Archive for December, 2008

Internal Medicine

I derive a great deal of satisfaction from trying to practise general medicine the way it should be done. Holistically… drafting out a problem list with everything from the acute problem to placement and addressing each issue in turn.

That said, the limiting factor is time. Which is affected by manpower. There are times when the patient load is increased and a shortage of manpower is present.

There are times when one small medical team has to take care of 40 patients. Understandably, in the constraints of time and resources, issues get missed, things are a much more rushed, and the stress level builds up.

We really need more good internists. How can this be addressed? It seems to me that despite the slightly increased remuneration (compared to previously, but still paltry compared to the procedural disciplines) and seamless training program for general medicine, it’s a very unattractive field. Boring to the impatient and frustrating to the internists who are forced to compromise on standards (or one cannot finish seeing every patient in a day). How can we make it more attractive? By having more good internists.

Hmmm, looks like we’re in a bit of a pickle.


Not Your Average Starbucks: Trung Nguyen Coffee (Liang Court)

trung-nguyen-signThis is the second outlet of Trung Nguyen Coffee in Singapore, the first being in Changi Airport Terminal 1, with plans for opening at least 2 more outlets apparently. Yes, walking through the newly opened Liang Court with a deluxe miso ramen from Tampopo in his belly, a potent smell of coffee wafted through the air and seized J. by the nostrils.

Imagine being grabbed by the nostrils. It’s not a pretty sight.

J., who had quit coffee for a mere 4 days, promptly threw his coffee-teetotaller resolve out the window and headed for the counter. Willpower is overrated.

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Gear: Gerber Paraframe I Serrated Edge

This is NOT a review. J. has not time to properly evaluate the day to day use of this knife yet.

A couple of days back, J. bought a new folding knife. The Gerber Paraframe I, with a 3-inch partly serrated blade and a framelock mechanism. And the paraframe design, of course.

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*@$%ing Racists

J., having grown up in meritocratic Singapore, was raised to be blind to race and gender. From young, looking at the fervent, talented hard workers from the female GEP schools outperform him in every aspect (aye, even sports because J. was a fat piece of shit), gender and race never even entered the picture. Except with respect to hormones, eventually, but that’s not really relevant.

Side note: Not so much religion, because one cannot choose one’s race/gender but can choose one’s religion. Unless you belong one particular race, in which case your religion’s pretty much set for you, the punishment listed for apostasy being execution (not usually carried out).

J. $*&%ing hates people who believe in the superiority of one race over the other, and he’s not the only one. A colleague of his who spent her medical school days overseas related how the salespeople at stores would consistently give preferential treatment to Caucasians over her, even though she has more spending power and carries herself better than most of them. It was this kind of treatment that eventually transformed her from a true innocent to one that exclaims, “Chao ang moh!”

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Short Post: Reality Check

You know, everyone bitches about their work.

But ultimately at the end of the day, I sincerely believe that we do the best we can under the circumstances, to provide the best possible patient care. And although we have different work practices in different conditions, the aim is still the same. I do believe it, that’s why I do what I do.

There, reality check over, back to the angry ranting!

Great Read: The Plot Against America by Philip Roth

The work of fiction writes about World War II and what might have happened had Franklin D. Roosevelt not won the election, had the famed aviator Lindbergh become President and if anti-Semitism had swept across America (well, that’s a bit of an exaggeration)… written from the perspective of a young Jewish boy watching his safe haven disintegrate around him.

It’s got a vivid description of American Jewish life, so detailed it seems the author were recalling from memory, enmeshed within an exciting “What-if?” scenario.

And J. feels that one of its strengths is that it never really strays into the realm of improbability. One can, especially seeing the reactions of people in the recent US elections, believe that such a scenario could have happened. And a similar one could still occur. It’s no 1984, but therein lies its strength.

Biostatistics for Research

J. attended the Biostatistics for Research (Advanced) Course held by the SGH PGMI (Post-Graduate Medical Institute) and it was good. He’s had a little bit of experience playing with SPSS on the basic-intermediate scale and thought it would be useful to understand the statistics of medical research a little better.

Maybe it goes a little too far, but possibly, just possibly, all clinicians should attend a course in medical research + biostatistics so as to better understand how the evidence that we rely on on a regular basis comes about. For instance, how tedious it is to come up with a scoring system (e.g. for cirrhosis) that has good clinical correlation.

It was a useful course, though the course prices ($700) was somewhat exorbitant and wiped out a good percentage of J.’s HO training fund. Ah well.