Friday, November 30, 2007

Happy days

Today is my last day in General practice at CD. friday is not busy so there werent many patients but I was in a way "happy" that everyone is sad that im leaving. well I mean its good to know that you made a good impression. I still think that being a Doctor's job is not to treat diseases its to treat ppl. to make them feel better to be able to trust you. to trust that they are in safe hands.

Dr D came to my office to tell me that there is an urgent call for me at reception. I thought what is it now. but then when I saw everyone gathering in the lounge I started smiling. I got one of the most beuatiful card. its like your history of the past few months summarised with sweet and pleasant words by every member of the staff. I felt humbled by their sweet remarks. to be loved and to be told that you are loved is a feeling only a great poet can attempt to describe. the 2 cleaning ladies who come as I leave every evening left me a note on the board wishing me all the best. how kind and sweet.

It brings tears to the eyes to witness pure emotions.

I am thankful for all of them for making this a memorable day in my life.

Thank you CD.

Monday, November 26, 2007

How Can I help?

It’s nearing the end of my rotation in General Practice. You get the patient who is almost embarrassed because they think that they have wasted your time. The patients who expect you to unsolve the mystery of, why oh why, they enjoy cracking their knuckles! Thank you for wasting 15 minutes of my time. That is an appointment someone else needed. You also get the patient who walks in to tell you about his pregnant wife, the car he crashed, the debt that he owes and the job he is searching for. Correct me if I am wrong but that is a problem I can not solve. at this point, I can give you painkillers for you headache and sleeping tablets for your insomnia but I can not speak to the bank, shout at your boss or find you a cheap flat. I can only sympathise, and albeit that that is all a patient may need, the source of the problem is still there. some people wont face it.

In a big way it seems that we are treating peoples social habits. Smoking, obesity, alcoholism to name but a few. How would it not get to me when I see lots of money spent on treating someone who wouldn’t stop smoking or drinking. Someone who wouldn’t stop eating. Someone who wouldn’t exercise, knowing damn well that the hip pain she got is actually because of her weight. ??

I don’t want to treat symptoms I want to treat people. People don’t like being told that they can and should fix the problem. No its “you are the Doctor, You fix it”… Well I simply cant.

Sunday, October 01, 2006

what was I Not in it for?

Do we get paid enough?
Before starting my first post ever I read the contract and thought wow! We get paid loads of money. Well you’d think that if you were a student and had to live on a tight budget. So I started the job with a night shift and this is exactly how it happened. I went in on a Wednesday night I was handed the page from the doctor doing the dayshift and I was thinking what am I supposed to do now?!!
I might say in a different post how the first night was, I don’t think any doctor would forget his first night shift especially if it is the first “day” of work.
Now remember I started by saying I “thought” we get paid loads of money.

First I need to be prepared for the ward round, i.e. all the patient notes are in the trolley, all their blood results are printed out, I have chased the X-ray, CT results etc. and I have carried the plan from yesterday.
So I have started at 8:30 am its 1 pm now and I haven’t had a break, on the feet taking notes listening to what the consultant is saying, laugh at the silly old jokes while your shoes are becoming so tight because you feet are puffed up. You got to be nice to your seniors, they sign your forms and they are going to offer you a job if you are “good”.

Once the round is finished you are bombarded with requests from the nurses, could you prescribe this , could you print that, oh mr smith has a chest pain could you go see him.

Nurses??, you gotta be nice to them they can make your life easy or they could make it a living hell.
So its 2pm and I haven’t had lunch yet so maybe its time for lunch huh?

The pharmacy shuts at 3 and you have got 4 patients to be discharged so you have to fill in their discharge letters and the medications they will take home, while at the same time you have to fill in requests for any x rays CT scans, ultrasound scans, heart scans etc.

So once im done at around 3 (If I am lucky) I have to make sure all patients have the plans carried out, all bloods taken and sent away they had their scans. And those who had the scans done the day before I have to run down to the Radiology department to get the “unverified report” from the secretaries for tomorrows ward round.

That means I have to eat my lunch while Im doing something else.
I am supposed to finish at 5:45 but I never managed to finish before 6:45, Im home by 7 I need to cook, eat and rest before I go to bed to begin another day.

This is a simplified version of what I have to do during a day shift.
In addition:
I have to work 8.30am -8.30pm once every 4 weeks. I have to fill in a night shift 12 hours in Accident and Emergency 4 nights in 8 weeks, and another 3 nights of 12 hours covering 5 wards during the 8 weeks.
And what tests your strength is that towards the end of your 12 hours shift, when you are really exhausted you get a relative coming up to you, upset, demanding to know why is this patient not getting any better?!!
I am required to apologize for a mistake that I have not done, to smile to them and reassure them that we are doing all we can to help his/her relative.

while deep inside me im so angry that I want to bang his head against the wall and walk away.

but hey what can I say.. I really Love my job and all that comes with it.

and to answer me: I was in it for many reasons, one thing for sure I was not in it for the money.

Friday, May 13, 2005

what Ill have to worry about everyday on the Job.

A father's letter to his internist son

Dear Dave,
Last September I attended the biennial congress of the British congress of the British Society of the History of Medicine in Newcastle-upon-Tyne, where I graduated 50 years ago.
After my presentation an elderly lady came over to me and asked, "Dr Jacoby, were you at Monkwearmouth Hospital?" I replied that I was and she said, "You treated me for diphtheria."
I immediately remembered her - my first patient on my first day as a real doctor, 1 July 1943. I had been called to the outpatient department from the house staff's quarters. I walked down the long corridor, with windows bricked up in case of bomb blasts, wearing a long white starched coat, my stethescope dangling around my neck in the most approved fashion. There was a diagnostic set in one pocket and a reflex hammer, tuning fork, and the handbook for new house officers, Pye's Surgical Handicraft, sticking out of the other. I was full of the self confidence of youth. I entered the outpatient waiting room and was directed to a small examination room and there was my patient - a nurse wearing a long white veil, as was customary.
She had a sore throat. I looked in her throat and I didn't see much. I knew all about how to treat brain abscesses, which in those days was to do nothing, because they were almost never diagnosed before death. I knew how to do major abdominal surgical operations, such as gastroenterostomies, at least in theory, although I would have killed the patient if I had attempted one. After all, I had been the fourth assistant many times when my surgical chief did thoracoplasties for empyema, a common operation in those days, Halstead radical mastectomies, and other equally bloody operations, such as abdominoperineal resections. I would be fighting the other student, the house officer, and the registrar for the right to dab the bleeding spot with gauze, before the surgeon deftly caught the spurter with a pair of artery forceps and tied it off. What I not been taught was how to treat a sore throat. I did not know what to do, so I prescribed a salt water gargle.
* "I immediately remembered her - my first patient on my first day as a real doctor."
Later in the morning I discussed the case with one of the other house officers who had graduated six months before me, so he knew everything. "George," he said, "if I were you I would do a throat culture and give her some sulfa." This was in the days before penicillin was available. I followed his suggestion and, to my amazement, the culture came back positive for diphtheria.
My patient was sent off to the fever hospital and later had to have a tracheotomy. After she recovered I saw her again and she told me that each morning the doctor used to greet her with the request to say "Sister Susie's sewing shirts for soldiers" or "Plum jam," both of which came out rather flat because her palate and pharynx had been paralysed. Her other recollection was being offered a tonsillectomy just before discharge. I remember noting that she had a dilated left pupil, from diphtheritic paralysis.
Fifty years later, as soon as a I realised who she was, I looked carefully at her face and declared, "You don't have an enlarged pupil any longer."
Now as a senior man in the profession, when you make rounds with your residents forgive them in their trespasses, which are many. Remember what happened to your father.

M G Jacoby

Friday, April 29, 2005

What you want to know will hurt you.

There was this 25 years old Lady who had a very successful life. She had a caring family and a loving husband.
The couple was trying to have a baby; they tried for more than a year before they decided

“We must get a professional's opinion.”

A series of tests led to Karyotyping, in other words the Lady’s genetic map to see if there is any abnormality with the chromosomes.
As you know the male has 46 chromosomes and an X and Y (sex chromosomes) the female has XX.
Now this Lady had an XY! So she was a man trapped inside the body of a woman. Only that is not true. She was a female, she had all the organs for a female but her ovaries were not functioning, and she did not have a developed womb. Otherwise everything was there.
Now The Doctors had 2 options.
1) To tell her the Truth.
2) Hide the Truth.

Nobody likes to make a decision on behalf of someone else.

Do we tell someone who lived for 25 years as a woman that she is a man?
How is she going to take it?
How is the husband going to take it?
How is the family going to take it?

We know from experience that women with breast cancer who end up losing their breast suffer psychologically as a result of feeling like “incomplete females”. So one could only imagine the profound impact such revelation will have on this lady.

The Dilemma:

We could conceal the truth and tell her you have non functioning ovaries, you can continue with your life but you will not have babies, it happens even in normal females!
Or we could tell her you are actually a male we don’t care how that may affect you psychologically but there you have it we are honest.

Well, you can argue being honest with being thoughtful.
Children, often ask a very annoying question : WHY? … why cant we fly? Wy do I have to eat? Why take a shower? So on.
But in this case it’s odd to ask: why do you want to be honest?
Is honest under such circumstances the right thing to do? hmmmm

on the other hand:
what gives us the right to say when to be honest and when to conceal the truth? Maybe lie?

one has to make up his own mind.

The Doctors ended up telling the parents and they came to a decision NOT to tell her that she has an XY chromosome.

Frances Peabody concluded a lecture called “the care of the patient” with these words:
“One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient”

Saturday, April 23, 2005

Time to choose a straitJacket

I don’t know about you but I did misinterpret images, I did mistake random shouts for someone calling my name. I did wake up at nights thinking I heard someone screaming.

scary; is when u r sitting with a schizophrenic patient and u start counting the similarities between you and him/her. Well coming to think of it , it’s not scary It funny. The thought that I maybe psychotic makes me laugh.
Thu I do have a positive family history I don’t take it seriously. I only hope that if I became psychotic I will have insight and realise i need help.

While I was doing my attachment in psychiatry, I came to watch a documentary on the Exorcist. Apparently the movie is based on a true story. take it easy i didnt know that!

What was interesting is that one of the preists interviewed, who is a specialist in chasing Demons, said: 99% of those who claim to be possessed by Demons need psychiatric help.

With that thought I went to my consultant and Asked him: what do you think of possession so he said: go to the ward and ask to talk to Mr M, we will discuss it afterwards.
Mr M was a preist, but according to him he fell a victim of temptation. He now sees the Saviour telling him to preach Christianity.
Mr M is a smart person but he is puzzled as to why has the Lord chose him althu he failed the church. The psychiatry report reads visual/auditory hallucinations.
I thoug to myself well George Bush said he talks to God. No one is raising an eye brow.

Now me being me, thought JINN, muslims believe in Jinn, those of you who watched Aladdin know Genie.
(for more info on Jinn read:

Now if you cant be bothered reading about JINN here u go, Jinn in Oman is similar to Ghosts/demons in the western culture.
There are many cases in Oman where people claim that they are possessed by Jinn.
Let me pause here and bring the definition of Delusions: A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person's culture or subculture (e.g. it is not an article of religious faith).
(note: see if you memorised this definition word for word?... Id be worried)

last bit makes a huge difference.

So if a muslim believed that Jinn exist and they have overpowered him this on its own does not make him psychotic because it is within his belief.

Anyways, so how many cases of Omanies are being treated by “spiritual healer” rather than by a professional psychiatrist? more importantly how many "spiritual healers" believe that the patient does need medical intevention.
society is opposed to the idea of taking their child for mental check up. a family of someone affected would rather believe that he/she is being overpowered by the mysterious Jinn, Ghost, demons whatever rather than believe that there is mental illness that could be treated before more damage is caused.
Is the Omani public finally coming to terms with the fact that the mind/brain can become ill just like any other part of the body?
I hope so..

It makes me also think that your best Doctor is not the one living thousands of miles with all his PHD, MSC, PMS, LOL, BRB, TYT after his name who knows nothing about your culture, your beliefs, your way of life.
sometimes the Best Dr is the average GP whos been treating you and your family for the past 10 years.

Friday, April 22, 2005

The Work of Nestle

A couple of weeks ago I was with the midwife as she was interviewing this Lady with a 2 years old son, she was 20 weeks pregnant at the time.
One of the Questions mothers-to-be are asked is: whether they will breast feed or bottle feed.

This lady smiled and said ill breast feed. Great news for everyone, healthy child healthy mother. healthy community.

The midwife told me afterwards that this lady suffered a lot with her first baby because her husband and her mother in Law were dead against breast feeding.
I could not understand. It is one thing for a woman not want to breast feed for many reasons, but for the husband to be against it knowing that it will benefit the child and the mother as well. I don’t understand it.

The midwife’s best guess was it’s because of the way the society looks at women who breast feed.
I thought to myself our society is blessed; no one would frown upon a mother breastfeeding her child in Oman provided she is not showing flesh.

I made a simple comparison in my mind. when people in the west talk about Breast feeding in public they assume that they will see some flesh, where as, when we talk about it , our imagination is of a woman who is wearing head scarf or a veil and she can cover herself and her child and feed him without being frowned upon.

This is an over simplified view but its an example of how a simple issue like breast feeding can be used to highlight social variations between 2 societies with different dressing codes and traditions.

I talked about how the way women dress could contribute to the difference in our perception, but imagine including things like, life style, having a maid, extended family, being a single mother etc. all these can be used to compare the 2 societies with breast feeding at the centre of it.

Needles to say while we are not that concerned about it in Oman, the National Health Services NHS in the UK has to set a whole campaign to encourage mothers to breast feed.

“Breast is Best”