“I wish I could go to bed”

14 02 2014

This came in via Medscape, which a Medical Education/Newsportal most of us subscribe to. It’s a compilation of reflections from the Medscape panel on “Why we practice Medicine”

If you have a subscription, you can see the rest of the slides here.

Every Pre-Med should read this

15 10 2013

While at the infinity pool at school, I had this discussion with my friend about what the philosophical basis of Medicine is. What exactly is Disease and how do or can we know for sure? There are no easy answers to that, though I get the inclination that the boundaries of the question and the lenses we use to look at it, change slightly depending on the problem at hand. I went around looking for answers and discovered that there is an entire field called the Philosophy of Medicine. I bumped into an article at the Internet Encyclopedia of Medicine discussing these perspectives. I felt that it gives a good overview on the theory and practise of Medicine and the fact that I am now more familiar with the subject, it is easier to understand the philosophical jargon. I feel that the article gave me a better philosophical foundation to understand both the evolution of ideas in Medicine and added some colour and structure to thinking about the field. I’m planning to read around the subject, with more content to come!

#archive The 3 Secrets of Highly Successful Graduates

31 08 2013

This is a really interesting piece of career advice I bumped int on Facebook.

Perspective I

19 07 2013

While I was trying to channel my anger into something constructive, I ran into a bunch of pictures in a feature by FSTOPPERS on Tom Hussey’s Reflections. It’s an eye opening look at the elderly staring back at a reflection of their younger selves. Hussey has a great portfolio on his website and you can see the entire collection here.

This something I ponder about a fair bit, in conjunction with reflections on Death, partly because that seems to be the next stage.  I’m surrounded by the elderly at work, so I am rather surprised/ashamed that I haven’t had the Old Age and Death conversation with anyone. Perhaps it’s the language barrier, perhaps I’m just caught up with the routine. I’ll do that the next time I see someone who might be willing.

That’s probably me in 40+years. If I live that long.



Of Logos and Evidence Based Medicine

22 11 2012

One of my friends was on exchange and I noticed a logo on the said friend’s facebook profile.

Looks familiar?

It kind of resembled my own school’s medical society logo.

NUS MedSoc Logo

I recall, back in my first year, we had a short lecture on the history of medicine and the lecturer briefly spoke about the logo, with an amused look. Apparently there is a bit of confusion with regards to the symbol and strictly speaking, the Stockholm school uses it the way it should be, based on its roots.

The winged rod with two intertwined snakes is actually the Staff of Hermes (Mercury in Roman Mythology), known as the Caduceus. Some historians interpret it to symbolise “balanced exchange and reciprocity” which are values which drive commerce. Since Mercury is the “the messenger of the gods, guide of the dead and protector of merchants, shepherds, gamblers, liars, and thieves” this has come to symbolise all these aspects. It’s often erroneously used by Medical Societies, especially the commercial ones, and this can be traced to it’s adoption as the symbol of the US Medical Corps in 1902. Wikipedia covers this in more detail in a very readable fashion.

The actual symbol representing Medicine, based on Greek mythology, is the Rod of Asclepius, the god of healing and it comprises a single snake twined around a rod, as below.

The Actual Rod of Healing


After a lecture today though, I think the (misused) logo can potentially be re-interpreted in the light of Evidence Based Medicine (EBM).

Simply put, EBM is an approach where we use evidence to analyse treatments (and lab tests, physical exam techniques etc) to objectively figure out whether our treatments (or tests) actually work. This might seem like a mundane question to those outside of the field, because, if someone takes a pill and gets better, a treatment works right? The reality is a little bit more complicated than that. As a counter to that, I might ask, how do you know that the pill made someone better? They might have gotten better anyway in a few days. In addition to this, for long term illness, one sometimes has good days and bad ones.  With this in mind, researchers (who are often Medical Doctors, but this can involve people from various healthcare fields) design studies to tease out the various factors so at the end of it, one can be confident that the treatment is effective.

An extra element of complexity is added when we consider the fact that certain treatments can be potentially harmful. Drugs sometimes have side effects or may have dramatic effects which can cause harm under various circumstances. An example is the use of “blood thinners” to prevention ischemic strokes due to blood clots choking the blood supply to the brain. Blood clotting (or coagulation) is a chemical reaction where proteins in the blood clump together with cells to form a clot. The clotting of blood is important to prevent bleeding but in diseases of the blood vessels, there is an increased tendency for blood to form a clot and block blood vessels.  Blood thinners, or more accurately, anti-coagulants, impair this process. They don’t actually make the blood thinner. However,  in a legitimate bleed, you still do want the blood to solidify and cause the bleeding to stop. A consequence of blood thinners is that the bleeding may not stop in the event of an injury.

With this in mind, it is imperative that Doctors use research and figure out how to balance the risk of an uncontrolled bleed versus the risk of a stroke in diseases of the blood vessels. Part of this strategy is to use the right drugs (some are weaker and hence less likely to cause bleeding) and to understand the patient and disease better (those with severe disease may still need stronger drugs). These days, there is a cost element that doctors need to be aware of, and we also know that the more complex a treatment, the less likely patients are to accept it and it may be more difficult to follow it. What this means is that our role has become more complex and we need to “balance and negotiate” a multitude of factors when we treat people.

If you dig around a little, there is this uncanny symbolism to the myths and paraphernalia associated with Hermes. A publisher used the staff as an emblem with a biblical quote reminding one to “be ye therefore wise as serpents, and harmless as doves.” Seems a lot like an exhortation to be a critical thinker but to balance it with empathy for patients. Hermes is also the “messenger of the Gods” and seen as a guide. Doctors are often looked up as people who “know the science” and there is a huge expectation upon us to be able to communicate this to patients, to help work with them to tailor their treatment. He is seen as swift and cunning and a navigator, and people expect us to be on their side when it comes to navigating the vast an complicated realm of healthcare.

I smugly laughed back in my first year when the lecturer potentially interpreted the Medical Society’s logo as representing the “commercialisation” of medicine. However, knowing this background it seems amusingly appropriate.

And the bit about Hermes as the god of Gamblers? Here’s a quote from the Oxford Handbook of Clinical Medicine (aka the Medical student’s pocket bible).

“Rather, medicine is for gamblers. Gamblers who use subtle clues to change their outlook from pessimism to optimism and vice versa”


Welcome Doctor Google [satire]

24 10 2012

I was randomly trying to look up information for a report when I discovered this trick. I cannot believe that Google is actually sifting through pages to give you a differential diagnoses. I think at this rate, Google will achieve self-consciousness by the time I graduate. They might also add in an empathy module. As such, maybe I should just quit school and focus on rehearsing my “would you like fries with that?”*


*Or “ni yao fries?”

“There is no such thing as a happy period”

18 10 2012

The menstrual cycle is an extremely well coordinated process involving four main players that act together like an orchestra. They are the hypothalamus, the anterior pituitary gland, the ovary and the endometrium” – Professor K. Arumugam, from A practical approach to problems in Gynecology for the undergraduate.

I happened to be reading that guidebook since I’m doing an Obstetrics and Gynecology attachment. The first time I talked to my friend about this quote, she bluntly remarked that it must have been written by a guy. And it’s true. Despite what the professor says, most of my girl friends would agree that a period is less like an orchestra and more like a Justin Bieber concert gone bad. The more time I spend in the Gynecology clinic, the more I am convinced of this fact. I am constantly surprised by the fact that women could have hidden such a large part of their lives from us men, though I feel that part of the reason is that we never really asked. I think the next time I’d be prepared to listen a bit and offer a hug and some anti-inflammatories.

In this context, it was absolutely hilarious when a friend shared this article with me about how a disgruntled boyfriend posted a complaint on the Facebook page of a Sanitary napkin company. I think Adweek has covered the story really well, including the original post on Facebook together with the company’s HILARIOUS video response. I strongly suggest you read the article.

To my guy friends, I think there’s a bit more we can do to make the world a better place. To my girl friends, Cheers mate!