Lord I feel regretted not to go back on Saturday...not to have chances to saygoodbye....and don't want this to happen again anytime in my life.
Lord....are you going to take his soul? are you going to take care of him? are you going to bring my whole family to you?
Lord....I don't know what to do....I don't know what to say....I really wish to have chance to hold his hands and tell him I love him...and God loves him too.
Lord....why didn't You let me see him again? What's the purpose of all these?
Lord...tell me what I should do...
星期一, 10月 26, 2009
星期四, 10月 15, 2009
星期六, 9月 26, 2009
As a Christian medical student....
I want to have compassion....
I want to change and help people...
I want to share the gospel....
I wan to tell them...you have a heavenly father who love you and accept you as who you are...
I want to tell them....you have a purpose in this world....a purpose God has given you...
I want to pray for them, hold their hands, hug them and tell them "Jesus loves you and I love you too."
However, as a medical student, I can't. This may be regarded as "crossing the line" or "imposing my belief on others".
I understand that these are all God work, not mine. But God....what do you want me to do as a medical student? How can I have the compassion like You, but also carry on with life..?
You have given me this gift and calling, how should I serve Your people?
I want to change and help people...
I want to share the gospel....
I wan to tell them...you have a heavenly father who love you and accept you as who you are...
I want to tell them....you have a purpose in this world....a purpose God has given you...
I want to pray for them, hold their hands, hug them and tell them "Jesus loves you and I love you too."
However, as a medical student, I can't. This may be regarded as "crossing the line" or "imposing my belief on others".
I understand that these are all God work, not mine. But God....what do you want me to do as a medical student? How can I have the compassion like You, but also carry on with life..?
You have given me this gift and calling, how should I serve Your people?
星期二, 6月 16, 2009
sharing and confidentiality
In an ideal church, people share their struggles, their problems, their joy and thus having true fellowship and grow together in Christ's love.
Why would people enclose their inner beings and get closer and closer? Because they trust each other and know that they are loved without being judged, knowing that they can trust this person without ending up with gossip spread around.
However, I do not find this confidentiality in my church.
Things are spread around. People gossip and tell each other "Do you know this so and so break up with so and so.." "Oh I don't want to end up with so and so with this problem".
And the saddest thing is....even when confronted with "Why are people talking about things that should kept between themselves?" They said, "talking about it is human nature....and sometimes we are not gossipping, we are just caring"
Do you know why patients share their most private problems to the doctor? Because even in the first year of medical school, we are taught again and again in terms of the confidentiality.
Do you know why would alcoholic anonymous work? Because it is ANONYMOUS! People feel the true freedom of telling the group "Hi my name is John and I'm a drug addict and alcoholic!". Instead of being judged, these people embrace each other and truly help each other with the problems.
In the past, I was very naive and simply share whatever in my mind, even my personal life and struggles. This was because God has opened up and "onioin skins"/shell and help me face with lots of things I used to refused to face. However, when knowing what kind of values and things people do, I've made up my mind. I feel sad and disappointed because this is not the church God wanted! In addition, they don't even realise this is wrong! Gossiping about people's lives has revealed the judgemental mentality and how can you expect true fellowship?
God, have mercy on my church. I want to truly love my church . I want to see the church manifest with Your love so that people around can see we are Your children.
However, at the moment I feel that I'm walking into a herd of lions, looking for "material" to "talk about" on dinner table. At the same times, instead of focusing on You alone, I felt stumbled and being hurt again and again. Lord, forgive me if I've offended You in any way. I'd like to ask for guidence and Your eyes towards the church.
Why would people enclose their inner beings and get closer and closer? Because they trust each other and know that they are loved without being judged, knowing that they can trust this person without ending up with gossip spread around.
However, I do not find this confidentiality in my church.
Things are spread around. People gossip and tell each other "Do you know this so and so break up with so and so.." "Oh I don't want to end up with so and so with this problem".
And the saddest thing is....even when confronted with "Why are people talking about things that should kept between themselves?" They said, "talking about it is human nature....and sometimes we are not gossipping, we are just caring"
Do you know why patients share their most private problems to the doctor? Because even in the first year of medical school, we are taught again and again in terms of the confidentiality.
Do you know why would alcoholic anonymous work? Because it is ANONYMOUS! People feel the true freedom of telling the group "Hi my name is John and I'm a drug addict and alcoholic!". Instead of being judged, these people embrace each other and truly help each other with the problems.
In the past, I was very naive and simply share whatever in my mind, even my personal life and struggles. This was because God has opened up and "onioin skins"/shell and help me face with lots of things I used to refused to face. However, when knowing what kind of values and things people do, I've made up my mind. I feel sad and disappointed because this is not the church God wanted! In addition, they don't even realise this is wrong! Gossiping about people's lives has revealed the judgemental mentality and how can you expect true fellowship?
God, have mercy on my church. I want to truly love my church . I want to see the church manifest with Your love so that people around can see we are Your children.
However, at the moment I feel that I'm walking into a herd of lions, looking for "material" to "talk about" on dinner table. At the same times, instead of focusing on You alone, I felt stumbled and being hurt again and again. Lord, forgive me if I've offended You in any way. I'd like to ask for guidence and Your eyes towards the church.
星期二, 5月 26, 2009
balance b/w study and church ministry
This is the question/struggle I have been having since primary school days.
In primary school, I was struggling between music (piano, double bass, theory, music appreciation, etc), homework, and as a cell group leader.
In high school, I was struggling going to cell groups, youth service and preparing for the entrance exam to senior high school and university.
In university, I was struggling going to cell groups, preparing cell group teaching material, calling cell group members, prayer meeting of the cell groups, prayer meeting of cell group leaders, youth service, study, clubs, and basketball team and things I'd like to learn.
And gradually.....my views towards all these struggles gradually changed.
Now what I'm learning everyday is not JUST study, but the ministry that God has given me. Or I should put it in another way, study IS the ministry that God has given me, just as important as the ministry in the church. Therefore, of course I'd enocourage everyone to serve more in the church, to go to prayer meeting provided that they can manage other aspects of lives.
People always say "Honor God and He will honor you in what you do". However, I don't think this should be the reason to drag people to the "church ministry" and tell them that your grades will be fine because you've honored God. That's NOT true!
While giving out examples of this person still did lots of things in the church while preparing exams and God honor him at the end of giving him great results. Why not talk about people DIDN't get good grades because they are too busy
Here I'm NOT saying not to put God as the first priority but I believe that "church ministry" does not equal to "Honor God" nor "put God as first priority".
I study for God to become a better doctor because this precious opportunity was given from God!
Putting God first means study well for the exams, even if that means I can't go to prayer meeting, cell groups, practicing worship on Saturday.
Of course, there may be times where we do put "grades" above God and there may be time that God wants us to honor Him by serving in the church.
However, I simply want to say "please do not judge people who may need more time in their study. That doesn't mean that they don't honor God !"
Ideas, preferences, beliefs, habits, cultures, traditions DO NOT equal to the truth and principle that God has given us!
This is also a reminder for me till today.
In primary school, I was struggling between music (piano, double bass, theory, music appreciation, etc), homework, and as a cell group leader.
In high school, I was struggling going to cell groups, youth service and preparing for the entrance exam to senior high school and university.
In university, I was struggling going to cell groups, preparing cell group teaching material, calling cell group members, prayer meeting of the cell groups, prayer meeting of cell group leaders, youth service, study, clubs, and basketball team and things I'd like to learn.
And gradually.....my views towards all these struggles gradually changed.
Now what I'm learning everyday is not JUST study, but the ministry that God has given me. Or I should put it in another way, study IS the ministry that God has given me, just as important as the ministry in the church. Therefore, of course I'd enocourage everyone to serve more in the church, to go to prayer meeting provided that they can manage other aspects of lives.
People always say "Honor God and He will honor you in what you do". However, I don't think this should be the reason to drag people to the "church ministry" and tell them that your grades will be fine because you've honored God. That's NOT true!
While giving out examples of this person still did lots of things in the church while preparing exams and God honor him at the end of giving him great results. Why not talk about people DIDN't get good grades because they are too busy
Here I'm NOT saying not to put God as the first priority but I believe that "church ministry" does not equal to "Honor God" nor "put God as first priority".
I study for God to become a better doctor because this precious opportunity was given from God!
Putting God first means study well for the exams, even if that means I can't go to prayer meeting, cell groups, practicing worship on Saturday.
Of course, there may be times where we do put "grades" above God and there may be time that God wants us to honor Him by serving in the church.
However, I simply want to say "please do not judge people who may need more time in their study. That doesn't mean that they don't honor God !"
Ideas, preferences, beliefs, habits, cultures, traditions DO NOT equal to the truth and principle that God has given us!
This is also a reminder for me till today.
living out a Christain life
How should I put the principle of God in my life?
-Study well because God is empowering me to become a good doctor, including knowledge, clinical skills, compassion, and good communication skills.
-During patient counter, the wellbeing of the patient should ALWAYS be my priority. NOT my study...even if the patient has good signs.
-When I see doctor/other medical students causing discomfort to the patients, I should have the courage to stop them no matter who they are.
-When possible, help each other to become a better doctors, including knowledge and good beside manner.
-When seeing sth wrong, not only point it out but DO NOT have the sense of self-righteousness.
-When having opportunities to serve the patient, the church, the people around, DO IT!
-Study well because God is empowering me to become a good doctor, including knowledge, clinical skills, compassion, and good communication skills.
-During patient counter, the wellbeing of the patient should ALWAYS be my priority. NOT my study...even if the patient has good signs.
-When I see doctor/other medical students causing discomfort to the patients, I should have the courage to stop them no matter who they are.
-When possible, help each other to become a better doctors, including knowledge and good beside manner.
-When seeing sth wrong, not only point it out but DO NOT have the sense of self-righteousness.
-When having opportunities to serve the patient, the church, the people around, DO IT!
星期四, 5月 07, 2009
星期日, 4月 26, 2009
Battle of mind
Help me always claim Your promises.
Not just talk about my problems to You, but tell my problems that my God is much bigger than you!!
Lord, thank you for giving me the opportunity to learn how to help people. I believe in You and Your grace.
Let the weak say I am strong. Let the poor say I am rich. Your grace is more than sufficient for me.
:)
Not just talk about my problems to You, but tell my problems that my God is much bigger than you!!
Lord, thank you for giving me the opportunity to learn how to help people. I believe in You and Your grace.
Let the weak say I am strong. Let the poor say I am rich. Your grace is more than sufficient for me.
:)
星期一, 4月 20, 2009
Purify my heart
Lord, purify my heart please.
Lord, please give me Your eyes, Your heart and Your compassion.
The more I complain, criticize them, the more I become like them.
I'm sorry Lord....they are also Your children, like me, sinners.
Help me truly live out Your life, as a true followers, with all my mind, all my heart, all my strength.
Lord, please give me Your eyes, Your heart and Your compassion.
The more I complain, criticize them, the more I become like them.
I'm sorry Lord....they are also Your children, like me, sinners.
Help me truly live out Your life, as a true followers, with all my mind, all my heart, all my strength.
星期日, 4月 19, 2009
self-righteousness
Self-righteousness is a very dangerous thing.
As in the previous blog where I need to keep reminding myself about the differences between right/wrong, beliefs, opinions, thoughts, values, traditions, etc. Somehow it is EXTREMELY easy for us to point a finger on someone and said what you do is wrong, forgetting the fact that what they are wrong may be just "wrong according to my values/opionions/thoughts/or actually......wrong". Before you jump to the conclusion and said, "wait! you can't simply say right/wrong is a relative thing", I want to clarify here that what I'm talking about is not the "obvious wrong things against the principles of God, ie love God, love your neighbors". For example, is abortion wrong? or let me ask you again, is abortion wrong when the girl is raped? or is abortion wrong when the girl who was raped is 10 years old?
or another example:before getting married, is holding hands wrong? is kissing wrong? is hugging wrong? is having sex wrong? is living together wrong? is staying in the same room with or without other people wrong?
How about this one: is judging people wrong? gossipping wrong? spreading gossip wrong? listening to gossip wrong?
And ultimately, when we are pointing finger at someone, or criticizing with other people, we have a tendency to forget about how imperfect we actually are! forget about if not were God's grace, we cannot come close to Him at all! If not were God's grace that provide us resources, family, friends, understanding, how can we possible stand here at the position we are right now?
We can do all the right things, all the "righteous" things but having the sense of self-righteousness is a sin in God's standard! Think about in the Bible, who did Jesus despise? Pharisee! Those who don't even know how much pride and self-righteousness in their minds but busy "doing the right thing"!
Why am I seeing pharisees in our church rather than Christ-followers? Why do they easily take someone out and pin them on the cross? Why do they always pick on someone and keep stoning them?
And the most scary thing is may be sometimes I'm one of them!
What is the point of doing 1 month to live, what's the point of going to easter camp, what's the point of going to cell group? when what they do is the contrary to what they believe?
講台上講的大都是對的 做的卻是錯的
上行下效 how can we grow? how can we even proudly say we are God's people?
Lord....have mercy on us.
I am imperfect. I am little, I am hyptocrites sometimes. Sometimes I don't even realise I've gone against You.
Lord help me become more and more like You. Help me see things in Your eyes, not in my sinful eyes, biased by my own flesh.
As in the previous blog where I need to keep reminding myself about the differences between right/wrong, beliefs, opinions, thoughts, values, traditions, etc. Somehow it is EXTREMELY easy for us to point a finger on someone and said what you do is wrong, forgetting the fact that what they are wrong may be just "wrong according to my values/opionions/thoughts/or actually......wrong". Before you jump to the conclusion and said, "wait! you can't simply say right/wrong is a relative thing", I want to clarify here that what I'm talking about is not the "obvious wrong things against the principles of God, ie love God, love your neighbors". For example, is abortion wrong? or let me ask you again, is abortion wrong when the girl is raped? or is abortion wrong when the girl who was raped is 10 years old?
or another example:before getting married, is holding hands wrong? is kissing wrong? is hugging wrong? is having sex wrong? is living together wrong? is staying in the same room with or without other people wrong?
How about this one: is judging people wrong? gossipping wrong? spreading gossip wrong? listening to gossip wrong?
And ultimately, when we are pointing finger at someone, or criticizing with other people, we have a tendency to forget about how imperfect we actually are! forget about if not were God's grace, we cannot come close to Him at all! If not were God's grace that provide us resources, family, friends, understanding, how can we possible stand here at the position we are right now?
We can do all the right things, all the "righteous" things but having the sense of self-righteousness is a sin in God's standard! Think about in the Bible, who did Jesus despise? Pharisee! Those who don't even know how much pride and self-righteousness in their minds but busy "doing the right thing"!
Why am I seeing pharisees in our church rather than Christ-followers? Why do they easily take someone out and pin them on the cross? Why do they always pick on someone and keep stoning them?
And the most scary thing is may be sometimes I'm one of them!
What is the point of doing 1 month to live, what's the point of going to easter camp, what's the point of going to cell group? when what they do is the contrary to what they believe?
講台上講的大都是對的 做的卻是錯的
上行下效 how can we grow? how can we even proudly say we are God's people?
Lord....have mercy on us.
I am imperfect. I am little, I am hyptocrites sometimes. Sometimes I don't even realise I've gone against You.
Lord help me become more and more like You. Help me see things in Your eyes, not in my sinful eyes, biased by my own flesh.
星期三, 4月 08, 2009
wish list
-get high marks in sem9 exam: 1 OSCE practice/wk, 1 long case/wk, 1 short case/day with someone that can encourage when feeling slacking off or tired. we can practice together and share cases and push each other in learning.
-someone can understand my feelings and need, with me saying AND without me saying. Recently I can really identify what a Broca dysphasia patients feel like----no one under what I'm trying to get. and it's highly likely that it is me that having the problems of expressing ideas.
-someone that can inspire and encorage in terms of the walk with God. From the light from the verse in the Bible, from counting blessings around, from willing to share and listen.
-someone to share and pray with. someone to encourage the pursuits of our dreams.
-someone that can respect me, including opinions, thoughts, beliefs, etc...respect me as a person.
May be....at the end, there's only God and me and my life/dream
-someone can understand my feelings and need, with me saying AND without me saying. Recently I can really identify what a Broca dysphasia patients feel like----no one under what I'm trying to get. and it's highly likely that it is me that having the problems of expressing ideas.
-someone that can inspire and encorage in terms of the walk with God. From the light from the verse in the Bible, from counting blessings around, from willing to share and listen.
-someone to share and pray with. someone to encourage the pursuits of our dreams.
-someone that can respect me, including opinions, thoughts, beliefs, etc...respect me as a person.
May be....at the end, there's only God and me and my life/dream
星期二, 4月 07, 2009
所以我們不可再彼此論斷，寧可定意，誰也不給弟兄放下絆腳跌人之物
主意
想法
意見
偏好
信念
信仰
這些都是不同的東西
但是有時候我們很不小心就把意見提升到信仰 which is wrong...
聖經上說 我們需要將我們的信念和信仰建立在愛的律法上，因為愛就完全的律法Romans 13:8-10, Gal 5:14; James 2:8
求神幫主我不要把意見強加於人 唯有你能叫人心知罪
願他人能從我神上學到你的愛 而不是我的軟弱
求主幫助
想法
意見
偏好
信念
信仰
這些都是不同的東西
但是有時候我們很不小心就把意見提升到信仰 which is wrong...
聖經上說 我們需要將我們的信念和信仰建立在愛的律法上，因為愛就完全的律法Romans 13:8-10, Gal 5:14; James 2:8
求神幫主我不要把意見強加於人 唯有你能叫人心知罪
願他人能從我神上學到你的愛 而不是我的軟弱
求主幫助
星期五, 3月 20, 2009
20/03/09 Fri Week 6 of GI
Morning:
-2 cannulations---remember to adjust the position of the hand on 22G needle so that the flush back can be seen, remember to press at the end of the cannula after inserting! (today I pressed on the head and made a mess! :p )
-saw a patient with advanced Rheumatoid arthritis --＞ should revise RA...and hand exam, the patient also has a Ganglion cyst (the Bible bump).
-examine a VRE patient with decompensated chronic liver disease and chronic renal failure due to type II hepatorenal syndrome. He is not feeling very well but kindly let us had a look.
-Tute with Le Page:
1. DDx for painless jaundice---malignancy of the head of the pancreas
2. inguinalscrotal swelling: chronic---testicle(testicular tumour), epididymas( cysts of the epididymis, epididymo-orchitis), tunica vaginalis (hydrocoele, haematocoele), spermatic cord(hydrocoele of the spermatic cord)
-Examine a patient with swollen testis....this is the first time for me to examine a testis. There's a 2 cm firm mass and I couldn't appreciate the the underlying structure. The patient is very kind and willing to let us have a feel.
-GI meeting with lunch~ Thank God and GI department for the great food!
hepatorenal syndrome: Type I acute(rapidly rising serum creatinine and very poor prognosis) and type II chronic(slowly progressive deterioration). It's a functional renal failure due to extensive vasodilatation from advanced liver disease on a setting of ascites and hyponatraemia. It may be precipitated by infection (esp spontaneous bacterial peritonitis), diuretics, nephrotoxic drugs, GI bleeding or large-volume paracentesis.
Mx: monitor diuretic use and stop if hyponatraemia or renal impairment develops. IV albumin if undergoing large-volume paracentesis. Cirrhotic patients with GI bleed should be given prophylactic antibiotics. Nephrotoxic drugs(aminoglycosides, NSAID) should be avoided
-correct hypovolaemia and precipitants.
-if fail to improve---terlipressin(vasopressin analog which insert more aquaporin to reabsorb more water) AND albumin
Afternoon:
PBL-colorectal cancer and haemorroids
ECG tute-may need to revise the basic again and go the lecture nxt see whether I can do thoses correctly
Renal revision-acute and chronic renal failure! great revision
End of block party---great to relax and play table tennis!!! so fun!
Plan for the weekend:
1. revise RA
2. FBE, coag, U/E, LFT, TFT
3. AF, CCF, IHD, Cholesterol and obesity as topics!
4. GI final revision
5. Sunday---long case presentation, do another case. Print revision notes for neuro, renal
6. Neuro Exam!!!!! Neuro basic knowledge revision.
7. Last week respiratory topics: Asthma, COPD, DVT/PE
(sounds a bit ambitious, let's see how many can be achieved)
-2 cannulations---remember to adjust the position of the hand on 22G needle so that the flush back can be seen, remember to press at the end of the cannula after inserting! (today I pressed on the head and made a mess! :p )
-saw a patient with advanced Rheumatoid arthritis --＞ should revise RA...and hand exam, the patient also has a Ganglion cyst (the Bible bump).
-examine a VRE patient with decompensated chronic liver disease and chronic renal failure due to type II hepatorenal syndrome. He is not feeling very well but kindly let us had a look.
-Tute with Le Page:
1. DDx for painless jaundice---malignancy of the head of the pancreas
2. inguinalscrotal swelling: chronic---testicle(testicular tumour), epididymas( cysts of the epididymis, epididymo-orchitis), tunica vaginalis (hydrocoele, haematocoele), spermatic cord(hydrocoele of the spermatic cord)
-Examine a patient with swollen testis....this is the first time for me to examine a testis. There's a 2 cm firm mass and I couldn't appreciate the the underlying structure. The patient is very kind and willing to let us have a feel.
-GI meeting with lunch~ Thank God and GI department for the great food!
hepatorenal syndrome: Type I acute(rapidly rising serum creatinine and very poor prognosis) and type II chronic(slowly progressive deterioration). It's a functional renal failure due to extensive vasodilatation from advanced liver disease on a setting of ascites and hyponatraemia. It may be precipitated by infection (esp spontaneous bacterial peritonitis), diuretics, nephrotoxic drugs, GI bleeding or large-volume paracentesis.
Mx: monitor diuretic use and stop if hyponatraemia or renal impairment develops. IV albumin if undergoing large-volume paracentesis. Cirrhotic patients with GI bleed should be given prophylactic antibiotics. Nephrotoxic drugs(aminoglycosides, NSAID) should be avoided
-correct hypovolaemia and precipitants.
-if fail to improve---terlipressin(vasopressin analog which insert more aquaporin to reabsorb more water) AND albumin
Afternoon:
PBL-colorectal cancer and haemorroids
ECG tute-may need to revise the basic again and go the lecture nxt see whether I can do thoses correctly
Renal revision-acute and chronic renal failure! great revision
End of block party---great to relax and play table tennis!!! so fun!
Plan for the weekend:
1. revise RA
2. FBE, coag, U/E, LFT, TFT
3. AF, CCF, IHD, Cholesterol and obesity as topics!
4. GI final revision
5. Sunday---long case presentation, do another case. Print revision notes for neuro, renal
6. Neuro Exam!!!!! Neuro basic knowledge revision.
7. Last week respiratory topics: Asthma, COPD, DVT/PE
(sounds a bit ambitious, let's see how many can be achieved)
星期一, 3月 16, 2009
today's patient Mon Week 6 of Gastro block...
morning in liver clinic: Hep C medication follow up, responds to treatment(liver enzyme level does not mean the virus is cleared; viral load is cleared patient may still have elevated liver enzymes), Hep B (Pt from china with an interpreter with her own opinion in interpretation, which is bad...), haemochromotosis (Pt with active Hep C had increased Iron, 100% satuaration, increased ferritin whose mother has recently been diagnosed with haemochromotosis too)
12:30pm: Claire's session on FBE, U/E, asthma, DVT/PE, COPD, smoking cessation and medication adherence. ( realised need to learn FBE and DDx, anaemia and consolidate the DDx for U/E. Need to know those topics back to front, practice the questions Clarie asked today:
-COPD: what is the role of pulmonary rehab? What is the role of surgery in COPD? What is your understanding of nutrition in Pt with COPD? What is the role of immunisation?
-Asthma: Please instruct/assess the patient in terms of using inhalers
-DDx for primary hypothyroidism: hashimoto disease, medication (amiodarone, Tx of thyrotoxicosis, lithium), thyroiditis, (then iodine deficiency, etc). Mx: Hx(fHx, medication, infection, Sx), Test(thyroid antibody)
-hyperthyroidism
*DDx for with low TSH and High FT4 and 3: graves' disease, toxic multinodular goitre, Hashimoto's thyroiditis, thyroiditis, Meds (thyroxine, amiodarone)
*Mx: ultrasound of the neck, looking for malignancy, THEN iodine uptake scan
Afternoon saw 2 cardio patients:
1. 78 y/0 gentlement presented with syncope yesterday and atril flutter on ECG on a background of T2DM, previous heart attack, HTN and hyperlipidaemia.
On inspection, he's an obese, pale looking gentlement lying in bed with mild tachypnoea (22 /min), having normal saline infusion. Obs: BP 150/90, afebrile, Sat 90%RA, PR 60/min.
Apex beat could not be appreciated due to obesity. Soft S1S2 with a very soft ejection systole murmur. No peripheral oedema but absent peripheral pulses. Loss of sensation on both legs up to the knee, with multiple lesions/ulcers and fungal infections?.
A brief Hx was taken. The Pt loss consciousness on the way to the toilet and could not recall the symptoms before the syncope. The patient has had silent inferior myocardio infarction ? years ago.
Meds: insulin, mixtard, atrovstatin (lipertor), clavicil,
The interview was stopped because the Pt would like to rest. May go back and talk to him tmr.
2. 34 y/0 5 wk postpartum lady presented with syncope on a back ground of potential 14 yrs Hx of palpitations and rapid heart beats and 3 yrs Hx of anxiety and panic attacks.
Last Thu, after feeling rapid heart beats, dizziness she loss consiousness for about 1 min. The similar event occured again and her husband noticed her faces turned pale before she passed out.
At the age of 20, she noticed these tachycardic episodes occured, various in frequency. 3 yrs ago, she as diagnosed with anxiety and panic attack associated with hot flush and palpitatoins, relieved by breathing technique. However, the rapid heart beats episodes seem to be consistant and not relived by the breathing technique.
There's no particular trigger for the tachycardia. The Pt reported that the beats were so fast that she couldn't tell whether it's regular or irregular and she couldn't tap out the beats. There is an increased in no. of tachycardia events during her second pregnancy. She drinks 2-3 cups of coffee a day and does not notice any association b/w the episodes and coffee. There's no recent infection, no family Hx of similar problems nor any significant health issues, no previous Hx of heart, thyroid problems and anaemia. She has never smoked and drank occasionally. She is currently on Halter moniter.
ECG: SVT with abrency? VT? to be confirmed......
4:00 CPC: lump in the nect and salivary tumour
most common salivary tumour is mucoepidermal carcinoma....
5:00 metabolic bone disease: bisphosphonate, PTH for oesteoporosis. oesteomalacia and Rickett's, Paget's disease (use bisphosphonate to slow down the bone turnover).
12:30pm: Claire's session on FBE, U/E, asthma, DVT/PE, COPD, smoking cessation and medication adherence. ( realised need to learn FBE and DDx, anaemia and consolidate the DDx for U/E. Need to know those topics back to front, practice the questions Clarie asked today:
-COPD: what is the role of pulmonary rehab? What is the role of surgery in COPD? What is your understanding of nutrition in Pt with COPD? What is the role of immunisation?
-Asthma: Please instruct/assess the patient in terms of using inhalers
-DDx for primary hypothyroidism: hashimoto disease, medication (amiodarone, Tx of thyrotoxicosis, lithium), thyroiditis, (then iodine deficiency, etc). Mx: Hx(fHx, medication, infection, Sx), Test(thyroid antibody)
-hyperthyroidism
*DDx for with low TSH and High FT4 and 3: graves' disease, toxic multinodular goitre, Hashimoto's thyroiditis, thyroiditis, Meds (thyroxine, amiodarone)
*Mx: ultrasound of the neck, looking for malignancy, THEN iodine uptake scan
Afternoon saw 2 cardio patients:
1. 78 y/0 gentlement presented with syncope yesterday and atril flutter on ECG on a background of T2DM, previous heart attack, HTN and hyperlipidaemia.
On inspection, he's an obese, pale looking gentlement lying in bed with mild tachypnoea (22 /min), having normal saline infusion. Obs: BP 150/90, afebrile, Sat 90%RA, PR 60/min.
Apex beat could not be appreciated due to obesity. Soft S1S2 with a very soft ejection systole murmur. No peripheral oedema but absent peripheral pulses. Loss of sensation on both legs up to the knee, with multiple lesions/ulcers and fungal infections?.
A brief Hx was taken. The Pt loss consciousness on the way to the toilet and could not recall the symptoms before the syncope. The patient has had silent inferior myocardio infarction ? years ago.
Meds: insulin, mixtard, atrovstatin (lipertor), clavicil,
The interview was stopped because the Pt would like to rest. May go back and talk to him tmr.
2. 34 y/0 5 wk postpartum lady presented with syncope on a back ground of potential 14 yrs Hx of palpitations and rapid heart beats and 3 yrs Hx of anxiety and panic attacks.
Last Thu, after feeling rapid heart beats, dizziness she loss consiousness for about 1 min. The similar event occured again and her husband noticed her faces turned pale before she passed out.
At the age of 20, she noticed these tachycardic episodes occured, various in frequency. 3 yrs ago, she as diagnosed with anxiety and panic attack associated with hot flush and palpitatoins, relieved by breathing technique. However, the rapid heart beats episodes seem to be consistant and not relived by the breathing technique.
There's no particular trigger for the tachycardia. The Pt reported that the beats were so fast that she couldn't tell whether it's regular or irregular and she couldn't tap out the beats. There is an increased in no. of tachycardia events during her second pregnancy. She drinks 2-3 cups of coffee a day and does not notice any association b/w the episodes and coffee. There's no recent infection, no family Hx of similar problems nor any significant health issues, no previous Hx of heart, thyroid problems and anaemia. She has never smoked and drank occasionally. She is currently on Halter moniter.
ECG: SVT with abrency? VT? to be confirmed......
4:00 CPC: lump in the nect and salivary tumour
most common salivary tumour is mucoepidermal carcinoma....
5:00 metabolic bone disease: bisphosphonate, PTH for oesteoporosis. oesteomalacia and Rickett's, Paget's disease (use bisphosphonate to slow down the bone turnover).
星期四, 2月 26, 2009
視病猶親 視病猶師
一位應是希臘來的老太太 因為ｃ型肝炎造成乾硬化 導致功能上的退化
前兩天剛從出院 兩天後又因為先生無法扶她站起來 進了急診室
在澳洲的醫院 語言不是很通順 醫師只能聽懂一兩成她所講的英語
醫病雙方都很挫折
這一次 醫療團隊問過她的兩個女兒以及先生 了解到家人無法照顧她 因此要安排進養護中心
老太太聽到後反應很大
直說“I go no where! I want to go home! I go no where!“
醫師試著解說後 轉頭跟住院醫師交代“記得請他的女兒好好勸她“ 而此時 老太太仍然很激動
不斷叫 我不要走 我不要去 我要回家！
當下看了 實在很難過 不只是為著現實的無奈 也為著醫師對她的態度
我知道我們以後工作忙 事情多 對於這種事 除了安排社工 跟家屬溝通 我們也真的愛莫能助
但是對於病人最起碼的尊重 不一定是要花長時間安慰 最起碼能多一點點體諒
體諒病人的挫折 難過 無法接受的情緒
今天 如果是自己的親人 就算我們愛莫能助 也不會無視於病人的存在轉頭下醫囑
今天 病人就像每一位病人的老師 教導醫師對於疾病 對於溝通 對於全人的關懷所該具備的知識 能力和態度
親人 老師 都是要抱著尊敬 關懷 感恩的心去面對
就算是一個陌生人 也會有最起碼的尊重
在醫學知識的累積下 難道這些基本的相處之道 基本的關懷都要蕩然無存？
那醫師除了“完成工作“ “不要被告“之外 還剩下什麼？
在批評台灣藐視人性之餘 我們對於病人 又有多好的見解？
前兩天剛從出院 兩天後又因為先生無法扶她站起來 進了急診室
在澳洲的醫院 語言不是很通順 醫師只能聽懂一兩成她所講的英語
醫病雙方都很挫折
這一次 醫療團隊問過她的兩個女兒以及先生 了解到家人無法照顧她 因此要安排進養護中心
老太太聽到後反應很大
直說“I go no where! I want to go home! I go no where!“
醫師試著解說後 轉頭跟住院醫師交代“記得請他的女兒好好勸她“ 而此時 老太太仍然很激動
不斷叫 我不要走 我不要去 我要回家！
當下看了 實在很難過 不只是為著現實的無奈 也為著醫師對她的態度
我知道我們以後工作忙 事情多 對於這種事 除了安排社工 跟家屬溝通 我們也真的愛莫能助
但是對於病人最起碼的尊重 不一定是要花長時間安慰 最起碼能多一點點體諒
體諒病人的挫折 難過 無法接受的情緒
今天 如果是自己的親人 就算我們愛莫能助 也不會無視於病人的存在轉頭下醫囑
今天 病人就像每一位病人的老師 教導醫師對於疾病 對於溝通 對於全人的關懷所該具備的知識 能力和態度
親人 老師 都是要抱著尊敬 關懷 感恩的心去面對
就算是一個陌生人 也會有最起碼的尊重
在醫學知識的累積下 難道這些基本的相處之道 基本的關懷都要蕩然無存？
那醫師除了“完成工作“ “不要被告“之外 還剩下什麼？
在批評台灣藐視人性之餘 我們對於病人 又有多好的見解？
星期五, 1月 16, 2009
台灣的醫療
先說這是我個人的感受 而非對台灣醫生的攻擊 可能是些抱怨 也只是想給台灣醫生的提醒
當然 台灣醫師的困境我只能試著了解 但是在困境之中 醫學的本質在哪裡？
在ptt與其他醫生/醫學生對於外婆目前狀況的討論 還有與醫院醫師的討論
發現 台灣對於病人的尊嚴 對生命的尊重 真的很缺乏
當然 這有可能是在不健全的法律下產生的結果
但是 就像跟澳洲醫師討論時 對方回我的 “國情不同 病人的尊嚴沒有不同！！“
若不是跟醫師提 palliative care and dignity 根本就不會出現在病情討論中
無論家屬接受度如何 起碼也要從“educate“開始嗎？
而不是單單只說 可能要氣切 要插管 要換導管 這根管子要重插
所謂“安寧的標準“是因為法律定的？ 社會定的？ 家屬的感覺？ 還是病人自己的感受？？
全人的醫療 台灣離這個標準 好遠
仍然停在治“病“ 而不是治“人“ 不是只用法律不全 醫師無保障就能當藉口的吧
醫師的角色 是教育者 溝通者 是為病人發聲 幫助家屬走過 這個要求在台灣是無法存在嗎？ 還
是醫學教育根本沒作好？
當然 台灣醫師的困境我只能試著了解 但是在困境之中 醫學的本質在哪裡？
在ptt與其他醫生/醫學生對於外婆目前狀況的討論 還有與醫院醫師的討論
發現 台灣對於病人的尊嚴 對生命的尊重 真的很缺乏
當然 這有可能是在不健全的法律下產生的結果
但是 就像跟澳洲醫師討論時 對方回我的 “國情不同 病人的尊嚴沒有不同！！“
若不是跟醫師提 palliative care and dignity 根本就不會出現在病情討論中
無論家屬接受度如何 起碼也要從“educate“開始嗎？
而不是單單只說 可能要氣切 要插管 要換導管 這根管子要重插
所謂“安寧的標準“是因為法律定的？ 社會定的？ 家屬的感覺？ 還是病人自己的感受？？
全人的醫療 台灣離這個標準 好遠
仍然停在治“病“ 而不是治“人“ 不是只用法律不全 醫師無保障就能當藉口的吧
醫師的角色 是教育者 溝通者 是為病人發聲 幫助家屬走過 這個要求在台灣是無法存在嗎？ 還
是醫學教育根本沒作好？
星期四, 1月 01, 2009
積極的態度 摘自週報
抱怨是複習過去的挫折，只引發現現今更多沮喪；感恩是尋找逆境的祝福，帶來今日充沛的活力
抱怨 是論斷人的弱點，浪費時間於消極不合作；感恩 是欣賞別人的長處，投資時間於創造雙贏。
抱怨是嘆息環境險阻，咒詛時不我予的厄運；感恩是順著環境的情勢，尋找意外的驚喜
抱怨是注意負面事實，鈍化解決問題的創造力；感恩是相信神的美意， 活化捕捉機會的靈敏度。
抱怨 是論斷人的弱點，浪費時間於消極不合作；感恩 是欣賞別人的長處，投資時間於創造雙贏。
抱怨是嘆息環境險阻，咒詛時不我予的厄運；感恩是順著環境的情勢，尋找意外的驚喜
抱怨是注意負面事實，鈍化解決問題的創造力；感恩是相信神的美意， 活化捕捉機會的靈敏度。
與你我共勉之～
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