Tuesday, May 30, 2006

Rural GP

As part of the sixth year course, we have to do a term of rural General Practice. The faculty makes us do this for two main reasons - to try and encourage some of us to do rural medicine again in future (perhaps as a career) and for our own education, ie allowing the medical students the opportunity to observe the differences between medicine practiced in the city and the country.

I am going to be posted in Australind, which these days is almost a suburb of WA's second largest city - Bunbury. It's not really going to be a very rural experience, not compared to some people who are travelling as far away as Kununurra or Kalgoorlie, but it should be a useful experience nonetheless.

Of course, this means updates to this site will be less frequent, depending on the availability of internet access and of course, how busy I am.

Hopefully I'll be able to get some nice pics!


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Monday, May 29, 2006

Where am I working next year?

The time has come to choose to the hospital I will be working at next year. I have from May 22 until June 22 to get my application in, complete with referees and about 3000 words of talking myself up. In Perth the choices are Royal Perth Hospital, Sir Charles Gairdener Hospital and Fremantle Hospital.

Due to a multitude of issues, the choice is not as simple as picking your favourite hospital. Broadly speaking there are issues to do with teaching, leave, travel, future changes to the health system in the state as well as trying choose the same hospital as your friends. At the moment, for the simple reason of travel, I'm tossing up between RPH and SCGH.

More on this when I make my final decision.

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Wednesday, May 24, 2006

Arsenal shirt saves life

What a lucky kid.

It shows I was right to support Arsenal. If I was wearing a normal T-shirt, I probably would be dead.
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Complementary medicine furore

Prince Charles has gotten himself into deep water by advocating the use of alternative therapies. Sure, the power of placebo is very strong, and if a medicine works, then by all means use it; but leading world figures should not be providing unqualified opinions about things they do not understand.

Why shouldn't alternative therapies be put under the same stringent regulations that govern the pharmaceutical industry? If patients are taking substances in the hope that they will help to treat a medical illness, don't they have the right to know if that therapy works? No nasty side effects? Perhaps there are no side effects because there are no active ingredients.

There was a classic case earlier this year, in Perth, of a whole family contracting measles because they had had homeopathic 'vaccinations' instead of traditional antigen-based vaccinations. Logically, homeopathic vaccinations do not even make sense. You cannot get immunised against a disease with, what is, effectively, water.

In my opinion, anybody who sells homeopathic/alternative medicine and advocates it over conventional therapies (which have evidence to prove their efficacy) should be liable for any adverse outcomes to the patient.

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Saturday, May 20, 2006

Are going to specialise? Part 1

People are always asking me: "So you're a medical student. Are you going to specialise?"

It's the bane of my existence. I always say: "No I haven't decided yet. I think I can rule out a few things, like psychiatry and geriatrics though..."

Obviously you would want to chose a specialty that you enjoyed working in, but to be honest, I haven't really found one area of medicine that I'm truly passionate about. Nothing where I could be happy to say, "I could probably do this for the rest of my life".

But it got me thinking - what do I want to do? And what kind of criteria would I use to decide?

There are a few points I would use to decide, over the next few posts I'll go into them a little bit more.

Number 1: The People
I guess the terms I've enjoyed the most have never really been about the work aspect part of it. Generally the mre enjoyable terms have been the ones where the people working there have actually been friendly and approachable - I enjoyed those terms because I enjoyed working with the people there.

For example, last year in Paediatrics, we weren't really attached to a team. The workload was really heavy and we had to find patients to clerk by ourselves. This year by contrast, we've each been attached to different Paediatric teams and I've found myself enjoying the term a lot more than last year. The people on my team are really easy to talk to and good to get along with.

Orthopaedics is another example. You could enjoy doing the surgery, ie the actual work - but I could easily see myself getting really annoyed at the people who work in the field, ie the (sometimes) arrogant Orthopaedic Surgeons.

I guess it's made me realise that when you chose a specialty, you're also choosing the people (or type of people, eg surgeons) you're going to be working with for the rest of your life.

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Sunday, May 14, 2006

Random Links #2

  • GUIdebook: Graphical User Interface gallery - A very well-made gallery of various operating system interfaces and a little bit about the history of each one. Great for you nostalgics out there.
  • Monet's Impression Sunrise- This is a little app which demonstrates how Monet used differences in contrast and hue to create his groundbreaking Impressionistic style.
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Sunday, May 07, 2006

Eskimo Joe 6/5/06 Amplifier, Perth


Eskimo Joe played at Amplifier last night, and they were f**kin awesome. They were rocking out the old tunes, belting out some brand new ones as well and generally giving the paying crowd a brilliant time. The opening acts, Faith in Plastics, and Red Jezebel were great value as well entertaining the growing crowd before the main act took the stage.

From memory, they debuted three (?) new songs: Black Fingernails, Red Wine, Forever Young (not a Youthgroup cover!), and another one, which they opened the set with (I didn't catch the name). Other songs played were (in no particular order): Liar, I'm So Tired, From the Sea, Planet Earth, Wake up, Come Down, Life is Better With You, Aint No Sunshine, This Room, Older Than You and Smoke. Let me know if I've missed one!

It was really good to see the lads back out on stage after an 8 month absence. Any fears I had for the new album are probably going to be unfounded - as the new material sounded great. Just like "A Song is a City" represented an evolution from "Girl", the "Black Fingernails, Red Wine" album seems like it will be another step in the evolution of sound from the Freo lads.

eskimo-joe-2

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Black Fingernails, Red Wine

Download the video clip to Eskimo Joe's new single Black Fingernails, Red Wine here.
(right click, save as)

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Friday, May 05, 2006

Prescribing antibiotics

The other day I woke up with a terrible pain in my mouth. I think it started with a small mouth ulcer, caused by this malaligned wisdom tooth continually bashing against the inside of my mouth. I think I then got a secondary infection - causing pain, redness and swelling. The pain was actually so bad I was taken regular paracetamol and even panadeine forte last night.

Anyway, I went to see the dentist today with high expectations of getting the tooth removed and/or getting some antibiotics to treat the infection.

Big shock! I was told that it was an infection, and that it would get better by itself! There was no need for antibiotics. All that was needed was to clean the area regularly, and it would heal up on its own accord. I wasn't very happy with this - I was in significant pain, and thought I needed antibiotics to treat (what I thought) was a significant infection.

Now this is a spiel which we (as med students) have been told to tell our patients all the time. If somebody came in with a middle ear infection, we would tell them that there was no need for antibiotics, that the risk of side effects from the medication were significant, and that it wouldn't change the natural progression of the disease. The risk of developing community resistance to bacteria is also an issue.

The thing is, when you're in the patient's seat, the situation feels a whole lot different.

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Tuesday, May 02, 2006

ADHD - Overprescription of dexamphetamines?

I've just started a new term this week - Women's and Children's Health. Pretty much it's just
the same stuff we did last year, with three weeks of Paediatrics followed by a single of week of O&G. Personally, I think it's a bit of a waste of time (although it's always good fun to play with the kids :D). I'm attached to a General Paeds/Resp team.

I spent this morning sitting in the outpatient clinic with the consultant, whilst we saw various cases. General paediatrics is pretty varied: we saw things like epilepsy, UTIs, asthma and Fanconi's anaemia, as well as things like ADHD (leading nicely into the point at hand).

At first, the consult started nicely enough with the patient's mother describing how her son was doing at school with respect to ADHD and his learning difficulties. Things were nice and civil, but then the mother asked the Paediatrician whether she could have a repeat prescription of dexamphetamines.

The Paediatrician had been writing in the notes, but suddenly stopped her writing and looked up, saying pointedly, "I've already given you a repeat prescription, last time you were here."

"Have you?"

"Yes, I'm pretty sure I have. Let me check." She checked.

"Yep, here it is. Two repeat prescriptions."

"Oh okay then. Must be my mistake."

"..."

"Um, when can we be seen by the GP? Can we not get the medication from the GP?"

At this point, the paediatrician lost it completely. This sudden look came over her and she started almost-shouting at the mother, telling her that she would not be allowed to be seen by the GP until it had been proven that the dexamphetamines were having an effect. And definitely not while the patient did not have a regular GP. And especially not when there are repeat prescritions outstanding. To be honest, it was a bit scary. I'd never seen anything like it before.

Seeing this ADHD patient brought up in my mind one of those controversial issues that seems to be plaguing Medicine, ie ADHD and the prescribing (or overprescribing) of stimulant medications. It's one of those things where everyone has an opinion, and depending on your training and area of expertise, you may have views one way or another.

It's a commonly held belief in the general community that ADHD is overdiagnosed, leading to overmedication of young children with stimulant medications. Unfortunately, there have been documented cases of young kids not taking their medications and instead selling them to their peers, or worse, drug dealers.

There are different schools of thoughts relating to this. One school of thought believes that ADHD is actually increasing in incidence, leading to an increased need for prescribing of medications. Another school of thought belives that the incident of ADHD has always remained steady, but we are starting to diagnose and treat it more. At the opposite end of the spectrum are people who believe that ADHD is a myth and that none of these medications are necessary. Between the extremes are people who believe that ADHD is overdiagnosed and that although there are patients who need medication, not all of them do.

The latter is probably the most likely of all the above scenarios, and various strategies have been implemented to counter this. Despite this, it doesn't look like the controversy is going to end, especially with the discovery of associated cardiovascular risk.

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