Monday 26 March, 2007

Hints and tips on the medical consultation

Posted in Advice, Emergency Dept., General Practice, Michael Tam at 21:37 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Whether you are seeing a patient in an outpatient clinic, the emergency department or in general practice, the ability to engage in a medical consultation is vital to clinical practice.

The medical consultation is your basic tool and good communication is king.

Throughout all modern Australian medical schools, the idea and skills of being a good communicator is drummed into students so I won’t necessarily repeat skills that are obvious or self-evident. Rather, the following are some tricks and suggestions that may make you a better communicator.

A good way to think about the goals of a medical consultation is that it has three functions (1):

  1. Build the doctor-patient relationship
  2. Collection of data
  3. To agree on a management plan

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Monday 26 February, 2007

Google-based medicine

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Rants, Wards at 23:00 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Warning: This article is as much tongue-in-cheek as useful advise.

As much as we aspire to EBM (evidence-based medicine) I suspect that many of us perform “GBM” (or Google-based medicine)!

Google has become an invaluable tool as part of my day to day practice. Indeed, I find certain aspects of practice irritating without access to the internet (e.g., the current general practice I’m working in as well as the occasional hospital ED that is restricted by a firewall).

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Wednesday 7 February, 2007

Physical examination begins with the hands

Posted in Advice, Emergency Dept., General Practice, Medicine, Michael Tam, Wards at 22:25 by Michael Tam

Original article by: Michael Tam :: Printer friendly

All too often for JMOs, physical examination of the hands is forgotten. In situations other than test conditions, most people “go for the money” – jumping immediately to the body system expected to have the problem. This is perhaps understandable in the time poor hospital environment.

Nevertheless, I feel that all physical examination should always begin with the hands. Even if there are no specific physical signs, the hands can tell you much about the patient:

  • Are they warm and well perfused?
  • Is the patient nervous and sweaty?
  • Do the hands tell you something about the patient’s occupation and lifestyle?

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Monday 29 January, 2007

How to do a good hospital discharge

Posted in Advice, Emergency Dept., Michael Tam, Rants, Wards at 21:44 by Michael Tam

Original article: Michael Tam :: Printer friendly

Consider a discharge of a patient from hospital (be it a ward or emergency department admission); what is the goal? You are trying to achieve a smooth transfer of care from the hospital team to the general practitioner. Thus, this article has an alternative title:

“How not to annoy the general practitioner with hospital discharges”

As a hospital JMO (the “turfer“), discharging a patient back into the community is often a relief. For the general practitioner who is on the receiving end (the “turfee”), there can often be many things that are frustrating and annoying. Having worked on both sides of the system, this article is about how to discharge patients without annoying the general practitioner (too much), and thereby, improving continuity of care.

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Develop your “outside” interests

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Wards at 21:15 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Cycling is fun!

As a junior medical officer, your time is often not your own. Between work, study, medicine related projects (e.g., research papers, presentations), family, meals and sleep there is often precious little time left!

Do not sacrifice your interests and hobbies for medicine as a junior medical officer. These “outside” interests makes you a holistic rounded person and in doing so, gives you a better understanding of humanity. This can only make you a better doctor.

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Sunday 12 November, 2006

Know the NSW Public Hospital (Medical Officers) Award

Posted in Advice, Emergency Dept., Michael Tam, Resources, Wards, Workplace at 9:29 by Michael Tam

Original artcle by: Michael Tam :: Printer friendly

Resources

Public Hospital (Medical Officers) Award

Serial C4272. Industrial Relations Commission of New South Wales. Issued 16 December 2005. [117 Kb]

Public Hospital (Medical Officers) Award – Hours of Work and Tenure

NSW Health Department Policy Directive (no. PD2005_457). Issued 28 January 2005. [32 Kb]

Looking back, I never even once received a copy of the Public Hospital (Medical Officers) Award when starting work at a number of NSW Public Hospitals. The Award sets out the conditions of employment for junior medical officers (i.e., interns, residents, registrars) and is set by the Industrial Relations Commission of NSW.

The second publication is a policy directive from the NSW Department of Health that I will go through.

I strongly encourage that all JMOs read through the Award. My experience is that NSW Public Hospitals (or their administration) do not follow many of the finer details of the Award when they think that they can get away with it. This is really quite disgusting. The purpose of the Award is so that your rights and entitlements are documented in stone. You shouldn’t have to fight for them.

Don’t let medical and hospital administration get away with labour theft because of your own ignorance of your employment contract and conditions.

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Thursday 21 September, 2006

Doctors’ Health Advisory Service

Posted in Advice, Michael Tam, Resources at 10:58 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Doctors’ Health Advisory Service

24 hour helpline:

(02) 9437 6552

Website:

http://www.doctorshealth.org.au

The Doctors’ Health Advisory Service (DHAS) operates independently and confidentially, and aims to ensure that no doctor or medical student in NSW lacks access to health care.

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Sunday 17 September, 2006

Stress as a junior medical officer

Posted in Advice, Michael Tam, Workplace at 23:36 by Michael Tam

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Being a junior medical officer is a stressful affair. The workload is heavy, your efforts are often devalued, and at times you have the thrill (or the terror) of having the responsibility of someone’s life proverbially in your hands.

Psychological distress is very common in junior doctors, sometimes with tragic results. Be mindful of your own and your colleagues’ mental well-being.

Doctors are not very good at looking after their own health or psychological needs and unfortunately, neither is the system. Your employers (i.e., hospital administration) only care when it is much too late, e.g., the recent “vow of action” by the Victorian State Government after the tragic suicides of two registrars in Melbourne hospitals (1).

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Monday 8 May, 2006

Get a professional e-mail address

Posted in Advice, Michael Tam at 20:36 by Michael Tam

Original article by: Michael Tam :: Printer friendly

When you are contacting other health workers in a professional capacity, foxygirl@hotmail.com is not going to cut it any more.

Get a professional e-mail address.

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Get a fax machine and number

Posted in Advice, Michael Tam at 20:19 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Being fax capable is the norm

As a doctor, junior or otherwise, you are a professional and need to present yourself as such. Even if you do not have a permanent practice, you should still have professional contact details. In another article, I highly recommended the use of a post office box. You should strongly consider purchasing a facsimile machine (or service) as well.

Being able to both receive and send faxes is considered part of the clinical and professional norm. All doctors in private practice would have a fax machine. All public organisations have as well. Faxes are great in that they have the relative security of postal mail (i.e., you can send clinical information) but also the speed of e-mail. Furthermore, a fax is much less likely to linger in someone’s (unchecked) inbox like e-mail.

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