To get the most from public hospital

In previous blog, I have mentioned difference in public versus private medical care. As consumer who pays for medical service either by direct charge or indirect charge through taxation but time consming waiting list, one would seek the best means to obtain good and personalised service in public system

1. Stress on making appointment to new case clinic

Usually the new case clinic is seen by senior doctors or specialist directly. This help to prevent missing important ill patient who may not have correct diagnosis on referral. This is much better than going back to the old clinic with regular FU and reporting a new symptom or new disease. Stree on getting referral addressed to the new case time slot of the specialist clinic.

2. Ask politely for being interviewed by senior team member of the in charge physicians team.

So always allow for being interview at day time. At rush hours or non office hour, usually the front line doctors or even the on call doctors are available. There is absolutely minimal effect in asking question or challange the care mode when you are interviewed by person without authority.

3  Make a gesture of asking for well documented information but do not make threat to complain

Human nature make public servants sensitive to clients requiring thorrough documentation of every details. But never pose a threat to complain, This iwill destroy the original relationship with caregiver.

4. Make careful research on mode of treatment of your own disease. Make suggestion or pose rational queries on the selected mode of treatment.

5. Before committing to have operation in this or that hospital. Do research on number of similar cases handled in those cedntres.also some hospital has shorter operatoperation waiting list than other. Borrow other address if necessary

6. Trust your care givers and maintain harmonious relatioship by mutual respect.

For private care, word of mouth and transparency of charge is important and reflect the professionalism of individual specialist.

If the specialist refues to discuss the cost or fees before committment of care or hospitalisation, beware of that. If the care of the specialist are to be split among other profession, the client retain the right to know how the fee is splitted or on which ground.

I am Dr Chung Shiu Shek specialised in cardiac and thoracic surgery. Feel free to discuss your own or your family medcial need with me. I strive to give my best possible advice to any questioners. Phone: 3160 8865  E mail: chungss@ymail.com

Thank you

Medical checkup : A devil or an angel

Recently I came across previously healthy persons having major pahtology after medcial examination for relatively non urgent symptoms.  It dose reveal how life is so fragile and the relative inaccuracy of sense of being good as indicator of own health.

One relatively young middle aged women complaint of feeling mass in the abdomen. Being regarded as inexperienced person, self reporting of a mass in the abdomen is usually wrong. The possiblity may be nothing, fecal loaded colon or ballotable kidney or transmitted abdominal aorta pulsation.

Further enquiry about the symptom is none. There is no change of bowel habit and appetite and body weight is normal.  She has early menopause and otherwise healthy. Routine USG examination review nodule and echogenic shadow in the liver. Subsequent high power imaging showed multiple enlarged cystic and cavernous haemangioma in liver. Haemangioma is one of the most commonest benign tumour in liver. It is even more benigh than polycystic disease.  The pathology of haemangioma is not certain but autopsies study did reveal lot of people dying with asymptomatic large cavernous haemangioma. She was told to lead normal life until condition change. Of course, rupture of haemangioma will be fatal and under reported because they seldom arrive alive at Emergency department.

Another patient has chronic appetite loss. X ray show upper mediastinal mass. CT showed huge mediastinal cyst displaying the esophagus and abutting trachea.
Early surgery is advised even if the chance of malignancy is low. Patient is feeling unexpected diagnosis being serious blow to life.

Following previous blogs on asymptomatic lung cancer, early lung cancer is usually not detected and can be found normally by low dose CT screening.

Whether we should screen ourselve for common disease or not?  Some may prefer not to know seious potential disease. However, cure of disease is usually only possible for early diagnosed cancer. So screening is useful for individual person althought nor always cost effective for whole society. (Because extra resource is needed to diagnose or rule out asymptomatic and normal but looking suspicious area.

If one afford to do screening with time and money, I think occasional CXR say every 3 - 4 years, stool x occult blood and exercise test (simlified with only resting or stress ECG and saturation monitor may be all required for middle aged person. For female cervical smear, breast examination is useful.
For elderly male, PSA for prostate and USG for hepatitis carrier will be necessary.

For whole society, immunisation of Hepatitis B vaccine, and health education and policy to eliminate promotion of smoking, alcohol and bad fast food is useful.
A postive attitude to life and treasure of life is always good.

So precious moment seems to be gone if one did not make preparation of possible bad things.

I have help cure some individual who only got news of advanced cancer in screening procedure. Hope they grow strong after difficult therapy pathway.

My name is Dr SS Chung, andrew, My clinic no is 3160 8865, I welcome question and query on helath issue and I practice general medicine, heart disease, chest disease and chest surgery and minimally invasive heart and lung and aortic surgery.

To be or not to be: ON call 36 小時

I have briefed the internet surfer that to be a doctor, one needs to sacrifice own lifestyle and time. Further doctors are not much respected nowadays as they need to dealt with personal conflict with patients at front line. Stress in life decrease quality of life of care taker. But is it worthwhile?
To many young people who graduate recently from secondary school. They may have to decide early in their life whether to take up the profession or not.

As one of the specialist in this field, I have every capacity that I need to make statement of this. It is worth while and still much challanging. To make sacrifice requires strength and determination. It is worth the effort to endure until you finish the training. Training takes 6 to 8 years on top of medical school teaching and life long commitment for further education is also required,
But it is worth while to devote oneself to meaningful life. Further, the recreational aspect for doctors education is fun.

So young people, do go for the touch job as medical student and future challange is worthwhile.

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

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.

Tuberculosis - Not a Dying Disease 肺結核從來沒有消失

Pulmonary tuberculosis is an infectious disease caused by slow growing bacterial species known as Mycobacteria. The name of this germ is borrowed from its characteristics of slow growing, indolent and can present as spore keeping bacteria alive in long term in adverse temperature and humidity condition similar to fungus. The air borne ability of the mycobacteria spore give it as much infectious concern as influenza. However, the man to man transmission ability is far lower than virus. Also the amount of infectious load is much higher than virus to cause clinical disease. For example, exposure to droplet transmitted virus like measle may cause successful disease transmission if only ten or a little more viral particle is inhaled by susceptible individual. In tuberculosis, intense exposure to hundreds of spores may not end up in clinical disease. However, as mycobacteria tuberculosis is ubiquitous in most human inhabitated area. Avoidance of it is much difficult.

Tuberculosis is still endemic disease in Hong Kong. Although treatment of such disease has made so much advancement that curing this disease is now mainly an out-patient managment problem.  A few decades ago, if young men or women has been infected with tuberculosis, the treatment of such is still old fashioned resting and sunlight and good nutrition. Housing in a sanatorium or convaslescent environment is only method to prevent spread of disease in densely potpulated cities. Paradoxically this air borne bacteria has much less infectivity potential if high ceilings, good ventilation and well space out beds in room with natural ventilation.  Few staff in such sanatorium will be infected due to working environment unless the nurse or doctor has overworked too much to have low immunity.

Are healthy individual always resistant to tuberculosis?  The answer may be yes and no. For malnourished and alcoholic, reactivation of tuberculosis and primary infection is likely. But for healthy individual, reaction to latent tuberculosis may be  exaggerated causing destruction of lung or granuloma formation.  Reactivation of tuberculosis or persistent of infection may also related to hormone, age and genetic make up.

Nowadays treatment of tuberculosis is effective and comprehensive. Different class of drugs has good effect on it. Investigation to underlying immune deficiency is necessary but rarely postive in endemic area like HK. But confusion with lung cancer shadow is much of a concern too. Therefore, if lung shadow has shown poor response to antituberculosis chemotherapy, excision biopsy is necessary in high risk individual like smokers of patients with strong family history of cancer.

Hong Kong has good system of treating pulmonary tuberculosis. Chest clinic offer walk in CXR and consultation if persistent cough for more than 2 weeks.
Supervision of tuberculosis treatment ensure good compliance. Expert of tuberculosis are easily found in governemnt services.

Sometime, thoracic surgeon may encounter cases mimmicking lung cancer. Final pathology turn out to be tuberculosis. The patient may be complaining about that. However, for lesion as big as a pseudo tumour, it is essential to remove it surgically even if good response to tuberculosis is found. Because if the lesion is left, confusion with later lung pathology or causing hemoptysis or bronchiectasis change may be as harmful as cancer itself.
For fit individual removal of granuloma of destryoed lobe by tuberculosis give better quality of life. Of course, to high risk indivdual lke patient with significant coroanary disease or renal failure, option for medical treatment alone is better suited then.