Saturday, January 31, 2009

Always Check Your Child's Homework...

Thought this was hilarious. My sister emailed it to me:
A first grade girl handed in the drawing below for a homework assignment.
After it was graded and the child brought it home, she returned to school the next day with the following note:



Dear Ms. Davis,
I want to be very clear on my child's illustration. It is NOT of me on a dance pole on a stage in a strip joint. I work at Home Depot and had commented to my daughter how much money we made in the recent snowstorm. This photo is of me selling a shovel.
Mrs. Harrington

Good advise, indeed!

Thursday, January 29, 2009

Lawsuit

I was invited to be an expert witness in a malpractice suit last week.
I received a short snippet of the case. And though the law firm was willing to pay me for my time, I politely declined.
It's a tough situation. I reviewed the case; the physician involved did make a mistake of not properly notifying the patient, however sad to say, I could see myself in that situation someday. Why is it, that while on one hand we yell and scream that doctors aren't Gods and are only human and should not be allowed certain powers, and yet on the other hand expect doctors to never make mistakes? If it was a blatantly negligent mistake that resulted in harm to the patient, that's one thing, but what about an honest, really human mistake that had little consequence?
In this case, the doctor was being sued for a side effect of a medication. The patient had presented in moderately dire straits. It was a judgment call, between using a medication of proven benefit to aid this patient, versus a known possible rare side effect. Unfortunately, in this case the odds won. The rare side effect wasn't so rare for this patient.
Would I have done differently? I don't know. I would at least ensure I talked about the possible risks with the patient and documented it (I'm not sure this doctor did).
I read that 50-65% of US physicians get sued at least once during their career. Those numbers were from 2001; I'm certain with the increasingly litiginous modern society it's even higher now (did anyone read about poor Asian laundromat owners being sued for millions of dollars for misplacing some slacks??). That's more than half of all doctors. How many of those lawsuits were rightful, and how many frivolous, I don't know.
All I do know is you see those ads on TV everyday, asking for patients who've ever had disease A and taken medication B, to join their class action lawsuit. And I've had a couple of patients ask me to 'modify' their medical records to aid in their lawsuits against others.
Apparently over $4 billion dollars were paid by medical insurers in 1999 in the USA alone. I'm sure that's alt least partially to blame for the crazy state of healthcare economics these days.
And so, while I'd love to get some extra cash for new HP desktop I just bought to replace my aging 7-year old 128 mb RAM computer, and while this case may (or may not) have its merits, I'm going to just wash my hands of this and let someone else stand in, if they want.
For someday, chances are, I'll be on the other side of the fence, be it for a real screw up, or financial motives of a malaligned patient. And if that day ever comes, all I hope for is to be able to face up to God, and my family and no one else, and say "I did what I believed was for the best of my patient."

Sunday, January 25, 2009

Happy Chinese New Year!

Happy Chinese New Year!
It's been a while since I celebrated Chinese New Year with family. After all, I did leave Malaysia in 1998. This year, it was special for many reasons.
With the exception of my younger brother and sister-in-law, my family was here in Iowa to join us for the celebrations. And not just my family, but my extended family too!
So, we have mom, dad, (older) brother, his wife, their kids, my sister, my mother-in-law and father-in-law.
Though we didn't exactly have 100% authentic CNY food, good ole' mom cooked up a storm and made some of our favorites. And dad snucked in 'imported' some foodstuff from Malaysia, including a home Yee Sang kit (minus the raw fish), which turned out pretty good.
Yes, although we lacked the noise of firecrackers, and though the smell of gunpowder and incense are missing, only to be replaced by the cold, dry stinging Midwestern winter air, I've realized that really, it's family that makes Chinese New Year special.

We had our feast early (since we work Monday); but tomorrow Kristin and I will for the very first time be handing out Chinese New Year angpows.
(and for that we're thankful that we only have a handful of kids to give to!)

To my Asian and non-Asian readers: Happy Chinese New Year; may the Year of the Ox bring us all peace and prosperity and a little bit of wealth in these economic times.

And to my pals back home, just know that I miss our good old times, but those memories of us visiting and playing cards and fireworks bring back wonderful memories. Gong xi fatt chai!

Tuesday, January 20, 2009

Another stupid comment

Some people just have too much time on their hands. I read this in the papers today.
...Its Federal Territory Youth chief XXX said inviting the Barbados-born singing sensation to Malaysia was “akin to insulting eastern culture, belittling local artistes, intentionally causing losses to the country’s economy and supporting Israel’s war policy, which is supported by America”.
...said it also found the Grammy award winner to be unsuitable because she often performed suggestively and wore skimpy, sexy outfits.
...said local concert sponsor Celcom should give priority to eastern cultures and local artistes. He said Rihanna’s appearance here would result in an outflow of local currency to the United States, and in turn, cause loss to the country and suffering to the Palestinians.
He reasoned that the United States supplies arms to its ally Israel from contributions and taxes collected from Americans. “Whether Rihanna realises it or not, we know that the taxes she has paid also contributed to the war in Gaza,” he said.
This is just plain stupid. Perhaps stupid if putting it mildly. Words like shallow-minded moron come to mind. It's akin to saying perhaps one shouldn't take a breath of air, because when we expire, we exhale the precious carbon dioxide that feeds the Western flora that then die and decompost and then in a gazillion years turn into precious petroleum that then feeds the Western war machinery.
Admit it; this stems from a few generalizations. Anything Western is bad. Anything American is bad, because America=Israel. And any woman who is beautiful and sexy is bad.
Probably because some men have so little self-refraint and moral values that the mere sight of a 'skimpily-clad' woman makes them hump coconut trees like a monkey in heat.
Reading things like this makes me embarassed to be of the same gender.
And you know what irritates me? Some of these political parties seem to do less for the common folk, for the citizens (and I mean all citizens, not just of a certain skin color); sometimes it seems that all they're good for is to hold demonstrations and come up with idiotic remarks.

Sunday, January 18, 2009

More application tips

A few weeks ago a reader had asked me to put up some tips for interviews, but because of my procastination and plain laziness it probably is already too late for that now, since interview season is already close to ending. Instead here is my advice for ranking and the match instead:
  1. Rank only hospitals you can see yourself working in. If you've already concluded you absolutely hate a certain town/hospital and you still rank that place, you may very well end up there if your top choices don't work out. It's really pointless (says me, personal opinion) to work in a place that makes you miserable; 3-5 years isn't exactly a short time. Sometimes it's best to scramble into something else.
  2. Rank them according to how much you like them. And not based on how much you think they like you, or your chances of getting in. If you understand how the match algorithm works, just because you didn't rank a place that is more likely to take you higher does not penalize against you; if your top choice did not accept you, then your next automatically becomes your top choice, and your rank order list carries more weight than theirs. Aim high.
  3. Along the lines of the above, remember everyone has different values and priorities. So, when ranking the program, do consider the big picture. Don't rank a place just based entirely on prestige. Things like quality of life, size of city, location are factors as well that you need to consider, especially if you're going to be far away from home, loved ones and may become homesick. Talk to family; ask them for their opinion.
  4. Pray, PRAY really hard to not get any messages on Unmatch Day. But plan to have easy access to emails and a phone on that day, in case you really do have to scramble and make immediate calls to secure a position. Never done it myself but I've been told open spots disappear by the minute. Do not waste time. Especially if you're in the other side of the world- doesn't matter if it's bedtime; WAKE UP and check your emails for word. Don't wait until it's 8 am your end to start calling.
  5. Though you want to avoid it, being unmatched isn't the end of the world. You can always scramble and though it might not be your top choice, you never know how things may turn out. I know several people who were unmatched, who are now in OB, or GI or some other residency and they're happy doing what they're doing.
  6. At the end of the interview trail (before the dateline for the Rank Order List) do take the time to send written thank-you notes. Maybe not to all the programs, but certainly most. It's a lot more sincere, polite and leaves a bigger impression, than an email. And eventhough you may sooner end up in the Arctic wearing only your boxers, do show some enthuasiasm in your thank you notes and say something positive about that place that invited you for the interview.
(Terminology for non-US applicants/grads, getting into a training program ie Residency involves a long tedious application process that leads to interviews and ends with applicants and programs ranking their choices. Results are made known on Match Day; usually a couple of days before that is Unmatch Day when unmatched applicants are made aware early so that they can try to scramble into any open residency spots)
To all you applicants out there, present and future, Good Luck and Happy Hunting. And keep an open mind about your future. You never know where God decides to put you.

Thursday, January 15, 2009

Chill

This might actually be a record for me. -39 C with windchill. At temperatures like this I've been told your pee can freeze before it hits the grown. I haven't tested that yet for fear of getting frostbite in my nether regions, and having to explain that to my colleagues in the ER.
"Erm, my bathroom window was open when I went to take a leak"
I'm sure they've heard of that one before. Anyways. Coming from Malaysia and experiencing winters not too long ago (damn, has it really been 11 years??) I've come across some unexpected, even surprising things. Among them:
  1. Yes, as Calvin (of Hobbes fame) pointed out, your boogers CAN and WILL freeze. You get pretty little yellow pebbles that you can flick off rather than wipe on the couch.
  2. It can still be freezing cold despite the warm-looking and tempting sun. Don't trust what Mother Nature is showing. Check the forecast.
  3. Yes, you can write your name in the snow with your pee. It takes a lot of acrobatics, especially if your name is something like "Elizabeth". And the ugly yellow stains last a while.
  4. In a weird qwerk of nature, it can rain (yes, rain!!) in the bitter cold. A phenomenon known as freezing rain, when things immediately freeze over upon contact with the grown, essentially giving you a thick layer of smooth ice. Extremely destructive. Despite my rave reviews of the Blizzak LM25 winter tires, my car was stuck 50 m from my home, just last week. In fact, even walking is damn near impossible.
  5. Don't mean squat that you can skateboard well (yes, believe it or not); snowboarding is a totally different animal (note to self: avoid doing a totally new dangerous sport just to impress a cute chick from Australia)
  6. Yes, you CAN soak in an outdoor hot tub in the winter. In fact, it's probably on the top 10 bodily experiences in my book (right above taking a dump on a high-tech Japanese toilet seat). It's surreal; your body in the warm, almost hot, water, while cold snowflakes fall on your face. Your body is confused. Just make sure you don't soak too long and pass out when you get up (like my friend April did!).
Still, believe it or not, I like winter. Not my favourite season, but I don't mind it. It's a pretty time of the year, and snow can be pretty darn fun.

Tuesday, January 13, 2009

Back!

We're back!
And after a few glorious days in the sun, it was a shock to the system coming back to cold, snowy Iowa. It was -21 C this morning (not counting windchill).
Anyway, we had a swell time. It was my first time being on a cruise. We were on the Norwegian Sky, a 7,000 ton, 2000 passenger ship, sailing from Miami, Florida to Nassau, Bahamas, then to Great Stirrup Cay (NCL's private island) and then back.
It was nice to get away from all the snow and the cold and to be able to bask in the sun. Having said that, we did sign up for a 1 hour snorkelling trip but were ill-prepared for the 18 C waters despite the sun, and so lasted only 15 minutes in the water.


And for the first time ever, I went parasailing! It was an experience; a state of magnificence tranquility. You know the boat was pulling you along but yet all you heard was wind. And my yelling, that is. Kristin had done this before, so she wasn't quite as hysterical as I was.


video

Yes, we had a wonderful honeymoon, and although it was only 4 days, it was good to be able to leave everything behind, and just enjoy each other's company.
One interesting thing I learnt about cruises; the average passenger gains 1-2 lbs per DAY. Given how the food is already included in the fee, and you have 6 restaurants to choose from anytime you wish, I can see why this happens. The (kiasu) Malaysian in me, naturally, saw to it that I was never hungry. I ate until I became crosseyed.

Thursday, January 08, 2009

Off to our honeymoon


From this, to this...



Yes, we leave for our belated honeymoon tomorrow. Nothing too long, just a 4-day cruise to the Bahamas. More family flying in next week so we made this a shorter trip. This will be my very first cruise, incidentally. And after a busy week oncall, a break like this is exactly what I'm needing.

Will be making stops on 2 island destinations. We haven't signed up for too many excursion activities yet, but have picked parasailing and snorkelling. Should be fun.

Then again, you read stories like this in the news...

See you next week!

Saturday, January 03, 2009

Rounds

I was in the hospital seeing patients on rounds this morning, when this realization hits me.
I've been a doctor for 8 years now, and countless years before as a medical student. Never have I pondered about this.
To my dismay, despite so many years, I shamefully do not have the answer.
Maybe one of you readers out there can cure me of my ignorance.

Why in the world do they call this 'Rounds'?

Do medical teams walk in circles when we go about seeing patients? Or is it because we (lack of exercise, it must be) are round in the middle? Perhaps the word describes the shape of our head, as we prematurely lose our scalp fur from work related stress (or high-MSG diets)? Or, maybe we never explain things well to patients, rather, just going around circles rather than being to the point?
Are doctors obsessed about shapes? If so, why not 'Squares' or 'Trapezoids'. Though admittedly it would not have the same ring: "Yes, Dr. Vagus is currently doing his squares on his patients..."
In an attempt to cure myself of my stupidity (or, well, at least to improve on it. Cure will not be possible) I googled this. And disturbingly, came up with this result when I used 'Rounds' as the search term:
Is the cosmos trying to tell me something? A means to an end: The cure to painful rounding is to shoot yourself? (on a bad call day such as this, that sounds almost appealing).

Friday, January 02, 2009

2009!

A couple of days late, I know.
But I'm still in disbelief it's 2009. I'm finding that I keep writing the wrong year in my progress notes. 1/2/08.
If someone asked me to summarize 2008 in a word, I'd probably say 'Change'.
It has been a year of big changes.
The year I completed my 12 years of training and went into practice.
The year I married my dreamgirl (twice, actually. One in Wisconsin, and the 2nd wedding in Malaysia).
The year we bought a house, and moved into our very first home.
From student/trainee balding bachelor, to consultant (still balding) husband.
Yes, 2008 was a good year. Though 2009 doesn't quite have a nice ring to it, I'm optimistic that this will be a good year, too. And, the bonus was that we got to start the year with family (mom's here, others arriving in a few weeks) and good friends visiting from Minnesota. Playing Wii.
Never mind that in our old age we did a New York countdown (at 11 pm Central time) and were in bed before midnight here!