Med school has ended

7 02 2014

That is an ironic thing to say considering how the title of this blog is medschneverends. Yet, today, I just finished my final end of rotation test and hung out with my group mates for a final post-test outing. I’m a very nostalgic kind of guy and thought about how I went from my first day with a stethoscope where I was convinced that all the heart sounds heard from a stethoscope were make believe to the stage where you listen to a patients chest and start making some inferences as to why the heart sounds the way it does and what treatment you can offer the patient.

It’s a long hard journey that would not have been possible without some lovely friends, patient mentors, my parents who have been very enabling and multitudes of willing patients who were kind enough to let me listen to their chest multiple times without complaining. This goes for the entire spectrum of clinical skills I’ve started acquiring and refining over the past three years.

It’s time to settle down and prep for the finals and on the bright side, it would mean some time to really digest all those years of learning and just maybe, I’ll be able to a bit of writing on the side too.

Cheers to many years of learning ahead!

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!

Books : The Girl with the Dragon Tattoo

9 09 2013




The National Library had this “mystery brown bag” scheme where you go to the book counter and pick out a small brown bag from a tray of bags and read the mystery book in it. I cheated. The first few books were some sappy romance novels so I kept putting them back until I chanced on this one.

Originally titled “Men who hate Women” I found Stieg Larsson’s thriller a little slow at the beginning. I had heard mixed reviews from different people. One friend hated it and stopped reading while another one was raving about it. It was dark, though once you get over the early part of it, you get a little desensitised and focus on the thriller/suspense aspect of it. I was also goaded on by Phillip Pullman’s endorsement on the cover so although I put the physical book down for almost a week, I looked up the library’s online service and borrowed the digital version (the Trilogy) to read on my iPad.

On one hand, it has a multi-layered complex plot, however, I did find myself questioning the plausibility of it sometimes especially with regards to the unlimited technological capacity of the protagonist. Nonetheless, this was a great read and I would highly recommend it to anyone who can stomach the dark themes. The universe also surprised me when I bumped into a Ms Salander later in the week 😉

Next up, I recently finished reading Subhas Anandan’s Autobiography.

#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.

On Liposuction …

29 08 2013

On Liposuction – Removal of abdominal adipose tissue with liposuction does not improve insulin sensitivity or risk factors for coronary heart disease, suggesting that the negative energy balance induced by diet and exercise are necessary for achieving the metabolic benefits of weight loss – Klein S et al, Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350(25):2549

There you go. Read the rest of the paper here. Via UpToDate

#archive Healthcare spending may reach 3.5% of GDP in 2030

10 08 2013

This is the one article that talks about how much of it’s GDP Singapore spends on healthcare. Granted that we have “better outcomes”, I am not sure if we should be spending only 1.6% while we spend 24% on Defence.

He said Singapore is currently spending about 1.6 per cent of the GDP on healthcare.

By 2016, it would go up to two per cent of GDP and by 2030 when the rapidly ageing population will be the biggest driver of rising expenditure going forward, healthcare spending may reach around 3.5 per cent of GDP, taking into account demographic changes and higher medical inflation.

Mr Tharman stressed that Singapore should focus on achieving international standards for healthcare outcomes rather than simply on increasing spending.

#archive Repudiating scientism, rather than surrendering to it

9 08 2013

Despite the shit storm that is engulfing the freethought community, PZ gives scientism a good
beating in this thorough essay.

Which is why I was disappointed with Pinker’s article. I expected two things: an explanation that science is one valid path to knowledge with wide applicability, so simply applying science is not the same as scientism; and an acknowledgment that other disciplines have made significant contributions to human well-being, and therefore we should not pretend to be all-encompassing.

He’s committing the fallacy of progress and scientism. There is no denying that we have better knowledge of science and engineering now, but that does not mean that we’re universally better, smarter, wiser, and more informed about everything. What I know would be utterly useless to a native hunter in New Guinea, or to an 18th century philosopher; it’s useful within a specific context, in a narrow subdomain of a 21st technological society. I think Pinker’s fantasy is not one of informing a knowledgeable person, but of imposing the imagined authority of a modern science on someone from a less technologically advanced culture.

Oh, fucking nonsense. Humanities scholars are just as interested in making new discoveries as evolutionary psychologists, and are just as enthusiastic about pursuing ideas. What I’ve seen is that university presidents and provosts are typically completely clueless about what scholars do — does anyone really believe Larry Summers had the slightest appreciation of the virtues of knowledge? — so it’s bizarre in the first place to cite the opinions of our administrative bureaucrats. What this anecdote actually translates to is that a scientist stops by with an idea that needs funding that will lead to big grants and possible patent opportunities, and president’s brain goes KA-CHING; humanities scholar stops by with a great insight about French Impressionism or the history of the Spanish Civil War, asks for travel funds (or more likely, pennies for paper and ink), and president’s brain fizzles and can’t figure out how this will bring in a million dollar NIH grant, so what good is it? Why can’t this deadwood get with it and do something with cancer genes or clinical trials?

Heart, soul, poetry, beauty are not grist for the analytical mill of science, but they really are the core, and if you don’t appreciate that, the breadth of your education is lacking.

#archive Dangerous Ideas : Productivity is overrated

4 08 2013

Been getting a couple of wake up calls. Cal Newport cautions about being a productivity tips junkie here and reminds readers to focus of intensity.

Spoiler warning

The key to really getting ahead has nothing to do with productivity. From my experience with successful young people (and, as I writer, I have quite a bit of exposure to this crowd) what you need, put simply, is a drive to keep working, with a laser-like intensity, on something even after you’ve lost immediate interest. Tenacity. A grating thirst to get it done. These are the precursors of accomplishment.

Having good productivity habits compliment this crucial skill. They take this intensity and place it in a schedule. They keep small things from crowding your mind. They eliminate the stress of what appointment you might be forgetting or what vital errand has to be done. But productivity is not a substitute for this work.

This is a mistake I sometimes intuit is being made by young people with an interest in this community. There is a belief that if you get just the right system, with just the right calendar technology, and to-do notebook, and task management philosophy, accomplishment will come automatically. You can just turn the system on and watch it churn out what needs to get done.

#archive George Saunder’s Graduation Speech

4 08 2013

Don’t read further if you don’t want the spoiler. I thought of using the blog/tagging format to keep track of the important stuff I read. You can read the full article here.

Each of us is born with a series of built-in confusions that are probably somehow Darwinian. These are: (1) we’re central to the universe (that is, our personal story is the main and most interesting story, the only story, really); (2) we’re separate from the universe (there’s US and then, out there, all that other junk – dogs and swing-sets, and the State of Nebraska and low-hanging clouds and, you know, other people), and (3) we’re permanent (death is real, o.k., sure – for you, but not for me).

Now, we don’t really believe these things – intellectually we know better – but we believe them viscerally, and live by them, and they cause us to prioritize our own needs over the needs of others, even though what we really want, in our hearts, is to be less selfish, more aware of what’s actually happening in the present moment, more open, and more loving.

Happy Nurses Day and a bit about Nightingale

31 07 2013

The week long celebration started on Monday. I haven’t been to the hospital the entire week, so I’m not entirely sure what is going on there nor have I been able to have a heart to heart talk with my nursing friends and colleagues.

I noticed, when I was in India, that they celebrate theirs on the 20th of May which is the birthday of Florence Nightingale. Although we grew up with the image of her as a self-sacrificial figure in the care of fallen soldiers, she was much more than that.

As an educated, empowered woman, she is, to an extent a feminist symbol for rejecting the suffocating expectations placed on an upper-class woman to be a baby-making machine. Instead, she decided to be a nurse, against the wishes of her her family. She was also known to travel widely and work with politicians, write extensively and do big-picture planning.

It is also easy to forget her role as a pioneer of the hospital  as a well organised system. Her experience in the Crimean War showed that many soldiers were dying from diseases apart from the battle injuries. She seems, from my reading of her Wikipedia entry, to be an early adopter of some sort of Evidence Based Medicine. Which, to put simply, is the use of scientific methods to understand if your treatment is working and to tease out the risks of it. Her background in statistics probably helped and she actually compiled data on her patients as opposed to basing her ideas on “experience”. The patterns she observed from this eventually led her to place great emphasis on sanitation.

The next time the ward sister reminds you the clean your hands in the MRSA ward, it’s Florence Nightingale speaking through her 😉

On a more personal note, although Nurses play a great variety of roles, my experience of them has largely been as “guardians”. Watching our backs, administering treatment, actually caring for patients, apart from merely treating them. Often, they take the brunt of the aggression from angry patients.

As a friend of mine often points out, I do wonder if they are under-appreciated by physicians, although there have been a lot of hints that the system could do better in taking care of them. Perhaps it is time to reconsider how nurses are remunerated? Maybe there is a need to clearly define, or perhaps redefine nursing? I do not know what the future holds and I don’t have immediate ideas. Nonetheless, I am greatly indebted to those nurses I have had to privilege to work with, both personally and professionally.

Happy Nurses Day!


And here is a picture of Nurses going on strike in Singapore in the 60s. It is still on the wall at SGH, I think 😛 Not that I am encouraging you to go on strike (we will all die), just that I have faith in the community to be resourceful and make bold reforms.

Nurses on Strike!