Cooking is all about experimenting & trial and error

So I decided to make salad for my sister- and I put together this:

It's basically toasted pine nuts, steamed butternut squash, chopped tomatoes, rocket salad and sweet onion sauce. I should put in red onions too which I forgot, I'm going to do that now. As a closing note, Pranav (my Aussie roomie) used to say cooking is all about experimenting and trial and error. Tis true!

Don't you love it when you discover a very uplifting song that speaks to you?

This is a song by Craig David called World Filled with Love:

Cause I'm caught living in a world filled with love,
so when tear drops fall from me like rain from above,
I can brush my troubles away,
know that deep down inside,
I got sun shining in my life.

I'm gonna ride this beautiful life

So my good friend Kan came over yesterday for lunch and we cooked Gordon Ramsay's chicken breasts stuffed with prosciutto and sage from his Healthy Appetite book. It was a really good chill-out time plus we got to make amazing food. Apparently my excitement for food/ newfound passion for food has inspired Kan to be a better cook and might have changed the rest of his life (he was not excited before about a lot of things but he said he left feeling super excited to cook). I think you can express how much you care for someone by cooking for them and also you can cheer them up. It's an act of spreading love :) I love Gordon Ramsay's way of cooking because he combines relatively few ingredients and makes the food amazing. It is also super easy to follow.

So the recipe is as follows:- cut chicken breast in the center so you have an opening to stuff ricotta cheese in- for the filling, mince sage and mix in salt + pepper
- wrap the chicken breast in prosciutto and slip in some sage leaves

- pan fry the chicken breast wrapped in prosciutto until it browns

- place thyme sprig on chicken breast and put this in oven at 350 for 12 minutes
- VOILA! Amazing homemade food :)

The final product:

How to write a specialist referral letter, mock case conferences and everything in between

Wow, I feel utterly exhausted now. I think it's because of the heat. I've forgotten how hot it can get here in Townsville and the heat was sort of back today (hotter than what we've been experiencing anyways for the past 2 weeks). Anyways, today we had our ecology of health guided learning session and our human biology guided learning session. In our ecology of health guided learning session, we learned how to write up a drug prescription, a specialist referral letter and how to fill a diagnostic imaging referral form. The drug prescription was actually pretty cool because we discussed in class how if the patient did have hypertension for example and you told them that they are alright but that they would have to take a medication 3 times a day for the rest of their lives, they would basically be like wtf? I think it's easy to get carried away with the Science side of things and forget about how it feels to be a patient. So our lecturer (who is a general practitioner) told us that it would probably be better to give them another medication given 1 time a day for a longer period of time to not make them panic that something is very wrong. It's basically really important because these little things will make them trust you/ not trust your recommendations and thus affect their compliance. Also for the specialist referral letter, it's interesting that you write them an actual letter (I thought it was just like forwarding their medical chart of some sort) and you have to sort out which medical history of your patient is relevant to their specific condition you are referring them about.

We also did a mock case conference whereby students role-played different medical professionals (we had students pretending to be physiotherapists, dieticians, social workers, podiatrists, endocrinologists, general practitioner and a diabetes educator). Basically we were to pretend as if the general practitioner is holding a teleconference whereby he wishes to consult medical specialties from different fields of expertise to help his patient (who happens to be an obese woman with diabetes, hypertension and osteoarthritis in both knees who is feeling depressed about her condition and has a son who is also frustrated that the treatment offered by their general practitioner has not been working). It was really amazing to see the level of knowledge each medical expertise had and what they contributed to the treatment plan. For example,
- the podiatrist was concerned about the neuropathy that could result from the patients' diabetes and recommended her get massages from the physiotherapist, going in for checks of the rate of loss of sensation in her feet and also going in for checks of range of motion in her feet. Also, she was also recommended to get orthotics installed in her shoes to make her more mobile
- the dieticians told her that they would formulate an eating plan for her and make sure that it was gradual so it doesn't feel like its' impossible to stick to and recommended that the patient talk to her son about this
- the patient herself got to talk about how she is feeling and her reactions to the treatment plan recommended
- the social worker suggested that the patient could look into help groups near her home where she could get financial help with her situation, ask for support (nurse) that could perhaps take care of her while her son took a break from caring for her
- the endocrinologist suggested that the patient tell them what medications are working and what are not and recommended some medications for it - they worded it in a way that was asking her basically why she was not taking her medications regularly - "was it because you are scared that you don't understand how they work?", "how are they affecting you?"

so on an so forth. We actually ran the mock case conference realistically where students had to act as if they were specifically addressing the patient and their relatives on a treatment plan and word things correctly (don't offend them by saying directly that they are obese and need to lose weight but find a nicer way of putting things)It was just really really really cool to see how much teamwork in a healthcare setting really works. Our facilitator also mentioned though that sometimes we might run into problems in these conferences where some specialties overlap such as physiotherapists and occupational therapies whereby health professionals can often feel like "oh, there goes my idea because we are suggesting the same thing". However, it is important to keep in mind that the purpose of such case conferences is to treat the patient and that it should be patient focused.

In our human biology guided learning session, we talked about the social context of reproduction and how people's attitudes and society's attitudes towards menstruation has changed by looking at advertisements from the 1940s compared to that found in the 1980s. (We never got around to looking at ads found in the 2000s). And for that we watched light-hearted ads aimed at this topic and got a good laugh about it. Also, we talked about different reproductive technology- embryo freezing, artificial insemination, genetic screening of blastocysts and egg donation- and what their implications are to health professionals, friends + families, legal and political systems, economic system and society in general. We also talked about how infertility affects the female and her partner and others in terms of feelings of inadequacy, disappointment and also expectations from others to have children and also feeling like they're not fulfilling their role in society.

Although these sessions at first glance do seem pointless and common-sensical, it's these activities I think that really hammer it home and makes a difference as to how good of a doctor you can be not only by showing compassion, but also really trying to understand things from the patient's perspective. I'm really happy that we are learning these sorts of things :) Thanks James Cook.

A short list of some life goals

So I just happened upon Missy Higgin's live performance on youtube for her song This is how it goes (She performed at Sydney's Darling Harbour) and the view of where she was performing just blew me away:
http://www.youtube.com/watch?v=vmRnVlhMYrw&feature=related

It made me think of some goals for my life that I would like to achieve (outside of medicine). So here goes the list so far:
-record a song cover with close friends
-record a song cover with a personal touch to it (add in some of my own musical ideas)
-record a song by the beachside
-attend a John Mayer concert
-DJ one night at a club
-dance at Sensation White at New Years Eve
-learn to play the guitar
-act in a musical
-learn a hip hop routine and perform it
-buy a keyboard and experiment with other instruments
-perform a song (doesn't matter if it's a song cover/ my own composition) at Darling Harbour (might have to wait a long long time for this one to ever happen but I can always hope)
-work in a kitchen as a chef for a full day
-eat at a Michelin star restaurant
-eat at Gordon Ramsay's restaurant at least once
-eat at El Bulli run by Ferran Adria (maybe if I get a reservation)
-take a picture against the sunset by the beach (like an artistic shot, not the typical profile picture shot)
-take an artistic shot of something that means a lot to me

Thats it for now, until I find newer goals to do in the near future!

Red Wine Beef Burger Recipe

Still recovering from a crazy dancing night out last night! Poor life choices rock - just had another glass of red wine for dinner today (after having a whole bottle of red wine to myself last night). To be fair, I had a really good buzz going on through the whole night (I started drinking at around 730 pm until about 1030pm so it was a good gradual buzz lasting me the whole night). Anyways, I just thought that I would start blogging about food that I cook. Today for dinner I made red wine burgers and it was a great success! Recipe is as follows:

Done in this order:
- marinate burger in red wine+pepper (i think freshly ground ones would be best)+salt for about an hour
-caramelize the onions- i used brown sugar (around 2 teaspoons but i used heaps of onions though) and then add in some worchestire sauce
-pan fry burger patty (best to grill but we dont have a grill)
-grill burger buns (we used the toaster oven)
-place cheese on bun (i used cheddar cheese)
voila!

I tried using Jack Daniels bbq sauce on the side but it didn't work well with the actual burger itself so I ate the burger by itself without any side sauces and it was amazing! You could really taste the red wine in the burger patty and the sweetness/ smokey taste of the caramelized onions.

Me and my roommate Pranav ate this with a side of red wine (Cabernet Sauvignon).

Talk about having the perfect dinner!

Dear Ecology of Health, you are not so useless after all!

Today in our Ecology of Health class our lecturer (who is a rural general practitioner) brought his 2 patients in so that we could learn some interviewing skills hands-on in order to get a complete patient history. I think it was a very useful exercise because oftentimes as doctors, you can forget about how patients see you so it's good to think things from their perspective. For example, the patient said that she would actually be more reassured/ appreciate more if the doctor admitted that he or she did not know what specifically was wrong with the patient rather than give false reassurance that the patient will get better. Also, the teenaged patient revealed that it would be better if the doctor talked directly to her rather than to their parents during the consultation.

For this past week we have learned some interviewing skills and non-verbal communication skills. For example, the way your practice is set up is important to make them feel dominated / reassured. Sitting across from the patient makes them to likely feel intimidated because you assume the dominant position. Seating them in a corner makes them feel less threatened and is more conducive. Seating them beside you, you are then assuming a more co-operative position. We also watched a video showing us the importance of the way you greet your patients before they enter the room- how much eye contact you give them, your body language (are you leaning forwards, or crossing your legs, or are you seated too far away from the patient, are you turning your back against your patient when they walk in, do you seem interested in them as an individual). I think these things are more important than what people make it out to be because it was just eye-opening to realize the differences in practices that I've been to in Singapore (GP vs specialist) vs that in Canada (GP vs specialist). Many of the practices in Singapore that I've been to have placed the patient across from the doctor, and to be honest, it did make me feel intimidated like the doctor is dominating. I think these things, though they appear to be small/ sometimes seemingly insignificant, makes the difference in providing the ideal environment/ circumstances for potential patients to open up and really tell you about their conditions. (Also apparently many doctors tend to cut off their patients within 15 seconds of them talking and don't get the full picture of what's going on so the key point here is to listen more than you talk).

Also, in class today it was mentioned that patients don't actually have an accurate way of judging how good of a doctor you are. They usually gauge that by how much you seem to care about them as an individual. So I mean it really comes down to how you present yourself for that first impression and also your interpersonal skills.

Though it sounded very common-sensical, I think it's a lot harder to master than it looks or sounds. It's certainly challenging I think sometimes to reassure potential patients with regards to their conditions, try to figure out what you think is causing their symptoms and at the same time to watch what you say (how you word things basically). I think it's amazing how just asking for their medical history, social history, family history, their current symptoms, how that's affecting their daily lives, what they expect from this consultation and what their allergies are can tell you so much about their lives and who they are as as individual. And to know that some of the things they are telling you, sometimes even their significant others don't even know. The trust they put in you is quite empowering. Also we were taught to reinforce what they just said to make sure you are on the same page as them and to show to them that you are in fact listening. Some good questions to ask would be like:
- What brings you here today? (like a good greeting message)
- How is this condition affecting your life?
- What kinds of treatment have you gotten for it and how have you responded to it?
- Who have you seen about this?
- What have you tried to do yourself to relieve these symptoms?
- Have you done something out of the ordinary recently that you think might have caused this symptom?
- How long have you had this symptom/ these symptoms for? Does anyone from your family have this condition?
- What is the pain like? (asking for quality of pain)

Finally when you do offer them the range of possible treatments, ask them how they feel about it (also have to read their body language and respond accordingly)

I think what intrigues me the most when given all this information is how it's similar to putting together a puzzle basically. The best part is that every patient presents with different symptoms (even if they are diagnosed with the same disease) because even though there is a normal range in things (like normal BP is usually 120/80), different heights and different individuals present with different blood pressures and can still be considered to be "normal". Also, often I think it would also be interesting to treat certain conditions when they have other conditions affecting them because it would definitely affect how you manage their condition and the advice they give you.

We also talked about the shift towards a more teamwork based healthcare system rather than the traditional view that the doctor is the dominant person in healthcare/ center of healthcare.

I'm really looking forward to that general practice placement in Melbourne this June where I'll hopefully observe a GP and help take some patient history. And that's the beauty in it :)