The Doctor is Out

angry doc will be taking a break from blogging this week.

We hope to return to our regular ranting in October.

In the meantime, you may obtain your regular dose of anger from my disciple.

Thank you.

Sometimes the Oldies say it best

The greetings of people in trouble
Reflections of my life
Oh, how they fill my mind

All my sorrows, sad tomorrows
Take me back to my own home

All my cryings; feel I'm dying
Take me back to my own home

I'm changing, arranging
I'm changing I'm changing everything
Ah, everything around me

The world is a bad place, a bad place
A terrible place to live
Oh, but I don't wanna die

- Reflections of My Life

What hurt the most?

To the girl who admitted for assault today,

I’m not very eloquent and sometimes I do not express myself well; when I asked you 'what hurt the most?' during this morning’s ward round, I didn’t really mean which of the injuries you sustained was the most painful.

I was really wondering which one of the so many ways you were wounded in hurt you the most.

Was it the fact that the person who did this to you was a close relative who betrayed your trust?

Was it the way that he ignored your humanity and continued to hit you when your back was turned and you were cowering, helpless from the fury and hoping that he would stop?

Was it the fear that you may never be able to love your mother again, after she told you not to make a police report?

Was it muted curiosity from your classmates when you wore that bloodied eye to school today?

Was it the fact that after all that, you had to come to the hospital alone and without enough money to pay for your medical bills?

Was it the blow this episode dealt to your self-esteem, at this most vulnerable time when you are turning from a child to a young woman?

Was it the strain it took to continue to wear that smile on your battered face when we came by your bed today?

You see, I really wanted to clarify myself and ask you again, but there was a lump in my throat then and I couldn’t speak anymore.

angry doc

Oranges and Lemons

Bonus Bogus Story

Singapore –

Average Hospital will replace the old number-based queue system at its outpatient clinics with a system based on fruits from next month onwards.

Mr Lam Boo Tan, manager of the hospital’s IT department announced this today at a press conference.

‘We received feedback from our clinic staff and clients that the old number-based queue system is a source of stress for both parties. We have displayed prominent signs to inform our clients that queue numbers may not be called in sequence, but oftentimes they will still inquire at registration or enter the consultation room before their number has been called to confirm when they see another number called before theirs. This disrupts clinic function and causes delay for all parties concerned.’

The new system, now under pilot in one of the clinics, uses a sequence of four icons of fruits instead of numerals. The icons are not assigned a specific numerical value, but are assigned in numerical sequence using a patented encoding system to ensure no duplication.

As there is no predictable pattern to the sequence the fruits are displayed in, patients can only know if their turn to see the doctor has come up by matching the fruits displayed on the display screen with those on their chits.

So far the system has received positive feedback from the staff and patients.

‘We have encountered some problems with confusion over oranges and lemons due to their similar appearance, but we will be customising the display to use familiar local fruits like durians and papayas before we implement this system hospital-wide.’ said Mr Lam.

Overheard...

... in psychiatry ward.

Medical student presenting a case for tutorial:

The patient's father could not accept his son's homosexuality, and took it as a blow to his own manhood.

quack culled

My windows crashed and I suspect quack may have had something to do with it.

Maybe he was carrying the bird flu virus.

In any case I have decided to remove quack from my blog.

He is now where all good ducks go to when they die - Peking.

Overheard...

... in the operating theatre.

Anaesthetist: OK, patient is under. You want any antibiotic prophylaxis?

Surgeon: Er… yes, thank you.

Anaesthetist: What do you want?

Surgeon: Er… the standard.

Anaesthetist: What’s your standard?

Surgeon: Er…

Anaesthetist: Cephalexin OK?

Surgeon: Er... OK, cephalexin.

Anaesthetist: What dose?

Surgeon: Er… the standard.

Anaesthetist: What’s your standard?

Surgeon: Er…

quack joins the blog

Please do not overfeed the duck.

What's in a Name?

Dear Sir,

I understand that you were offended by the fact that I referred to you by your age, race, gender and diagnosis instead of your full name when discussing your condition with my consultant at ward round this morning. I would like to explain my reasons for doing so.

1. We doctors are age-ist, racist, and sexist.

Many disease conditions are age-group specific, and some diseases show a predilection for certain ethnic groups. By presenting you by your age and race, we immediately place certain diagnoses higher up the list of possibilities and relegate others to the bottom.

And of course we do not usually consider the prostate as a cause of urinary problems in women, or the ovaries as the source of abdominal pain in men.

So you see, pigeon-holing you in your age, race, and gender category helps us in diagnosing and managing your illness.

2. Your name, much as it is special to you, does not really help our team in identifying you as a unique individual.

As of this morning, I have three Muhammeds, four Tan Ah Kaus, and two Sivas on my ward list.

The hospital understands this problem, which is why you are made to wear a little bracelet with your name and hospital registration number on it so we don't confuse you with other patients who share your name.

Also, your name doesn't really help us in arriving at a diagnosis or treatment plan either.

3. I’ll level with you: nurses identify patients by their bed numbers, physicians by their diagnoses, surgeons by the operation they will be undergoing or have undergone, and the finance department by their bill numbers. That’s because that’s how you relate to our work functions.

(And let’s face it: you do the same. To you and your family, the Nursing Officer is the ‘old missy’, the staff nurse ‘young missy’, my consultant the ‘big doctor’, and myself the ‘small doctor’. I have no problems with that, since classifying us by our function helps you in relating yourself to your environment.)


So you see, much as I would like to add that personal touch by referring to you by your name, it really adds little to our work process and may in fact create confusion.

I am sure you will prefer I use my limited brain capacity to remember what illness you have and how I should treat it, to remembering your name.

Sure it's not world-class service, but you're in a hospital, not a hotel.

Thank you.

angry doc

Fable for the Day

Death speaks:

"There was a merchant in Baghdad who sent his servant to market to buy provisions and in a little while the servant came back, white and trembling, and said, Master, just now when I was in the market-place I was jostled by a woman in the crowd and when I turned I saw it was Death that jostled me. She looked at me and made a threatening gesture; now, lend me your horse, and I will ride away from this city and avoid my fate. I will go to Samarra and there death will not find me.

The merchant lent him his horse, and the servant mounted it, and he dug his spurs in its flanks and as fast as the horse could gallop he went.

Then the merchant went down to the marketplace and he saw me standing in the crowd and he came to me and said, Why did you make a threatening gesture to my servant when you saw him this morning? That was not a threatening gesture, I said, it was only a start of surprise. I was astonished to see him in Bagdad, for I had an appointment with him tonight in Samarra."

Sometimes I feel like the merchant.

X-ray Conference

OK, I'm stumped.

Anyone can tell me what's wrong with this X-ray?

Pull my finger!

On call last night, Dick was called to the Emergency to see a young man who had been in a traffic accident and sustained injuries to his back and pelvis.

Dick arrived just when they were rolling the patient to his side to examine the spine. Being the urologist, Dick was given the honour of performing the rectal examination to see if the urethra had been torn and if there had been any nerve injury to the anal sphincter.

So with his right index finger in the patient’s rectum, Dick proceeded to test if the patient can still control his sphincter.

‘Squeeze my finger,’ he ordered the patient.

‘Huh?’

The dazed patient did not seem to comprehend his command.

‘Eh, look here - squeeze my finger,’ repeated Dick, louder this time because like all doctors he knew the solution when you do not get the respond you want is to repeat the question in a louder voice.

‘Huh? What?’

The patient, neck immobilised by a cervical collar, strained his eyes to look at Dick, hoping that eye contact will provide some clue as to what Dick wanted from him.

By now Dick was getting a little impatient. Tapping the fellow on his shoulder with his free (left) hand and waving his index finger, he repeated himself, this time even more loudly.

‘Squeeze on my finger.’

'Er... OK...'

Still puzzled, but eager to oblige, the patient reached out with his right hand and squeezed Dick’s left index finger with his hand.

The emergency staff fought to stop themselves from laughing out loud.

Dick looked up, unfazed, and declared:

‘GCS 15*.’

The emergency staff burst out in laughter.

* - Glasgow Coma Scale, a measure of consciousness. 15 is the highest score.

angry doc is so dumb...

... they have to tell him which side of the BP cuff to place against the patient.

Se7en Meme

OK, I got tagged by fortycalibernap. Like HIV, the only thing when you can do when you get it is to suffer and spread it, so here goes.

(see Disclaimer)

Seven Things That Scare Me
1. Blades
2. Needles
3. Blood
4. Women who have crushes on me (something MUST be wrong with them!)
5. Men who have crushes on me (NO! I won’t go to aerobics classes with you!)
6. Having my real identity revealed
7. Regret

Seven Things That I Like Most
1. Feeling of warm body fluid over my latex covered appendage/s
2. Feeling a fractured bone snap back into alignment
3. Inserting a chest-tube
4. Closing skin
5. The rush from a ‘Trauma Code’
6. A ‘thank you’ which is heart-felt and which I truly deserve
7. My monthly paycheck

Seven Important Things In My Room
1. Pen
2. Stethoscope
3. Mask
4. Torchlight
5. Gloves
6. Caffeinated beverage
7. Panadol

Seven Random Facts About Me
1. I once killed a man with my bare hands when I crushed his ribcage during CPR
2. I was never afraid during SARS. Never.
3. I was so jinxed the ICU staff called me ‘The Angel of Death’
4. I was once ‘Best Houseman’
5. My hands are small
6. I don't have a single dental filling
7. I made up my mind when I was a medical student to care less so I wouldn't feel the pain so much

Seven Things I Plan To Do Before I Die
1. Live

Seven Things I Can Do
1. Repair digital nerves
2. Sense a psychotic when he/she comes through the door
3. Chinese calligraphy
4. Dance
5. Tie a knot in a cherry stalk with my tongue
6. Admit when I don’t have the answer
7. Keep my anger in control most of the time

Seven Things I Can’t Do
1. Walk and chew gum
2. Juggle
3. Another back-to-back call
4. Tell the exact moment when someone dies
5. Feel your pain
6. Believe
7. Truly love

Seven Things I Say The Most (aka Seven Lies I Tell The Most)
1. Nice to see you again
2. Trust me; it’s for your own good.
3. Everything is alright.
4. It’ll be your turn soon.
5. Don’t worry; I’ve done this many times before
6. Yes, that's supposed to happen
7. This won’t hurt

Seven Celebrity Crushes
1. Hugh Laurie (as House MD)
2. Mandy Patinkin (as Dr Jeffrey Geiger)
3. Hippocrates (as the Father of Medicine)
4. William Osler (as Sir William Osler)
5. Jack Kevorkian (as Dr Death)
6. Rockson Tan (as the Top Rock)
7. Blinkymummy (as she is)

Seven People Who Have To Do This
1. Dr BL Og
2. Distinguished Mediocrity
3. Dr Oz Bloke
4. Dr Quack
5. belladona
6. jodong
7. australian med student

(Yes, I realise you don’t have blogs; but isn’t it time you had one?)

So won't the real angry doc please stand up?

My disciple (may the Dark Side be with you) Distinguished Mediocrity got busted yesterday.

Once again it reinforces the fact that anonymity on the blogosphere is an illusion.

Over the past weeks I am privileged to have readers come visit and comment on this blog; I value your comments, because whether they agree with my opinions or question them, they give me perspective.

A few readers have asked or speculated about my place of practice. I am sorry I am unable to reveal that. In fact, I deliberately disguise my practice profile and jumble up my stories to make it hard to pinpoint my practice - events are not reproduced exactly but embellished, toned down, composited, or even made up. The doctor/s featured in the stories may not even be the same person. Hence the Disclaimer at the top of the page, you see.

The reason why I resort to such duplicity is partly due to the pledge that we all had to take when we registered with the Singapore Medical Council:

SMC PHYSICIANS PLEDGE

"I solemnly pledge to:

dedicate my life to the service of humanity;
give due respect and gratitude to my teachers;
practise my profession with conscience and dignity;
make the health of my patient my first consideration;
respect the secrets which are confided in me;
uphold the honour and noble traditions of the medical profession;
respect my colleagues as my professional brothers and sisters;
not allow the considerations of race, religion, nationality or socialstanding to intervene between my duty and my patient;
maintain due respect for human life;
use my medical knowledge in accordance with the laws of humanity;
comply with the provisions of the Ethical Code;
and constantly strive to add to my knowledge and skill.

I make these promises solemnly, freely and upon my honour."

The last bit is of course bollocks, since we were all forced to take the oath or take a hike. The fact that they make you state that it's pledged 'freely' tells you as much.

Truth be told I remember the Hippocratic Oath better than this pledge, but in any case I respect my patients' right to privacy.

So in the interest of patient-doctor confidentiality, I cannot reveal my real identity for that may in turn reveal the identities of the patient/s whose actions I based the stories on this blog upon.

As a further means to disguise my real identity, I have also tried to minimise on information about my personal life. Also, I started this blog to vent about some of the unhappy episodes in my years in the profession; certainly the stories on this blog are not representative of my entire practice. This means that angry doc may come across as a perpetually angry doctor with no personal life. If that's the case I think I've achieved the effect I'm after.

I hope you will enjoy reading the blog.

Thank you.

Top Ten List 3

Yet another list from K.

Top Ten Reasons why being a Polyclinic Doctor is like being a Bus-driver

10. You are assigned a number.

9. You sit on your butt the whole day, doing the same thing day in, day out.

8. Your customers complain about the waiting time.

7. Your customers complain if you are too slow.

6. Your customers complain if you are too fast.

5. The customer is always right.

4. Apart from doing your work, you have to fiddle with a computer which adds nothing to your service, but helps the company collect revenue more efficiently.

3. You get paid the same salary, regardless of how many customers your serve each day.

2. All your customers are ‘backseat drivers’ who think they can do your job better than you can, regardless of whether they have a license or not.

1. Lots of people put their lives in your hand every day… at an affordable price!

Top Ten List 2

Another list from my friend K.

Top Ten Reasons why being a Polyclinic Doctor is like being a cheap Geylang Prostitute

10. You are assigned a room with a number.

9. There is a red light above your door.

8. You have to physically touch strangers in the course of your work.

7. There is a washbasin and a place to lie down in your workroom.

6. Latex and lubricant.

5. You don't do housecalls.

4. Many of your customers are the elderly.

3. Business picks up on Saturdays.

2. You sometimes catch diseases from your customers.

1. Your customers wouldn’t be there if they could afford better.

Man charged with giving unsound medical advice

If only...

Bonus Bogus Story

Singapore -

A man was charged in court today for wrongfully causing the blindness and loss of limb of another man.

Mr Ngo Yeet Aw, 56, is charged with causing grevious bodily harm to Mr Watt Eh Foo, also 56.

Mr Ngo allegedly advised Mr Watt, a diabetes patient, to ignore a recommendation by his doctor to start on insulin therapy. Mr Watt became blind last month as a complication of his poorly-controlled diabetes. As a result of his visual impairment, he injured his left leg, which subsequently became gangrenous and had to be amputated.

Police arrested Mr Ngo after a complaint was filed by Mr Watt’s doctor, who cannot be named because he is a potential defendant in the case. He was charged in court today.

“I told him he should be started on insulin before his eyes and legs become affected, but he said his good friend told him that people who start insulin will end up with multiple complications. Idiots don’t realise that the poorly-controlled diabetes is the reason why they have all these complications and why they need to be on insulin in the first place, not the other way round!” said the angry doctor.

Mr Ngo’s lawyer, Mr Susa, told Straight Times that he plans to use the insanity plea again, but this time with a twist.

“Anyone who takes the word of a layman over a doctor in the matters of medical treatment can arguably be called insane, so my client’s words cannot be directly responsible for the plaintiff’s insane actions. If anything, the doctor should be censured for not picking up and treating his insanity!” said Mr Susa.

Mr Watt is currently warded at the Institute of Mental Health for psychiatric assessment. Straight Times’ sources inform us that the preliminary assessment by the psychiatrist as “Insane? Maybe. Stupid? Definitely.”

The Five Ages of Man

To the rude bastard who came into my room before his number was called yesterday asking to be seen before his turn,

I am sorry I was unable to see you first because of your specific combination of age and gender. While you might think that your ‘type’ is unique and deserves to be seen first, I would like to inform you to the fact that each age group has a reason too as to why they think they should have priority.

Here’s how it goes:

Infant
For some reasons mothers think that babies can’t wait, and should be seen first.

(I don’t really see why that should be the case because that seems to be about all that they do: sleep, wait for hunger to come, then cry for milk, get fed, sleep, etc. It’s not like they have something else important to do.)

Child
Incompetent parents who cannot control their children think that it’s our fault when they kids get impatient and start throwing tantrums in the waiting area, so they should be seen first.

(I understand it’s embarrassing to the parents involved, but I hardly think it’s fair for the rest of the patients to subsidise your inept parenting skills with their time.)

Youth
Parents think that their school-going kids need to see the doctor sooner so they can get the medicine sooner so that they can get well sooner so they can go back to school sooner, preferably within the same day, so they should be seen first.

(Please, when your school-going child is sick, he or she needs rest. The reason why doctors treat children is not so that they can quickly go back to school and take the exam which their future so depends on, but so they can be more comfortable while they recuperate. In fact, the only reason why your kid is having a chronic headache is because of all the stress you are putting him through (to the point when he has to read 10-year series while waiting to see me!). Let him sit there and not have to do anything for a change!)

Adult
Working adults think that the whole economy will collapse if they are not back in office before lunchtime, so they should be seen first.

(Have some perspective. I don’t care who you are and what you do, but the world will go on even if you collapsed and died of a heart attack this very minute. Sometimes an illness is your body’s way of telling you to take a break.)

Adult Female
Adult females are either ‘possibly pregnant’, ‘pregnant’ or ‘recently pregnant’. Curiously, conventional wisdom states that they must not wait too long while in any of the three states, so they must be seen first.

(Fact is, it’s not exactly a strenuous exercise sitting there waiting for me. And pregnancy is a 9-month process; seeing me an hour earlier is not going to speed it up. If you’ve recently delivered, you have gone through the worst pain known to mankind, so don’t bitch about the minor discomfort that is sitting in a chair.)

Elderly
Old people think that because of their frailty, they cannot wait too long, and should be seen first.

(You are retired! What else have you got to do? The fact that you have been around this long should mean that you are used to waiting more than the rest. Certainly waiting time doesn’t seem to be an obstacle for those of you queuing outside the court for a ringside seat at the latest murder trial. For those who are in a wheelchair, why are you complaining? You’ve got your own chair when some people have to stand!)


So you see, no matter what age or gender you are, there is always some other group that think they deserve to be seen before you do.

I’m not particular, since I have to see all of you eventually anyway. I would in fact prefer an open bidding system where the highest bidder gets seen first, with the money going towards my pocket. But for some reason the clinic administration feels that that is unfair and insists on the first-come first-serve rule.

Well, I guess as long as both you and I are in this system, you’ll have to continue to wait till your turn comes up.

Sorry.

angry doc

Top Ten List

K, a friend who locums at the polyclinics and A&E occasionally, sent me this list:

Top Ten Stories your Doctor WON'T buy

10. But I watch my diet very carefully, and I exercise every day!

9. I'm not drunk. I only had one beer.

8. I’ve been taking the medicines religiously everyday, but the pharmacy gave me extra last visit, so I decided to come back only after I’ve finished them.

7. I was going at less than 50 kmh.

6. My teacher/boss/sergeant told me I could go home, but I should still come and get an MC.

5. I fell down and hit my fist against the floor.

4. But the previous doctors always gave me sleeping pills!

3. I don’t know who the people who attacked me were; must have been a case of mistaken identity.

2. I cannot possibly be pregnant.

1. I fell onto it while I was changing a light-bulb in the bathroom; that’s why I was naked.

ICE ICE Baby

For those who are old enough to remember when Vanilla Ice dominated the airwaves, I apologise for reimplanting that tune inside your brain. You will now be playing it in your head for the next few days. But the topic I wish to blog on today is not white rappers, but something related to the clinical encounter.

Back in the days of Community, Occupational, and Family Medince (COFM, aka cough-medicine) in med school, we were told that being a doctor involved more than diagnosing and treating diseases. There was also this other inconvenience called the patient we had to deal with.

We were told that every patient had his ICE - Ideas, Concerns, and Expectations. Now let's see how much I can remember of what dear old Prof Goh has taught...

Ideas
By which we usually mean erroneous ideas, exemplified by the new mother who comes to your clinic stinking because she hasn’t taken a shower in a month for fear of ‘wind’ getting into her bones.

Concerns
By which we usually mean irrational concerns, exemplified by the woman who refuses to go for a Pap smear because she’s worried about the cost of treatment for cervical cancer if she is found to have it. Well, I suppose a funeral is expensive too but that’s one expense we all can’t avoid anyway.

Expectations
By which we usually mean unrealistic expectations, exemplified by the guy who thinks he needs 2 days MC because he’s got an itch on his arm.

The underlying message from COFM seemed to be that a good physician will take into account and explore these ICE, and deal with them effectively to ensure a good clinical episode. The other implication is of course that if you fail to take the ICE into account, you are a bad doctor.

In other words, ICE is the reason why patients are sometimes bastards.

Well, what they forget is, sometime, on the ICE planet, the doctors strike back…

The truth is, my dear patients, we too have our own ICE – doctors' Indicators, Clinical Guidelines, and Ethics!

(Aspiring medical students, if you read this in a textbook someday, remember you saw it here first.)

Indicators
By which I mean performace indicators. Doctors in the public sector are already audited, and Ministry of Health plans to audit all those in the private sector too, down to GPs. This means that our performance bonus or continuation of license will depend on how well we meet the target numbers.

So if your blood pressure is consistently above 140/90mmHg, or your HbA1c is consistently above 7, and you refuse to step up your treatment, GO SEE ANOTHER DOCTOR! I don't care if you have a valid reason for not being able to live up to the Ministry's standards like you have no money for the medicines or if you are blind, live alone, and have no one to administer your insulin - it's totally unfair for me to suffer for your predicament. Go sabo someone else!

Clinical Guidelines
In case you haven’t realised, doctors don’t suka-suka treat their patients. There are studies involving tens of thousands of human guinea pigs conducted by big drug comapnies who tell us that's how they prove their medicine is the best one for you. If we deviate from these guidelines, we might get into trouble with the Medical Council when something goes wrong. The fact that the drug company sponsored my last conference-trip to Hawaii has nothing to do with this, of course.

So if you don’t want to follow the treatment I recommend, GO SEE ANOTHER DOCTOR! Again, don't expect me to risk losing my license just so you can be treated according to something you read on the internet, newspapers, or your religious text. If you just happen to be one of those people for whom standard treatment doesn't work, please get out of the gene pool and my patient pool.

Ethics
Last and definitely the least. There is a code of conduct which governs the things a doctor should and may not do. Doing something that is considered ‘unbecoming to the profession’ is punishable by the Medical Council too and very malu when your classmates find out.

So if you want to get your kicks from cough syrup, sleeping pills, or give or receive sexual favours from me, I will tell you: "GO SEE ANOTHER DOCTOR!". Go make your request somewhere else... like the Bubble Tea stall which happens to be co-located on my premises...


I guess my point is, at the end of the day we are all human beings with our own wants and constraints. I don't believe any of us (patient or doctor) wakes up in the morning and decides to go to a clinic just to piss someone off. Doctors know patients have their reasons for encounter (another COFM term), but patients must also understand doctors have limits and standards placed upon them.

It's professional, not personal.

Bonus Quote from House MD

Dr. Eric Foreman: I thought treating patients is why we became doctors?

Dr. Gregory House: No, treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable

Life’s a Gamble

The comments on the post on Patient Autonomy generated some questions concerning cholesterol and cardiovascular risk.

I would first of all like to remind all of the Disclaimer. I will not answer any medical query directly because it is illegal and irresponsible for me to do so.

What I am going to do instead is to rant in general about the issue of cardiovascular risks.

Fact is, modern medicine, like life, is just a big gamble. We rely on the principle that God is essentially fair when dealing with doctors, and when a patient has a certain disease he would have certain sets of symptoms and signs so we can make a diagnosis, and when we treat a certain disease a certain way the patient usually improves.

That forms the basis of modern Evidence-Based Medicine, which in a nutshell means we treat 10,000 people with drug A and 10,000 people with drug B for five years, and then see which group does better. If the difference is big, we recommend all patients take that 'better' drug. Risk factors are studied the same way.

But of course the problem is what works for one person may not always for another.

In my practice I have utilised the angry doc 4D model to explain this concept to my patients. It runs thus:

Getting a heart attack or stroke is like striking the top prize in 4D.

Having risk factors is like buying 4D tickets.

The more risk factors you have, the more tickets you've bought yourself. So if you are a healthy 30 year-old who doesn’t smoke, exercises regularly, is not obese, and have parents who do not have heart disease or stroke, you have one ticket. If you are 65, fat, have high blood pressure, smoke like a chimney, have two parents who had heart attacks, have high cholesterol etc., you have bought yourself a handful of tickets.

If your blood pressure or cholesterol levels are high, you have bought 10 big 10 small on those tickets (OK, I don’t actually buy 4D but I assume that’s how it works?).

So now, the question is: who has a higher chance of striking the top prize?

The second question is: who will strike top prize?

The fact is the healthy young guy can still strike the top prize, and that the old smoker may not strike at all.

But the real question you should be asking yourself is: am I feeling lucky?

Well, are ya?

Bonus Risk Assessment (see Disclaimer)

Here's an online calculator you can use to assess your cardiovascular risk.

Medicine - a priestly calling?

Even though the Hippocratic Oath (in its original form) is no longer mandatory for entry into the profession, most if not all doctors will be familiar with it. It occurred to me that the Oath mirrors the Ten Commandments in an uncanny way.

See for yourself (Oath in blue, Commandments in black):

I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath.

I. I am the LORD thy God, which have brought thee out of the land of Egypt, out of the house of bondage. Thou shalt have no other gods before me.

To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.

V. Honour thy father and thy mother: that thy days may be long upon the land which the LORD thy God giveth thee.

I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion.

VI. Thou shalt not kill.

But I will preserve the purity of my life and my art.

II. Thou shalt not take the name of the LORD thy God in vain; for the LORD will not hold him guiltless that taketh his name in vain.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

X. Thou shalt not covet thy neighbour's house, thou shalt not covet thy neighbour's wife, nor his manservant, nor his maidservant, nor his ox, nor his ass, nor any thing that is thy neighbour's.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

VII. Thou shalt not commit adultery.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

IX. Thou shalt not bear false witness against thy neighbour.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

II. Thou shalt not make unto thee any graven image, or any likeness of any thing that is in heaven above, or that is in the earth beneath, or that is in the water under the earth. Thou shalt not bow down thyself to them, nor serve them: for I the LORD thy God am a jealous God, visiting the iniquity of the fathers upon the children unto the third and fourth generation of them that hate me; And shewing mercy unto thousands of them that love me, and keep my commandments.

Ah, but that was only eight of the commandments!

So which are the two commandments that doctors do not keep?

IV. Remember the sabbath day, to keep it holy. Six days shalt thou labour, and do all thy work: But the seventh day is the sabbath of the LORD thy God: in it thou shalt not do any work, thou, nor thy son, nor thy daughter, thy manservant, nor thy maidservant, nor thy cattle, nor thy stranger that is within thy gates: For in six days the LORD made heaven and earth, the sea, and all that in them is, and rested the seventh day: wherefore the LORD blessed the sabbath day, and hallowed it.

VIII. Thou shalt not steal.

So now you know why doctors have to go on-call on weekends, and why they are allowed to charge such high fees.

It's all in the Oath, man.

Skin is thicker than blood

Dengue Season means more demand for platelet transfusions in the hospitals, so do lend a helping hand (and arm) at the Blood Bank if you can.

This story is dedicated to all the housemen who managed to squeeze blood from stones.

BTS: Hello? You paged?

What I say: Hi, this is angry doc, calling from Cheap Good Hospital. I’ve got a patient with a bleeding ulcer and I need some packed cells.

BTS: OK… what’s his Hb?

What I want to say: Well, it’s probably 8 now, but before the last two packs it was…

What I say: 6.4.

BTS: Hmm… what’s his blood group.

What I say: B+

BTS: Hmm… we are short of B+ now. How many units do you need?

What I want to say: You know, I swear this job can be done by a recording. He needs two units actually, but since I know what you are going to say…

What I say: Four.

BTS: Hmm... cannot lah; I can only give you one.

What I want to say: Yikes! You’re even stingier than I thought.

What I say: But he’s still bleeding… can you approve another unit please?

BTS: No. We’re really very short on B+ now.

What I want to say: OK, I didn’t think I would have to sink so low, but…

What I say: C’mon. I can tell from your voice you are a kind doctor, right? What’s your name?

BTS: Charity*. What’s yours?

What I want to say: …

What I say: Irony…

BTS: Irony?

What I say: Er… Ernie. That’s right… Ernie.

BTS: Ernie? You went to med school with my sister, right?

What I want to say: Well, I slept through most of med school and don’t remember much, but if it’ll help…

What I say: Yes! I bet you are as sweet and pretty as your sister.

BTS: *giggle* Well, let your blood bank know I’ve approved two units.

What I want to say: I feel so dirty… but…

What I say: Thanks.

* - Apologies to the real Dr Charity. Now who can tell me what Charity’s sister’s name is?

Increase my killing power, eh?

Help angry doc increase his killing power!

Sponsor him for this upcoming talk.

Heart Failure

Found this e-book about a doctor’s disillusionment with the medical education system. Sad to say his observations are also applicable to the local medical school and medical educational system.

This particular paragraph:

“There is an atmosphere of deceit. We are told to tell the parents that the reason we are the third person to ask the same questions and perform the same physical exam - pressing on all the same sore spots - is because we are making sure nothing is missed. Bullshit. The veneer of this-is-in-your-child's-best-interest is nothing more than you-and-your-family-will-be-respected-only-so-far-as-you-can-be-exploited as tools for our education. Self-interest disguised as selfless service.”

reminded me of an episode during my surgical posting...

Bonus Real-Life Story (see Disclaimer)

A couple of medical students came to me asking for ‘interesting cases’ to see. I brought them to a patient with an inflammed gallbladder, and after making them promise that they would NOT repeat the manoeuvre on the patient, demonstrated Murphy’s sign.

A couple of minutes later I walked past the cubicle only to see them trying to elicit Murphy’s sign on the same patient.

What. The. Fuck.

Have these guys no sense of decency or integrity? Or are they just stupid? I mean, Murphy’s sign is nothing but a snobbish doctor’s way of saying ‘this guy has pain HERE’, named after an old dead American guy! How is it educational to see a patient wince in pain over and over again? Just because some vain dead angmoh tagged his name to a particular way of causing pain doesn’t make it educational*, morons!

I regret not having invented there and then the ‘angry doc’ sign:

Erythema in the shape of a hand over the cheek indicative of the student having been punished for a particularly inconsiderate act.

Anyway, those sadistic buggers have probably graduated now and are practising in a medical establishment near you.

Good luck. Stay healthy.

* - OK, angry doc admits he was a jerk to have demonstrated the sign to begin with...

You misunderestimate the power of the drug side...

As a follow-up to my post yesterday, here are a couple of articles on the evil pharmaceutical empire.

I suspect the reason why doctors don't stand up to them is because they are the ones who supply us with our little magic bullets. They decide what medicines to make, which trials to sponsor, and because of 'evidence-based medicine' we end up prescribing the 'best' drugs.

Dance like puppets on strings...

Q&A

Inspired by Dr BL Og, I submit my replies to questions posed by blinkymummy:

1. Don't you have friends who say funny things?

Yes, but it's usually about our patients too.

2. Taxi drivers who give way to you along ECP?

One time I cut into the lane of a taxi driver on ECP, traffic police came after me. I waved my stethoscope at him and he backed off.

Then Monday I tried the same thing again, traffic police came again. I waved my stethoscope, but then this time he waved his handcuffs back at me...

3. The tree in your garden which looks like Bart Simpson?

No, but I've got a cactus that looks like Marge Simpson.

4. The girl who looks damn good but spits shopping lists?

Got. I sent her to see a specialist already.

5. The topless SLK you ordered during clinic?

Not allowed to drive anymore. See 2. above.

6. Don't you go to Ngee Ann City to see lion dance competitions?

Well, I was driving to Ngee Ann City, but see 2. above...

7. There has got to be something else?!!!

I actually got two other blogs on separate accounts. :)

You can't handle the truth!

How long before angry doc's ugly face appears on TV?

Do the hustle!

(Pharmaceutical company sales representative comes into my room just as I prepare to leave for lunch.)

Drug-pusher: Good afternoon, angry doc. Can you spare me five minutes?

What I want to say: No! I want to have my lunch. Why do you people always think that you petty concerns with your sales figures and commission are more important than my stomach?

What I say: Er… OK.

Drug-pusher: I’m Jennifer from LSD. This is my card.

What I want to say: Why are you guys always called Jennifer? BSc… tell me, when you were studying at the university, did you ever imagine that you were one day going to become a peddler? Nevermind. What drug are you pushing today?

What I say: How can I help you?

Drug-pusher: I’m here to tell you about our latest drug. Yada yada yada. Here’s the abstract of the latest study comparing our product with the other company’s product, which shows a 15% difference in yada yada yada.

What I want to say: Yawn.

What I say: Yes…

Drug-pusher: So please think of our product the next time you have a patient with this condition. *flash big smile*

What I want to say: No. The next time I see a patient with this condition I’m going to treat him according to proper clinical guidelines, not something a drug-pusher told me.

What I say: Thank you.

Drug-pusher: Would you like some free samples of the product for your patients?

What I want to say: Do you realise that’s exactly how drug-pushers get young people hooked on drugs? Does your mother know you are doing this for a living? Have you no shame?

What I say: No thanks.

Drug-pusher: OK. Here are some free pens for you.

What I want to say: Yippy. I went through medical school precisely so that I can have a chance to get free pens. And I’m sure the product name on the free pens will cause me to prescribe more of your product from subliminal suggestion. Oh, and for your information these pens are cheapo crap; that’s why your company buys them as freebies. I use them when I want something to throw at medical students.

What I say: Thank you.

Drug-pusher: Oh, and we are having a dinner-talk next weekend at the Ritzy Hotel where professor Marijuana from New Mexico will be speaking on the latest study. Would you be able to attend?

What I want to say: Nice. Now we are spending big bucks and giving fancy dinners to sell more drugs. Guess who’s gonna pay for all the expenses eventually?

What I say: No, thank you.

Drug-pusher: OK. Thank you for your time. Remember our product!

What I say: I will…

What I want to say: … when I finally feel like taking some bribes!

Bonus movie news

Michael Moore is making a movie on the dubious practices of the pharmaceutical industry. angry doc will be watching that one…

Angry Doctor on the web 3

Another article I found googling "Angry Doctor".

Just so you know angry doc is NOT the only angry doctor around...

Angry Doctor on the web 2

Googling "Angry Doctor" brought up this article.

So many angry doctors, so... er... so many angry doctors...