Handy hints and tips to save both you and your patient…
Do you have any suggestions, criticisms or general thoughts about this website? Or perhaps you have a “wish list” of some topics that you want to go up on this site?
If so, post a comment on this page! I’m interested to read what people have to say about “The Medicine Box”.
Best regards,
Michael Tam
(“The Medicine Box” Administrator)
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| This book details the design, goals, development and construction of the website. It contains a review and analysis of the state of the project after six months. In addition, the report is a guidebook to the development of online medical education resources. | |
Peter Wu said,
Wednesday 16 August, 2006 at 0:18
Dear Michael and May,
I am a 6th year UNSW student who is 8.5 weeks away from our exams.
I stumbled across your website when I was googling about perioperative
use of anticoagulation. I was absolutely aghast when I found this page.
HOW COME NO ONE HAS EVER TOLD ME ABOUT THIS PAGE?
I was both angry and thrilled.
I was angry becuase I didn’t find out about this site earlier.
I was thrilled because the articles are just amazing, as if they were
designed for the final year studnets to pass their exams.
I seldomly have the urge to expression my appreciation. However, I would
really like to tell you guys how much I appreciate the articles you posted.
You prabably hear this all the time :) but I still have to say it
“Thank you thank you thank you~”
I found a light house in the storm \ (^_^) /
Mel said,
Wednesday 13 September, 2006 at 8:16
Impressive site!
(Note: originally posted in the “About” page – moved by Administrator)
Dr P Velayutham said,
Monday 11 December, 2006 at 3:09
dear doctors,
you seem to do a wonderful and dedicated job. i am an endocrinologist trained and practising in India. i stumbled across this site incidentally. nice work. i definitely will try to contribute to the site when and where ever possible. all the best.
Dr p Velayutham
gabriel said,
Thursday 14 December, 2006 at 16:30
This is a wondeful and most helpful website. I can imagine the enormous amount of energey and effort you put in to develop this web site but this will be an invaluable tool for many doctors to come.
thank you so much
Gabi
Deb Kendall said,
Saturday 31 March, 2007 at 7:51
Thanks for the wonderful info on metabolic syndrome. I hope to do lots of self study for the clinical diabetes educator exam. I was home sick this week and googled right into you. You are my favorite favorite right now!
Deb K RN
mtcl82 said,
Wednesday 25 April, 2007 at 20:50
Hi Michael and May,
I followed the link from Paging Dr. forums to your site.
I find your articles very helpful in a practical sense, and the work you put in to creating this site deserves to be commended.
However, I was somewhat puzzled by the fact that your blog entries (Medical Rants) were on sale, in PRINT, as well as the ‘creation of the medicine box’. With all due respect, who in their right minds would purchase a book containing blog entries that can be accessed free on the web? Your blog and this website are good, but not THAT good.. if you understand what I mean..
Keep up the good work though..
mtlc82
Michael Tam said,
Wednesday 25 April, 2007 at 21:04
Okay…
I fail to see your point entirely, unless you are complaining about getting free stuff. The websites are free as are the compiled PDF e-books. If you want a printed copy, obviously you are going to have to pay the printer of which the books are basically at cost.
With all due respects, who complains about being able to access free information? Thank you for suggesting that I am perhaps wasting my time. :-?
Cheers.
B said,
Tuesday 1 May, 2007 at 10:37
G’day purveyors of scholarly tidbits!
This website has just been meritoriously added to my stringently selected bookmark tab on the Mozilla browser. Although I am not among the typical target audience of medical practitioners and doctors-to-be (regretfully), this site will serve me well as a satiating source of my topical information diet (keep up the rantings!), and form part of my “continuing professional education” resource sites, although I lament that the nature of my current work will thwart the retention of most of the information due to lack of use and practical application! (Have the found genetic association to a photographic memory yet?? Hook me up with some gene therapy!)
I was very suprised to find that both of you worked at 407 Doctors! Just a stones throw away from where I work.
If I may humbly seek your advice on an issue; given the current skyrocketing intake of graduate entry medical students and the foreseeable downstream burden it will place on the availability of quality junior training positions and posts, what measures are being, or should be taken to account for this? I am considering an attempt at GEM but fear it may be a fruitless endeavour if I graduate to find a black hole of substantial work opportunities!
Cheers :)
Michael Tam said,
Tuesday 1 May, 2007 at 18:25
Thank you for your comments!
With regards to post-graduation training, there is at present a substantial unanswered question of where and how positions will be made available to the “tsunami” of medical graduates in the coming decade. It is estimated that the number of medical graduates will close to double by 2012.
As published in a recent edition of the Medical Journal of Australia (1):
What is unstated here is that COAG has only guaranteed intern positions for Commonwealth funded medical students. Potential students looking at full-fee paying positions must think carefully!
That being said, medicine is a fulfilling career and even with workforce bottlenecks in Australia, there are plentiful international opportunities.
References
(1) Joyce C., Stoelwinder J., McNeil J., Piterman L. Riding the wave: current and emerging trends in graduates from Australian university medical schools. MJA 2007; 186 (6): 309-312 [Link]
Subterranean said,
Saturday 6 October, 2007 at 10:23
Howdy Michael and May,
I just wanted to say a huge thankyou for putting the time and effort into making this site – as a medical student it is an invaluable resource and incredibly helpful to get such practical and useful advice in which I can apply into my growing knowledge base.
Keep up the amazing work – it is hugely appreciated!
sub
Rex said,
Wednesday 7 November, 2007 at 7:19
Regarding the South Park article on God.
God will get you for calling him vengeful!
Betty R. Stewart said,
Thursday 29 November, 2007 at 14:11
Someone has already asked this question, but I did not see the respond answer. Can you write on an IV bag with a mark? Will it leak throught? I would like to know…Betty Stewart RN
Michael Tam said,
Friday 30 November, 2007 at 1:13
Dear Betty,
See the follow up comments here.
Tammie said,
Friday 18 July, 2008 at 15:34
[edit]
Dear Tammie,
I empathise with your loss but the content of your comment was not appropriate for the feedback thread.
Yours sincerely,
Michael Tam
Antonia O'Rourke said,
Saturday 19 July, 2008 at 7:57
[edit]
Dear Antonia,
The content of your comment was not appropriate for the feedback thread.
Yours sincerely,
Michael Tam
mor_maew said,
Thursday 6 November, 2008 at 22:39
Dear Michael and May
Thank you for this wonderful site . This blog not only provide medical knowledge but also show your generous mind to all of us .
Thnak you very much
Sam said,
Thursday 27 November, 2008 at 15:03
[edit]
Your comment has no relevance in the website feedback page.
Regards,
Michael Tam
drhassan said,
Thursday 5 March, 2009 at 13:24
Hi ,i was really impressed in the way you present the fluid management , which is really confusing, as it is presented in different ways , and no simple international standard formula , i think the best people who can help in solving this issue are the anesthetists and nephrologist as they are the best to understand fluid physiology , and body reaction to dehydration or over hydration , i refer you to a very good website which helps a lot in understanding this subject(up to date)
http://www.uptodate.com
regards
Drhassan GYN ONCOLOGY
JustPaige. said,
Wednesday 22 April, 2009 at 13:01
[edit]
Unfortunately, the comments of this page is not the appropriate venue for your questions. Please consider discussing the issues you raised with a general practitioner or clinical psychologist.
Eire said,
Tuesday 9 June, 2009 at 9:10
I was very surprised after reading the article on “don’t prescribe pain medication and benzo’s to new patients.” My surprise came with the example that was given. It was a pretty major assumption to suppose that the elderly woman was an opiate seeking addict. I would not want a GP that jumped to such conclusions without any factual evidence of such. The elderly rarely run to their Doctor when an issue arises because of the expense, same goes for prescriptions. Regardless of the other issues she may have, financially she may not be able to cover the costs they will bring. Perhaps the pain relief she was given was, in her mind, enough. Just because she didn’t come back does not mean she is addicted to opiates or you were duped. Also factoring in the nationality differences, it is unclear if she even understands the true nature of her issues. Being from another country, and being elderly…makes her economic mindset even more of an issue. There could be a number of reasons for the prior Doctor issue. I realize there is a large issue of abuse ongoing but GP’s still have to recognize that not everyone is out to dupe them, and sometimes they are explanations for not following up as requested, especially with the elderly, or even those with issues that overwhelm their lives, yet still suffer from chronic pain.
Michael Tam said,
Tuesday 9 June, 2009 at 14:18
Thank you for your comments Eire but may I suggest that you read the continuing discussion in the comments of that article. On investigation after her non-attendance she had in fact received a huge quantity of opiates from numerous prescribers in a pattern that can only be explained by diversion.
As per that article, the best stance to take is to not prescribe strong opioid analgesics or benzodiazepines to new patients to the practice if they are specifically requested. Patients who are on either agents long term will already have an arrangement with one prescriber. The onus is on the patient to demonstrate that their regular prescriber is happy for you, the new treating physician, to supply their regular prescription. If their regular prescriber is going on leave or is otherwise unavailable, the continuing management of their chronic pain will almost certainly be planned.
It should also be noted the requirements under NSW law. It is illegal to prescribe drugs of addiction (specifically S8 drugs like strong opiates) to people with drug dependence without the prior approval of NSW Health.
Chronic pain is difficult to manage and yes, many patients are under-treated. Nevertheless, acknowledgement must be made to the serious problem of diversion of prescription medications as well as the risk of medication dependence. No one likes the idea that we are potentially leaving patients in pain but this must be balanced by the reality that strong opioid analgesics in themselves are not effective therapy for chronic pain and prescribing opiates to people with drug dependence is harmful. The requirements for patients to receive regular strong opiates and benzodiazepines in the Australian system is that they must engage with a single prescriber.
Marcia Burtt said,
Sunday 16 August, 2009 at 4:56
As a non-health professional, after spending some time online trying to understand coumadin-heparin bridging, I was thrilled and grateful to read your clear explanations.
What is still not clear to me is the difference between how coumadin prevents clotting as opposed to how heparin prevents it. I gather they function differently.
If coumadin takes 4 days or so to take effect, why can’t it be restarted the day before surgery?
Michael Tam said,
Sunday 16 August, 2009 at 10:35
Dear Marcia,
The summary on coagulation in Wikipedia is actually pretty good: http://en.wikipedia.org/wiki/Coagulation
The coagulation cascade is a rather complicated system. Heparin and warfarin affect different parts of that system.
With regards to warfarin and surgery, remember that not all surgery goes to plan and bleeding complications are not uncommon. Furthermore, it isn’t that warfarin takes “4 or so days to take effect” but rather, it takes that time before you reach near its full effect for the dose. For any major surgery, it would be safer to use a quick/short acting and easily reversible anticoagulant during the period of surgery.
Michael Tam said,
Sunday 16 August, 2009 at 10:28
Dear tim D.,
I moved your comment here.