Terminal Intern Syndrome

BBS上很有名的一篇「末期銀蛋症候群」，
作者Dr.Aribuda Wulumoje Chou這位仁兄的唬爛功力實在太強了 m(_ _)m

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Terminal Intern Syndrome(TIS)
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This new developed syndrome is defined by Dr.Aribuda Wulumoje Chou in Journal of TIS 2002-April. It was defined as:



(1)general weakness, unliking to move, and hiding in Doctor's reserch room or Duty room, keeping from from ward round and meeting.

(2)bad temper,loss of patient, easy angry, especially when in busy or doing bird thing

(3)elective deafness, hear BB-Call selectively

(4)careless and loss of responsibillity, being easy murmuring



It may be terminal, but never being expired.(except commiting suicide)

And according to it's etiology, it devided to two types: Primary TIS and Secondary TIS.



A.Incidence:

TIS is foud in 70% of Intern doctor population, in some hospital, such as CMCH and KMCH, it may approch to even 85%. female to male ratio being: 1:1.5, relates to Intern Doctor population ration (male to female: 1.5:1). Primarry TIS to Secondary TIS ratio be 0.05-0.07:1.

B.Risk Factor:

1.Being a Intern Docotr:

if your are not an Intern Doctor, congraturation, your are free from TIS

2.Once a bussy Intern Docotr:

a bussy Intern doctor would be 9 times to develope TIS then easy one, but there would be a case report(Journal of TIS ,2001-May, by Dr.Aribuda Wulumoje Chou)recealed that someone may being terminal when he is an easy Intern Doctor (now corrected to be "Primary TIS")

3.Hospital that abuse Intern:

A hospital that abuse Intern would increase incidence rate.

4.Nurse that show no respect to Intern Doctor: Especily in Internal Medicine Dep., a Intern Doctor would loss his name and even his familly name, and just be called:"Intern".

5.Personality problem:

May related to personality of Intern doctor himself or from the out side circumstances.



C.Nature Course:

People being a Intern Doctor can be devied in to three groups:

1.Primary TIS:Who just being terminal when being an Intern Doctor,and may associate with Refusing Being Intern Syndrome(RBIS). An Intern Doctor that being always easy, but become terminal near ending may controbute to this group.

2.Secondary TIS:

Intern Doctor that initially worked hard and studied hard in clinic affair, and as times goes by, progressive general weakness and loss of patient, gradually elective deafness somtimes happened. then developed into terminal stage--TIS.

3.Rare Intern Doctor free from TIS, may due to easy compromised personality.



D.Diagnosis:

1.TIS in the asymtomatic Intern Doctor:

May showed arrised of serum GOT/GPT, and BUN/Cre. due to over-working and no time for hydration and urine voiding. Decrease of serum glocouse due to no times to eat always occured. And may increase of serum anti-Nurse Ag and present of TIS-DNA expression.

2.TIS in syptomic Intern Doctor:

may showed increase of serum glocouse(pc) and normal range of GOT/GPT.

Hyper-antiNurseamia, and TIS-DNA related TIS-protein-Chou may hyper-expression and somtimes cause shock, whitch called Chou's phenomenon and remains mystery for it's reason.



E.Menegement and treatment:

1.Injection of Anti-anti-nurse Ab:

may be response sometimes but recurrent rate would be 85% in 5 days. Now clinicaly used only when acute group transmission.

2.Free of Intern Docter's duty:

Intern Doctors are student and doctor, and when be a student should keep from clinic loading.(ex. forbindden calling when Intern being in meeting)

3.Show basicly respect to Intern Doctor:

An bussy Intern Doctor would be more confored when nurse treat him kindly .

4.Psychologic treatment may be indicated and should use under the recommendation of psychologist.

5.A CD team would be heplful but limitted.



F.Prognosis

1.All TIS are self-limitted, and currable when end of Intern-ship.

2.All Intern Doctore that ever suffered from TIS, would suffered from Terminal Resident Syndrome(TRS) occasionally in their furthure life.



G.Relative syndrome:

(A)Refusing Being Intern Syndrome(RBIS):

Lots of Clerk Doctors suffered RBIS, he posible cause of RBIS may relate to the risk factors of TIS they will meet.

(B)Terminal Resident Syndrome(TRS):

Residents would suffered from TRS due to large loading of clinic affair and paper works.May relate to TIS, and when TIS acute group transmission happening would increase TRS incidence rate.

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