[醫書直說] Med 4 小心得 Recommendations

Med 4 有四科，分別係婦產科Obs and Gyn，兒科 Paediatrics，家庭及社區醫學Family and Community Medicine同埋精神科Psychiatry（排名跟住我rotation嘅次序，而我一直覺得呢個順序係有意思嘅）。四科其實都係獨當一面嘅專科，要讀晒都唔容易。有人一本書都唔駛買，淨係用notes都得（多謝我哋啲senior寫咗啲神notes留比我哋），我就都係鍾意睇書所以亦都有用textbook。
The 4 rotations in year 4 are namely O&G, Paed, Family and Comm Med and Psy. I always think there is a meaning behind this special order...These are four specialties with substantial knowledge needed for each one of them, so it was not too easy to master them all. Some people don't have to use any textbook at all, thanks to our respectable seniors who wrote some very good notes for us. I personally prefer textbooks as a core.

教科書推薦 Textbook Recommendations

• 婦產科Obs and Gyn
• The Terminology
• The Johns Hopkins Manual of Gynecology and Obstetrics 4e (2010)
• NTEC Clinical Guidelines
• 兒科 Paediatrics
• Illustrated Textbook of Paediatrics 4e (2011)
• 20 Cases of Counselling (HKU)
• 家庭及社區醫學Family and Community Medicine
• General Practice: Clinical Cases Uncovered (2008)
• Toronto Notes (2012)
• 精神科Psychiatry
• Oxford Handbook of Psychiatry 2e (2009)
• MRCPsych: Passing the CASC Exam (2009)
• First Aid for the Psychiatry Clerkship 3e (2011)

婦產科可以見到BB出世，係我覺得醫學上難得可以皆大歡喜嘅情況。我有幸跟到好多好醫生，特別係喺產房（等）執仔，產科病房跟round同手術室學PCOS，見識到好多，更令我有諗過做婦產科添。

I think one of the happiest scenes in medicine is the delivery of the newborn. I was lucky to have so many good teachers (better than 10 Teachers haha) especially in the labour ward, obstetric ward and operation theatre to teach. I enjoyed it so much that once I had the idea of training in this specialty as well...

兒科要有好好嘅內科根底，而又要學習同父母好好咁溝通。我喺PICU/NICU 學到好多有用嘅知識，而我就好記得學過點樣除紙尿片哈哈！而且都有機會見到一啲我以為教科書上面先會見到嘅病。而我喺考clinical嘅時候更明白到考試要有系統，因此我先至可以由一塊乾淨嘅尿片診斷到一個Hirschsprung's disease。

You will need a good foundation in internal medicine for paediatrics, as well as good communication and counselling skills with the parents. I learned so much in the PICU and NICU, especially how to remove diapers! I also saw many cases I thought I would only see on textbooks. During my clinical exam I realised the importance of having a system, and in that way I diagnosed Hirschsprung's disease from a clean diaper.

社區醫學我覺得教得幾好，有機會可以試下了解下啲統計學嘅用處同點樣睇醫學文獻。家庭醫學就其實可以好深入，包括兒科，精神科，婦產，耳鼻喉，泌尿等等，其實要到 med 5 讀晒咁多科先真係叫做識。我仲好記得我見過一個後生嘅女病人睇高血壓，內科檢查咗好多嘢，例如腎功能，Cushing's等等無發現先轉介家庭醫學診所。我覺得佢有少少疑似 hirsutism，於是向教授問下有無可能係PCOS，一問之下佢一直月經都唔準，而之前都無抽過血驗 sex hormones。雖然最後我無睇番個病人究竟係咪 PCOS，但我已經好享受可以同醫生一齊睇症，一齊思考，一齊解難。

Community medicine is quite well taught, with chances for us to understand the use of statistics in medicine and how to appreciate medical literature. Family medicine is indeed a complicated topic, as it comprises of many specialties including paediatrics, psychiatry, O&G, ENT, urology and let alone medicine and surgery. I think I am only competent for the exam after med 5. I once saw a young lady with hypertension, who underwent a number of investigations for the condition previously such as renal function and screening for Cushing's but these were all negative. She was then referred to the Family Medicine clinic. I reckoned she had hirsutism, and suggested to the professor the diagnosis of PCOS. Upon further asking, she indeed had irregular menses and no tests were done on sex hormones. Although I did not follow the patient up and I do not know if she really has PCOS, I really enjoyed the process of seeing the patient together with the doctor, thinking together and solving problems together. 

精神科嘅精髓係要喪練OSCE。我要多謝我啲組員同我一齊練OSCE，一齊上Grandround俾人鬧，一齊clerk case，仲有要多謝好多醫生扮病人陪我哋練習。我從呢個考試之後就學會用如何準備臨場考試（咪就係準備同埋練囉）。我亦學會知識嘅範圍同深度同樣重要，呢一科有好多唔同類型嘅病，唔能夠太集中讀某一兩種病而忽略咗另外嘅病，因為同一個病人有可能有幾個問題，如果你淨係識抑鬱症，而唔識人格障礙，就會忽略咗呢個好重要嘅問題。呢個亦都係一個難得嘅機會從另一個角度去了解你啲病人，學會 Bio-Psycho-Social 框架同埋家庭同社會問題對病人嘅重要。問病歷都可以好攰，要一邊問一邊思考句說話嘅內容同形式有冇問題，仲有可能問完晒到最尾睇病歷先知其實一切都係假嘅......

The essence of psychiatry was to practise OSCE like hell. I had a really nice group of friends and we practised OSCE together, sit in the grandrounds together, clerked cases together. Also I appreciated the help from our tutors who acted out the OSCE stations for us to practise. I learned the importance of good preparation and repetitive practice for clinical exams. Also I learned the breadth and depth of knowledge are equally important, as multiple diagnoses are possible in the same patient, and if you only know mood disorder you may miss his personality disorder altogether! I took this as an opportunity to understand our patients from another perspective, and to learn to importance of social and family issues in patient care. It can be really exhausting to take a good thorough history as you have to guide the conversation naturally while analysing if the patient has any of the pathological signs. Sometimes it came to us as a surprise when we found out everything the patient said was not the truth...

總結嚟講，有人話 med 4 係輕鬆嘅一年，但係我覺得如果你要識晒咁多科，都要下一啲苦功，先可以順利無憂無慮地到去 elective，準備返黎六月 med 5開學。

Some people may say med 4 is a relatively easy year, but I think it is a year when you need to put in effort to learn well before you leave for your happy elective and start as a med 5 in June.