2012年7月14日 星期六

On call 36 hours 小時

Doctors need to be on call for whole day and night and finish work only after the usual 8 or 12 hour daily schedule before going to bed. But this happen to be only apllicable for trainee. For specialist doctor or chief of service in each major specilaty involving emergency care and surgical operation. They are on call for life or on call 24 hours a day and 7 days a week.

Who pay them for the on call? None but the devotion to work and satisfaction in treating patients. Hospital authority would not compensate for that. Neither would the chief of service ask for the compensation like the hours counted in recent doctor- HA settlement on contract hours court case in Hong Kong High court.

The court or judge does sympathise on call doctors but the judge cynically approve for minimal or bare inevitable counting of hourly paid for Sunday "voluntary" or traditionally implied obligatory duty in Sunday or rest day ward round and coverage.

So private specialists doctor are on call everyday for their patient. Neither would they charge a standby fee. But they can choose to accept patient or not. So their call is not compulsory.

To be a doctor , think twice about that. You may need to study 18 hours a day to get finished the medical school. Work with on call 36 hours or at least 32 hours once every three or five days during training. Then on call every day practically for life.

Is it worthwhile, in future blog, I would explain to you that it is worth.

My name is Dr Chung Shiu Shek, specialist in cardiac and thoracic surgery. My clinic number is 3160 8865

The most live-able city in the world HONG KONG 香港最能活的城市

Despite all the bad comment on the future of Hong Kong, the Economist Magazine/News corporation has rated Hong Kong the best city to live in the world in year 2011.
I would not doubt about it but the ranking surpasses previous years of being rated the fourth to tenth comes so abruptly amidst the political turmoil of this place.

Hong Kong is my home and my birhplace. I have no hesitation to admit my citizenship as Chinese or Mainland china civilian but the tie to region HKSAR is more close to my blood and knowledge than ever. Before the 1997 change over, I have much reservation but a real practical issue to wirte down my nationality as Overseas British National with my HK passport. I would rather wirte down Chinese bracket BON (British overseas National) in Hong Kong rather than identifying myself as second class UK countryman but without any right of citizenship or residency.

How come other people recognise the strong points of living in Hong Kong but other people including most Hong Kong people thought the glory of the Jewels of the East has faded out more or less entirely. We are only one but not the most recogisable independent cities in Mainland China. We cannot surpass but to be surpasssed by cities like Beijing, Shanghai, Tianjin and Chongqing. Even the size of economy will be taken over soon by Shenzhen and then Guangdong or even Xiamen.

The one and probably more significant factor is the medical facility and accessibility in Hong Kong. I am proud of myself being one the medical supplier (specialist doctor in cardiac and lung surgery) in Hong Kong. I would not agree this is perfect but would say it is keeping on improving. But most Hong Kong majority would criticise the apparent self sufficiency of the medical system available in Hong Kong.  In prinicple, all public health care is  free but rationed. All specialist care are availabe at nominal charge and the care provided is up to international standard. However, this is far from the truth to see primary care is failing badly in preventive medicine aspect. Lots of people complaint the general satisfaction lacking in Hospital authority hospital.Thousands of hospital authority staff be in professional or allied health voted by foot to leave the system.

Yet , vaccination is nearly universally compliant, control of disease like SARS or swine flu is superb, major surgery like liver and heart transplant, sex change or conjoint twins operation are successfully done from time to time. For the problem of private medical care. It is not regulated and a lot of over charging is suspected. However, the success can be illustrated by the fact that lot of wealthy mainland people come to HK for medical consultation or even treatment and lots of wealthy businessman enjoyed good care by lot of private specialists.  Care in Hong Kong is good provided that there is no counting of cost of time in public HA service or no restriction of charge or resources for private market.

In Hong Kong, the proportion of national expenditure is only around 9 to 12 percent of GDP.  But the standard of care is good and doctors and nurses enjoyed good living support. If hong kong is so good in providing first class medical service at such an efficent expenditure. Then other countries should model their health system to simulate Hong Kong.  Everyone knows there is no free lunch in the world. So the local or insider would recognise a lot of hidden problem of heath care in Hong Kong. Thanks to the marketing or image controller persons in Hospital Authority. The drawback of the system is not exposed or shown to journalist who are only expatriate or visitor in Hong Kong.

If you ask one of British overseas worker or Philipino maid in Hong Kong. Are they enjoying good medical care system in Hong Kong. They would certainly point out that medical care in Hong Kong tends to be fragmented and haphazard and accessibility is far from simple or intuitive.  The specialists is availabe at high price and competition among health provider is not transparent and open.  A few giant specialists clinics or doctor dominate the private market and the fees they charge are ususally not afforable from general public.

I remember not long ago (actually availabe in Wikepedia) that one overseas Malaysian British citizen died of treatable disease in one of the public hospital in Hong Kong. Her Causcacian husband spent more than eight years to secure out of court settlement for the lack of care or even discriminative care availabe in public hospital system.
Although this isolated event has lot of overtone of cultural or racial difference, this illustrate the medical care in Hong Kong is like a cat and mouse game. Those who is familiar with the system can play the game well. thouse who do not or just take it for granted would not recieving expert care.

As an insider, I would expose the skill and trick to recieve good medical care in public system and private care to all. Hope everybody get the best care in Hong Kong.
Three cheers to the journalist who choose Hong Kong to be the best place to live because of an "excellent" medical care system.

My name is Dr Chung Shiu Shek who provide 24 hours emergency medical care to all enquirers and  I am specialist in cardiac, lung, chest surgery.
My clinic no is  3160 8865

2012年7月3日 星期二

Hyperthermia and Over sweating 多汗症

In Hong Kong, summer temperature is very high and city pollution and over-crowding create an ever increasing stress for out door activites or transit.  Human bodies have adaptive ability to extreme ambient environment.  Working under hight temperature would cause dehydration, heat stroke and cardiac complications.
Over sweating is the consequence of compensation in heat dissipation method in body
Over sweating in the palm and axilla cause embarassment in social life. Usually this begin in young adolescent and has incapacitating effect on social interaction of the youngster.
Both male and female are affected. It appear that male are affected more or they are willing to seek help more. For female, the problem is related more to odor than wetness. Armpit odor is more a problem for them in summer when less covered clothing is trendy then.

Treatment of oversweating or primary hyperhidrosis has long been used in society.

They include

1) self help method
2) Local anti-perspirant
3) removal of sweat gland by local ablation, surgery or injection
4) Botox injection
5) hormonal therapy or drug treatment
6) electophoresis - iontophoresis
7) surgical treatment of sympathectomy

The last method is most effective and durable.

But the drawback must be stated before surgical treatment.

They are:

1) over sweating in body
2) reduce facial flushing or red or lively color of face
3) small chance of failure
4) definite though small risk of sympathetic damage causing dropped eyelids (Horner 's syndrome) and small pupil

For educated patients with well thought of problem, surgery is usually fruitful. Stay in hospital is short and stay for post operative one or two days are common.
wound pain and anaesthetic problem is minimal
Decrease in sweating is permenant.