Monthly Archives: June, 2008

Neurotic vs Psychotic

One of the most important principles I try to uphold when speaking on a medical topic  to a public audience  is to mentally try to refrain from using medical jargon which will only serve to confuse the audience and lead to blank stares. Too often, we doctors get carried away by our lingua franca that we forget the lay audience speak good old plain English!

Therefore, I was really impressed with a psychiatrist colleague who answered the question:

“Doc, what is the difference between a psychotic and a neurotic?”

with the following answer:

Well, a psychotic thinks two plus two is five,

while a neurotic knows two plus two is four, but this really bothers him!”

Smokers Offered Money To Give Up

Want to avoid cancer? What’s the most important lifestyle measure that you can do?

Take a look at the following diagram from WHO:

It tells us two things:

  1. 40% of cancers are preventable.
  2. The single most lifestyle measure is..you guessed it..stop smoking.

The big headache for health prevention experts worldwide is how to implement effective control programs, taking into account the above two facts.

So it was quite something else when the BBC reported that the National Health Service was going to implement an innovative scheme to provide GBP 150 per person to buy groceries in return for quitting smoking for 12 weeks. Read this here.

So how are they going to know if someone had actually quit smoking? Well, they have to report weekly to nominated chemists and undergo a carbon monoxide breath test. If it is negative, then they will be paid weekly. Sounds pragmatic, doesnt it?

Some quarters may yell “bribery and corruption” …but, at least, it may prove more effective than the millions of dollars of anti-smoking ads that are being poured into the mass media which so far has brought questionable results..

Doctors play God, or don’t they?

Many years ago, as a junior resident in a large overcrowded public hospital, I chanced upon an elderly man lying in bed looking very pale and ill and surrounded by two younger men looking at their friend(the patient) as if he was in death’s throes. As I breezed past on the way home after a rather tough stint, the younger man stopped me in my tracks and said if we could do something to help the elderly man as they had been told earlier by another doctor that the patient was terminally ill, nothing could be done and that the best thing would be to take him home to spend his last days comfortably in his own bed.

It was already late night but as there was a bit of extra time left before the call-duty was over, I took a brief look at his case-notes and summarised that the working diagnosis was that of advanced cancer of the lungs.

Having promised the patient’s friends that we would take a second look the next morning with the team, I headed off for home.

To cut a long story short, the diagnosis turned out to be a lung infection called aspergillosis and in next to no time, the patient was cured and able to walk home quite well.

I was constantly reminded of this gentleman as he would faithfully turn up once a year outside my office during the main festivity season bringing a celebratory gift. Although he did not speak English, the words, gestures and smile spoke volumes in terms of gratitude. These visits went on for several years till my staff took his visits almost for granted.

One fine day, we all realised that his visit had stopped coming for some time and it wasn’t till much later that word got to us that this fine old man had finally succumbed at home to what was presumably old-age.

This whole episode really got me thinking whether we as doctors do actually determine the fate of fellow human-beings. Much as the Hippocrates Oath or the Geneva Declaration on Health determine our behaviour towards patients, doctors are subjected to various constraints sometimes beyond their control. A missed diagnosis, inadequate review, insufficient resources are some of the factors which may hinder appropriate treatment and consequently lead to a different fate than what God probably intended…

Health..a basic human right?

Met a disgruntled patient the other day..”why can’t the government take care of its citizens’ healthcare needs – after all, health is a basic human right!”

That set me thinking on quite a few fronts.

Is health a basic human right?

The WHO constitution states:“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”

The problem of course for governments is whether it is financially viable to provide the best healthcare for each and every of its citizens. Things were not so bad three decades ago where perhaps the most expensive medical procedure would have been an open-heart bypass.

Today, we have organ transplants and, more costly in the long-term, repeated procedures like hemodialysis where you need to attend a center three times a week for the rest of your life, each time incurring a cost of about USD$200. Whatever the source of funding, its going to impose a tremendous strain on the budget. Personally, I do not know of any government which will pprovide a  carte blanche for a patient to be given completely free dialysis treatment for the rest of his life.

So what do governments do? They could provide a partial subsidy or, in the case of a third-party payor (like insurance companies) only provide limited coverage.

As countries grapple with the ever-increasing healthcare costs, it wouldn’t be a surprise for more and more to adopt the maxim :

Basic healthcare is a basic human right!

Travellers’ Diarrhoea – or, I have a gut feeling its…

Summer is upon us soon; and that means its travel time again.

Whatever your reason for taking off to some faraway land, many seasoned travellers will agree that travellers’ diarrhoea(TD) is one of the most common illness to affect tourists. Many will recall that what was to be the perfect vacation has been spoiled by an attack of the ‘runs’. WHO estimates sufferers run(pardon the pun) into the millions yearly, more specifically 10 million per year.

It respects no time or place – hence the colorful colloqualisms by which TD is also known : Bali Belly, Bangkok Belly, Cairo Curse, Dakar Dash and Montezuma’s Revenge.

The symptoms of TD are abdominal cramps,bloating, fever, diarrhea, nausea and vomiting. In almost a third (1/3) of TD victims, the symptoms will be severe enough to require admission to hospital. TD occurs within days of going to a new area and is usually(but not always) caused by a visitor’s gut being not immune to the local variety of bugs. This explains why some locals can drink straight from the tap without ill-effects while the newly-arrived visitor will be sent scurrying to the nearest toilet after a few hours.

In this context, it would be useful for international travelers to be aware in which country that tap-water is safe for drinking. Check out www.safewateronline.com to get the latest updates. The ratings for different countries are based on significant indicators produced by World Health Organization, Unicef & World Bank. It is significant to note that Malaysia belongs to rating 4(out of 5), which means that the main cities have safe tap water suitable for drinking and the prevalence of water-borne disease is low.

Been caught out with a bug that is giving you the runs weeks after returning home? Well, I came across such a patient who was finally found to have Giardia lambdia , a bug found in uncooked fresh-water seafood like oysters. This bug does not respond to antibiotics and one needs to take stuff like metronidazole.

The protozoa Giardia Lambdia that can cause you untold misery! The protozoa Giardia Lambdia (under the electron microscope) that can cause untold misery.

So what measures should the intrepid traveler take?

  • Before leaving home, take out health insurance and arm yourself with stop-gap remedies like Imodium, Lomotil and Travelan.
  • Do not consume uncooked salads and fresh fruit, especially when one did not observe its preparation. Make sure gloves are used to prepare foods.
  • Bottled water has been god-sent but make sure the caps are sealed. In some countries, the bottles are recycled with water from dubious sources.
  • Ice-cubes in high-risk countries are a no-no. The author survived on coke on a summer trip to India until the last day, when he had ice added, with severe recriminations.
  • Where immediate medical help is not available, rehydration is an important measure but the tummy should not be subjected to ‘difficult to digest’ foods. The use of probiotic-based drinks like Vitagen may help. Using Imodium and Lomotil is fine to stop the runs temporarily till you reach home, but, ultimately, the bugs need to be shown the door and antibiotics commenced to knock them off. So see the doctor as soon as feasible.

(I am making the usual disclaimer for this article – consult your doctor first before anything else)

Tis the season for earthquakes..what to do if you’re caught in one?

After the recent tremors in Sichuan,China there is the possibility of a few more coming (aftershocks or otherwise).

If you happen to be caught in one (God forbid), you have two choices:

1. Adopt the traditional drop, cover and hold on tactic. As the name implies, run under cover beneath the nearest bed or table.

2.Practise the triangle of life, widely promoted by self-proclaimed earthquake expert Doug Copp. Basically, he states that when buildings collapse, the weight of the ceilings falling on cars or furniture crushes these objects, leaving a space or void next to these objects, forming a triangle. He advocates that people should get into these spaces rather than go underneath car-roofs or furniture. In other words, roll off the bed and stay next to it rather than under it.

The triangle of life method is not without controversy. It has been denounced by the American Red Cross as ‘not appropriate’ for US buildings, which are supposedly sturdier. The American Red Cross and most American earthquake safety bodies recommend the time-honored drop,cover and hold on technique.

It is interesting to note that the OECD Report on Earthquake Safety in schools in China published in 2005 did not specifically mention which of the two methods were more effective. Can anyone shed some light on what is being practised in China?


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