Tuesday 17 February 2015

Govt postpones separation of drug prescribing, dispensing | theSundaily

Read More »

Monday 16 February 2015

Separate dispensary irrelevant

Read More »

Sunday 15 February 2015

Pharmacies to dispense medicine?

http://www.thestar.com.my/News/Nation/2015/02/15/Pharmacies-to-dispense-medicines-if-proposal-accepted/

"Instead of getting their medicine from private clinics, patients will have to obtain it from pharmacies if the Health Ministry accepts the proposed “Doc­tors diagnose, pharmacists dispense” system."

 The debate has been going on for quite some time. Should pharmacists who have arguably more knowledge and skills in various aspects of pharmacology, be given the sole right to dispense medication to patients?

In my opinion, if the proposed “Doc­tors diagnose, pharmacists dispense” system is implemented, there will be some immediate foreseeable changes to the country's medical system.

1. Medications will be available to the public at a cheaper cost.
How much cheaper? No idea, as this cannot be accurately predicted. With the introduction of the system, thousands of pharmacy stores will begin to mushroom across Malaysia, and its either stiff competition driving the prices of medication down even further, or the sudden surge of demand for medication driving the prices up. But it is known that private GPs tend to charge patients more for the medication alone, so the introduction of the system should make medicines more affordable.

2. On the other hand, consultation fees from your local clinic GP will go up!
In the current system, local GPs earn by charging consultation fees AND selling medications. The profit earned from selling medicine can account for up to half of the doctor's income. If the new system is implemented, do you think that private GPs all over malaysia will sit back and enjoy their paycut? Definitely not. Whine all you want my poor patients, complain to the government, write letters to the newspaper, I have loans to pay, mouths to feed, says the private clinic doctor.

3. "Some" inconvenience to the patient
If there is a pharmacy located just next to the clinic, wonderful! Patients will have no trouble walking a few extra steps to obtain the medication.
If the nearest pharmacy is situated across a busy street, yeah there may be some inconvenience, but should be still alright.
In the setting of a rural area, where there are only one or two private clinics and one or two pharmacies, the distance between the clinic and the pharmacy can be quite far, and patients will have to drive from one place to another to obtain medicine.
That being said, under the new system, doctors and pharmacists will be forced to partner up and open their business close to if not next to each other. Those who choose to go solo, doctors or pharmacists alike, risk losing potential customers in the long run.

4. Full potential of pharmacists goes untapped
In an ideal situation, doctors and pharmacists work as a team. Doctors prescribe and pharmacists counter check by reviewing the entire medication record for interactions, drugs with duplicating effects, advise patients on side effects of the various medication, answer patients' questions regarding the drugs, and advise doctors on choices of medication depending on their cost and potency.
However, reality the way I see it is that if the new system is introduced abruptly, doctors and pharmacists who own separate business will work independently with little communication and teamwork.
Pharmacists cannot check for drug interactions even if they want to because they do not have the patient's medication records and history in hand.
How many pharmacists would pick up the phone and asks the doctor for a change in prescription because there is a cheaper drug in the market with the same effect? Will the doctor feel insulted if he/she is "questioned" regarding his/her choice of drug?
And how many pharmacists would be ready to share the legal burden with the doctors if problem arises such as a dangerous side effect of a drug goes unexplained to the patient?

My point is that if there is no close team work between doctors and pharmacists, any true benefits of the new system will be hard to achieve, and instead we will be getting a lot pointing fingers, frustration, and distrust across both groups of medical professionals.


Read More »

Friday 13 February 2015

Bones (part 1): Playing with the cells


Osteoblasts: synthesise bone matrix
                    mineralise bone

Osteocytes: osteoblasts that become trapped in the matrix they produced.

Osteoclasts: play a role in bone resorption





Bone matrix: consist of proteins (mainly collagen) and mineral

Osteoid: Unmineralized bone matrix (consist of collagen and other proteins)

Organic matrix/organic part of the bone matrix: same as osteoid, just another way of saying it's unmineralised

Hydroxyapatite: The mineral that is added to the organic matrix to form calcified/mineralised bone.  Ca₁₀(PO₄)₆(OH)₂



Calcitonin inhibits osteoclasts activity directly, thus reduces bone resorption.

Parathyroid hormone and 1,25 dihydroxycholecalciferol stimulates osteoclastogenesis indirectly by binding to osteoblasts and increases expression of RANKL which in turn stimulates formation of new osteoclasts.





Wolff's law: Bone remodels along lines of mechanical stress, becoming stronger or weaker where mechanical demand is more or less.

Piezoelectric effect: Mechanical energy is converted to electrical energy (voltage gradient) which stimulates osteoblastic activity






Reference:
1. OMG who cares.... www.wikipedia.com
2. Orthopedic principles, David IP
3. The effect of vitamin D on osteoblasts and osteoclasts, Ikeda Kyoji, 1999
4. Can I just skip this part? This ain't a scientific article and I am just too lazy....
Read More »

Wednesday 11 February 2015

An absolute newbie's experiment with drawing

Houseman: "Pheww......Thank God you don't play hard to get!"

Alright, I know it's downright ugly. And really it's kinda embarassing to post this, but here you go, my first drawing since primary school when I played with crayons.

The picture was drawn in my ipad air, using the app "Tayasui sketches".


I put my left hand on the table to act as a template and attempt to draw on the tablet with my right. Needless to say, even after countless of undos, I can't seem to get the drawing right.....
Hopefully next time when I draw something, it will be much better than THIS! lol...
Read More »

Monday 26 January 2015

Passion to become a doctor???

(Like the previous post, this is also imported from facebook)


Warren Buffett, world's second richest man, gave a talk to students of Nebraska in 1997.The topic is on how to stay out of debts. In the middle of the talk, during a short question and answer session, a young female student was given the microphone. She cheerfully asked the big boss: "How would you advise people who aren't necessarily going into a career field which you will make a large-base salary, like in medicine? How about people who do arts and those who perform music? How can they keep up with the rest of the world financially?"

The billionaire said:
"It is true, that the market system does not pay as well in some activities as it would seem appropriate for the importance of those activities to society. Take teaching for example. Teaching does not pay well, but what could be more important?

A big part of one's career selection often boils down to 2 factors- money and passion. If you are fortunate to have found the job that you love and making big bucks out of it, great. But what if u can't have both? Would you trade a job that you enjoy much but with average wages, for an uncomfortable life at the kind of work that pays lucratively and one which promises a comfortable retirement?

Lets apply this to the field of medicine.
Doctor A is a passionate junior doctor who loves interacting and treating sick patients. He obtains great satisfaction in his work. However, because of the long years in medical school, he has fallen behind in wealth accumulation compared to his friends in other fields of work. He has a debt of hundreds of thousands in school loan. His income is at best, average, considering the 70-80 long hours per week of hard work. He cannot find a secondary income because he comes home feeling very tired after work. Still, he is a happy man. That is before the monthly house and car mortgage kicks in, and his marriage has given him his first baby. He starts saving a lot of money for his child education and retirement plans, cutting off expenses here and there. Somewhere along the line, deep down inside he starts thinking: "I am a highly-educated professional. I work extremely hard, harder than any of my colleagues in the hospital. Yet here I am living a life of frugality by force and wondering if I can send my kids to a nice college (medical school??) later in life. Could I have chosen a different path? Surely with my talents and hardworking, I could have succeeded in other more financially rewarding careers, making 10 times more than what I am earning now."

Doctor B is a young doctor who has a lot of passion - for money. As for patients, he is just fed-up seeing them day in and day out. Before entering medical school, he is fairly certain that doctors are well paid and their jobs are stable. But now, he thinks differently. "I have a specialist who breathes down my neck every morning, patients who are unappreciative towards the service i provide to them, potential medicolegal lawsuits hanging in the air with lawyers waiting to put me in jail or bankrupt me with the slightest mistakes i make. I have to deal with faeces, blood, drug addicts, anxious relatives who ask me a thousand questions, and sick faces of patients which surround the entire hospital." Doctor B continues to work hard in the environment he dislikes, migrating to other country where healthcare workers are paid more handsomely, force himself to further study, specializing in the field of anaesthesia which he makes minimal patient contact but with a higher salary. He now makes 80000 dollars a month, and wonders how soon retirement is going to come.

Continuing Warren Buffet's speech and answer to the student's question:
"Generally it pays to go with something you love. It's very difficult to find somebody my age who said that they love what they are doing their entire life, but feel terribly sad they made that choice, because they didn't make a lot of money."
"One does not necessarily have to make a lot of money to enjoy themselves. I enjoy myself when i had 10000 dollars. I live in the same house i bought 41years ago when i had 10000 dollars. I like the house then, i like the house now."

It is true that a doctor's work can be tough and challenging, financially unrewarding if being
compared with other professionals like lawyers and accountants. But if such comparisons are not made, and one lowers their expectation of monetary return, a doctor can be happy at work, doing their childhood dream job, as well as doing reasonably well financially.

Conversely, an unhappy doctor at work who feels that he is "stuck" in the world of medicine needs to open up his mind. The only place that a person can get stuck is on the thought that studying medicine and becoming a doctor means there is no turning back, and a late realization that being a doctor is just not my thing means that nothing can be done other than continue down the path that he or she had once chosen. Learn to diversify into other field of work such as writing a book, starting a small side business instead of spending time specializing in something that has no interest to the person other than making money. Persistence and effort poured into other trades may turn them from being a secondary income to a primary income, and goes a long way if one's aim is to ultimately quit being an unhappy doctor, show the mean, bullying consultant the middle finger and kiss good bye to patients, wishing them good health and speed recovery.

Quoting from a popular book "Your money or your life", if someone points a gun at you and says "You want your money or your life?", calmly tell the gunman "If possible I would like both thank you very much". (Just a fancy sentence, in real life situation of course give him all your money la)

By the way, I have a younger brother who is 16 years old, and he has no idea what he wants to make of a future career.
"Something not so stressful, something i like doing and something that gives me adequate income." He said, and I smiled.

(imported from facebook)




Read More »

House hunting experience

(Ok, this is imported from notes I wrote in facebook. Due to the fact that it was written just last week in this pre-working holiday period, I decided to post it here as well)



House-hunting began when I received news of the location of my housemanship posting. Remaining physically in Perak while searching for a house to live in Kuching has proven to be tough and challenging.Although there was help from various friends living in Kuching, most of the searches were done online. Browsing through property websites and skimming through classiified ads, one can get quickly confused about the definition of an ideal home.

1. "Must be near hospital, cannot be too far. House must be, haha, cheap la, just started working where got money oh. But basic things like furnitures, fridge, washing machine must have la. Building preferably new one, old property later got problem headache also. Since there are 5 of us, the porch in front of the house must be able to park 4-5 cars......."

I believe that people looking for houses to rent like me and you, freshly started looking with a certain picture in mind, a level of standard and expectations to be met. Unfortunately, most will be quickly disappointed by the difficulty of searching for fantastic deals in the property market. Houses that are clean, newly renovated with the smell of fresh paint and fully furnished are often managed by investors who enjoy cash in their pocket every month. Houses that look a bit dirty, worn-down, unfurnished or partially furnished are often managed by people who doesn't have time to deal with the house and would like to be rid of the problem of vacancy thus willing to compromise rental rates. Don't get me wrong, great deals are out there, just that it takes time and a bit of luck to find. Otherwise, like a pack of wolves on a small piece of delicious meat, other people will most probably have taken the deal already.

Judging from what I have learnt so far, if you need a house, do your research and choose one. Don't be the guy who sits on the fence and watch as the parade goes by, or the picky guy who is searching for his perfect wife forever.

2. Ever been to the section of the supermarket where they sell biscuit and cookies, and as you push the shopping trolley and take a stroll down the lane, you wonder which cookie or biscuit that you have never eaten before will taste good? And how to judge which cookies to buy? Yes, we will consider the wrapping first, whether there is a box, whether it is wrapped by some attractive, high-quality, recyclable paper rather than the noobish-looking plastic wrapping. Next, we see the picture on the wrapping, if the drawings make our saliva drool. Then we see the price of the cookie. If the price is fair or expensive, probably it's worth it. If it's cheap then probably it's garbage. Yes, i don't know about you readers, but I myself do that ALL the time.

Browsing through the net, looking at those house-for-rent ads, I saw many of the advertisers put up photos showing the interior and exterior of the house. Looking at some of those photos, I told myself: "Hey, the house looks really clean, neat and new. I can live inside one like that." It happened so that there was one double-storey house which is located really near the hospital that me and my friends are going to work. Price is affordable. But the advertisement of the house does not come with pictures showing the interior of the house. So, i enquired the help of my friend living in Kuching who also happens to be a professional house inspector. In he went, interviewing the house owner and the tenants who currently still live there, taking pictures with his phone. And my gosh, the pictures that were shown to us are terrible. The living room has cans of opened soft drinks scattered all over. The kitchen under low lighting appears dark and gloomy. The backyard shows untrimmed tall grasses. The bedrooms are messy and the toilet seat looks absolutely awesome. After some pressure from the house owner for answers, the house was quickly rejected.

But, if the house were to be vacant. The owner would have hired a maid to clean the entire house. Photos posted online would show sparkling clean kitchen under good lighting. Bedrooms will be tidy with beds made up neatly. Emphasis will be on the brand new toilet seat, zoomed in to hide the ugly water markings on the wall surrounding it. Photo of the living room would been taken at an angle that shows both the tv-set and the air-con. The backyard photo will be gone missing.

In the end, a house for sold or rent is just another product that requires packaging. It is also important to have ourselves or a person representing us to have a look at the house before any decision is made. Then, emphasis will be on the flaws instead of only the shiny, sparkling part.

We humans packaged ourselves as well many a times. Ever seen a guy driving to school with his brand new car even though he lives literally just beside, and because the weather is absolutely hot that he can't walk or cycle for 3 minutes? Ever seen a guy macho-ing up in front of a girl he admires even though he is just a small kid inside. It's natural for us to try and hide as many of our flaws as we can and socially blend in, but the packaging itself should not change our identity. A doctor who only earns 7000 ringgit a month need not struggle financially to drive BMWs and live in high-class residential areas.

Well that's it for now. Back to house-hunting.

(Imported from facebook)


Read More »