electives day 2

day 2

things of notice -

• the distance between doctors and radiologists - doctors write with a wonderful handwriting which is quite illegible for the radiologist, and does not include dx for reference.
• make patients check the spelling of their names - to reduce human errors.
• glucometer (for DM etc) is used 2 hours after meal. however people will normally carry out the test 2.5 hours after - because they only remember when they START the meal. which means telling the patient to use the glucometer 2.5 hours the meal may be yield more accurate results.
• Although Dr.L is a cardiologist, he does a through systems review and physical examination. unlike some other specialist doctors whom only focus on their strengths, he emphasizes on the importance of being a generalist, a doctor before a specialist. As a result, he was able to pick up non-cardiac diseases e.g. colorectal cancer, adrenal adenoma, etc.
• look carefully at the previous records. compare the results. this may yield surprising results, such as a patient having sustained HT for 10 years - nobody realised that he had also an elevated K level. After this consideration, Renin-Angiotensin ratio study was done to assess hyperaldestronism. (whereas is the angiotensin is in excess, there is hyperaldestronism) the result was positive, and the patient was found to have a suprarenal gland adenoma secreting angiotensin.
• techniques of venepuncture - bend needle to accommodate for the angulation of the arm, elevate arm after injection while putting on bandage - no blood spill.
• the Dr. Explains every investigation results throughly. this will increase patient satisfaction and compliance.

patients

• pregnent HT - drugs will be limited
• Lupus anticoagulance
• aldesterone-secreting adenoma HT