Thursday, June 04, 2009

My Padang-Bukit Tinggi trip

I went there in May. Just sharing my photos



Tuesday, June 02, 2009

Congratulations Lee Kok Sun!

Kok Sun has graduated and is waiting for his induction course. I should actually call him Dr Lee !
I think the first time I met him was as a little boy. His mum or dad would bring him to see me when he was sick.

Today he came to see me because he was sick ! This time , instead of just examining and writing a prescription, respecting him for his knowledge as a doctor , I asked him what his concern was and told him what I was prescribing and asked his opinion what he wanted.

No doubt I was a doctor long before he was born , then again he probably knows much more than me about anatomy and the latest drugs even though I try my best to keep abreast of the latest in medical advances.

In medicine , what one learns 5 years ago is out of date and management changes .
Even drugs that were first choice are now looked upon in disdain.
Take for example atenolol , a beta blocker drug indicated for hypertension. I never liked it very much because it gave most people a slow heart and can cause spasm in the lungs and worse still, for me it could cause impotence. So I reserved it for old women who had a lot of anxiety because of the calming effect of this drug and no history of asthma.Through meta studies over very long periods of time , it is now known to precipitate diabetes mellitus in susceptible people!

Another drug that does the same ( precipitate diabetes)are diuretics that were once used a lot especially when there was a slight degree of heart failure.

As for diabtes, Dibenclamide used to be first line and glucophage was abandoned . Then now we have a reversal and use glucophage rather than dibenclamide. Why? Because dibenclamide does not protect the remaning islet of Langerhans, insulin producing cells and can make a non insulin dependent diabetic into an insulin dependent diabetic over the years. So what else can be prescribed if the patient needs more than one drug? Januvia is the latest and I think safest ..but it hurts the pocket !

You could always opt for homeopathy though!

So now with the babies I used to treat becoming doctors , I guess I need to be on my toes so as not to show how out of date my medical knowledge is...

Gone are the days when an older person can say " I have eaten more salt than you therefore I know better than you what to do !"

So my prayers for Dr Lee.....

May you be the best Dr that you can be and may you always have the enthusiasm and good attitude towards your patients.

Really they are not called patients for nothing need to have a lot of patience!