Video: PaxilBack (with lyrics)

This video by the Gray Kid has been around since the end of 2006. Since J.’s currently doing his Psychological Medicine (Psychiatry) posting, the video seemed appropriate.

Paxil = paroxetine, a selective serotonin reuptake inhibitor (SSRI). That’s the same class of drugs as Prozac (fluoxetine) and is used to treat major depressive disorder and obsessive compulsive disorder (OCD), among other psychiatric illnesses. The trade name in Singapore is actually Seroxat.

PaxilBack

Lyrics below.

Thanks to WordPress’ Spam Filter

WordPress has been one of the most user-friendly, powerful blogging services J.’s used online (the others being Blogspot, Xanga, Livejournal, and the now defunct Diary-X) and he’d just like to point out what a relief having Akismet spam filter. Akismet is the spam filter developed by Automattic which is strongly associated with WordPress.

(Yes, even more so than the increase from 50MB of storage space for free accounts to an incredible 3GB of space)

Even a tiny personal blog like J.’s attracts an incredible quantity of spam. In the space of slightly over one year, Akismet has saved J. tons of time by catching 11,958 spam mail which are deleted automatically after 15 days. That’s amazing behind-the-scenes work. It’s about time we remembered the humble spam-filter.

Thank you Akismet!

Posting: Geriatrics

J. gets awesome postings. The most recent one was Geriatrics at AH, a place generally considered by many to be essentially a geriatric hospital (though exceptions exist). With the final MBBS examinations looming, platitudes of how medical students “are not studying to pass the examinations. The aim is to learn to become good doctors.” start to ring hollow.

So it was that J. approached this posting with skepticism and trepidation, his mind racing frantically to find ways to avoid having to show up.

It was a good thing he failed to find any.

The tutors were only too willing to teach during the ward rounds, and J. learnt quite a fair bit about both geriatrics as well as general medicine from the geriatricians there. Given that the Geriatrics department at AH treats all medical patients above 75 years old, the variety of cases is very wide, and the geriatricians there never fail to amaze J. with their sheer quantity of knowledge about a wide spectrum of diseases.

While previously J. would describe geriatrics as a “pain in the bottom”, this posting has opened his eyes and he now describes it more accurately as “medicine as it should be practised“.

Medicine-Law Debate: Remuneration

The Medicine-Law Debate marked the end of the Inaugural Medicine-Law Challenge 2008, where the two faculties of NUS offering professional degrees tested their physical, mental and verbal skills against each other in soccer, rugby, floorball and debate.

Overall, Medicine wins with 3 wins to Law’s 2, but who wins and who loses doesn’t really matter. It’s more a matter of increasing interaction between the two faculties’ students and reviving a partnership that used to exist (or so J. hears, but don’t quote him on that, y’hear?)

Back to the subject at hand. The subject of the debate was [roughly] “This house believes that it is dangerous for society to pay its lawyers more than its doctors.”

Pfft… when J. heard the topic, he almost puked blood. It would have been very amusing for the lawyers to be on the proposition, don’t you think? Unfortunately, the hapless medicine team set off to defend this indefe… well… difficult topic against the faculty of law.

Differences in Hospital Computerised Systems

With less than 2 months before the final MBBS, final year students are thinking about what order they want to do their HO rotations and in which hospitals. And when it comes to hospitals, all aspects come into play: location, teaching, people to work with, how good it looks on a resume, so on and so forth. One surprising factor that came in are the computerised systems.

It’s now the IT age. Accordingly, the hospitals have moved with the times. The ol’ whiteboard with patients’ info (for staff) in TTSH had given way to two large flat screen panels at the nurses’ counter. The X-ray, CT, MRI films no longer need to be printed out. They can be viewed on the computer monitor with real-life adjustment of views/contrast/brightness. Discharge summaries no longer need to be written out by hand. Patient lab results can be pulled out easily.

With this convenience comes problems, however. Things that are more complicated tend to break down more easily, and the IT upgrades don’t stretch to all areas. For instance, the computers in some of the TTSH MO rooms look (and work) like it’d be an act of mercy to put them down. In some wards in NUH, over half the COWS (Computers on Wheels) are non-functioning. On the whole, however, things have improved.

One thing that stood out in the contrast between hospitals is which system they used for patient information. In the SingHealth cluster (SGH, CGH, KKWCH) it’s from iSoft. For National Healthcare Group (AH, TTSH, NUH), it’s the self-developed Computerised Patient Support System (CPSS). A quick survey of his classmates as well as the members of the current batch of house officers that J. knows revealed that in general, it’s not much of a fight. The vast majority support iSoft. It’s supposedly faster, better designed, easier to use and more pleasing on the eye.

HO pay ain’t too bad

The grass is always greener on the other side, people are never satisfied, yadda yadda, which explains why you’ll notice that J. seems to be perpetually complaining that doctors are underpaid (well, actually he doesn’t always complain. he’s generally pretty okay with things.)

Anyway, at a time when fuel prices have risen, taxi fares gone up, flour prices up, property prices up, COE prices down (yay! except for the petrol bit), it is somewhat heartening to learn that the monthly pay of house officers, greenhorns in the doctoring (ahem.) business, has been risen as of 2008 by an undisclosed amount somewhat less than the equivalent of 2 calls a month.

People aren’t going to be satisfied, yes, but it’s a still good time to count our blessings, aye? And get back to mugging for the MBBS.

Public Transport and Getting to Work/School.

In the 18th Jan 2008 issue of the Straits Times, one article spoke on the plans for public transport in the future, to make the bus and rail system “the other car”. J. spent 15min on that article and thought it was an insightful read and one that brings a lot of hope for the future… maybe. The new changes to the bus systems such the estimated arrival time at bus stops in Orchard road, the bus routes at almost every bus stop have been welcome changes, and much more useful and less a waste of money than the failure that is “TV Mobile”.

Because as it is, taking public transport to work is a pain in the hindquarters. Currently, J. stays around a Northerly district in Singapore that requires taking a 15-min bus ride to the nearest MRT station. As a medical student, J. has been posted to all the major hospitals.

Estimated Total Time Taken for J. (i.e. walking, waiting) to Reach MO Room/Student lounge from home

• CGH – 2hr 15min
• NUH – 1hr 45min
• AH – 1hr 40min
• SGH – 1hr 30min
• TTSH – 40min
• KKWCH – 40min

That’s a lot of traveling time. Especially, when going to CGH can burn 4 out of 24 hours. It’s ridiculous given that ward rounds start at 7.30am most days and 6.30am post-take.

Handwashing or Alcohol Handrub?

An article came out in the 18 Jan 2008 Straits Times titled: Does your doctor wash his hands?

The gist of it is that an internal audit of doctors in Singapore General Hospital showed that half the doctors at Singapore General Hospital (SGH) don’t wash their hands between patients. Ew. It doesn’t come as much of a surprise to J.

Doctors vary in their attention to infection control. Surgeons are fantastic are infection control in the operating theatre, but not in the wards. Infectious diseases physicians are naturally the most enlightened, eschewing labcoats, ties and long sleeves in favour of consistent handwashing. One SGH ID physician wears a badge around that says, “Ask me if I’ve washed my hands.” Even in medical school, you can tell the difference between folks’ meticulousness in infection control. Furthermore, it’s probably not an ID physician that instituted the policy in SGH that medical students must wear ties at all times.

J. is pretty obsessive about cleaning hands. Unfortunately to the extent that when watching Operation Theatre II, he cringed at the touching group hug scene because the play had said “the plague is spread by the slightest skin contact”.

Anyway, that said, J. just thought he’d point out something missing in the newspapers: alcohol/chlorhexidine handrub is a good alternative to handwashing. So if your doctor decides to use an alcohol handrub after examining you, don’t think that it’s a lackadaisical attempt at cleaning his hands. It can be superior in many instances.

It’s been shown to help decrease nosocomial infections (Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub.)

Grey’s Anatomy Episode – Energy Healing

Potential spoilers ahead for Season 4 Episode 11 that aired on 10 Jan 2008.

On the episode, a 49-year-old lady named Elizabeth Archer comes in with something (probably chest pain), was sent to the cardiac cath lab where she was diagnosed with dissection of the proximal 2/3rds of the left anterior descending (LAD) artery. That’s a major branch of the left main coronary artery and supplies the interventricular septum and a big chunk of the left ventricle. Important, important artery.

It turns out she’s a faith healer. Well, not quite. Energy healer. As she says, “I am a healer and I have faith, but I’m not sure the two are related.” In the show, she passes hands over a patient with persistent stable ventricular tachycardia (who’s on amiodarone, a drug with less predictable pharmacokinetics) as well as over a patient of Sloan’s with a “Staph infection” (speculated by J. to be Staphylococcus aureus cellulitis which any decent hospital would have covered with crystalline penicilline and cloxacillin) and the two recover.

It also turns out that she refuses surgery. This is peculiar and not-quite peculiar because the first-line therapy for coronary artery dissection is usually angioplasty and stenting of the dissection, usually performed in the cardiac cath lab at the time of angiography. Perhaps she had already been assessed and found to be unsuitable, in which case the next step would likely be a coronary artery bypass (hence the need for Dr Erica Hahn)

Video: The PCR Song (with lyrics)

Addendum: There’s a follow up to the PCR song – Bio-Rad’s GTCA Song.

PCR = Polymerase Chain Reaction, used for gene amplication for work with DNA/RNA.

It’s actually an advertisement for PCR machines by Bio-Rad, and damn it’s good.

Lyrics below.