Seen at the doctors' parking amongst the BMWs and Mercedes. Love it!

-- Sent from my Palm Pre

Popquiz

Question: What endocrine gland produces ferritin?

Answer: None.
That was a trick question. Ferritin is not a hormone, but someone should tell that to the doctor who referred a 75 year old man to me who had to drive 2 hours for the consult. As it turns out he's iron-deficient from something else, suspicious for an occult lower GI malignancy.

Transformers 3: Dark of the Moon

Predictable storyline, check.
Wooden acting, check.
Excessive action scenes with fighting robots, check.
Hot chick, check.

Wife and I went out for date night today, and caught Transformers: Dark of the Moon. And it was my first 3D movie, and I had to say despite the superficial movie plot, I really enjoyed it! If you grew up watching the cartoons, then the movies are going to the a must-see.

And despite the lack of acting experiences, I thought Rosie Huntington-Whiteley did a pretty decent job. Not that Megan Fox is close to winning an Oscar anytime soon. And I have to say, seeing the first 60 seconds of Rosie on the big screen in 3D was nothing short of spectacular (if you've seen the show, you know what I mean). There was a unanimous gasp coming from the moviegoers.

Perhaps it was somewhat of a coincidence too that was watched it tonight, and that men first stepped on the moon July 21st.

(P/S: was that really Buzz Aldrin in the show? If it was, that was pretty damn cool)

Relationships

Mr. K came to be the other day as a new consultation for his diabetes. I was somewhat surprised, as he had uncomplicated, relatively well-controlled diabetes as reflected by his good hemoglobin A1c. Not the kind of consult I usually see as an endocrinologist. And so I asked him why he was wanting a specialist to treat him and not his GP anymore.
And I was not expecting his answer.

"Because I read in the papers that my doctor was paid $50,000 by the drug companies last year."

There was a recent report in the papers about doctors being paid consultants for pharmaceutical companies. Either being a spokesperson, or giving lectures on certain drugs to other physicians. That report listed the 20-highest paid doctors in the state. And Mr. K's physician was on that list. And the amazing thing was, according to that report some doctors were paid up to $2 million (remember, this is in addition to the doctors' salaries) (that sum was an outlier- for some patents he owned). Many others were being paid well over tens of thousands of dollars a year, presumably for giving talks.

It's a controversial subject, but perfectly legal.The relationship between doctors and industry. Some being for, while many being against. Some clinics have allow visits by drug reps; some strictly do not. In fact I think even more lenient in Asia where drug companies can pay for your overseas trip to a conference.

The obvious benefits of the relationship are, doctors are able to learn about newer medications. The ability to get free samples and discount coupons to be given to patients in the practice.

Downsides, the concern that this may bias the doctors towards more expensive medications. Conflict of interest. And my personal issue (yes, you can tell which position I take): even if it's just a drug lunch or a cup of coffee, ultimately you know this is coming out from the patient's pocket.

And so, I feel a certain amount of guilt knowing that, really, my patients are paying for the meal the drug rep brought to our office. As such, I avoid these as much as I can (admittedly when I was a resident I had less qualms). And the reps know it too- I'm never very chatty or warm with them- and they try to avoid me too unless they need my signature to leave samples for our clinic.

It's a personal, and yet professional choice. And I no longer give talks that are sponsored by a drug company: I did this just once before 3 years ago not knowing they'd pay me to talk about something I was passionate about- only after I got the cheque did I shamefully realize how things work. And so, while $1000 to give a 1-hour talk about thyroid issues is a nice sum, it's something I'd prefer to do without. And I think it helps me sleep better at night.

For apparently, patients like Mr. K agree with me.

Melting....

Perhaps Al Gore was right. Maybe there is something to this global warming thing.
44° C heat index!
Phew. At least the humidity is nowhere near Malaysia's and you still hardly sweat. Which means you can wear your boxers for 3-4 days before you need to launder them. Not that I'd do anything like that.
It's hard to imagine with this heat, that 7 months from now on a bad day, the temperature's going to be 70° C LOWER than this. Yes folks, we hit -25° C with windchill not too infrequently in winter.
Stay cool, folks.
Plenty of fluids, stay indoors. And don't do anything stupid like leave your child or pet in the car.

You know the drill.

A Fresh Start

Ah, July.

Start of the academic year for the US/Canadian medical systems. Where when one was a medstudent previously, is now an intern.

And what it means for consultants like us, is fresh blood (spoken with a Transylvian accent, followed by a sardonic laugh)! New 4th year med students and fresh-faced anxious interns. Which means new entertainment for us (just kidding. Kinda).

It's always interesting seeing the fresh faces this time of the year. Whether it's a fresh 4th year medstudent. Or a fresh intern. Or a fresh fellow (person having completed residency and starting off in subspecialty training).

You see all kinds of characters. Some you like. Some you'd love to work with. Some you'd hate.

• There's the very nervous kids. The ones who are trembling so bad when they're examining the patients that you'd think they had a lesion in their basal ganglia (hah, you thought an endo would forget his neuroanatomy, didn't you?). These medstudents/interns tend to be a slight shade of bile green, and look like they were at a funeral. Liable to puke if you pimped them a bit too much with questions on adrenocortical physiology. I tend to buy the medstudents on rotation with me Starbucks; but with these students, I have to be careful about buying them any caffeinated drinks.


• And then there's the arrogant SOBs. The ones who act like they know it all, just because they scored a 99 on the USMLE step 1 (which by they way does not predict how good a doctor you'd be). These are the ones who tell you on Day 1: "I'm going to be a neurosurgeon/interventional cardiologist/[insert high-paying subspecialty]". These are the ones I sometimes (shame on me) enjoy watching fumble when I throw out my customary teaching-round questions. Eventually they wisen up and realize that they may need a letter of reference from you, and stop acting like they own the ground you walk on.


• Ah, and let's not forget the Beauty Queens/Studmuffins. All medschools have 'em, students who look like they should be modelling for a career instead. Admittedly, some eye candy on rounds, especially when you have a long census, makes work more bearable. And it's always amusing to me (a tinge of envy, perhaps?) to watch the George Clooneys of the medschools schmooch the nurses. "Oh, don't you worry. I'll get the patient chart and bring it to you. And oh, there's some donuts in the nurses' breakroom too; go help yourself.." Oh, if only I was like that in medschool.


• There's also the walking dictionaries. The students who know every single factoid listed in every published medical textbook. And they'd be happy to recite it to you too, whenever the need may arise. I have to say, I've found these students very helpful- they're often also very keen on explaining the pathophysiology of things to the patients. And so, when things get busy, I sometimes have my students spend some time after rounds to again go over what is hyperthyroidism, or adrenal insufficiency.


• Of course, we next have the eager beavers. Usually medstudents who are aiming for a very competitive residency, and need to get good letters of references. The ones who volunteer to see the next consult, and the next, and the next. Something the other students are only more than happy to oblige. These students tend to carry the most patients. To their credit, often their work is exemplary (for a fourth-year) as well. They'd bring you the charts even before you asked for it. Notes all written in detail. Heck, they'd probably give me a shoeshine and back massage too if I asked for it!


• And on the other end of the spectrum, we have the uninterested. Students who couldn't be bothered, and are not hiding the fact that they're bored. They're yawning when you're talking to the patients. They're texting or surfing the next on their smartphones when you're teaching. They don't complete the reading assignments you gave them. I see two subgroups of these students; very unambitious people aiming for residencies even a tadpole could get into, or students late in the academic year after they've matched, and are suffering from a bad case of 'senioritis'. These are the most painful students to work with, and while I've not yet failed anyone yet, one young lady got close to it. When she yet again did not read up on the topic I had assigned her, her excuse which became classic in her medschool after I wrote that on her evaluation, was "It was Mardi Gras yesterday..."

Despite these many personalities though, the best students are probably the ones with a good mix of the above with the exception of the last. And working with these different personalities certainly makes work a lot more interesting. More so when you're now looking at things from the other angle of being a consultant, and not a student anymore.

(And for the record, I was the anxious kid in internship. Especially in the first few weeks of my ICU rotation. I was so uptight that my anal sphincter probably could have crushed beercans. And I had palpitations and insomnia going into call each time).

Congratulations, you even made it into our local papers!

-- Sent from my Palm Pre

Malaysia: On the Verge of a Revolution?

Reading all that is going on in Malaysia, I can't help but feel maybe a bit of apprehension for the safety and freedom of the Rakyat, but much more than that, I feel hopeful.

Being so far away from my native homeland, I can't say I understand her ins and outs and ongoing issues in detail anymore; I can't say I understand Bersih's goals 100%, or why some people (politicians aside) claim they have underlying motives. Also being one who isn't paying Malaysian taxes, perhaps I have little right to complain.

Then again, I still consider myself Malaysian. And so I believe I have the right to an opinion...

I'm hopeful that the rally that will happen today (Malaysian time) will bring the much needed change that our nation needs.

For far too long, Malaysian has been controlled, monopolized by one political group. And with monopoly and absolute power, comes arrogance, corruption, inefficiency and ultimately the downfall of a nation as a whole. When rewards are handed out not for quality of work, but for race, or family or friends, or on a 'you-scratch-my-back-I-scratch-yours' basis, then the country suffers.

Malaysians as a whole are just sick and tired of the bullshit that is being churned out and forced down our throats. The unimaginable amount of money wasted on stupid projects, like spending RM 1.8 million to upkeep the official Malaysian Facebook page. Or the RM 50 million to give every Malaysian an email account (when there are numerous free accounts out there). And oh yea, is it just coincidence that this contract was awarded to a family member of one of the leaders? At the same time, roads get more expensive. Goods. Gasoline. Etc etc etc.

We're sick and tired of 'leaders' playing the race card and threatening racial rioting if certain things were not enforced when the truth is they are just trying to drive the Rakyat apart to use certain groups to support their cause. Because they are worried that without their poison, the people are actually deep down just, and fair, and honest, and would like to judge others based on their action, not their skin color.

We're sick of the government twisting things around, and adjusting the law to suit their purposes. Like arresting people who are merely expressing their God-given right to free speech. And to stoop so low as to arrest people for merely wearing yellow (the color of the group rallying for fair and free elections). And then to deny them of legal representation, pulling the ole 'Emergency Ordinance' hat trick. Claiming that the act of speaking up as a group will pose a threat to national security. When in fact, it is a threat to their political power and money. And if it's national security you're worried about, why not arrest that asshole who was waving the keris and making threats to other groups? Or the other asshole who made subtle threats to the Chinese?

This rally is not about race. It's not about personal glory. It's not about a single political group. This is about wanting change, and while it will be some time before the next general elections to see any results, the next 24 hours will be interesting.

To my fellow Malaysian: be safe, and while expatriates like me are far away, our thoughts and prayers and spirit will be with you.

Here's my middle finger to the corrupted out there; may the next elections bring the change that is so much needed.

Happy 4th, everyone!
Love, from the Jersey shore...

-- Sent from my Palm Pre

Seen at the mall.
Seriously, does anyone actually use this??

-- Sent from my Palm Pre