Dr Chan 日記

I have not updated this blog for really a long while.... 'cause I really get myself stucked into very busy works.
Have done 1 presentation, on a very small and interesting girl presented with failure to thrive, polyuria and polydipsia. She is diagnosed to have Bartter syndrome as evidenced by polyuria and polydipsia with increased Potassium loss and calcium loss in urine and hypokalaemic, hypochloriaemic metabolic alkalosis, hyperreninaemia, normal blood pressure and nephrocalcinosis. After treatment of Indomethacin, her condition improved. The failure to thrive and developmental delay improved.
Also busy with the medical record and reports, I have left that over for quite some time and I need to complete it ASAP! May be apart from Busy, I am also lazy!

It's July now, it's time to farewell to some of my colleagues. It's a difficult time for the department and it's a difficult time for me too. I feel sorry for them as they leave us because of the manpower policy.
During the past 1 month, I really see a lot of unfair things. The colleagues whom work so hard for the department in the past, did not warrants any words of praise when they leave. I can't accept that.... but it does happened!

I always welcome discussion, I believe that through constructive discussion, we could arrive at a meaningful and mutually agreed decision. I don't know why there was person that dislike discussion and always think everything in her own way. Every now and then, we would encountered persons whom had so many complicated problems and multi-disciplinary approach is the best services for them. To me, seeing them in a multi-disciplinary clinic is providing the best of our care and yet saving time in communicating among different therapist and also saving time for the child.
Yesterday, having asked by my senior for such arrangement on the care of a child. First of all, I think they should have better communication among the senior before asking the junior about the plan. Usually the management plan is formulated by the senior and not the junior in charge. Secondly, the child do have the problem involving different therapist and is a very complicated case.
The booking had been made already, if the quene is too long for that particular clinic, please cut the quota rather than asking the junior to justify their referral. Afterall, there was no well known referral criteria told to the junior that what cases would not benefit from such referral and please not to refer. If the senior's workload is too heavy, then please cut down the quota rather than open it and then turn down the referral by whatever means.
I am not meant to challenge them, in fact, I appreciate their service. That's why I think the child could be benefit from them before the referral. However, I was disappointed this time.......
So at last, I will cancel the appointment!

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Today, received an email from one of my best friends. She send me this nice flash movie and it really great! She is a nice girl with a special kind of charm, and her temper is so special too! Really thinking of whether she had found her true love or not. Personally, I wish she could soon find her way through her difficult time and really could have a very happy future with the one who really cares about her and who really love her.

Yesterday went out for my family gathering again, the weather is so hot. We nearly killed by the bright sunshine. Forget to bring any sun blocker... Just went to take some photos with all of them, it's so good to have such gathering with them.
Somehow, went back home very late last night and only could sleep for a little bit only. Today, of course is a busy day for me. Need to have the ward round, the out patient clinic and then ward round again. Initially plan to go out with my friend, however, I am so tired. I can't have enough power today. Just like a bunny without the battery?!
We quarrel again as she expect me to go out for a movie, then of course, everything become a mess and I felt unhappy with that. However, I don't think I do anything wrong, I never told that I would like to have this kind of activity today and I waw really tired. So I slept and just wake up! Hope tomorrow would be a nice day!

Heard of something bad from the un-official channels, there had been some unhappiness in the nursing staff recently. They were quite angry with the things that happened last week during the department meeting.
There had been 2 recent events of delay in carring out orders by the nursing staff. Their senior were asked about the matter and of course, they were then being blamed by their senior and they were so upset about it! To be frank and fair, I think it's a matter had happened or not, if it did, then it's their fault that they couldn't denied. Moreover, the main thing about the whole incident was that, the nursing staff didn't realised their fault and the reason for the delay was because they were too busy for the whole day!
I don't know why they kept saying that they were too busy to do all the things despites the thing that it was not the real situation. Of course, if it's only a single incident, I don't think we would like to report anything. Furthermore, to discuss this matter in the department meeting is because we, doctor, would like to know whether there is any particular reason why they couldn't follow the order/carry out the order promptly. If we know the reason, we would try our best to solve it. It's unreasonable to let the problem went on and on without doing anything about it. Giving too many excuses (or the same excuses over and over again) don't solve the problem. We need to face the problem more positively before we could improve our practice.

Since one of my colleagues is taking his sick leave, I was urgently called to attended the Out-patient Clinic for him. Hope he will soon get better.
The diagnosis of the PUO girl is still unknown, it's likely to be rheumatological cause. However, further testings are still in progress for the exact diagnosis. She was seen by the Professor in the University
Hospital and there was appearance of Malar rash. Repeated bone marrow examination seems to have ruled out for malignancy. The Autoimmune markers were repeated and all the markers were negative. The Anti-ds DNA were not raised. One particular interesting thing is that her ANA pattern was quite special and the ANA test was now sent to Australia for further testing. She was started on oral systemic steroid therapy and fever subsided. She will be back to us this month for follow up clinic in the rheumatology clinic. By that time, I hope there may be some break through in her exact diangosis.
There was recently a number of child abuse cases in our ward. Some of the kids are ok but some are very naughty. Almost most of the time, I found that the kid are naughty and the parents were giving physical punishment to them. Sometimes, the parents loss their temper and beat the child for 1-2 stroke with cane/hand only. However, due to the presence of physical signs (even very mild one), child abuse conference was held and ended with the outcome of 'high risk of child abuse'. I don't know whether it's reasonable or not, we seems to over use our power to activate this mechanism in this way. For those having multiple bruises, severe injuried cases, I have no reservation to make the diagnosis of Abuse, but for these 'grey' cases, I have some reservation.
May be this is due to my past experience. When I was young, some degree of physical punishment is still accepted. Even the school use physical punishment to teach those naughty students to behave. But things had changed with times, I understand from the current point of view that any way of physical punishment is not allowed. That's why we had so many child abuse cases. I personally think that if a very detailed enquiry to the kids were made in the local population, most of the kids would reported that they had been physically punished before. Then, child abuse would be suspected from every single kid.
Afterall, we could not catered for child abuse conference and social investigation on all the kids. I do believe that there was very caring parents whom never beat their children in their lifetime.