Nocturnale

Bitten by the iPod Touch

admin — Fri, 12 Mar 2010 13:33:13 +0000

With unmitigated glee, I bought an iPod Touch 3rd Generation on the eve of Chinese New Year 2010. This impossibly thin contraption has completely debunked my understanding of what a PDA is supposed to be about. The iPod Touch is solidly built, has an ultra-modern, attractive design and feels very good on the palm of my hand. The LCD screen is superbly crisp and makes watching movies a divine pleasure.

And not to forget the third-party apps… oh those thank-god-how-could-I-live-without awesome apps you get to install on your iPod Touch! I lost count of the hours spent playing Canabalt, Doodle Jump, Plants vs Zombies, and recently Street Fighter IV. Apple has really made a success out of iPhone/iPod Touch and the accolades are very well justified. I love my iPod Touch and I bring it everywhere I go. It is one of the best things I have ever bought for myself.

My New Toyota Vios

What to wear for MRCP(UK) PACES?

nocturnale — Fri, 29 Jan 2010 13:38:17 +0000

A world-weary consultant physician once told me,”Half is skill, half is appeal.” His words of wisdom, uttered in the context of PACES exam were spot-on. If you want to receive the nod of approval from the Royal Colleges, you have got to play the game, look the look, go the whole nine yards!

Trust me, looking professionally smashing in your best garment will put you in a good stead to impress the examiners. Here is my advice on what to wear for a male candidate.

Wear slim fitting attire!
Buy a slim-fit dress shirt – you want to aim for snug fit, not overly tight which would otherwise encumber your physical examination and compromise your techniques. Wear a brand you are comfortable with. I wore a G2000 to my exam.
Buy a slim-fit straight-cut pants – again, you want the pants to fit just nice and not overly constrictive. And please, avoid pleated pants like a plague. I wore an Italian-made bespoke pants to my exam.
Stay away from short-sleeved shirts – they look too casual, too ‘devil-may-care’ like. Instead, get a long-sleeved dress shirt and fold it to elbow length. This will make you look 100 times more refined.
Put on a shining pair of dress shoes, a Derby or an Oxford would be good. The hue must fit the color of your belt. No loafers please. I wore a set of Rockport to my exam.
No ties, no rings, no suit – In line with the Royal Colleges infection control recommendation, I believe suits and ties will be completely phased out as exam attire. I wore no suit or tie to my exam. In fact, only one candidate in my carousel donned the full 2-piece garment suit, the rest of us were just shirts and pants. I cannot imagine why anyone would still want to put on a full suit. For me, a plain shirt with pants is not only a natural thing to do but also sensible and practical. The weight of a jacket and the pretense of a tie is something I am glad to be rid of when facing eight tempestuous patient encounters!
Meticulous grooming, it goes without saying!
Wear a reasonable whiff of fragrance, don’t overdo it.
Do your shopping early. Get comfortable in the dress attire and wear it a few times before going for the real deal.
MRCP(UK) is not about couture splendor or exhibition of metrosexual prowess. But a candidate who display discerning discretion in his appearance is sure to exude an air of confidence so vital to planting a reassuring impression on the examiners.

I was at my sartorial best on the day of exam and the results did not disappoint. Do you have any other great tips to share? What about you female candidates out there? What did you wear?

Little Napoleons in Ministry of Health, Malaysia

nocturnale — Thu, 14 Jan 2010 02:56:05 +0000

There seems to be no end to my misery in dealing with the Ministry of Health bureaucrats in Putrajaya. I don’t know if passing the MRCP(UK) bestows upon you a period of jinx but I certainly feel that way.

A simple application to the headquarters to formally begin the so called gazzettement turned out to be a most revealing experience on the work ethics of those MOH administrators. It’s been almost a month since I submitted my application. Two personal trips to the office and innumerable phone calls later still did not yield any progress in my application.

Worse, the encounters were met with scorn, with voices that suggest futility and total non-comittment. When asked about the status of my gazzettement letter, the reply came in the effect that ‘I am very busy, they can wait.’.

Enough restrain was left in me to avert an ugly altercation. But I had to vent this out here, for better or for worse.

This is classically your colloquial Little Napoleon. He or she hold a very special, high-stakes position, no less. Lesser mortals like yours truly, although more qualified academically must haplessly pander to their whim and inclinations, which is ridiculous.

I am sure I am not the first person to have gone through this ordeal and most certainly not the last. I wondered how many other newly-minted specialists have had to endure the patronizing air of these arrogant administrators. Their noses are held so high up that they forget quite sadly to their perils that without us, the entire health system will grind to a halt and their livelihood will be decimated as a consequence.

But alas, that will never happen. The government as we know is such a charitable organization. They will safeguard the interest of these Napoleons and duly escort them to their retirement safe haven. They are, lest we forget, untouchable. Are they all not? What are we to do?

As they say, shame on you, Kementerian Kesihatan Malaysia! Shame on you!

Motto for MRCP(UK) PACES Candidates

nocturnale — Sat, 09 Jan 2010 12:59:45 +0000

A motto is a guiding principle. A beacon of light by which you use to navigate your way around a treacherous path. A motto when conjured and executed with strong conviction is a powerful tool. A tool that one can use to inspire him to success in any endeavor he puts his hand on.

Do you have a motto when starting on your journey to MRCP(UK) glory? Any profound words of wisdom that you call upon during times of difficulties when the goings get tough?

Personally, I stuck to this mantra through thick and thin, which gave me strength in the darkest hours of my PACES preparation. I remember it from a passage I read from one of Michael Connelly’s novels featuring tough L.A. detective Hieronymous Bosch.

These words struck me like how a flash of lightning would electrify the sky. They gave me the fuel to go forward, to keep trudging along, to fight the fight and ultimately to win the war that is the MRCP(UK).

Vision to see, courage to do and faith to believe.

Ace Your History Taking Station for MRCP(UK) PACES

nocturnale — Sat, 02 Jan 2010 04:53:21 +0000

I have said it countless times that every MRCP(UK) PACES candidate should score well in History Taking Station 2.

The encounter with two senior consultants watching over you can be excruciatingly disconcerting. I know it well, having been through it before. But there is no reason why one should not pass or better ace this station. Extracting a pertinent and cogent history is a skill that you can hone to perfection. Grab the full 10 points from each examiner. It can be done!

In this podcast, I dispense some genuine advice on how to practice taking history on a level that would make the Royal Colleges proud.

Fistball ♥ Chuu Jiun

nocturnale — Fri, 01 Jan 2010 12:45:01 +0000

This SlideShowPro photo gallery requires the Flash Player plugin and a web browser with JavaScript enabled.

Spent an exhausting but joyful weekend in Nibong Tebal, Penang. We drove the 350km up north on Christmas eve to help @fistball plunder his would-be-wife. It was curiously liberating this time around as it marked the first real vacation we took after passing our MRCP(UK) exams.

We enjoyed the warm small town hospitality afforded to us and we are really grateful for all the generosity from the bride’s congenial family. I think it was to their credit that we were made comfortable and not felt a tad uneasy.

I am lousy with the camera, not to mention the digital slr that I was entrusted with. But seeing that it’s my brother’s red letter day and unhindered by the fact that this is my so-called first wedding photography commission, I gave my best shot.

I hope the results though far from anything remotely stunning, would be at least considered a sight for sore eyes. No jeering please.

The Moon is Round Again

The Best Noodles in Hong Kong

nocturnale — Wed, 23 Dec 2009 13:43:16 +0000

I suppose that whenever people talk about Hong Kong, those springy wanton noodles comes to mind unbidden. This is not without a valid reason. I can personally testify that the best noodles that can be eaten in this world hails from Hong Kong. They make our Malaysian version pales in comparison.

Noodle shops are a dime a dozen in the Pearl of Orient. Unless you are lucky enough to have a local guide to help you around, it can be something of a tall order finding and eating a great bowl of noodles.

Fear not. Download this one-page pdf guide by noted food blogger Josh Tse to the crème de la crème of noodles in Hong Kong. Take it from me. Tse’s recommendations will leave you wanting for more. Grab it, print it out and tote it along on your next trip to Hong Kong. Eat only the best. Life is too short to waste time on mediocrity.

All the recommended noodle shops are sublime. But if I have to name the best among the lot, I would say Mak’s Noodles at Central comfortably sits atop the crown. Die die must try!

Colorectal Cancer TV Advertisement

MRCP(UK) PACES 2009/3 New Format Station 5 Case Reconstruction #1

nocturnale — Sun, 20 Dec 2009 02:07:44 +0000

Exam venue: Kuala Lumpur
Examiners: Andrew Elder (Consultant Geriatrician) & Norella Kong (Consultant Nephrologist)
Lead Examiner: Norella Kong

Role: Senior House Officer in the Outpatient Clinic

28-year-old man with recent DVT on warfarin started 3 weeks ago. He had an argument with his girlfriend, which prompted him to overdose on his warfarin tablets. He presented to the clinic with a severe headache.

Task: Please assess and advise him accordingly.

I walked in and saw a healthy looking chap sitting cheerfully on the chair. I knew immediately this is a surrogate actor with no real physical signs. But I realized I could not afford to make any mistakes or worse make assumptions, so I treaded carefully just the same.

This was my first station and I was extremely psyched up. I put on my best professional air and kicked off the station with a resounding,”Hello, my name is Dr. X. I’ve been asked to have a look at you and I understand that you’ve been having this bad headache. Would you like to bring me through the problems in your words and we will go on from there?”

I probed his headache in detail within the timespan allowable (worst headache ever, no speech or visual disturbance, no limb weakness or neck pain/stiffness, no vomiting, no fever and no recent head injury). I then asked him why and how much he had overdosed, to which he answered,” Only one extra tablet yesterday.” I also enquired about any other additional medications that he was taking at that time.

I scanned through his skin for bruises (of course there’s none) and I made sure they watched me do this with some polished measures of showmanship. I proceeded to do a neurological examination. The examiner stopped me, “Let’s say there is no extrapyramidal signs to be elicited. Go on.” I went on to do CN examination specifically for 3rd nerve palsy. The examiner stopped me again saying,” No need for that, it’s normal.” I then proceeded to do a fundoscopy examination (no hemorrhages seen). I then went on to elicit for Brudzinski and Kernig’s sign to which it’s negative, by which time I have a few minutes left to wrap up the consultation (still on track with my timing which I have practiced adhering to perfection).

I pulled up a chair by the bed, not allowing the time constraint to disrupt my composure, sat down and asked him the inevitable question,”As we discuss this, many patients will have thoughts about what may be causing their symptoms. Are you worried about anything in particular?” I have practiced this ‘end-game’ routine quite painstakingly, so I knew I could use this to my advantage. I put up a concerned demeanor and told him what my plan is and what to expect next after allaying his fear in a few succinct sentences. He seemed satisfied. I shook his hands firmly and thanked him for the time.

I then turned towards the examiner and readied myself for the punches.

Things happened rather fast. You do not have the luxury of time to pause and think about the next step to take. Everything felt very instinctive and fluid.

Patient’s concern: Will I have to admitted to the hospital? Why?

Questions asked:

How would you investigate?
How would you manage?
Do you think the patient’s INR will be raised significantly?
What advice would you give the patient?

Overall comment: Walking out of the station, I have no idea whether I did well. The examiners’ poker facies is too difficult to judge. I really give my all and try and replicate what a safe doctor would and should do in a real clinical setting. I feel the cases presented were typically your bread and butter acute medicine material. This should be the focus of all future candidates facing this station.

Verdict: I kept thinking if I scored badly at this sub-station, what else had I missed? But in the end when the results were revealed, I performed better than I thought with a perfect score 14/14 .

Do you have any Station 5 Brief Clinical Consultation cases to share? Do post them on this thread on the comments column below or send them via the contact form here!

Passing Mark for New MRCP(UK) PACES Format

nocturnale — Fri, 11 Dec 2009 10:18:06 +0000

The mail from the Royal Colleges of Physicians of the United Kingdom has just arrived. It is a hefty stack of documents comprising the President’s congratulatory message, Membership brochures, admission ceremony RSVP and what else but the eagerly awaited ~~judgement~~ results letter.

The Royal Colleges have been keeping mum and many speculated wildly about the cut-off between pass and fail. Now, it’s finally divulged. For the new PACES format introduced in the third diet of 2009, the examination board set the Pass Mark at 138.

That is 138 points from a possible 172 (or 80%). This is most definitely increased from the previous 42/56 pass mark or 75%. In other words, you gotta be damn near-perfect in order to pass this new PACES exam! There is very little margin for mistakes.

I am so relieved I had made the mark. My bet is that the Royal Colleges will very likely hike the passing mark further and examiners will be more stringent in their marking as the system adapts to this new format.

Seriously, I have an ominous feeling the incoming PACES candidates are in for a rough ride.

Colorectal Cancer TV Advertisement

nocturnale — Wed, 09 Dec 2009 13:18:53 +0000

A couple of weeks ago, I was in Hong Kong and I caught this ad on national TV. TV commercials in their most entertaining way, reflect the prevailing zeitgeist of a country. As a physician, I am especially attracted to health messages conveyed in TV ads and this particular 30-second short is evocative.

It shows a reverse-motion playback of a middle-age Chinese gentleman ingesting various junk food. The video pans out in the latter part revealing all sorts of food substances the digestive system puts up with in the first 50 years of a human life. Very strong and powerful graphical message there!

The ad is commissioned by Hong Kong Cancer Fund and posters like the one above are ubiquitous around subway stations in Hong Kong. I think they did a commendable job at that, advocating public awareness on bowel cancer. Liow Tiong Lai, take note!