U2 360 concert

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

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

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

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?

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

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

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

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

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

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

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

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!