Dr Chan 日記

Having checked my tons of E-Mails... Came across a number of E-Mails of my colleagues.... Unhappy to find out that there were much unhappiness on the on-call list. There was actually a number of controversy among the junior staff on the number of calls that were assigned to each individual each month. There was actually clear guideline on the arrangement of duty as set out before. But I was disappointed enough to find that there are a lots of '?' on the call list as brought out by others.
The number of calls among the same level was not the same, and even worse, it's not fair. Those taking long leave have more calls than those taking short leave. It's seems that there were some doctors whom usually could enjoyed the fewer on-call roster than the others.
Even worse is that, there was no formal call score that we could referring to..... Everything seems to be in the mind of our senior whom definitely would said that the call system is fair to everyone of different ranking. Due to that reason, no body would like to cover the duty of the others while the other was sick as there will be no reward for such 'sincere' act. Even worse is that, the department allow such condition to happen without thinking of any contingency plan, such as letting the senior to step down to cover the on-call duty of the junior.
I am very unhappy to find such things to happen. If there still have no solution, I am worrying that there might be a bad atmosphere among the junior staff that will make the condition worse enough to have everyone trying to escape from their on-call duty!?!?

Over a period of time, I have been annoyed by the working logistics of our new department. Everyone in the department seems to be some 'lazy'. I know that may be I have gone too far in criticising the others. There had been various occasions that I encountered diagnostic difficulties and planned to seek the expert advice from the team head. Most of the time, I didn't get very satisfactory solution despites he/she had the ultimate responsibility for making the decision on the management plan.
May be I have too much expectation on my team head and so I have such bad experiences. If I tried to lower my expectation a little bit, may be everything will be doing alright.
For example, I would like to ask for a more concrete plan on the management of a girl with PUO. During the past few days, my team head went for the annual leave and before the leave, nothing new was given on the management plan while the time when he/she is away. And as a contingency, there was another team head that will 'lead' the team, but I don't think there would be much changes. He/she just asked about the previous management plan and was disappointed to find that there was none (the team heads should have better communication among themselves). Then as there was no definitive management plan, then he/she will not going to formulate one at this time and would like to wait and see......
So, it seems that 'WAIT and SEE' is the norm of my department now...........
I am so unhappy about all these............

I just like a little boy in a small boat.......... in a big big sea... don't know where I am and don't know how to do......
Over the past 1 week, I have great problem in managing a girl with PUO. She presented with prolonged fever for 20 days with the symptoms of sore throat and multiple tender cervical lymphadenopathy for 1 week followed by skin rash of limbs and trunk. She was given antibiotics of Unasyn for 10 days since Day 7 of her illness. There was no other symptoms of cough, runny nose, nausea, vomiting nor diarrhoea. There was no history of travel and there was no history of insect bite and she did not kept any pets at home. There was no history of recent weight loss and there was no family history of autoimmune disease, tuberculosis.
Physical examination showed multiple small non-tender cervical lymph nodes with generalised maculopapular rash over the body with prominent involvement over the distal part of the limbs. There was no hepatosplenomegaly.
Investigations results showed there was persistent leukopenia with the lowest white cell counts of 1.5 x 10^9/l. L/RFT were normal with moderate increase in LDH to 538. Microbiological investigations showed no growth on blood culture, negative malarial screen, Widal test, Weil-felix test, Mantoux test. Rubella IgM, Measles IgM, EBV IgM, Dengue fever IgM were all -ve. Autoimmune markers of ANA was -ve and the C3 and C4 level were normal. Inital CRP was normal 9.9 and subsequent CRP raised to 16. ESR was 35 on admission and raised to the latest of 50 today.
She had been given 7-day-course of iv cefotaxime without apparent response.
I have run into diagnostic difficulty and requested for skin biopsy, lymph node biopsy and bone marrow examination. I feel particular annoyed when I found that there was not much helpful input from my senior. Anyway, I continue with my discussion among our junior collegues and I start to look up the possible causes through the medline search. I found that there was an uncommon condition that may involve South East Asia girl with skin rash, fever, leukopenia and cervical lymphadenopathy and the diagnosis may rely on the skin biopsy that will be scheduled tomorrow. I hope this may help in making the correct diagnosis so as to alleviate my stress in my work.....
Hope everything would be fine and hope the girl will be able to recover soon......

This blog is for sharing of my everyday work including living and working. Particularly I would put down some of the interesting/difficult cases. This is also a place of sharing of my happiness and unhappiness during my working time......