Alhamdulillah, Alhamudulillah, Alhamdulillah
Bukankah Kami telah melapangkan bagimu: dadamu (Wahai Muhammad serta mengisinya Dengan iman dan hidayah petunjuk) ?  Dan Kami telah meringankan daripadamu: bebanmu (menyiarkan Islam)  Yang memberati tanggunganmu, (dengan memberikan berbagai kemudahan Dalam melaksanakannya)?  Dan Kami telah meninggikan bagimu: sebutan namamu (dengan mengurniakan pangkat Nabi dan berbagai kemuliaan)  Oleh itu, maka (tetapkanlah kepercayaanmu) Bahawa Sesungguhnya tiap-tiap kesukaran disertai kemudahan  Bahawa Sesungguhnya tiap-tiap kesukaran disertai kemudahan.  Kemudian apabila Engkau telah selesai (daripada sesuatu amal Soleh), maka bersungguh-sungguhlah Engkau berusaha (mengerjakan amal soleh Yang lain)  Dan kepada Tuhanmu sahaja hendaklah Engkau memohon  – An-Nasyrah
Jikalau sebelum ini saya rasa ingin menangis kerana tekanan kerja dan tekanan perasaan, tapi hari ini terasa ingin menangis, terharu dengan sokongan dan doa sahabat-sahabat. Pagi-pagi, dalam menahan kantuk, telefon bimbit tidak putus-putus berbunyi menandakan pesanan masuk. Semuanya mengucapkan selamat, untuk menempuh peperiksaan OSCE. (Macam tau-tau aja saya sangat tertekan). Alhamdulillah, walaupun mungkin performance saya tidak begitu sempurna, namun saya panjatkan syukur setinggi-tinggi kepada Allah, dan terima kasih kepada mak & ayah, serta sahabat-sahabat yang mendoakan saya, termasuk yang tidak menzahirkannya. Hari ini saya melangkah ke bilik peperiksaan dengan tenang (walaupun gelabah juga bila berada di hadapan pemeriksa), berkat doa kalian. Semoga Allah memberkati.
GP OSCE 220110
Station 1: Consultation – Patient with BMI>30
Mid age Female patient was told that her weight is worrisome and that she needs to change her lifestyle. She came to you to seek your advice.
– First and foremost ask the patient what does she understand about her current condition and what is her current concern.
– Explain to the patient what is BMI and what it signifies. What does BMI>30 means and what risks it brings to her.
– Explain the word ‘obesity’ politely.
– Ask if she already has any medical illness and what medication she is taking.
– Ask the patient about her lifestyle; diet, exercise, daily activity/occupation, etc.
– In this case, my patient then showed me her ‘meal diary’. She wanted me to comment on her food intake. (Therefore, you need to know what is the ideal food intake for a normal person (no illness, optimal BMI), patient with high BMI and high risk patient (cardiovascular risk). Please refer to Clinical Practice Guideline – Management of Obesity)
– Tell the patient the ideal food intake, what changes she need to make. (NEVER say you HAVE/MUST do this and that. Use words such as ‘maybe you can start on this…‘ or ‘if possible, you can add in this and that…‘)
– Ask patient how frequent she exercises, what type of exercises, and the duration of exercise. Comment on the adequacy of the exercise. (We must know different types of exercises for different ages, and how much calories are burn in each type of exercise. Again, please refer to the CPG.)
– Ask how frequent she goes for medical check-ups, and when was the last check-up. Any problem in the result? If yes, what action has been made?
– Refer her to any support group system.
– Confirm with her that she understands what we are talking about.
Station 2: Mini Clinical Examination – Chronic hypertensive patient follow-up (consultation, physical examination & investigation)
– After the introduction, ask about his current wellbeing – feeling well or not well, his last check-up results, associated medical illness, medication that he is currently taking.
– Oh, dont forget about compliance to the meds and lifestyle changes! (including diet, exercise, daily activities… etc)
– Ask about all the symptoms and signs of complications of hypertension. (Please refer to CPG for Management of Hypertension)
– Get the physical examination and investigation result from the examiner. The examiner would not tell unless you ask!
– Make a conclusion based on the history taking, examination and investigation result. Whether his BP is well-controlled or not, and what advice need to be given to the patient. (Again, refer to CPG)
– In my case, apart from retinal changes, my patient’s physical examination and investigations are all within normal range.
Station 3: Clinical skills – Procedure (venepuncture) for Thyroid function test
– My tips: practice makes perfect, and please remember all the colour codes of the bottle for each investigation. Oh, and you must know how to fill in the form!!
Station 4: Clinical skills – Instruction to a chronic bronchial asthmatic patient on how to use peak flow meter and its interpretation
– Honestly, I did not really revise on this. I read the GINA guidelines, but did not practice the practical things~~
– Teach the patient how to use the peakflow meter device. Take the best of 3 readings and interprete the result based on the chart given. (Honestly, I did not know how to read the chart!)
– Lastly, give advices to the patient.
Station 5: Physical examination of feet of a chronic diabetic patient
– Examine as usual. A focused and specific examination. Then conclude.
Station 6: Consultation – Patient with positive blood result for Thalassaemia Minor (Trait)
– Ask patient what he understands about his problem. Any other member in the family having the same problem.
– Any symptom of anaemia he experiences
– Explain what thalassaemia is, what is its significance and what risk it brings.
– My patient asks if this disease is dangerous and infectious. How it will affect his life. So, answer his curiousity politely and carefully!
– If the patient is single, ask if he’s planning to get marry soon. Explain why it is important to get his future partner to go for screening for thalassaemia before they get married.
– Explain the risk of thalassaemia major in the offsprings if his partner also has thalassaemia trait.
– Explain what is thalassaemia major and it risks.
– What precaution need to be made, and what treatment is needed (if any).
Station 7: Rest station