09/04/2011
Walshe JM (August 2003). "The story of penicillamine: a difficult birth". Mov. Disord. 18 (8): 853–9
http://onlinelibrary.wiley.com/doi/10.1002/mds.10458/full
今天在唸書的時候,看到 D-penicillamine 這個藥,覺得很不熟,隨手查了一下相關資料,卻無意間看到這個藥物的發明人 John M. Walshe (他還活著) 寫了一篇文章,介紹 1950 年代,他發明這個藥物的故事。
當年他是在肝臟手術患者的小便中,意外發現一個沒看過的新物質,後來才發現是術前施打的 Penicillin 的代謝產物。在檢驗這個產物的過程中,發現他有敖合金屬的能力。後來因為他換工作的關係,接觸到了 Wilson disease 的病患,某天突然想到,這個東西搞不好可以用來排掉無法代謝的銅,於是他自己吞了一堆 D-penicillamine 試驗安全性 (當時還沒有相關法規和倫理委員會),接著就找了兩位病患試吃,一年之後終於看到實驗成果。
當時的Wilson權威都不相信他的藥,所以推廣上受到很多阻礙,幾經波折之後才成為被承認的療法。如果當年有 IRB,很可能就不會有這個藥的誕生了。
作者在文末嘆到,雖然國際大藥廠投入了很多經費研究,但現今 Wilson disease 使用的藥物,全是在學術單位發展出來的。
幸運的一點是,當年沒有合成出後來才知道有毒的 L-Penicillamine,而是一開始就合成出有效的 D-Penicillamine。成功還是需要一點運氣啊!
有時候讀讀這種醫學發展的歷史,也滿有趣的。很多今日看來理所當然的東西,當年只是源自於當年某人的一點好奇。
09/02/2011
帶著剛畢業的 PGY 1 學弟妹值班,真是很累的事,很多東西還是得親力親為。
有鑒於剛入行的學弟妹很難上手,我決定針對值班常見問題,以我自己的淺薄經驗,
寫了一份 PGY/Intern survival guide,跟學弟妹分享,作為教學用途。
今天暫時先完成基本的病人評估方式,呼吸喘,發燒,和意識障礙的處理原則,
以後有空會增加更多。檔案的聯結在此,有興趣的 PGY/Intern 學弟妹歡迎下載。

https://docs.google.com/leaf?id=0B4BhmC8V2mivZTUyN2Y4OTMtZjU4MC00YzM3LTgzNWMtY2U4NDlkMDlkZTgx&hl=en_US

本人才疏學淺,這份資料只是個人經驗,若有錯誤,歡迎來信指正。
08/27/2011
http://udn.com/NEWS/OPINION/X1/6552700.shtml#ixzz1WBuVbZr5


病人多、醫護少 衛署「去函」能改善? 【聯合報╱洪任諭/資深住院醫師(台北市)】2011.08.27 03:15 am 近來有醫師疑似過勞死,引發輿論質疑,衛生署提出調查數字,認為我國住院醫師每周平均工時,和美國相當,這是明顯低估。
以醫學中心內科為例,因為責任制,加班是常態,每天超過十二至十三小時很常見。值班每月九至十一班,每班廿四小時,隔天不補休。若夜間遇到重症急救,可能連續工作卅六小時,假日人力縮減,狀況就更加劇。內科尚如此,遑論外科。
醫院評鑑雖訂有每人照護十五床以下,在出入快的科,可能白天五個病人出院,三個病人入院,夜間急診收二個,隔天雖總數不變,但卻是處理了十位病患。
新病患需從頭詳細問診,且出入院有大量文書需繕寫。照顧床數超過的醫院,當然只能短報。若照實呈報評鑑無法通過,健保給付會降低,財務更吃緊,非但不能擴編人力,可能還要減薪,無疑雪上加霜。病人多、醫護少是事實,就算衛生署「去函要求改善」,血汗醫院也是巧婦難為無米之炊。
工時長是症狀,「重症無醫師」才是病因。衛生署不對症下藥,增加重症人力,卻欲以法規強制壓縮工時,將適得其反。一旦工時納入醫院評鑑,屆時招不到人的醫院,只好被迫造假工時數據以通過評鑑。
內外婦兒、急診等重症科「錢少事多糾紛多」,人盡皆知。只道德「呼籲」大家投入重症,消極「去函」要求醫院改善,請問衛生署,要怎麼改善?

08/09/2011

PCManFM, the default file manager of LXDE, just got a new release. This application need libfm 0.1.16 to work and incidently that is also released today!

PCManFM has seen some significant improvements since the last release back in October 2010. Probably the most notable UI change is the reintroducation of the tree view in side pane that was removed in the rewrite.

pcmanfm-0.9.9.tar.gz, sha1: de7099f57d7139a3d184cd162e02f5f5601667ec
libfm-0.1.16.tar.gz, sha1: c3f4b10baa596ddfc09ae9efbd2c922a26114de8

Changelog for PCManFM
5cbad00 Explicitly link to libfm.
a672793 Fix #3094303 – Regression: Dnd to add folder to bookmarks is broken.
3c969e7 Focus folder view after switching page.
5089e13 Update to use latest libfm API. Fix #3300800 – Deletion prompt has no title.
fa7d474 Fix untranslatable messages.
792cf32 Make “%d items selected” status message translatable.
b282aec Fix #3308324 – “~ in locatio bar cause pcmanfm crash”. Fix #3286157 – “Entering path with two initial slashes // crashes”. Fix #3284001 – “Crash when entering path with trailing slash”. This is related to GTK+ bug #650114, which is already fixed.
813241d Add “Reload folder” to “View” menu.
8a2866f Apply patch #3135578 – Problems with the selection and opening a file.
11d77a6 Apply patch #3163496 – “Menu key to call context menu” with some modifications.
164a371 Apply patch #3301636 – Make slash and tilde activate location bar.
253bdaa Close tab page when the folder which it shows is deleted or unmounted.
fb74b05 Use a less problematic way to show “root mode” warnings.
9756804 Update statusbar text, volume info, and window title correctly for every pages.
792db54 Use enum values instead of integer values for bookmark open methods.
ca184dd Use new API: fm_folder_model_get_is_loaded().
32f6ac2 Rework tabbed-browsing again and create one separate GtkHPaned widget for every page.
ea5e99a Save side pane mode.
5c2f12d Fix free disk space display. Fix #3037825 – Bottom bar not updated.
9a84c1c Rework tabbed-browsing again and make the code cleaner.
25a6a7b Add correct version checks for libraries in configure.ac.
ff8faeb Deprecate fm_folder_get_for_path() API and use fm_folder_get() instead.
28a479b Rename variables for consistancy.
a1c270d Make status bar message more user-friendly and correct.
b4e898b Use new fm_path_entry_set_path() and fm_path_entry_get_path() APIs.
1dfc8e4 Fix #3114626 – PCManFM 0.9.9 Umount partitions problem.
30cf77f Prevent removing built ui files and fix #3181001 – data/ui/*.glade files missing in tarball .
c1f4b6c Set a proper default desktop font if the config value is lacking.
41ad5c3 Add a new config value tab_max_chars to limit the maximum width of tabs.
6240436 Rework tab browsing so we can have more tabs in available space just like the old pcmanfm 0.5 series.
b7a953d Little fix.
cac3de0 * Fix #3139753 – Create New asks for name of new “file” even for a new folder. * Update translations.
9197e75 Add “Create New” popup menu to “File” main menu. Close bug #3107416.
3d14164 Fix #3095516 – PCManFM does not write preferences from main menu.
13a4a38 Add checks for invalid enum values when loading config files.
6d95cbc Fix #3112447 – Daemon mode opens window.
376cc92 Update translations and fix #3114640 – PCManFM 0.9.9 Right-clic on desktop partly hard coded.
6033d80 Escape strings while passing through IPC.
d7d1289 Handle string arguments with prefix –.
1098cfe Little fixes.
cda6259 Reimplement a simpler yet cleaner IPC mechanism again.
cdf5dfc Support mouse button 8 and 9 for back and forward.
5715ba7 Fix #3094187 – Icons file no change when “Stick to Positon” is unchecked.
4e0e602 Trivial fix.
b2e074e Improve handling of backward compatibility for old config files.
2ed76de Fix #3085503 – always_show_tabs=1 don’t work.
b510014 Require correct version of libfm.
9afd9e1 Bump version number to 0.9.9. Fix #3071296 – pcman windows always show up on first desktop.
422e106 Apply patch #3089346 – Re-enbale fake transparency when using pcmanfm 0.9.X.
7fd8aba Use our own round() implementation to avoid using C99 only function.
248b813 Add missing file to data/Makefile.am

Changelog for libfm
c5595a9 Remove docs directory from make file
d036dce fixed makefile
d06d8a0 we need m4 folder
4c7b7a2 fix file authors
7f5466e added missing license header
d22b41f Try to fix Lubuntu bug #820865 – pcmanfm cut&paste a folder to a destination folder withouth write permission causes data loss. https://bugs.launchpad.net/ubuntu/+source/pcmanfm/+bug/820865
2c8fdfb Trivial fix.
fe9ea77 Add missing license info and fix some build problems found by “make distcheck”.
3153210 * Bump ABI version with libtool -version-info to 1:0:0. * Update AUTHORS info.
9c49624 Fix #3094303 – Regression: Dnd to add folder to bookmarks is broken.
70e45ab Add optional window titles to commonly used dialogs provided by fm-gtk-utils.c. Fix #3300800 – Deletion prompt has no title.
94d9f4e Fix untranslatable messages.
d20b968 Make menu of side pane translatable.
37eee68 Apply patch #3301641 – Typing “~” in location bar loads root folder.
89630cf API changed: fm_folder_get_is_loading() -> fm_folder_get_is_loaded(), fm_folder_model_get_is_loading() -> fm_folder_model_get_is_loaded(). Add fm_folder_view_get_is_loaded(). Correctly update popup menu of FmSidePane when mode is changed.
cd79d62 Add missing g_object_ref.
8a69a3d Little fixes.
90c685c Add “changed”, “removed”, “content-changed”, and “fs-info” signals to FmFolder and add filesystem size query to FmFolder.
c076d3e Check for correct required versions of libraries in configure.ac.
d3f856f Little fix for dir tree.
1d09555 Include proper headers.
29bf2a1 Add FmSidePane class for a better implementation of side pane.
b54f630 Some fixes for FmDirTreeView.
c1b0d37 Add FmDirTreeView and FmDirTreeModel to implement directory tree for left pane.
7915d1f Add new API: fm_path_depth().
682f9e2 Add new API: fm_file_info_is_hidden() and have FmFolderModel use it. Remove the unused API fm_folder_get_for_path().
fe1854e Implement %k field code for Exec key according to desktop entry spec.
debea4a Little fix for statusbar message in demo program.
03ec420 Fix #3093778 – Pasting empty string causes copying “/” to current folder.
db84c10 Remove the useless “status” signal from FmFolderView and add some APIs for accessing data members.
180db97 Update comments.
3bdd675 Add a FmPathEntryModel custom tree model for FmPathEntry to save memory.
8003719 Little fix for cancellable.
392601b Use another way to implement auto-completion for path entry and try to utilize most existing functionality provided by gtk+.
d53456f Rework FmPathEntry and make it simpler and faster.
d500b33 Add a simple and basic implementation of button-style path bar.
197c7e1 Fix #3086703 – PCManFM crashes on non existent directories.
61443ac Fix #3115734 – Copying to long path names.
26062bb * Do chdir to / if cwd is under the mounted filesystem which is going to be unmounted. * Fix #3114626 – PCManFM 0.9.9 Umount partitions problem.
2243156 Fix #3127903 – Fails to give permission denied error when overwriting.
2f61ade Fix reference of invalid widget pointer in properties dialog.
415083d Prevent removing built ui files and fix #3181001 – data/ui/*.glade files missing in tarball.
883793d Show tooltips for tab labels when the label text is ellipsized.
3204482 * Use a forward compatible way to register uri scheme handlers as in glib >= 2.27. * Fix #3094197 – Prepare deprecation of the gio module.
67375dd Fix #3132262 – Crash when trying to restore files from trash.
17511bd Fix #3148077 – Latest pcmanfm/libfm crashes when trying to open /proc/self/fd/ (or its symlink /dev/fd/). In this same system nautilus opens that directory fine.
0f04125 Fix #3143296 – spaces are still (or again) not escaped in paths to execute.
36dfad2 Fix #3135910 – “Extract here” doesn’t handle space and encoding characters.
d419535 Add some macros to validate enum values.
1b2560c Changed order of typedeffing enums and declaring them – for C++ compatibility
cf8446b Do further checks for scripts.
1a249bf List “gobject-2.0″ in configure.ac explicitly.

07/29/2011

The tool for setting look and feel of your session, LXAppearance, has been released in a new version.

Get the file at sourceforge.net: lxappearance-0.5.1.tar.gz, sha1: 5cdff02e2c0ba268dbcbe2a9aa5febe3daa7e842

17a9171 Updated copyright year
bb69b4a Removing useless whitespaces at EOL and EOF.
c7b7bbf Correcting automake handling for –enable-man configure option that has never worked in the first place.
7961ca4 Rather than failing with an error when build is run with –enable-man=no, now printing only a warning instead.
b16606c Rather than unconditionally regenerating the manpage, setting the –enable-man default to yes.
df55eb9 BUG: Always build manual pages
d170c61 Update FSF address
aeb2da6 fixed assignment and plugged memory leak
fad3989 fixed the types of the app struct members holding the gtk-xft-hintstyle and gtk-xft-hintstyle properties
1bf9b9a Remove deprecated property in ui file
3936b38 Fix typo in gtk-3.0 file saving
89574cc Don’t use GTK_DIALOG_NO_SEPARATOR for gtk3
8108db6 Add an option to compile with gtk3
e2eadb8 Use an option to enable more warnings instead of the maintainer mode
c26fee9 Write gtkrc file in gtk3 directory
1eef2a2 Revert also commit on plugin
b864865 Revert part of the commit for compiler warnings, to fix loading themes.
29e7d94 Fix silent build
5b0f6f6 Update po with migration to UI
d31af5a Fix not capitalized string
97f5808 Add another item to .gitignore
203587a Remove some compiler warnings
2d9128f Add new font configuration tab.
073c072 Apply patch on GTK3 migration
2664156 Remove 1 compiler warning.
59bae74 Add new item to .gitignore
39bff85 Use directly ui file instead of glade files
6f83e86 Add .gitignore
8f1bbe3 Really apply previous changes
62d4031 Improve build system (new flags, silent rules)

07/29/2011

The common packages has some files that are good to have around, wallpapers and openbox configuration and such.

Get the file at sourceforge.net: lxde-common-0.5.5.tar.gz, sha1: 27ce9bcaf109ded61aa0c691a8dc6059a04a6d08

87c368d Fix install location of pcmanfm.conf file
736ded3 Add missing openbox-lxde manpage
4a461c3 Fix location of pcmanfm config file
7c95c46 fixed pcmanfm config file path after 0.9.8 release
38c0d2f Minor adjust for PCManfm 0.9 LXDE profile name in LXDE session.
908f14c pcmanfm2 has been finally re-named as pcmanfm
278a3f5 fixed pcmanfm command to call the proper config table on pcmanfm2
96fa5ab Set terminal=lxterminal to make it consistent with the terminal setting in lxpanel.
07dae88 Bump version of lxde-common to 0.5.5.
bf7093b * Fix config file of pcmanfm2. * Fix autostart for pcmanfm2.
fcefd17 Properly set XDG_MENU_PREFIX.
00acd9d remove old config file
0f3b683 swtich from pcmanfm to pcmanfm2
3f17c3a Sync lxde-common/debian from debian.
28309e5 Ensure the existance of the ‘Desktop’ folder
34cd793 start xscreensaver after lxpanel and pcmanfm
847a8e7 Launch dbus in startlxde when needed.

07/29/2011

As is normal with this package there are just one non transaltion related change in this release, the point of this package is to provide transaltions of text for the application menu and we now support 91 different translations.

Get the file at sourceforge.net: lxmenu-data-0.1.2.tar.gz, sha1: 57490607f67d43167beb326ebc927524dd6dd1ab

77e17cf remove distribution of mkinstalldirs

07/29/2011

The LXDE Desktop Manager has been updated. This releases is a translation update but also add a minor bugfix.

Get the file at sourceforge.net: lxdm-0.4.1.tar.gz, sha1: 652886ac27ac01b24e7d13c3be3b1e582e2159cc

3eb70bf fix lost data entry when install

07/29/2011

This release is mainly a translation update. There are some smaller things changed, see the condensed log below.

Get the file at sourceforge.net: lxinput-0.3.1.tar.gz, sha1: eb4a846b90e353f2201de23860888f3e6bc9061b

2d42550 debian: Add build-depends on xsltproc
46b4269 debian: build-depends on docbook-xml and group build-depends needed by autogen.sh
1300a03 debian: Force –enable-man and use verbose mode
7614973 Add debian directory
a61aa3d Correct ids in .ui file
13d94b1 Add an option to compile with gtk3
ffd0d77 Add an option to enable more warnings instead of maiintainer mode
3a0fc90 Add additional flags for maintainer mode
22e5efb Add silent rules
b7e39af Remove some compiler warnings
89e0a0c Add .gitignore
48a5b77 Add INSTALL file
53e5422 Use directly the .ui file
0caaa22 Add optional entry when a program which change keymap is installed (support only lxkeymap for now)

07/24/2011
理學檢查,一般是指醫師透過視診、聽診、觸診、叩診...等方式為病人進行檢查,尋找疾病的徵象,以輔助診斷。通常是只用五官感覺、加上觸覺...等,僅以徒手,或用簡單工具例如聽診器輔助,就能進行的基本檢查,為內科醫師的基本功。在過去沒有先進檢查工具的年代,這些基本檢查,佔有至關重要的角色。

時至今日,隨著放射科影像學發展,各種實驗室檢查推陳出新,理學檢查的重要性看似不若以往,其功能也常被各種更準確的檢查取代,整個醫療過程對理學檢查的依賴降低了,因此許多醫學生對這些傳統的檢查方式,不再像過去一樣熟悉。但實際上,醫療上還是有很多時候,是無法完全依賴先進檢查工具的,反而得靠傳統的詳細問診,和理學檢查基本功輔助,才能快速獲得正確的臨床診斷。更不要說有很多較為落後地區,是沒有這些先進的設施,或無法馬上取得。

最近的值班,又有一次單靠理學檢查,成功治療病人的經驗,再次印證了理學檢查的重要性。病人是老年男性,右下肺有惡性腫瘤,因為呼吸衰竭轉入加護病房。合併感染,因此有抗生素在治療。入院時有意識變差的狀況,原以為是電解質不平衡導致,但當時負責的醫師細心的幫他安排腦部掃描,赫然發現,除了電解質異常,竟然還合併腦幹的中風。這名患者除了癌症,還合併有許多其他器官的疾病,又有會危及生命中樞的問題,預後極差,意識不清,再加上呼吸衰竭,能夠治癒的機會微乎其微。家屬也能夠理解狀況,因此雖然不捨,還是簽具了同意書,要求呼吸衰竭不予插管,並希望臨終時能留著一口氣帶病患回家。

身為當班的值班醫師,才交班完畢沒多久,就接獲通知這名患者呼吸費力,血氧濃度下降。前往診視後,呼吸用輔助肌肉,並且腹部出現俗稱翹翹板呼吸,橫隔無力的徵象,應是呼吸衰竭的狀況。聽診發現雙側大量痰音,但病人意識不清無法有效咳痰,抽痰又未顯著改善。眼看能用的藥物,他的醫師都用上了,我能夠再使力的空間很少了。這個,當然就是醫療上無法治癒的病人。

這樣的狀況,當然撐不了多久,心電圖監視器上,就出現心跳逐漸下降的情況。原先是心律不整心房顫動,心跳 140 下,幾秒鐘內突然掉到 50 ~ 60,血氧濃度從 95% 掉到 60~70%,血壓也掉了下來。大家不約而同推著急救設備,跑向病室。眼看心跳快沒了,馬上給予強心藥劑注射,同時以甦醒球 (ambu) 給氧,心跳恢復了,血氧也稍微拉上來。因為有簽署放棄急救的同意書,我們不給這位病人插管,也不施行心肺復甦術。但家屬還沒趕到,救護車也還沒叫到,那他們想留一口氣回家的心願呢?病患不住在北部,路途很遙遠,還不要說到家,如果沒有把他撐住,他可能根本活不到救護車來接他。

一邊在思索還有什麼可以做,我回想,記得早上才看過他的 X 光片,主要的病灶是右下肺的腫瘤,其餘部份雖有浸潤,但並不非常厲害。不等我想完,血氧又掉了,剩下 30 ~ 40%。固然四肢冰冷循環差可能造成機器偵測不到訊號,但病人看起來有發紺,心跳變慢, 四肢冰冷,我想沒人會懷疑他缺氧。那再來呢?呼吸衰竭不能插管急救,那我還有其他武器可以用嗎?我找來值班實習醫師幫忙以 ambu bagging 給氧,好讓我有空檔診察病人其他部位。

擠著甦醒球給氧,幫助病患呼吸,這時我卻注意到病患的右側胸部沒有起伏,只有左側可以充氣。雖然並不明顯,但仔細觀察,還是可以發現到右側胸部並未隨著呼吸起伏。我又用手摸了一次,兩側的胸廓起伏是不對稱的。我趕緊拿起床邊的聽診器一聽,右側完全沒有呼吸音,這就解釋了為何血氧突然拉不上來。

當然,大家都知道,造成單側沒有呼吸音原因很多,但最常見的,不外乎氣胸、肋膜積水、還有全肺塌陷。這時候照 X 光片或是抽血都是緩不濟急的方法,因為都是要至少半小時以上才能得到結果,基本理學檢查在這時候顯得格外寶貴。我馬上進行了胸部的叩診,左側肺部為響亮的鼓音,而右側為頓頓的濁音。若為右側氣胸,那應該右側要有響亮的鼓音,而非左側。會聽到濁音,通常是積水或是全肺塌陷。我又觸診了患者的氣管,氣管位置稍微往右側偏移。若為右側大量積水,氣管應該會被推向左側。再者,早上才看過 X 光片,是沒有積水的,不可能在一兩小時內突然間淹滿。當然外傷患者,可以因為胸腔出血快速產生血胸積滿液體,但這是臥床的內科病患,這樣的可能性實在低。不但如此,摸到氣管略為偏向右側,亦是右側肺部容積減少的間接證據。各種的徵象,都支持右側全肺塌陷這個診斷。左側的叩診聲音變響亮,更是可以支持這個診斷,因為右側塌陷後左肺會代償性擴張,過度通氣。因此,憑著理學檢查,我們就徒手找到答案了。那下一步呢?

早上聽診過病患的胸腔,痰液極多,且意識不清無法自咳。在這樣的病患,會突然間肺部塌陷,十之八九是痰液塞住呼吸道。當然對這樣的患者,理論上氣管內插管,會是很好的急救方式,但眼前這位患者是拒絕插管急救的,那該如何?我跟在場的護理人員表示,要為病患進行拍痰 (以扣擊胸部,讓痰液鬆開好抽出的技巧,經常由看護施行)。大家都露出懷疑的表情,並且告訴我他們之前抽過,抽不出痰。顧不得大家的疑惑,我把病患翻成左側躺,懷疑痰塞住的一側朝上,並且開始拍痰抽痰。幾分鐘後,搭配擠壓甦醒球,血氧回升至 98%,再次聽診發現右肺呼吸音恢復,叩診為鼓音,兩邊胸部也會隨著呼吸正常起伏了。隨後又有一次類似情況,這次護理人員不再懷疑,反而很主動的把病患翻過來拍痰。患者不但血氧濃度回升,原先是昏迷,手腳還開始稍微會動了。當然還有一個可能的鑑別診斷,是腫瘤造成右側肺出血。這種情況翻左側躺是禁忌,因為出血會流到好的那側肺部。不過,如果出血量真有這麼大,應該不會完全抽不出東西才對,而且當下情況危急,不處理那他就沒命了。因此針對可能性最高的診斷處理,我認為是很合適的。

這次是基本理學檢查一次快速、成功、而有效的應用。我也藉此機會,跟參與的值班實習醫師講述了方才的過程,希望他能夠在未來行醫的路上,回想起這段故事。當然,故事的結局並不是喜劇。這名病患最後還是因為其他問題太過嚴重,無法治療,在臨終之際由家屬叫救護車帶回家了。但不管怎麼說,能把過去所學,在臨床實際有效應用,還是令人欣慰的。

在緊急情況下,許多平時不難的事情,會因為緊張亂了手腳,更不要提不熟悉的項目。在緊急情況下要能夠冷靜,有條不紊的判斷,除了仰賴急重症教育,靠的還是平日基本功的累積,還有好習慣的養成。我並不是聽診高手,但至少我願意堅持,持續重視理學檢查這個好習慣。在帶實習生時,遇到異常的呼吸音,我也一定會盯著他們去聽。這些基本功,無一不是老前輩的智慧結晶,今日雖已有許多先進檢查工具輔助,對這些傳統技能,身為內科醫師,依舊不能放棄練習。這次的經驗,又讓人有更多可以堅持好習慣的動力了。

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