From The Editor
Dr Leong Khai Pang
I stand by what I wrote in this column in the July-September 2005 issueo Medical Digest. I said that the most important quality o a doctor is hisor her ethics and moral character.I shall reveal what I have learnt is the second most important. It isortitude or persistence under adversity. It is seductive to always takethe easy out. We transer the care o dicult patients (either medicallyor temperamentally, or both) to other doctors. We order 20 tests and5 scans to arrive at the diagnosis rather than work through the datarom the history and examination. We resign rom our work when weencounter diculty with our colleagues or administrators. We becomebitter when we are not happy with the prevailing culture, but we donothing to make things better, except being a gadfy.Being a doctor is never easy; being a very good doctor is even harder.Being able to work through diculty, to trust that the solution will revealitsel sooner or later, and to constantly keep our eye on the desiredoutcome is a great personal strength.I think that we must decide rom the outset what we want to achieveas a doctor. This objective may be achieved in public service or privatepractice. Frittering away our time on picayune or constantly working inour job and not on it are good ways to lose sight o our long-term goals.We should not alter course just because we encounter some hardship.Similarly, we should not game the system and turn our back to it ater wehave gained what we wanted.Do we speak up constructively when we see that things are wrong?Do we set an example o strength and consistency or our colleaguesand juniors? Do we require our sta to take on hardship that we willnever bear ourselves? Do we only love patients and colleagues who arelovable? Who will love the ugly and the dicult? When we are old andgray, when we meet ormer colleagues or coee and kaya toast, dowe regret the opportunities wasted, deeds undone or words unsaid?Or do we triumph over disasters averted, wrongs righted or hypocrisyexposed?Make a dierence. Stand up and be prepared to slug it out. Be a gooddoctor.
The denitive diagnosis is ventricular tachycardia.Let’s look at the telemetry strips. There are usion beats in the top 2 strips(1st, 9th 10th complexes rom the let in the top strip, 3rd, 4th, 14th and 15thcomplexes in the second strip). There is also a capture beat with a P wavepreceding a narrow complex QRS in the third strip (8th complex). These eaturesare consistent with ventricular tachycardia.The patient’s cardiac rhythm reverted to sinus ater direct-current cardioversion(above).
Dr David Foo is the Head of theDepartment of Cardiology, Tan Tock SengHospital.