Friday, September 29, 2006


At first:

"Phew, I've passed my SSM(Special Study Module)...No need to stay back next summer. Thank you Lord."

Next minute:

"Walau, Alex and Hsupheen got distinction ar...#$@%^&*"
Plus, like I was telling hsupheen, can't even blame different tutors cos we were under the same tutor.

Goes to show how subjective emotions can be. And how superficial I can get sometimes; a side of me I don't show as much as possible.

*btw, nice work alex, hsupheen and whoever else who got top marks. No hard feelings ya?* :-)

Thursday, September 28, 2006

For what is in the light....

Disclaimer: This post is not anti-establishment or anti-authority in any way. It merely reflects the author's views and personal journey of discovery. He may not know enough or know any better, preferring those who read to form their own conclusions. Also, non-medics are advised not to read this unless they want to be extremely bored.

This post will probably make sense more to the medics, but I posted it because its a sort of revelation to me how things happen behind the scenes in the 'system' in the UK. Recently the small surgery in the community I go to brought up some interesting issues. Most of the GP visits have been good fun so far, with my only regret being I wasn't at another practice when a certain celebrity visited.

Anyway, my GP asked me to look up results of a trial called ASCOT, which basically compares medicines for treating high blood pressure, which is pretty common in the community. The results of this trial was supposed to be groundbreaking(jargon coming up). Results showed ACE inhibitors and calcium channel blockers were more effective in the treatment of hypertension (high BP) than the traditional treatment of beta blockers and diuretics. Being a typical student who doesn't look up trials and journals for 'self-development' often, I had no idea where to look. What I did find out, was interesting though. To cut a long story short:

- ASCOT was considered so groundbreaking it influenced the British Hypertension Society and NICE (National Institue of Health and Clinical Excellence) to change their guidelines.

- Soon the entire country will experience a change in the drugs given to treat hypertension due to the change in guidelines mentioned above.

- However an increasing number of doctors are concerned about the validity of ASCOT, as large and as effective as it sounds.

- A search of letters in BMJ showed doctors from all over the country writing in to say:
- ASCOT's primary outcome was statistically insignificant and most of its successes were in
achieving its secondary outcomes.
- Failure to achieve primary outcomes would constitute a Type 1 error which would make any trial irrelevant.
- The treatment regimens in ASCOT compared an established regimen (amlodipine) with a
underpowered regimen of atenolol, which could potentially mean the trial was skewed from
the outset.
- If anyone is so inclined, you check the various feedback here if you enter BMJ via your uni's
Athens code.

Bottom line? even though I am not a fan of looking for problems when there are none, and creating controversy out of molehills, I think I've seen enough to understand why evidence-based medicine is both necessary and yet so dangerous when wrongly manipulated. Consider this maybe hypothetical situation:

NHS is in the unenviable position of having to govern the medical profession in the UK and having to promote and encourage drug research as well. In between keeping both happy, compromises have to be made, sometimes at the cost of the public. Say due to the results of trial A sponsored by drug company X, reception by the public is great. Suddenly everyone who has that illness wants to be on drug A. New guidelines are drawn up to accomodate drug A while people request that their treatment be changed to include drug A. What people do not realise is that these results, while looking good in the news, may not necessarily hold water under critical analysis. And while changing people to drug A may not cause any unwanted side effects (even if real evidence shows that actual benefit is negligible), people forget the cost involved.

Case in point: Cervical ca screening guidelines changed from 5 yearly to 3 yearly.

Surely more money involved rite? But is it cost effective? To get an idea, listen to the question as proposed by a article:

"Suppose you are faced with the decision about investing GBP 385,000 annually to benefit your local population. You can prevent one death every 22 years by routine 5 yearly screening beyond age 50, one death a year and harm an extra 1,000* by switching to 3 yearly screening under 50,


10 deaths a year through support that helps smokers stop, and have enough spare to provide first rate nursing care and family support at home for 183 patients facing death from cancer.

Which would you choose?"

*by false positive diagnosis

Which means, hypothetically, NHS are going to lose even more money and the public are not going to get healthier, and docs are not going to get paid more, rather the reverse. Which has implications for those of us wanting to stay back.

Haha I sound like a bitter old cynic now.

Guess the whole point (wow if you're still reading you must really be into this. *pat on the back!*) of this is, the realisation never to take anything at face value, no matter how amazing the news sounds, and how credible the source may sound. And the need to really start keeping myself up to date on these things..cos patients know so much more than us its scary.

Tuesday, September 26, 2006

"These people come near to me with their mouth and honor me with their lips, but their hearts are far from me. Their worship of me is made up only of rules taught by men." Isaiah 29:13

"...In repentance and rest is your salvation, in quietness and trust is your strength, but you would have none of it. You said, 'No we will flee on horses,..' " Isa 30:15,16

"Woe to those who go down to Egypt for help, who rely on horses, who trust in the multitude of their chariots and in the great strength of their horsemen, but do not look to the Holy One of Israel, or seek help from the Lord." Isa 31:1

"For the sake of Jacob my servant, of Israel my chosen, I summon you by name and bestow on you a title of honour, though you do not acknowledge me." Isa 45:4

"Even to your old age and gray hairs, I am he, I am he who will sustain you. I have made you and I will carry you; I will sustain you and I will rescue you." Isa 46:4

Monday, September 25, 2006

The Importance Of Barrow

What's to stop countries from launching nuclear missiles at each other? Why, the knowledge that retaliation would occur swiftly and surely in the form of nuclear missiles aimed right back at them.

And why is Barrow involved in all of this? Barrow the 'ulu' place that people fear being thrown into for a year, the place where people excape from on weekends in lieu of bigger cities, where you can see sheep from your window; this small quiet town is actually, the base of Vickers Shipbuilding and Engineering Limited. This company manufactured 4 Vanguard-class nuclear-powered ballistic submarines, which are, at the moment, the United Kingdom's ONLY nuclear deterrent. For the military buffs, read about it here.

So do not mock Barrow. Especially since got ASDA and Tesco and plenty of bookstores.

Saturday, September 23, 2006

The zoo

A nice hot day for a walk to the zoo..Just to give you guys an idea of Barrow countryside. This is a view of the small village of Dalton.

Arrived but minus friends, so settled down to wait. Got bored so started snapping. These flowers were at the entrance.

Car park looks nice and full.

Finally they arrived. From left to right, Ed, Tom, Alice(hidden behind Jay) and Hsupheen. This is when we saw:

Not the most reassuring sign to start with. Somehow we began to think that there was some kind of discrimination going on too:

Anyway, most of the animal photos can be viewed here. The highlight of the trip was seeing the tiger feeding session where they put huge chunks of meat on top of poles about 2 stories tall. The idea is to get the tigers working for their food so they won't be fat pussycats who sit around waiting for their dinner.

The downside was, seeing the giraffes. All seemed well at first, until one of the 3 giraffes present began to spread its legs. I kid you not. And started to wee. That was ok in itself...when you've got to go, you've got to go, no matter how many people are watching you. But what was even worse was that the neighbouring giraffe, for some reason known only to itself, began to duck under the weeing giraffe and lick its wee.

That was not the worst, by any means. What was worse was directly after that, feeding time came around:

If only they knew. And even though she saw the whole thing, someone just couldnt resist:

All the while I was trying to avoid the animal and stay within camera distance.

After that Ed was on animal touching mode too. But all too soon, it was time to leave. (Actually we had to do groceries) But before leaving, one more shot.

South Lakes Animal Park: Well worth a visit. Just remember to bring a Asda receipt when you come, cos for some reason that gets you GBP 5 off the price.

Friday, September 22, 2006

Just came back from playing pool at the docs mess in hospital where we were joined by this paediatric SHO from Pakistan. We had quite a conversation while he was trying to get his shots lined up. Among the stuff we discussed:

"So, how much are all of you paying to study here?" (On the list of Top 10 Questions to ask a Malaysian student)

"Erm, about 16,000 pounds a year."

- stunned silence -

"So how much did you pay to graduate back home?"

"Well, (and he gives an apologetic look) I paid 150 pounds for my medical education back home."

"Actually (he continues), I am very pitying you. How in the world are you going to pay back all that money? I am earning about 2000 pounds a month as an SHO here and I am only saving about 12,000 pounds after working here for 2 years. And do you know now the NHS is paying doctors less and less per year?"

Maybe becos I'm fortunate to have parents and a family that always assures me not to worry about cost whenever I attempt to broach the topic, or because I am heartless enough to forget time and again that I'm being sponsored and cash doesn't just magically appear in Natwest for me, but I've not really sat down and considered that part of the question yet.

But its one to think about nevertheless. Cos in 2 years I'll be graduating. And the big question; stay or go back. And all the other factors to consider. Can't avoid it forever.

At least i won the game.

Thursday, September 21, 2006


another sign of age. was at the hospital shop to get an envelope and stamps and on paying the GBP 2 bill, found the only note in my wallet was a GBP 50. Looked up at cashier, shaking her head. First thing I heard was a loud sound of compressed laughter from someone behind me. Looking back, could see a long line(mostly women) laughing at me.

Ok, embarassing...move on. Right.

So today I took a history from a couple who came in worried because their 16 month old baby had a breath holding attack. They were pretty worried, understandably but the child seemed fine. Did the full history and wrapped it up quickly as they were about to leave. As I walked out with them, the lady asked me "Weren't you the lad with the 50 pound note at the shop yesterday?"

"Oh (rats)..haha. Yes that was me." (should have stopped here but...) "Yup wasn't that funny? Did you know there was someone just behind me who went 'pfffft!' and started laughing?

Mum looks at me.

"That would've been me"


so I was wondering what would happen at 11.59pm 20th september and during the next 2 minutes. will I be endowed with 'the wisdom of 23-ness' and pass on from the naivety of 22 all at once? Would I be a better person, better equipped to deal with people and relationships and work and responsibility and blame and bills and all the other stuff adults tend to be bothered with?

22 to 23. Isn't it just numbers in the end? Change is never instant (except in some blinding flash I alluded to in my previous post) and I believe thats what marks growth, not age. Speaking in that sense, I hope I grow up 2-3 years before I 'turn 24'.

Hard to undstand leh...

Wednesday, September 20, 2006

One of those instances when something stands out above the muck and mud of life. Like lightning that stabs out the surroundings in stark white contrast. When what's really vital is revealed and all other preconceived notions, petty jealousies, future plans and accusations fade away in a second.

And when we finally understand, something of what it cost to say, "Not my will but Yours be done."

Sunday, September 17, 2006


'knock knock'
'who's there?'
'the interrupting sheep'
'the interrupting sheep wh-'

Sunday, September 10, 2006

How many have we killed?

"He can be a handful at times." The consultant twiddling his pen and alternating between his notes and the slightly ruffled mother in front of him. "How's he at school?" Mum frowns for a while, trying to decipher the Indian accent, then "Well, he's all right. The teachers know about his condition and all." The consultant turns back and scribbles on his notes.

"What does he get excited about?"

"Well, he goes mad over pipes and plumbing. Before that it was anything purple." Mum smiles apologetically. At that, the kid looks up. "Long ones, mum!" For the first time he looks interested. "I like.....long ones, short ones.....around and around." Pulling at his mum's sleeve.


"Now, you should all be able to tell it when you see it. Can you point out the signs of PVS in him?"

"Erm...not being able to maintain own respiration, in a comatose state....erm"

"Ok you lot, that's your reading job for today. Case reports in by end of the week, please."


"I appreciate your concern, Mrs.. but I'm afraid that keeping him on any longer will not be of much use."


Disregarding the definition of consciousness in a patient in exchange for his signs and symptoms. All along we thought they couldn't hear and had no chance of understanding. Even the ones who seemed to be in a world of their own making, whether by familial association or otherwise. Put together by classification and labels made to ease the labour of trying to describe a difficult and complex presentation. But what if they had, in fact been aware all along?

-Prompted by the news that MRI scans showed a patient in a vegetative state responding to verbal conversation in a similar way to a normal person.