Saturday, 2 June 2007

Busy, Busy Busy

This week has seen Dr Aoki begin his lectures for the new first year doctors. Many of the junior doctors turned up with their copy of Dr Aoki's book and he was happy to answer questions for the residents during and following the lecture.

Here are some photos below:

This week also saw me invited to conduct Bedside Teaching Rounds in the ER department. The residents, myself and Dr O. saw a great case that turned out to be a different diagnosis to what I had initially expected and putting together the history, physical examination and laboratory data provided the clues to the probable diagnosis.

I will therefore be teaching in both General Internal Medicine and Emergency Medicine in the foreseeable future.

I have also had my Kyorin medical student shadow me for the last 3 weeks and I think his eyes have been opened as to how a good history and physical examination are sometimes better than machines ! :)

I have noticed both from medical students and junior doctors that their knowledge of drugs including generic names, mode of action, side effects and interactions are not as good as they should be. This is a very important part of being a practising physician and although, as i am informed, it is not an important part for passing the final examination, it is however important for treating patients safely and effectively.

For example, in a recent case, a patient was admitted after overdosing on anti-epileptic agents, neuroleptic agents and tricyclic anti-depressants. After checking the drug interactions, which had not been done, we found that the combination proved to be a potentially lethal cocktail which could induce a Long QT interval and hence, Torsade de Pointes. After reviewing the ECG it indeed showed a prolonged QT of 458 msec !!!!! Hence, if the patient had developed a tachyarrhythmia or VF, the therapy would have been Magnesium rather than other anti-arrhythmic drugs which is a very important point.

Unfortunately, there is no guarantee that the previous physicians checked about the interactions of these drugs which brings me back to the emphasis on the proper education of pharmacology.

It is very, very important to know details about drugs and especially about Generic names and junior doctors by just re-writing the drugs on admission to hospital or on discharge without knowing why they were prescribed or checking side-effects / interactions is not sufficient and this needs to change.

There are some very good British and American pharmacology textbooks and I would strongly suggests that medical students and junior doctors obtain such reading material to improve upon where they may have deficiencies in their knowledge on pharmacology.

Next week sees the Famous Professor Stein visit from the USA and it should be a very busy week for me again and most enjoyable too!!

Have a great weekend.