Dr Kien

2012 HOLIDAY TRIP

2012-01-21T22:38:00.000-08:00

I just got back from over 2 weeks away to Singapore and Vietnam, my fatherland. It was one of those trips that make you feel great to be home ... in Australia, I mean. The heat was a killer!

However, I managed one of my prime goals: taking my son Liêm to Nghệ An. The Cao-xuâns, my great-grand father, my grand father and my father were all born there. During the uprising against the french occupation, the Cao-xuân family was scattered everywhere. My siblings were born in Huế, Rạch Giá, and I, the youngest, was born in Saigon. My late father often spoke fondly of his homeland - which we could not visit because of the Vietnam Civil War. I first visited the shrine and graves of my forefathers in 2001. Ten years later, I brought along my 8 year old son. I was impressed that he understood the meaning of the trip, and he never once complained during the horrible bus rides between Hà Nội and Nghệ An - six hours each way.

We also brought him to see my wife's ancestral graves in Nha Trang.

Many of me relatives did not get why we did this. They all thought I was nutty. To them a holiday must be all for fun and pleasure. The "family duty business" is too difficult to combine with other "fun" events. Perhaps, they were right, but I don't mind being called sentimental.

My frequent response : "Good meals, good drinks, 5-star hotels, swimming pools, services ... you can buy the best anywhere. The only differences between a trip to France and a trip to Vietnam are the language and the ancestral graves."

I also attended a dinner where I met my old high school friends. Some I haven't seen for over 38 years. Each now has his own agenda. While the chatting went on with the iced beer, the much expected nostalgia was not there. They all have changed, due to the constant stress of the country's poverty and the brainwashing of the ruling regime. The main aim in life for some is to survive and take as much as quickly as they can: pleasure, money, personal favours, political gains, ... anything.

Afterwards they all went to the brothel. "We all do it as a routine here", said one I used to have respect for.

Flabbergasted, I left the group with a bad taste in my mouth.

The food was not that great either.

Sax for the public

2011-11-19T20:25:00.000-08:00

Sunday Nov 20 2011 - last on the program! 36^o and sticky!

I learn sax from Wayne at Shine Music School Parramatta. After 6 lessons, he conned me into doing this. The acoustics of Granville Town Hall was not the best but it was all for charity (Westmead Childrens Hospital) so I was glad to be the oldest performing student ever!

My health

2011-11-18T16:31:00.000-08:00

This post goes to those caring clients who keep wondering whether I am unwell with some mysterious illness. The answer is no. I am super well.

1. The fact that I have my hair short is not due to some medical treatment. I simply lose my hair, as people do at my age - and once I was so sick of the state of my hair, I shaved it off - trying to look like Bruce Willis. Now I like the simple hair do, so I stay with it. I also found out my skin got much better since I stopped using shampoo.

So thank you for caring but please stop asking me about the state of my hair!

And my goaty? It is to balance out the loss up top.

Also, the wife likes it. So I wear it, OK?

2. My hours have been reduced. Since Dr Lee Teh joined us, I have reduced my hours a bit (actually quite a bit) so he can get his clientele up. I also want to just spend more time with my family. My 8 year old is growing up too fast.

Activities

2011-11-18T15:25:00.000-08:00

How time flies when you have ... stress!

What have I done in the last few months?

Let's see:

1. Bought a shop - OMG. What was i thinking. The legal hoops have been terrible, and the headache is still going on: What with the leases, purchasers, sellers, super, lessors, lessees, solicitors, loan brokers, financial advisors, bankers, bank tellers. Boo!!!

2. Began learning the saxophone - yep. Whenever I am stressed I learn new thing to distract myself from the stress. And this time I picked the woodwind that is made of brass! What a mistake! My lips are permanently swollen. Angelina Jolie would have been jealous of them.

3. Threw my son's birthday party. He's 8 and we had 25 kids under 10 coming over at lunch and stayed until afternoon the next day. Noises, spits, shoes, dirt, wet, noises, staines, socks, ... Boo! Boo!

Modern decor

2011-08-06T20:20:00.000-07:00

"May I take your coat, sir?"

As soon as I heard the cordial suggestion, I knew we were in trouble. Before we walked through its large door, we thought the place was a rather nice ... café!

Then came the menu. Hmmm, no dollar signs any where. Can't be free, can it? Is it the good chefs' charity week? NO! The price was written in tiny words, in very good artisitc type I must say, on the bottom of the page.

Two hundred and fifty dollars per person.

For lunch? LUNCH? I felt a slight epigastric discomfort and my heart went a bit berserk. The wife was completely oblivous to the situation.

Seeing the sweat beads on my forehead, she murmured: "Don't shake, I carry your credit cards!"

"Thanks, darl, what can I do without you ... Anyway, who told you about this place? ... You told me it's à-la-cart and now just look at this ..."

But our coates were taken away, we already sipped the welcoming champagne, our fate was sealed.

After several glasses of sparklings and decent food ... I felt better but needed to go for a pee.

A nice hostess - not waitress - lead me through a maze of hallways with nice paintings hanging on the walls, to ... the lavatory. And just like the menu, ... No signs! No silhouettes of a stick man with or without a skirt, no M & F, no Gents & Ladies. Just two black doors. I learned my lesson with the menu and stayed calm while bending down trying to look for the wordings.

"What are you doing, sir?"

"Errr ... I am trying to see which door is for me, there must be a trick here ... 'cos I can't see a anything written on the bottom of either door!"

"Just push sir, it's OK for either male or female."

I went in ..."Excuse me, it's dark in here. Where's the damn light switch?"

Then I realised something. It wasn't not dark, it was black! Bar the few halogen downlights, everything else in there was black. Black marble sinks, black taps, black knobs, ... black toilets!

"This is medically unethical. How do I know if I suffered from gastrointestinal haemorrhage in a place like this!"

I fumbled and tumbled a bit and finally got myself out of the toilet.

Modern decor? More like a nasty test to see if you could find out where to correctly put your bits! And I thought I might have ... failed in there.

I rushed back to see the Mrs had already paid the bill. I hurrily walked her out the door before one of those well-dressed rich dudes used the crazy loo.

WOW! That was worth the two hundred and fifty dollars per person!

Messages and Signals

2011-07-17T16:24:00.000-07:00

"PLEASE TURN"

I am told this when driving into the dark tunnel at Lane Cove. Part of my brain at the time is used to tell my foot to gently press on the brake pedal to slow down to the 80km/hr limit, the rest of the thinking organ is used to adjust to the sudden dimmed lighting. So this message from the flashing lightbox on the ceiling of the tunnel confuses me very much.

Yes, I will turn ... but where? I can neither turn left nor right as there is no upcoming crossroads inside the tunnel. I can only turn ... straight! (which I already know I am).

Fifty meters later, another message flashes: "HEADLIGHTS ON".

Errr .. Thanks for trying to help me saving energy ... but ... how do you know, my big brother, that I have my headlights on? Is this message directed at me and my car, or at the guy in front of me? Should I turn my headlights off now?

Whoever write these messages are absolute nutters. At the speed of 80km/hr drivers cannot read the entire demand "PLEASE TURN HEADLIGHTS ON". I wonder why we often do crazy things on the road!

Pain in the neck

2011-07-03T03:27:00.000-07:00

I have a wry neck for about 10 days now. The stupid connecting bit between my head and my torso simply refuses to turn in a certain direction. So I walk as if I am ducking a continuing stream of bullets firing at my right ear. When I drive I cannot change lane. So I drive like a P plater with half a demerit point remaining.

My wife tells me the neck spasm is due to bad deeds in my past. What did I do? I did return those overdue books to my school library. I always say sorry to other players when I win at poker. They never say it to me when I lose!

So what do I blame for my bad neck?

Call of Duty - Black Ops!

Yep. The mad computer game I play on my son's Wii.

When the battle gets overwhelmingly frantic I tend to twist my body into impossible postures to help guide my avatar ducking those fast coming bullets.

It is really weird. Although you know all your kicking and ducking don't do anything to the movement of your representative in the computer game, you still do it. So I contort my body and stay in the twisted posture until some enemy guy kills me.

My son laughs whenever he sees me playing: "Why do you kick your legs and twist your neck like that? Just be faster with the remote control!"

So kids, be careful playing these stupid addictive games. They are a pain in the neck! But for now please excuse me, I have to go and improve my tomahawk throwing skill...

PS - wife says I am too old to play the game. But it's rated MA (mature audiences - I am a mature adult, hopefully?). It's not SG (spouse guidance recommended), thank you!

Immunisation debate

2011-06-25T18:49:00.000-07:00

I just read this on Medscape.
( http://www.medscape.com/viewarticle/745167?src=mpnews&spon=34 )

June 23, 2011 —The United States is experiencing the highest reported number of measles cases since 1996, most of which were acquired during international travel, the Centers for Disease Control and Prevention (CDC) said in an advisory sent to healthcare professionals yesterday.

From January 1 through June 17 this year, 156 confirmed cases of measles were reported to the CDC. Most cases (136) were associated with importations from measles-endemic countries or countries in which large outbreaks are occurring. The imported cases involved unvaccinated US residents who recently traveled abroad, unvaccinated visitors to the United States, and people linked to these imported cases.

To date, 12 outbreaks (3 or more linked cases) have occurred, accounting for 47% of the 156 cases. Of the total case-patients, 133 (85%) were unvaccinated or had undocumented vaccination status. Of the 139 case-patients who were US residents, 86 (62%) were unvaccinated, 30 (22%) had undocumented vaccination status, 11 (8%) had received 1 dose of measles-mumps-rubella (MMR) vaccine, 11 (8%) had received 2 MMR doses, and 1 (1%) had received 3 documented MMR doses.

Measles was declared eliminated in the United States in 2000 as a result of high 2-dose measles vaccine coverage, but it is still endemic or large outbreaks are occurring in countries in Europe (including France, the United Kingdom, Spain, and Switzerland), Africa, and Asia (including India).

OK, so what will the anti-vaccination mob say? "Phew! Lucky we're not American!" ? "It's all CIA made up story!" ? "My child is never near those horrible people and places!" ? "It's scaremongering propaganda from colonel Gaddafi!" ?

Waiting and waiting and ... but WAIT! there's more ....

2011-04-23T16:48:00.000-07:00

One day last week I had a lot of free time so I decided to punish myself by going into a Telstra shop in Castle Hill - looking to buy a wireless broadband USB stick.

Modern looking design, nice white benches on the walls with bits of orange and blue. There were lots of service persons servicing many customers. I approached the big reception bench and waited a bit. While I was waiting I curiously had a listen to the chatting between the service persons and their clients. It was mostly about the weather, about dogs and occasionally about news from Lybia - not much about buying a phone or anything Telstra sells.

After about 15 minutes, a nice gentleman came to me and asked for my name. I asked him what for and he nicely replied: "To put your name down on the waiting list, we are very busy and can only arrange an appointment for you - say - in about 2 hours..."

"What? Why the long wait? So your people could chat to these clients about Lybia and what not?"

It turned out they had to chat up because they had to wait for the contract to go through or for the wrong number to disconnect or for the main server to boot up or for blah blah blah ... about 30 mins per client!

I told the nice manager I had to go for a pee and disappeared. I was fuming!

"Why can they not see other clients while the first lot could just sit there and wait for those things to go through?"

On my way to the car park, I reflected upon our service at the medical practice. I felt the frustration my clients go through waiting for us, their GPs.

"We are just as bad ... Are we, really ?"

Then I thought about it a bit more and realised we are not the same sort of service.

I cannot ask a crying lonely woman who just lost her fifth pet turtle to simply sit there and cry on her own for a bit while I run next door to see the screaming child with a sore throat. I cannot tell a man with impending heart attack to calmly meditate in the street waiting for the 000 bus so I can counsel the man who happened to run over a confused turtle.

I admit sometimes I do leave a patient in the room and go to see another in the next room. Like when mother instinct takes over and a woman decides to breast feed her crying baby at the end of 2nd month vaccination. While this is a very amazingly lovely caring natural act, I would look like a dork to just sit there being amazed by it.

Everyday I look for a finale for our waiting room horror show. But so far I got nothin' !

There was a happy ending to my day though.

I drove to Carlingford Telstra shop and got my stick in 5 minutes. There was only one salesperson on duty and she served 4 clients all at once. Maybe she was paid on commission while the Cattle Hill mob got paid by the hour?

PS: The turtle story was fictitious to protect the identity of the distraught woman. (but if you must know ... it was a hamster, ... or was it a kitten? I can't remember).

I'll be off for 3 weeks

2011-03-25T03:09:00.001-07:00

Yeay!!! If all is going as planned I'll off to China from April 06 to 26. It's my first overseas trip for a over a year. And as required, I have renewed my passport.

I almost cried when I compared the new to the old passport photo. Where have all my black hair gone to? ... in fact, hairs of any colour, where did they go? I look like a deformed criminal try hard.

Tragic Japan

2011-03-14T03:57:00.000-07:00

This latest of the current series of natural disasters reminds us of how angry mother earth can get. We should stop ripping her off and start paying her rent!

Private billing

2011-02-17T19:12:00.000-08:00

The staff and doctors at our office had a brief meeting yesterday - well, not an official meeting, more like an impromtu gathering around a small chocolate cake and singing Happy Birthday to ... me.

During the sugary fix, we spoke of our business a bit. And one thing led to another, we decided to stop bulk billing to new patients.

This was a bit of a surprise to everyone, but it would be a neccessary step for a practice like ours. We found that due to the recent overload of new "once-off" patients we gradually lose our loyal regular ones, who were slowly squeezed out by the long waiting time.

So, it's official, folks!

From March 1 2011, NEW patients will be private-billed.

Patients who have consulted our doctors before March 1 will continue to be bulk-billed.

We are taking steps to make the transition and transaction painless.

[Yes. The knife really means business!]

Traffic oddities

2011-02-16T02:21:00.000-08:00

Please! Christmas was over 2 months ago!

Please remove those reindeer stag horns from the side windows of your car. Frankly, they look nothing like stag horns. More like your mal-nourished grandma is giving me a rude finger signal while ET is trying to escape from the otherside of your stupid car!

I spend 45 mintues each way, to and from work everyday - well, 4 days a week. And these are things on the road that really get up my flat nose.

I can't stand the "P plates" that are stuck so deep behind the plates or turned up-side-down. Why bother hiding them? We can tell you are a P-plater by the way you drive. And we'll be very happy to give you the entire road so you can speed to the next "safety camera".

Speaking of number plates, personalised plates are so annoying. Quick examples:

BMW-xxx . OK. I can tell you drive a BMW. Wow! But do you really have to spell it out twice, no, in fact, 3 times on your car? Or maybe it is YOU that can't remember it's a BMW.

It's OK to put your initials on the plate but first make sure it's not a medical acronym.

HPV-xxx. What does that stand for ? "Henry Parkinson the Fifth" or something similar? To the rest of us, it's Human PapillomaVirus. Yep! It's a virus that make WARTS, including the genital variety.

HSV-xxx. Holden Special Vehicle? or more commonly known as Herpes Simplex Virus.

XYZ-888. So many number 8's !!! Any chance you are Chinese?

Some must be very cute... in their own language! "FGT-RDE" ... Huh? Whatever that abbreviated phrase is, it must have been quite funny ... in your family. But me? I have no idea and I don't bother try to work it out. I am too hungry and in severe need to use the lavatory - so don't test my mental skill at 7:25 PM on the M2, please!

Some are very short. Like "1" or "ME". Why spend so much money for so much less metal? And these are almost always found on some super cars that look as if they can be utilised in one of those great bank robbery jobs. Is that stupid or what! If you are running away from the cops, would it not be better to have one of those plates with cryptic tongue twisters?

"Car 2 to Radio 1, ... attention all units... suspect is in a red Hyundai or KIA or maybe Fiat ... running down the 616, register number ... XRTWSE... no, no ... XTRZEW ... no, no, ... TWSAXZ ... Oh Crikey! Scrap that, just pin the crime on the Maserati with number plate 'ME' ... "

And finally, please don't tail-gate me when I am trying to terrorise the old lady in the pink Vee-Dub Beetle in front of me!

Open Disastrous

2011-02-01T16:25:00.000-08:00

I bought the Australian Open tickets last October so last week I took my wife and son to Melbourne. It was my first one-week break in more than a year. I deserved it as I had worked on my own for 3 weeks whilst the lady doctors here all took off around Christmas time.

Was it a good break? Hah!

Sydney airport

The check-in blonde hurried us through and somehow managed to tag our bags to go to Hobart! We had no idea until my wife got a bit concerned. The girl said gate 49 but the display now said gate 50. The wife asked me to check. Of course, I told her to stop being silly. She kept nagging, so I went and checked the sticky notes on our boarding passes. "SYD-HOB". "Hmmm, how cryptic! May be the luggage are sent by ... hobbyist courier?" I rationalised. As I told the stewardess on boarding, she quickly ran about yelling some cryptic words. I felt terrible because the flight to Hobart was also delayed after that. As it turned out, the Tassie-bound woman checking in just before me was supposed to have 4 bags. She changed her mind and only chucked in 2. Maybe her new husband did not tun up. So we somehow got the 2 spare tags heading for Hobart. And yes, the entire Sydney-Melbourne flight time was for a lecture of how horrible life would be if the wife's commands weren't heeded to.

Shitzu's bite.

Not sure of the spelling but this breed of dog shoud be banned. The wife's long time friend has 2 of these and one of them didn't like me. She jumped up and aimed for my face. Unfortunately she was so fat and could only got to the level of my crotch. Wham! I turned quickly and got a huge bite and bruise on the upper part of my thigh - about 3 cm from the most sensitiv bit of my anatomy. Phew!!! During the taxi trip home, the lecture was on how to behave about other people's pets. What? I was just reaching over for my drink when the monster got me!

Lost seeds

Nadal lost to Ferrer. "What is going on here?" I asked. I paid a lot of money to see Federer and Nadal in the final. I was certain it was written in the contract somewhere. Then I saw Federer got knocked out by a guy who looked almost exactly like the kid who beat me up daily in primary school. I am sure there weren't many Serbian kids in my school in Saigon, but this Djorkovic really looked like the thug I used to fear and hate. No lectures for few days, the professor was too busy shopping.

"I AM CALM!!!!!"

When we got back to Sydney airport, our booked maxi-taxi got ... lost - or rather the booking was "not confirmed". We - 12 people and all (yes, I and all the in-laws) - had to drag our luggage back to the end of a long taxi queue. I was fuming! The lecturer was kind and gave me a "calm down" hug. Yep, she was the one who made the shonky taxi booking.

U2 360 concert

2010-12-14T17:56:00.000-08:00

Yep. I took my Mrs to the U2 concert in ANZ Stadium on Tuesday Dec 14 evening.

Now I can't hear a thing! I guess it was in a stadium so the audio engineers could not help using the volume knob a bit.

The spacey-insecty stage with the flashy lighting was "awesome" at first but after a while got a little boring.

We sat behind 4 young people (ie in their early 20s) and in front of 4 older people (the 60+). So we (late 40s) fit in pretty well.

I liked the messages on freedom and human rights, but felt my rights were violated by the young people who kept standing up dancing, obscuring our ... $300 view!

We were disappointed by the sound last time with Leonard Cohen at the Acer Arena and now with U2 at the ANZ Stadium. Why can't Sydney build a decent concert venue?

Leaks

2010-12-12T14:52:00.000-08:00

In my profession, the word "leaks" brings up an image of a male standing at the urinals with a long queue behind him waiting - ala prostate issue; or a grandma with a prolapse of some sort. And "wiki"? Apparently it means "quick" in Hawaiian. So "wiki-leaks" is an odd term.

Freedom of information is good, but some information should not be free for everyone. We are in a war of some kind right now. If you say you don't want to be involved, then move elsewhere "neutral"! May I suggest Greenland or some other waste lands that no countries would ever want to associate with.

I don't get the kind of vandalism these leaking wiki mob represent. You eat western food, you poo the western way, you get western health care and education (OK, you pay tax the western way too - I hear you) - and freedom. But why use your freedom - which is only available in the western world - to back-stab the same system that provides all these good stuffs for you?

Why don't you go to the Taliban; the Chinese and (yeah!) North Korean terrritories and ... leak their wiki back to the world?

I came from Communist Vietnam and I know it all too well. If you leak anything there, your "wiki" (I think it means genitalia in some Afrikan tribal lingos) is the first item to get lopped off!

Use your freedom to help those dying asking for it. Join Amnesty International. Join the Free Liu Xiaobo Group.

And don't compare Liu Xiaobo to Julian Assange. The Chinese guy is jailed for asking for freedom. The Australian idiot is jailed for abusing it.

Cricket season

2010-11-25T18:53:00.001-08:00

It's that time of year again: the telly shows nothing but cricket.

I don't know how but after nearly 30 years, I still simply cannot ever come close to liking this national sport of ours. It's crazy. A bunch of people wearing white clothing, throwing and hitting a tiny red ball, and every now and then going into some kind of rapture, jumping up and down in jubilation. And whenever this occurs, some guy, also in white outfit, walks a lonely walk into the crowd. You have no idea who he is. No numbers or names on the back of his jersey. What is worse is that he is always replaced by another guy, wearing exactly same white outfits, with no ID on the Napisan cardigan.

And a game or "test" can last for days.

And the heroes are all overweight blokes, all do adverts for hairloss clinics when they cannot stretch the white garment any further.

Trust me, I did try to like it. But I guess you must be born into a cricket fanatic family to develop the passion. I came to Australia as a refugee in my early teens, and then was fostered into a lovely family of ... Irish background. Luckily, they weren't passionate about hurling.

I have managed to enjoy Vegemite, tolerate the flies, hate the Poms, prefer VB to Bollinger. But this sport, named after a small but annoyingly noisy insect, may take a bit longer for me to watch it in full.

Racism

2010-11-24T18:56:00.000-08:00

This was a beauty.

A obviously drugged-up man was very confrontational at our reception desk.
After reading our policy on the notice board and knowing I will not budge and will not give him the Diazepam, he pulled out his favourite weaponry of insult.

- You slant-eye-ed, Asian ****ing scum. If I were looking like one of you Chinese lot you would give me the stuff, yeah?

My immediate reply:

- You're half wrong there, sir. I am Vietnamese, not Chinese. But you are also half right. If you somehow manage to morph yourself into an individual of Asian-appearance, right here, right now, I'll give you whatever you want, seriously.

He left, perhaps looking for his make-up artist friend.

Look, where?

2010-11-05T13:38:00.000-07:00

I hate it when people greet you on the PHONE with "Look".

- Hello, it's Dr Kien ... How can I ...
- Look, I had an appointment earlier tomorrow with Dr Sonso. Blah, blah... .

How can I "look" when my only sensory apparatus for communication with you is an auditory one?

Being rude is one thing, but asking me to use my ears to see is beyond me!

Tests for everything

2010-10-28T14:10:00.000-07:00

It's always on either a Monday or Tuesday, more often after a long weekend. A new patient comes in and wants to "check for everything".

"OK, Doc. I know I've been bad. But now I am ready to turn the new leaf. I need to know how much damage I've done to my body. Can you check for everything, cancer, AIDS, arthritis, ... EVRYTHING you can think of ... but make sure I don't have cancer".

This sort of requests put us doctors in a rather troubled spot.

The obvious problem is cost. We cannot order "everything". Mainly because we don't really know that many... . The menu is huge! Medicare will knock on our doors even before the delivery truck arrived. Do you know how much it costs to have your liver function checked?

But then, we are always intrigued by the repentant patients. It is an opportunity to scare the living day light out of the hung over and sorry being bfore us. If we refuse to order some of the tests, he or she may disappear from our "preventive medicine radar".

Another issue is that a normal test result does not mean you are well. Our body is a constantly changing organism. I guess inside my body right now there are a few thousand cells wanting to go cancerous. Some may aleady have become cancerous. They may not show up in the test result pages.

[By the way, don't worry. If you keep your general health in good shape, your immune system and its allied armies will track down these insurgent cancer cells and knock them off.]

Also, does a normal result some how reinforce the patient's delusion that his or her recent self-destructive behaviour is OK? "Great mate. All that drinking and smoking and eating did not affect my PSA level! What's on this weekend?".

The "Whole body scan to exclude all cancers" is ridiculously misleading and is a total waste of time and money! I can tell you that you have less cancer cells in you before you inflict upon yourself with this crazy gimmick! What if it finds a cancer in a peculiar spot that we cannot get to to know what it is? What if this cancer turns out to be a very slow one and can only kill you in 200 years time?

What we should test for are the proven worthy tests: fats, sugar, blood in poo. The PSA (prostate specific antigen) is a rather hairy issue - which I will not discuss here.

Tests are not your warranty. Let your doctor monitor your weight, girth, blood pressure, and every now and then stick a few small instruments into your body. Then we will order some tests.

Dr Google

2010-10-26T14:36:00.000-07:00

Just type "sneeze cancer" in Google. Now press "Search". Whoa!

Over 400,000 hits! Yes, there are evidence of "sneeze" and "cancer" can be associated, at least as two words appearing on the same web page. By this research, I can conclude your one-off sneeze this morning could be caused by a malignant neoplastic process.

Oh! My! Goodness! ... How many times have I seen a worried person coming in with a briefcase full of printed pages of Google results on his or her symptoms.

"Are you sure doctor? That my sneeze is only a cold, and not this hideous post nasal cancer? - And just you look at that picture there. How horrible! Are you sure I am not ending up with that thing in my mouth???"

Half of the time (mainly in the morning) I will try to reassure you. But when I am tired (say 6PM), I'd let Dr Google ruin your day.

The thing about the web is that the web authors must try to attract viewers by making the information interesting. In order from most to least interesting causes for sneezing, post nasal cancer beats hay fever and common cold; and sniffing pepper comes last. So there are more web pages associating sneezing with cancer than with sniffing pepper. The real-life incidence is in reverse order. I have the feeling the pepper aetiology is a lot more common than the neoplastic one.

Examples:

A guy who coughed up a piece of foul-smelling old food, that was tucked behind his tonsils in the last god knows how long, was convinced it was a "broncholith" - and Dr Google diagnosed it as lung cancer.

A man presented with an itch in the perineum (the area between the scrotum and the anus) was convinced it was due to prostate cancer. The malignancy was cured by changing his underpants more frequently.

The crying mother brought in her pubertal son with a tender swollen nipple. She had consulted Dr Google earlier that morning and was told even famous men like Tom Cruise could have breast cancer. The boy was petrified. I had a hard time telling him some milk may come out later and that he was lucky to have it in only one breast. I also revealed to him a secret : both of mine were more sore and even bigger during my early teen years!

Google is good in helping you find out more about your problem once it has been diagnosed. I use Google myself to find information about drugs, diseases etc, often with the patient present so we learn together. It is a great tool.

However, Googling is not so good in working out the diagnosis by yourself.

So first get a diagnosis from your doctor, THEN Google. And try to filter out the silly webpages. I don't know how they do it, but the silly hoax sites full of inappropriate advertisements always seem to get to the top of the search list.

Pathological Paths

2010-10-20T14:51:00.000-07:00

Osteopaths, Naturopaths vs Psychopaths, Sociopaths - and Chiropractors

Fatigue

Every now and then I get a spanking new patient coming in with a list of investigation requests. Now is a middle-aged woman. She is quite blunt in telling me straight off that she only sees me to get a few tests done for her own doctor. Why? Because her doctor cannot refer her herself. Medicare would not pay her back the rebate for the tests.

Fair enough. Sometimes struck off doctors still have a lot to offer to their loyal patients.

It is when I see what the requests are that it really kills me. The most irritating is the serum level of some inert metal that I cannot find on my periodic table of known elements. Should I be rude enough to ask if the patient had been away from earth and somehow inhaled this toxic unknown element from the moon?

Seeing my grimace, the patient then reveals her secret. It's her naturopathic doctor who has heard of this metal and attended a course in Congo on the effect this 205th element on the poor client's "recurrent fatigue". And there are at least 2 websites on this subject. One from Romania, the other from Iceland. How could I be so ignorant!???

Don't get me wrong. I do believe in naturopathy. Lots of my patients are on herbs and other natural therapeutic products. For example, I do believe in Vitamin C, Zinc and Garlic as supplementary medicines for cold and flu.

But I get really weary of the invention of odd and baseless causes for common problems.

Most people are tired. Everyone is tired at one time or another. Tiredness is not likely to be caused by the overloading or lacking of some weird element. I think the most common causes are deficiency in Vitamin R (rest) and in Vitamin S (sleep). Vitamin M (money) sometimes helps.

Back pain

Likewise, most people have back pain. Unless you are some kind of robot, you must have had some back pain once in your life. It is simply because man has not evolved well. His head is too heavy for his tiny neck and his hips cannot sustain his weight well. He decided to walk on two legs long before his spine had evolved to accommodate such change. So he wobbles a lot, then sometimes he waddles (during pregnant periods in women and during beer drinking years in men).

Not only we are designed poorly; we also do crazy things to our body.

We fashioned our hooves ala Prada-style. And thanks to the computer mouse we no longer use our shoulders and arms. We only use our right index finger and our right wrist. A farmer's back pain does not last long because he knows he must use the correct muscles. In contrast, an accountant is a totally different animal; designed to climb trees but instead he sits dead still for 10 hours, cranks his neck and stares at the monitor, and only moves the mouse in right hand back and forth repeatedly every 10 seconds. At home he slouches uncomfortably on the sofa, stares at the TV while his thumb frantically harrasses the remote control.

I believe human will evolve into a cyclop with one finger attached to a large remote.

So instead of moving about like you are supposed to (ie, be the homo-sapien that you are) and retraining your muscles to regain your painless posture, you hobble a long way to get a quick fix from some "back guy". This guy has such healing power your best friend (or neighbour) cannot even describe.

Again, I have nothing against genuine chiropractors and osteopaths. It's the psychopaths disguised as healers that really get me. They have most odd methods of practice.

What with the pencil lines being ruler-ed onto the spine Xray films!??

Yes, thanks to the pencil markings, I can see you have a half a degree tilt to the left. So what! If that's how you already are for the last 40 years, why fix it now? Your back pain started last week, but your spine has been like that for half a century! God (or mother nature to atheists) did not create us with a ruler! So don't use rulers and protractors to measure our spine!

And Xrays are not that helpful in managing simple back pain, and sometimes dangerous when not interpreted correctly. A doctor friend of mine was silly enough to have ordered a spine series for his grand-mother. The old Chinese lady had some minor backache but still was quite well and was able to walk to the shops everyday. When she asked him about the mild compression fracture seen in one of her vertebrae, he foolishly described her osteoporosis as "rotten bone" in Chinese. The lady was so frightened she decided to lie in bed all the time. She fixated to the false idea that standing and walking would in further damage her back. My friend tried really hard to get his grandma off the bed but all his effort proved useless. Soon immobility took hold, she shrivelled away and died.

It's a different story if you are a pre-teen with scoliosis; I would immediately refer you to the spine specialist.

Corporate Medicine

2010-10-07T17:40:00.000-07:00

I read on smh.com.au the sorry story of a GP who signed up with one of the corporate medical mammoths and later got chewed up by the same monster. It sent a tingle up my spine to think I nearly went the same way 10 years ago.

In 2001, 2-3 weeks after I opened the door of my GP practice in Avoca Street Randwick, a highly ranked representative of a medical corporate appeared. He sat in my waiting room for about 30 mins, counting my clients like sheep - well, I saw only 10-15 patients per day at that time. Then he came in to see me and told me to either sign up with his business or get out of town. He told me I would not survive here.

"We buy you out, or you join us. We don't want this practice to be here."

He offerred to pay off my debts, all of them (Yay!).
The condition was I would have to work for his boss for 5 years (Boo!).
He would look after all my income issues (Yay!).
I just had to work HARD - including odd shifts in odd places (Boo!).
After 5 years, I would be able to leave (Yay!).
However, I ought not to open a practice within 5km radius from any of his centers (Boo!).

The temptations were there. The only problem was I hated the way the guy spoke to me. He and I are both doctors. There usually exists a fraternity mutual respect between decent doctors. This guy got nothing. He was one big fat business bully!

I politely showed Dr Bully the door and promised when my business collapsed, I would consider calling for his help. He looked at my empty waiting room, threw a wry smile and said he'd get my call in one month.

Ten years on, I am still struggling to make ends meet. I don't like the car I drive, an old Honda - no Mercesdes, not even a BMW. I don't like the butterfly in my stomach every time I read the loan statements.

But I like the way I work - as my own boss.

I can spend 1 minute to give a script or 1 hour to calm down a distressed newly widowed man. No receptionists can knock on my door to hurry me up. I do home visits. I joke and laugh with my colleagues and staff. I walk out to a quick lunch even when there are people waiting for me - I can't help them if I am too hungry to think.

It is sad that medicine is going down this corporate path. It is a big machine that mows down all health funds, for little results. But it makes big bucks. Simple. You go there, your GP sees you then almost immediately refers you to the Xray specialist in the next room who also belongs to the corporate. You take the report to your GP. He refers you to the physiotherapist who also belongs to the corporate. Tching! Tching! Tching! ... within less than 30 minutes, the mower chomps down 3-4 transactions from Medicare and other health funds. And you, the corporate's valued client, bounce like a beach ball between the rooms in that beautiful corporate building. Whether you get better is not the issue. Your job is just to keep bouncing.

Sure the contract says the doctors can have autonomy. They supposedly can do what they like. But if they follow the herd and refer as often as and as many as they can to pathologists, radiologists, psychologists, whateverologists of the corporate, then the corporate will let them work in more agreeable environment - longer holidays, perhaps.

I just now read the article about the late Dr Bill Marchione. I knew Bill well, he graduated in my year. That was just terrible the way he ended his life. We doctors should never be sucked into a cut-throat business like this.

In the current climate of Ms Nicola Roxon's "health care reforms", my business might collapse. But I'd rather go to CentreLink than work for CentreStink.

And to Edmund, Primum non nocere!

Boatpeople

2010-08-12T07:00:00.000-07:00

Another wave of boatfuls of refugees are coming and Mr Abbott and Ms Gillard are turning into real sad headcases.

What can I say about this?

Imagine you are a university professor, married, 2 kids, living in your home then "the revolution" start. And the bad people come. They burn your house, rape your wife. You have no weapons. You cannot fight with your books. You run away to the coast with your kids with the money you saved. You must get the people smuggler to get you out. You cannot build or buy a boat yourself. You don't have any idea where to, but you must get out because your homeland is no longer a safe place. Now, what would YOU do when this professor and his kids get "smuggled" here? The fact that he could pay to get on a boat does not mean he is safe in his homeland.

Thank God for the people smugglers! And for the dinky canoes they shoved the poor refugees on and set them out to perilous seas. Yes! Without these bastards and their ruthless money grabbing schemes, I'd be long dead and buried in a nameless grave somewhere in Cambodia!

Yep. I was one of those boat people from Vietnam in the 1970-80s. I was 16, unable to do well at school because of my family's "counter-revolutionary background", and on the verge of getting conscripted to go and fight the Khmer Rouge with a rusty AK-47. My parents were desperate. They had to go the way many other Vietnamese parents did at the time.

They had to find money and worked very hard to get contact with the people smugglers. They sent each of their children out, one or two at a time. They watched their kids going away with total strangers, into some small boats and then their kids vanished. They waited for months or years for a telegram from Thailand or Malaysia. Half of the time, they'd never get the news - good or bad. Their kids had 50% chance of making it to a free country. The other 50%? They would disappear forever, with no news. Never a confirmation of death. Just simply no news.

I have a son. Liem is nealry 7 now. I don't know if I could ever have the guts to let him go on one of those boats. The pain would be so enormous that I'd probably die. But I am not in my parents shoes, watching me and my brothers and sisters growing up and getting "killed" slowly in a country ruled by a bunch of know-it-all illiterates with ruthless vengeance.

Now I live in Sydney, happily. I can't remember very well the hunger I had in My Tho prison where I spent 6 months after being caught escaping on a small boat. I still see the faint scars of scabies on my skin, but they stopped hurting long time ago.

But I remember the fear in my sister's eyes every time the Siamese pirates on their large fishing vessels approached our dinky canoe during our 8 days trip on the sea, from Vietnam to Malaysia.

I don't know much of why the Pakistani or Iranian refugees had to come to our shore on these boats. What I know is, they would not leave their homeland just because Australia has the best beaches in the world. They leave their parents and relatives behind and risk their lives and their childrens lives because of only one thing. A place where you can live without fear.

You most likely would not know what it feels like living in fear and in a neighbourhood where you cannot trust anyone. It's a mad mad thing to be in. You fear everyone, even your best school friend. My brother was so scared when he received the "congratulation letter" for being conscripted to join the war in Cambodia. Of course he went into hiding.

Fear is an incredibly sickening feeling. I remember my brother's face as he climbed down form the roof of our house, shivering with fear and soaking wet from the rain. He had to stay and hide up there for 5 hours while my parents convinced the Viet Cong police that their son had disappeared. My brother was 18. He escaped soon after that day. Now he lives in Germany.

I later found out it was my best friend who told the police that he saw my brother in our house that day. This guy had the gut to contact me on facebook the other day. It is amazing how people can forget. I can't.

So before you switch off the news, get off your comfy couch to refill the wineglass, don't mumble some vague obscenity about these poor refugees. Perhaps you should spend some time getting to know one of them.

Results over the phone

2010-07-23T16:30:00.000-07:00

My poor receptionists are going nuts. They don't know what to do. They however get very fit running between the front desk and my door.

- Knock, knock!
- Grrrrh ....
- Sorry, doc. What can I tell this irate person on the phone about her pathology results? Are they back and normal? Are they not back but predicted to be abnormal? Are they missing? Are they back but not yet confirmed? Is it urgent? Should she come today or next year? She's on her way to Africa for 1 year, ...
- Who's she?
- Errr ... I'll ask ... wait a sec ... (running to the front for 20 seconds) ... Sorry, she hung up. She sounded very angry. I am so sorry.
- Grrrrh ....

So it goes on and on, day after day, week after week ...

Our practice protocol says that we do not give results over the phone. I know it is a crazy waste of effort and gross inconvenience for patients to come and sit and wait and wait and wait just to be told ..."Hi. All is well. Thanks. Goodbye."

But the flip side of this is detrimental: an abnormal results not well explained or a normal result misunderstood.

Remember poor George in Seinfeld? The sorry guy could not sleep for days because his doctor had rang him and said his test was "negative". In his pessimistic world, "negative" was just a polite way to say "you're dead".

A "negative skin biopsy" is good news. A "positive blood culture" is not as good.

There was a story circulated in the early 1990s of a suicide after the patient heard over the phone that he was "AIDS positive". The report was that his blood group was "A Positive (rhesus+)". It was not known if the receptionist on the other end of the line had had any weird accent. Nonetheless, this could have been true and obviously not a very funny story.

Some doctors let their staff tell patients if the results are normal. While I think this is reasonable enough, I also think discussing results face-to-face presents an opportunity to ~~earn more Medicare rebate~~ look for other hidden issues. Often people come to see me and ask for tests for "feeling tired" but the real issue is their troubled marriage.

I confess sometimes I tell people their results over the phone. But usually I call them (and not the other way around) - mostly for more pressing results like pregnancy tests or abnormal clotting results.

So before you tear my dotty receptionists to pieces, please remember poor George Constanza.

Medicare Dental Referrals

2010-07-15T15:21:00.000-07:00

I get really peeved every time I see the advertisements about Medicare funded dental care on the local papers. They are blatantly and unethically misleading.

The deal is this: You want your teeth whitened. You read the ad. You go see me (your GP). I write up a piece of a joke called a "care plan". You take that to your dentist. Voila! Your teeth get whiter. Your dentist get $4250 richer from Ms Roxon. I get $110 richer from Ms Roxon. Everybody's happy! Right?

NO! NO! and one more time ... NO!

The care plan is for major dental/denture works ONLY for those who are chronically ill. These are the people with poorly controlled diabetes, siginificant heart failure, kidney failure, severe asthma, bronchitis, active cancer therapies, etc.

This means: NOT YOU with the slightly coloured teeth!

And the bruised little toe on your left foot after you fell over 6 weeks ago at the pub does not qualify as a chronic illness.

What bugs me is that we, the general practitioners, somehow get this job of deciding who qualify for this stupid scheme. And we lose both ways: If we refuse we are accused of being mean (a few of my patients have abused me for being unhelpful). If we reluctantly go along then we are accused of rorting the system ... and for what ? 110 bucks?

And it gets worse ...

If the "care plan" was ever found out to be fraud, the doctor pays back $110, AND the $4250 the dentist had spent on the white powder. The doctor also cops a lot of guilt/shame, not counting the fines, etc. ... and for what ? 110 bucks?

And the dentist keeps the money - because he "only follows orders" from the crook doctor!

The government wins because they appear generous.
The dentist wins because he is on your side.
I , your GP, lose because I don't think your teeth are as yellow as you see them.

So if you are inflicted by some real chronic illness and you have rotten teeth, see your DOCTOR first then ask him/her to direct you to the ethical dentists he/she knows.

A good dentist is one who helps you chew your food well.

Having a Hollywood smile does not improve your diabetes.

If the government is serious about dental care for the public, they should pay dental care for everyone. And stop using us GPs as bouncers.

And one more thing. I don't do this plan not because I am afraid of being caught by Medicare. The thing that I am most scared of, the thing that will cause so much guilt for me to lose sleep, the thing that chews me up every time I do something silly, is .... me!

Bulky billing and long wait

2009-11-12T22:48:00.000-08:00

Every week I get one or two complaints about long waiting time in our waiting room. This has been a really thorny issue which we are struggling to deal with.

On one hand, we like to see patient as soon as they come. On the other, most presentations we have now are more complicated than the usual cold and flu. We have more elderly patients. We also have more mums with very small babies in huge prams.

To make thing worse, many other practices around us have stopped bulk billing, leaving only a few places that bulk bill, and we are one of those last standing - often overwhelmed by the exodus from the private billing practices.

The appointment went out the window in 2008 as we cannot turn away the "walk-ins" with urgent problems.

I think health care shoulde be free for everyone. But if doctors are overwhelmed by the sheer demand of patient load, they'll get tired and their level of care will plummet.

Many people have asked me to follow the trend and private bill - mainly to survive financially and maintain level of care. They have their reasons. They want to pay and have less time waiting. They threaten to leave our practcie if the waiting time continues to stretch.

Others asked me to bulk bill, because they cannot afford the fee.

Let me know what you think. Will you likely to pay for shorter waiting time, or should health care be free - regardless?

Things that bug me: #2

2008-12-20T04:50:00.000-08:00

- Whow... is this one of those tablets that once you start taking it, you have to take it for the REST of your LIFE?

... No. You don't have to. Just stop whenever you want to increase your chance to cop a heart attack or a stroke!

I don't understand this frequently heard comment about preventative medicines. It's like two guys get stuck in quicksand. One guy grabs a tree branch and the other guy continues to sink but manages to yell out: "Hey, don't grab that, if you do, you have to hang on to it forever ...".

Things that bug me: #1

2008-12-20T04:34:00.000-08:00

-It's just a referral, Doc. My "normal" doctor is away, I know you don't like to do this ... but the receptionist at the specialist wants a referral, can you fax it over ?

...Errr , who are you?

-I'm new to this practice.

...Who's the specialist?

-Some lung physician in town, don't you have a list I can look at and find out his name ?

... What's is the problem?

-It's a long story, I only need a referral!

... OK! Let me get this right... You want me, your "abnormal" doctor, to write a legal document to someone I don't know, discussing about someone I don't know, who has a complicated problem I also don't have a clue about ?

-Yes, Can you also back date it to yesterday and fax it now, please ?

Avoca Street Medical Centre

2007-05-13T17:07:00.000-07:00

Hello all,

I have created this blog to help my patients (clients) to contact me on non-urgent issues.

Most importantly, please tell me about how we can improve our services.

Thank you.

Kien