology). 

Unfortunately the PBL system is far from thorough in its coverage, and it does require a lot of maturity and self discipline from medical studies to self study topics which are not necessarily discussed in the PBL tutorials.  

There was this consultant doing a ward round with a first year doctor. They were seeing a patient with liver failure. When asked about the signs of liver failure, the consultant got a “I don’t know”. Exasperated, the consultant tried to teach VERY BASIC symptoms and signs of liver failure. Then asked the houseman about causes of liver faillure. Got a shrug of the shoulders. 

The consultant couldn’t believe it anymore, and asked the doctor how is it possible that he doesn’t know something so common and basic.

The simple reply was “It wasn’t one of the clinical scenarios covered in the medical PBL course”. The consultant tore out his hair in disbelief.

Trained in the traditional medical system, even a lazy medical student would have at least seen 50 patients with alcholic liver failure in their first clinical year (3rd year in medical school). Nowadays, a graduate from medical school, after spending 5 years “studying medicine” cannot answer very basic questions about liver failure and its causes. And they claim that PBL produces doctors who are just as good, or possibly better. I remained unconvinced..

Will never manage any treatment

A 80 yo man was unfortunately diagnosed with lung cancer. Extremely anxious to begin with, made worse by the fact that his grandson has recently died from metastatic cancer.

He wasn’t able to tolerate lying down flat, he told me. Even for his diagnostic CT, he had to lie on his side. He and his wife said he will panic if he were to lie down.

Told him I will offer him radiotherapy, but when I described the treatment to him, he quickly dismissed it, saying there is no way he will manage lying down fro radiotherapy. He was already in panic whilst I was talking to him about treatment. His face became all red, his respiratory rate went up.

It was really difficult, but eventually I managed to convince him to simply give it a try; if he cannot manage it, we will not force him. I told him I have helped many anxious people through it. I prescribed him some lorazepam to take before coming for treatment.

Saw him last week for consent. Still very suspicious, anxious and doubtful. Certain that he will not manage. Eventually managed to get him planned without any major issue.

A week later, a very happy man. Couldn’t stop thanking me. Wife said he is a totally new person, so I’ve got the patient a totally happy wife as well.

Sounded like he has major anxiety disorder; probably should stay on some anxiolytic for the rest of his life.

The flirt

Unusual complain today. I have a young man with a curable cancer receiving chemotherapy on the ward. He is tall, well built and rather handsome. he has a wife and 2 kids to whom he is close to.

I received word from the ward staff that he is flirting excessively and intensively with them. I will be seeing him again this afternoon and has to speak to him about it.

Never had such complains before. I am sure he doesn’t mean to tempt the staff nurse to sleep with him (I certainly hope not! ).  Often men who are blessed with good stature and good looks are so used to getting what they want from girls they simply can’t get out of the habit of flirting, esp when the wife is not around to “monitor” him.  I hope that is all there is.. Well, I will find out.

Maturity for clinical contact

People here start medical school quite young. Many are 18 or 19 by the time they enter medical school. Most have little in terms of life experience, especially nowadays when parents tend to be overprotective and sheltering. 

Nowadays, many university has a new medical curriculum which puts medical students into clinical contact the very first year they come in. 

I had a medical student who told me last week that during her first year, she was placed into my specialist oncology hospital for training in general clinical skills. The examination and history taking part was OK. What she couldn’t take was seeing people suffer from cancer. It was her first clinical contact, and emotionally she was far from prepared to see people who may be dying from cancer. The whole experience left her in tears, severely shaken.

She is now in final years, and attached to oncology again (her choice for special study module). Thankfully the fact she choose oncology for her optional attachment suggests that she wasn’t scarred for life by her first clinical encounter. Somehow early introduction to clinical contact can be tricky when the students aren’t really mature enough emotionally to deal with it. There must be some way to prepare them beforehand.

What not to say

My 5 year old, after a trip to Stratford upon Avon was asked to share in front of the whole class. Proudly she told them she visited Anne Hathaway’s cottage.

The teacher was pleased until she said “..and I learnt that she had sex at the wrong time, that’s why she was pregnant when she married William Shakespeare…”

The teacher quickly said “Oh dear” and stopped her sharing. Opps, not appropriate for that age group.

Next, I hope I would not get a string of angry parents knowing on my door telling me off.

The funny fallout from swine flu

It’s early days yet. Some reported cases in Scotland. People down south is getting worried. Staff here in A&E are demanding face masks, although there is no reported case in my city.

One day the infection control nurse found a junior doctor whose scrub pockets are bulging to the brim. When asked what they are: it turned out to be pocketfuls of facemasks that he was trying to smuggle out of hospital for himself and his family. Embarrassingly has to be told to empty his pocket or face charges of theft.

Wonder how many doctors have already sneaked out lots of surgical masks unnoticed; well not until the theatre suddenly found that they are running out of masks…

Musical chair

Recently the clinical director stepped down, another consultant has taken over the role. In my hospital there is this tradition where the clinical director will occupy this big room next to the clinical oncology seminar room. Thus each time someone steps down, the old director will move out, and the new will move in. However there are not many rooms available so people have to move around. At the same time, one of the consultants is retiring (the pervious director is moving into it), and another has unfortunately passed away prematurely.

I was thinking perhaps I should upgrade to a better room now, since my room is pretty hot, without proper ventilation nor conditioning esp in the winter. The air can be very stale and stuffy.

So I asked the new clinical director. I have been eyeing his previous room, which is just across where my current room is.

Unfortunately another consultant (more junior than me) has made the first move, so it was his. His existing room is quite far away in a separate building and he would rather be near the majority.

Doop!

Well, the only room left is the room vacated by the consultant who died prematurely.

The only other chineses consultant in the hospital told me: don’t move into that room; bad fung shui (bad omen, since the previous occupant died prematurely). I couldn’t help but laugh that a consultant colleague can be so superstitious!

Giving A level tuition

For half a year now I have been giving free A level chemistry tuition to church friend’s son. They have very modest earning income; so I was happy to obliged. I thought surely a level chemistry can’t be too hard, since I got an A without any sweat those many  years ago.

But then it was more than 20 years ago! My goodness, how have I underestimated the challenge. So many things that used to click instantly seem so difficult to work out. My knowledge of chemistry have narrowed over the years into medical molecular biochemistry that simple organic and inorganic chemistry seem to be french to me.

I am also too busy with work and my kids to have proper time reading it up properly. But I don’t want to let this kid down. So I try my best, helping him through his past year papers, frantically reading his chemistry text books and revision notes as I do. It was a humbling experience: I learnt that I may be able to do a lot of things, but I am not necessarily as intelligent as I think! There are many times I just have to say I don’t know, looking things up from the books and the internet (which I don’t have easy assess to in his house).

Surprisingly, I got lots of feedback through the parents how happy he was with the tuition I give. Well, it wasn’t just because it was free. He got better grades during his class assessment, his teacher was surprised, and he was so much more confident. However he didn’t get as good a grade as he wished in the real A level exam, though he got an average of B in Chemistry. 

Has has more assessment coming up: I’ve got much more work to do…