The grand old bus station.Visited the district hospital today. Although there were not that many patients, I found the managements by the junior medical officers were not satisfactory. But, what to do, district hospitals are run by junior MOs fresh from housemanship, with little experiences. Like what I had it before, we really learned the hard way, sometimes by mistake, at the expense of the patients.
Take for example, some of the 'primitive' managements I encountered:
1. Starting on Daonil for newly diagnosed Type 2 DM.
2. Putting patient on double CCB, Nifedipine and Diltiazem, for patient with uncontrolled hypertension.
3. Putting patient on high dose diuretic and neglecting to maximize the use of ACEI and beta-blocker.
4. Failure to review the use of Slow K, causing iatrogenic hyperkalaemia.
5. Treating thyrotoxicosis with chicken dose of carbimazole.
Although some of the MOs are junior, some are also quite 'chronic'. It can't really help, but, the reason they are called 'chronic', reflecting their 'resistant' to register new knowledge.
I ended up doing full round in the wards till the late afternoon.
Wish there are more physicians who can visit district hospitals more often.
Take for example, some of the 'primitive' managements I encountered:
1. Starting on Daonil for newly diagnosed Type 2 DM.
2. Putting patient on double CCB, Nifedipine and Diltiazem, for patient with uncontrolled hypertension.
3. Putting patient on high dose diuretic and neglecting to maximize the use of ACEI and beta-blocker.
4. Failure to review the use of Slow K, causing iatrogenic hyperkalaemia.
5. Treating thyrotoxicosis with chicken dose of carbimazole.
Although some of the MOs are junior, some are also quite 'chronic'. It can't really help, but, the reason they are called 'chronic', reflecting their 'resistant' to register new knowledge.
I ended up doing full round in the wards till the late afternoon.
Wish there are more physicians who can visit district hospitals more often.
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