To X-ray or Not to X-ray

That is the question. Of course we’re no Prince Hamlet but we do have to make a wise decision on whether we should request an x-ray for a patient who has recently injured/sprained his foot, ankle or knee.

For feet or ankle joints. Quite simple. By Ottawa rules, as long as there is pain over these 4 areas when pressure is applied, do an x-ray.

  • Posterior part of lateral maleolus.
  • Posterior part of medial maleolus.
  • Base of 5th metatarsal bone.
  • Navicular bone.

If patient is unable to bear weight on the affected ankle joint, do an x-ray.

For knee joints. Only do an x-ray when:

  • Patient is above 55 years of age.
  • Tenderness over the patella and nothing else.
  • Tenderness over head of fibula.
  • Patient is unable to flex his knees to 90 degrees.
  • Patient is unable to bear weight despite limping.

Then again, rules are rules. And rules are meant to be broken, when your life is at stake. Things don’t usually go the way you want it to be.

Patient: Hi Doc, morning. I want an x-ray.

Me: Morning. Er. Huh? What’s the x-ray for?

Patient: It’s for my knees. Can I get it done today?

Me: Wait wait wait. What’s wrong with your knees?

Patient: I have this pain in my knees.

Me: And how long has the pain been? Months? Any falls or injuries?

Patient: Just yesterday. Had a twitching pain in the right knee for a couple of secs. No fall what-so-ever. Thought might as well I get both x-ray’d since I’m here.

Me: …

Me: I doubt you need an x-ray for that sort of ..

Patient: Why not? I personally took leave today so that I could come to have an x-ray done and you’re not giving it to me?! Are you going to be held responsible if anything happens to my knees?!

Just one of those daily nonsense I get during the usual jam-packed clinic sessions. Life ain’t as easy as you think it would be.

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Generation Y

As usual, I get my daily dose of Malaysian news from the Malaysian Insider and came across this article about the Generation Y, or Echo Boomers.

Employers are becoming increasingly dismayed by Malaysian’s Generation Y job seekers who generally have a poor command of the English language and lack communication skills, are too spoiled to handle stress, and in a hurry to climb the corporate ladder yet indifferent to the need for experience.

These Gen Y recruits, when compared with previous generations, are also less impressed with job benefits such as medical insurance and bonuses, preferring instead immediate cash rewards for performance, surveys among employers and trade groups have revealed.

Graduates these days come from colleges and immediately want to become managers, without even any experience. You can’t scold them and they can’t handle stress.

Believe me, it’s happening in the medical world too. Young doctors are calling in their parents when they are unable to take leaves or cope with their on-call duties. Doctors who just go AWOL because he/she can’t stand the heat. Doctors who break down easily after “lectured” by the senior ones. Doctors who think quitting is the best option available. So on and so forth.

So why is this happening? I’ve got the slightest clue. Maybe the Generation Y are way too pampered? Over protective parents? Softies?

One of the favorite quotes: Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. As the day goes by, this phrase will most likely phase out. Should just change it to: Give a man a fish and you feed him for a day. Don’t stop giving, and you feed him for a lifetime.

Bear in mind that the Generation  Y doctors are going to grow older and eventually they’re the ones who will be treating you, whether you like it or not. However, without being able to handle the pressure, how far can one go? Only time will tell.

Where do I stand then? Come to think of it, this is rather amusing. By definition, I’m in the Generation Y category too since I’m born between 1977-1994. And yet, I can’t stand all this utter nonsense.

Kuala Lumpur International Airport 2 (KLIA2)

Finally a chance to have a look at Malaysia’s most boasted new low cost carrier airport which opened recently. Looks better than KLIA itself. Maybe coz’ it’s new, but I guess gotta give credit to where it’s due. Looks way more vibrant and livelier as compared to the main airport. Here’s a couple of shots taken on my flight back to Singapore.

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A really big display board.

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Starbucks’ one of the main tenants. Another one is located in the other block.

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Really surprised to see Tissot to take up a slot here.

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AirAsia check in kiosks. Now everyone gets to fly, as long as you pay for every little darn thing. No money no talk.

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It’s empty coz’ it’s located right after the immigration counters. OMG. So strategic!

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Integrated shopping mall.

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You see more people here as compared to its main counterpart. Understandable since it’s a terminal for the low cost carriers, more people  are able to fly.

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Big shiny gates to greet you along the way.

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A plus point for the waiting area as compared to LCCT. Clean. No smell. No flies. Brightly-lit with clean toilets. Clean toilets are very important, you know. Right?

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And finally, the gate. Most stuff ain’t in order yet. Many shops are yet to open. And be warned, you may end up being breathless if you’re exiting the plane, walking towards to immigration counter. It’s a long stretch. Despite the area being air-conditioned, I ended up sweating. Do grab any trolleys you see along the way if you’re carrying any heavy bags, or you might just end up regretting not doing so.