Tuesday, September 29, 2015

It Has Been A Good Day

I guess I've got God to thank for after all.

It's been an awesome day I must say at KK Setapak, with extremely friendly nurses who introduced as 'doctor baru' to the patients to ease our learning experiences.

I got to do basic antenatal examination, a few history taking sessions and two presentations with an awesome senior Medical Officer who was pleasant beyond belief.

Family Medicine has taught me the importance of empathizing with the laymen - of seeing things the way your everyday Joe sees them; the meaning of symptoms and how significant (or insignificant) they may be in the layman's daily routine.

To ensure adherence on the part of the patient to an otherwise lifelong regime of disciplined medicine-taking, one needs to first ensure the patient knows what he's involved in - what it does, what it is for, how long it's going to take (e.g. he has to know that diabetic medication is a life-long effort, not some three-day regime which can be switched off in a short while), how it has to be taken (e.g. you cannot cut down doses based on how you feel - you cut down doses only if you meet certain evidence-based guidelines for dose-determination). You need to understand his lifestyle, his baseline understanding of his condition; his priorities in life - all this is important before you start telling him how to go about his problem. Because for some, diabetes might not seem like a big deal until you tell them the destruction it can cause to one's quality of life. For some, taking metformin and glibenclamide might seem like a mindless unimportant and perhaps, annoying task to your John Doe; but once he knows how important it is in controlling his raging blood sugar levels, you stand a good chance in convincing him in being adherent to the treatment regime.

Family Medicine is the medicine that deals most extensively with the John Does of everyday life - with the community at large, and with making medicine as accessible as possible to all walks of life.

It truly is the gate keeper of medicine - the key in ensuring a health-aware society.

Monday, September 28, 2015


In medical school (at least in the school I attend), there appears to be an ever-increasing emphasis on the ability to reflect on one's practice.

In my previous post, I reflected on the malpractices rampant in urban Malaysian GP surgeries.

This morning would be my first at a Klinik Kesihatan in Setapak.

For some reason I cannot explain, I do not feel as anxious as I used to be - perhaps it is because I have become acclimatized to ever-changing scenarios?

But today's morning reading took me to Psalm 139 verses 23 to 24:

Search me, O God, and know my heart; try me and know my thoughts
And see if there be any wicked way in me, and lead me in the way everlasting.

I know I am quite a stubborn, hard-headed and hot-headed person, and I do not like to lose in an argument. But over the past few years, especially in the past 6 months, I have learnt that to be gentle does not mean we admit to being weak; it does not mean we are easily stepped on. It just means that we abstain from overt violence of word or deed for the sake of peace and concord. Although I am trying to amend some of my ways (for example, talking less, and spending more time observing and listening, and perhaps talking serious stuff more), I know I still fall short in many areas, especially when it comes to dealing with people of various sorts of shades and persuasions. And in this matter I sometimes feel like throwing in the towel. But today's reading spoke to me - it was as though the words of the Psalmist and my need for Someone to search my inner being, were one and the same.

What was even more striking was the fact that Psalm 140 (the psalm that follows Psalm 139) began with the opening verse:

Deliver me, O Lord, from the evil man; preserve me from violent men who imagine mischief in their hearts and continually gather for war
Keep me, O Lord, from the hands of the wicked; preserve me from violent men who have purposed to overthrow my goings

In medical school, there are just a few things which can mar your day - but the chief among them would be unscrupulous, arrogant and malignant Attendings and MOs who seem to be out for the blood of whoever is under them in the so-called food chain (a concept which I still abhor, since there shouldn't be such blatant feudalism if medicine were to continue developing as an ever-changing field). A handful of these malignant ones is enough to darken one's day, especially those whose lips are like double-edged swords, whose tongues speak nothing but insults and derogaratory remarks. As to why our Good Lord permitted them to enter medicine, only heaven knows. But as for the rest of us who happen to be under them, we can only implore the mercy of God to preserve our going in and coming out when dealing with these malignancies. 

Indeed, preserve us from the violent men, and from the hands of the wicked. The lips can only speak what the heart contains - so wicked words and diabolical remarks and insults, from whence do these come from? Within, of course!

But I thank God for this new day. May it be a fruitful one, and one which will be full of learning points to take note of. 

Signing out.

Saturday, September 26, 2015

When Medicine Starts Losing Its Dignity

It has been a week since I began my GP posting, and at the end of it, the posting has left me more questions than answers. 

Ethical questions, questions on the faith, questions on human character.

The GP I was with was what I would call a charlatan of sorts. He abused antibiotics and simply used nebulized ventolin on any patient with a cough lasting more than 3 days. Ciprofloxacin and Metronidazole and Amoxicillin featured rather prominently on his prescriptions. He talked very condescendingly to his patients, which made me feel as though he underestimated their thinking power. I would say that he was also quite a chauvinist, and a misogynist. 

But what made it all the more memorable for me was his behaviour towards me.

The very first day I was with him, he asked me and my partner about our motives in studying medicine. 'Why do you want to be a doctor?' he asked. I answered him that somehow I felt attracted to the profession. The next question he asked both of us was 'What does your father do?'. 

Usually at this point in time I would resort to a lie (mea culpa) - especially when other doctors ask me about my father's profession. It isn't because I am ashamed of my father, rather I feel that unnecessarily revealing the fact that I am the son of a doctor only makes it difficult for me to behave like my true self publicly, especially in front of other doctors. There is a sort of expectation which doctors tend to have of other doctors' children. 

Usually I have this prepared script which I tend to blurt out - like 'My father is an engineer' and if they asked me about my siblings, I'll just answer that they're studying engineering or something of that sort.

However, that day I just decided to tell the truth and hopefully shame the devil. But what I didn't know was that this Dr was the Adversary's advocate himself. 

The next question he asked me after I had told him that my father was a doctor was 'So how many patients does your father see in a day?' I hesitated to answer this question too, because from my observation, I knew that this man's clinic definitely had an upwards of 100 patients per day - a certainly towering figure compared to my father's practice. But I decided to tell the truth and answered him with a double-figure number. In fact, I was merely overestimating at best, because the actual number was far lower. On some days it can be just single digits.

This man's face turned into one of disbelief. 'Twenty?' he asked in disbelief. 'You might as well tell your father to close the clinic.'

What in the Lord's Name was that? I felt very insulted - not only did this drug pusher feel very confident in his prescribing malpractices in front of medical students, but he felt equally justified in insulting my father's practice as well. This was rude behaviour in action, but I was too stunned by his indiscretion to reply. 

The worst part was that two days later he told me (he thought it was funny) after finding out my father's age, that since nobody was going to take over my father's practice, he might as well buy it over from him. I was very enraged - the coffin has not even been lowered into the grave, and this man was already asking for the clinic! May the Lord deal strongly with his arrogance. 

Even much more to my chagrin was the fact that his hypocrisy was so blatant. This man's clinic had Biblical verses printed on quaint little colorful posters stuck on nearly every wall in his clinic, which even had a little chapel at the back with images of Our Lady and her spouse. But this man's carnal behaviour was jarringly opposed to the Faith he supposedly professed. 

His vulgarity, his carnality, the way he liked to boast about all his achievements (Dear sir, did you know that being Catholic, you should also know that no matter how great one's charitable works are, one should not boast about it? What the right hand does, the left must not know - this is in Holy Writ) his money-minded prescriptions, his treatment of patients (I pity some of them, because they were just too plain ignorant that they were being fleeced), the way he talked to his secretary and his assistants, the way he back-stabbed his locums (I feel it is not right to criticize their prescriptions behind their backs, no matter how much you disagree with them - if you really need to criticise their practice, you might as well just correct them in their face or else hold your silence. After all, you were the one who decided to employ them.)

In just 3 days I felt that his chain of clinics was more like an empire of drug-pushers with medical licenses. I also felt that his physiotherapist was way too powerful - having a say in the employment of auxiliary workers. His poor radiographer always seemed to be stashed in a corner. In that practice,the other doctors were just yes-men. He was king. 

And despite all his obvious shortcomings, this man still had to cheek to tell me to convert to Catholicism. Even if I was a non-Christian, I would rather die than become a Catholic - especially if the invitation came from such a man. This man was a shame to the Catholic church, let alone to the rest of Christendom.

My father may have been a poor doctor - but I know that he has never fleeced his patients. I know that he listens to his patients and does not simply cut them off in mid-sentence with some presumptuous diagnosis. He does not simply prescribe drugs - and he does not non-chalantly wave his patients away - I know this for a fact because even though he sees way fewer patients than this man, he still comes home late. He abstains from charging the poor the full sum, and minimizes the number of medcations per patient, because he knows polypharmacy is profitable only to the doctor, but to the patient, it is just paid torment. 

Yes, he was poorer than this so-called doctor (or licensed drug pusher) but at least I know that his money is definitely cleaner. 

The GP posting was an eye opener for me, because I had to chance to see the rot in the system. To see the rot as it is made me all the more resolved to stamp this ungodly practice out once I have attained a position of seniority and power high enough to crush this serpent beneath my heel.

But until then, I will just make a mental note of this malpractice and continue on with my journey through medical school. 

Friday, September 25, 2015

Surrendering All

I stumbled across this verse during today's somewhat brief reading: Trust in the Lord with all your heart and lean not on your own understanding.

This resounds really well with what I have been trying to do this new semester - to get rid of the trash in my life and try to live right. I kinda failed miserably a few times, sometimes for many days in a row. Some nights I just feel so helpless when I realized that instead of kicking some old habits, I have unconsciously slipped back into the dirty mire again. 

But then again, kicking something bad needs more than just one thrust. It requires (with some help upstairs) quite a number of chops and heaves before we can start making progress, even the slightest ones. 

I have told myself (although I still fail at times) that this semester I should really start living out whatever Christian principles I have placed aside all this while. No more slip shod cafeteria Christianity for me. No more double-standards. No more cheating God. No more excuses for whatever dirty laundry I have. 

I have decided that it is time to stop being a hypocrite. Even if people might not know, I know God knows what kind of person I can be on a bad day. Like, really screwed to the point even I don't want to talk about it.

But what was reassuring was the verse that totally resounded with what I longed to do this semester - that I should stop thinking carnally, and start establishing my ways aright. That I should not do things in the manner a carnal man would - devoid of the fear of God - but rather I should live out my faith with fear and trembling. Who am I kidding here? God Himself?

Monday, August 24, 2015


Can't we just be plain honest with each other?

If only we could just say 'Yes' for Yes, and 'No' for no. If only we could sincerely lend, and not behave like disgruntled money lenders towards our friends. If only we stopped our false humility and our false courtesy to voice out what we really felt and thought.

It's a difficult world to navigate ourselves about nowadays.

Wednesday, July 29, 2015

Ending Third Year

This is quite stale news, but just for the record, I am already in fourth year. 

Yes, done with Intermediate Cycles 2 and 3, and voila, here I am facing Senior Cycle 1.

May God grant me patience during my Paediatrics posting. And help me appear less fearsome in countenance when dealing with young children. I know I have a reputation for making babies cry, so dear Lord, I ain't sure how to not make them cry, but I'll try.

Intermediate Cycle 3 is something I call an 'oddball, clown in the box' semester. The perfect combination of chaos, a whirlwind of God-knows-what hustle and a rude introduction to the pricks of the medical world. Thankfully I did not get to see such ruinous lack of piety or tyrannous rape of medical ethics when I was in my formative years, else I would have given up the idea of studying medicine. 

I couldn't have survived IC3 without plenty of help (the same way I might not have survived IC2 without some assistance, both temporal and divine). 

Been down in the pits since January, and noticed a rise in the recklessness of my tongue in the past few months. Thankfully my brains did not fry, else I might not be here typing out what I deem, the perfect hodge-podge of IC3 madness. 

Imagine not knowing even basic Orthopedics after your introductory 2-week orthopedic posting! The feeling of rejection when the so-called 'professional' specialist who was hired to guide students throughout the Orthopedic posting at X Hospital decided to just 'makan gaji buta' and treat us like wall flowers. 

Even worse was the Breast and Endocrine posting! The MOs and some of the HOs were really cocky bastards - and you know what, at the end of the day, they just blamed their cockiness on their workload. Which is actual bullshit, because I've done two electives in Penang General Hospital, which believe me is way busier than that country-bumpkin settlement out in the middle of nowhere, and I was treated with respect by HOs and MOs who were willing to teach any medical students eventhough they weren't paid to do so. So, shame on you, Hospital X. 

Well, IC3 was the semester that drove home the point: Do not be like Dr X when you grow up, because he was such a pain-in-the B. 

Shouting will not teach anybody anything, And blaming your workload for your lack of manners is a poor disguise of your wrong choice of profession. 

Wolves in sheeps' clothing indeed.

Overall, I am glad IC3 is over, and I did well for the IC3 finals despite the carnage that was IC3. 

So, that's it. Done with the craziness of IC3. And now saying hello to the great unknown (or is it?) of Senior Cycle 1!

Monday, July 27, 2015


It has been a long time since my last post.

To be honest, it isn't because I have been busy.

I mean, yes, I have been busy, but that isn't the reason for my relative silence on this blog. 

These past few months I have realized my utter loneliness. For all the hustle and bustle of life, I feel somewhat empty. 

On every side, I begin to see the dark side of some of those people I call friends. And although I try to turn a blind eye but guess what, the people I am desperately trying to offer the benefit of the doubt just make it all the obvious that they don't deserve it.

I feel alone, in the midst of the crowd. I may laugh so much, but inside, I know that I'm doing that to make up for the sadness inside. I say 'It's nothing' but actually there is so much that I cannot express.

I try to speak to the few friends I still have, but it appears that they don't see the problems I see, or even offer to try to see things the way I see it. I get frustrated, more so because I've always tried to put myself in other people's shoes. But the same is not being done for me. 

I begin to loathe certain people more. I know you're supposed to forgive, but inside, I have often railed out against God. I feel life has been unjust to me. I mean, is it true that we ought to do unto others what we desire others to do unto us? Because I think whatever good I may have sown has not been returned in like, nor has it seen even the first fruits yet. 

I tried to fit in, but for some reason or another, I never completely did. 

I am a frustrated man. I am frustrated because I feel like an odd ball.

I feel rejected by my own race, betrayed by my clumsy tongue which cannot speak Mandarin with the fluency I would have loved it to, disappointed by certain judgment calls my friends have carried out against me, and crushed by the fact that I feel so alone.

You step into a church to find some sort of solace, but all you feel is emptiness. You talk to your parents but it only provides relief for a short time, after which I once again feel lonely. 

I drown myself in my books, and tire myself out by running round hospitals and staying long hours on electives, but to no avail. I feel desperately empty.

The worst part is I look at myself and I loathe it. For some reason I feel that I may have been responsible for my own state. 

All the intelligence in the world is meaningless to me. Because I feel very much alone.

I feel a sadness I cannot express, a disappointment with life I cannot exactly pin point, and a sense of loneliness I cannot explain. 

I feel like a misfit. But I cannot let that despair destroy me, because I know my parents need me. They need me, so I cannot let myself perish in my depression.

So help me God.