An effective gloving or not

When I was in medical school, a microbiologist pointed out that the dirtiest part of a public toilet would be the door knob or door handle with the reason that the cleaner would clean commode and toilet floor in a particular time interval. But nobody would not bother to clean door knob that all toilet users need to touch it after their business. He claimed that million of germs could transmit from that source.

Based on above knowledge, I may be obsessed, I sometime see currency notes, which may have passed in the hands of hundreds of people before it comes to my pocket, as a kind of toilet door knob from the health point of view. I really don't know if there are harmful germs on £5 and £10 notes. But I believe that food handlers should not touch currency note while foods are being prepared.

I like Subway sandwich for many reasons. It is fresh. I can choose the type of bread and ingredients. I can order to toast it or not. I can select the salads and sauces (Mustard is my fav). It is also a good practice that food handlers are instructed to put gloves on while working.

Unfortunately, I came across a shop somewhere in Britain, which has been in sub-standard, in terms of hygiene although sale persons were on gloves.

When I got there, there were two sale persons in that Subway shop. I ordered BMT with Hearty Italian bread. The first person's job was cutting the bread and putting the meats inside, before toasting with cheese. After that, the second person put salads, which were cucumber, pepper, onion, iceberg as I chose, finishing by spreading with sauce. Then, it was packed. What was next!

The next step was that the sale assistant took the money with his semi-wet gloved hand, operating the machine and returning the change. When I got out of the shop, he had been dealing with next customers, repeating the same steps.

Any comment welcome.

If someone wants to know the actual place of this branch, I would be happy to tell for the sake of Subway customers. Just drop a comment.

Spreading sauce


finishing sandwich making


Holding the machine with food preparing hands, concentrating on digits


I was taking the change

Continuing medical education

A couple of years ago, my relative from Burma was visiting Britain, staying at home for a month. He noticed I was reading medical books and journals as my hobby or my task or whatever it was described.

"Work hard, Steve. Study harder to get a higher level"

His expression made me surprised. I was not preparing for any exam. I was doing a routine thing as a doctor. But in his eyes, I had to keep reading books because I still needed to learn a lot. He treated me as a student, patronising me a lot. I did not explain too much why I had to read books while working at hospital in Britain. I felt it was not worth doing so. He was just a visitor going back to Burma in a few weeks.

Basically, it is compulsory in Britain that all levels of doctors, from first year medics to consultants and professors, to do "continuing medical education" while practising. We need to keep updated with recent developments and advances in medicine while refreshing existing knowledge and skills. That is part of the duty of a good doctor. We are entitled with study days and leaves for that purpose. We need to attend education meetings and conferences .

I am wondering how a consultant physician from Burma seeing patients till late evening after working from 8Am to 4PM at hospital, would have a chance to update his or her knowledge. At the same time, I believe if patients and their families in Burma found out that their doctor keeps reading medical books, they would not trust him/her any more with the thought that our doctor had not got enough knowledge yet , but still studying. They might move to new doctors.

I still remember my early career when I ran a private clinic in Insein, northern part of former capital city, Yangon. I treated minor illness with pills and I did not request too much laboratory tests. There was a specialist clinic nearby. At that point, a funny thing was going on. The local people had been spreading words, saying that the specialist doctor from that clinic had no idea how to treat without blood tests and claiming that that young doctor, it was me, was much better. Every evening, there had been a long queue in my clinic.

Next, it is disappointing that there is a poor referral system in Burma. The doctors want to keep their patients with them for some reason, regardless of the conditions. My aunt has a sleeping difficulty and anxiety , and a cardiologist has been treating her with sleeping pill for many years, instead of referring to a psychiatrist or counselling service. Again, from the patient point of view, if they are advised to see other doctor for a different problem , they may think the referring doctor is not efficient. I heard several similar stories before. So we can't blame doctors' way of practice in Burma. But I believe general people would need to be educated. At the same time, the authorities concerned need to make sure the referral system in Burma running smoothly and effectively for the sake of our patients. Reinforcement may be required.



Friday afternoon Library at the hospital I am working


Evidence based Medicine corner


Reading a medical journal

Plagiarism Mania

What is Plagiarism?

According to the Merriam-Webster Online Dictionary, to "plagiarize" means to steal and pass off (the ideas or words of another) as one's own : use (another's production) without crediting the source.

Plagiarism is a serious fraud. Some journalists have ended their career as they stole someone else’s work. There were many students who had to leave university after submitting an essay with missing reference. Most schools have been using plagiarism detector software.

It was an earthquake in the journalism world. 27-year-old Jayson Blair, who had been one of only two African-American editors in the history of the University of Maryland's Diamondback newspaper, and had been hired as a full reporter at the New York Times at an impressively young age, resigned only 6 days after first being accused of copying a story from another newspaper.(source)

Later, it was discovered that he had a bipolar disorder which is a serious mental problem.

Above article I came across for some reason made me remind a Burmese blogger and her scandal. Apparently, she(he) was bitterly criticised by a lobby of people who found out her copy works. Personally, I like her blog posts which are pretty entertaining. At the same time, I tried to help her out. At this point, my thought was that if there is any strong relation between plagiarism and some mental or personality disorder.

Basically, psychiatry is an interesting speciality, explaining a variety of mental and personal disorders, although, I believe, there are many areas the psychiatrists have not explored yet. (Click here for Who classification of mental and behavioural disorders). (Easy view on Wiki)

In my attempt to establish “the repeated plagiarism” as a psychological condition, unfortunately I could not find any relevant publication or paper available on free Internet sources while waiting for a reply email from my friend, who is a psychiatrist. I think it can be added under that heading of Habit and impulse disorders, together with

• Pathological gambling
• Pathological fire-setting (pyromania)
• Pathological stealing (kleptomania)
• Trichotillomania
  

Can we call this condition as Plagiarmania or Plagiamania or Plagiarism mania?

Probably, the treatment option would include cognitive and behaviour therapy, rather than criticising and shouting in an uneducated manner. Own GP would be helpful this point.

Basically, no body is perfect in the world while some proportion of healthy looking persons may have a mild form of personality deviation. Who knows?

By the way, if someone wants to check own personality disorder privately, click here.

Thank you

All the best

No alcohol, moderate alcohol and excess alcohol

We can say alcohol (also called ETOH at work) is the most easily available recreational drug or agent. Many patients are smart as they know what they are doing very well. During the medical interview last week, I asked my patient as routine "Do you like lager or wine? How much do you drink?, he answered " No too much, Doctor, only 10 -12 units a week, only weekend really!" . ( Gosh.. much less than my limit). Of course, this is in England. Most people have been familiar with alcohol units and recommendations. The UK authorities suggest that the tolerable maximum weekly consumption of alcohol for men is 21 units, and for women 14 units. Beer cans and all liquor bottles show up the formation of alcohol units as a legal requirement.

Obviously, we know very well alcohol excess is strongly associated with a wide spectrum of problems, from health issues to social consequences. If so, can we say it is safe enough to take a drink in moderation, that is, 21 units/week for men and 14 units/week for women?

According to cancer research UK, drinking 1-2 units a day can increase the risk of the seven cancers linked to alcohol.(Full story). I believe this is a reliable research report. What would be the next? Should we give up our drinking habit at the expense of our recreation?

At the same time, I am thinking myself why I want to live long. For what? For my patients? For my family? For human beings? For animals? I was so surprised to see a 81 year old man at work who kept asking me why he had osteoarthritis (joint pain), why he was not able to walk like others. Maybe he was demented. But at least he was not aware basically that it is inevitable for everybody to face the deterioration phase, like an old car, before going to heaven or hell, provided that the mode of death is not a sudden death.

Well, what I am trying to say is that so long as we know what we are doing, it is fair enough. No alcohol or moderate alcohol or excess alcohol, what ever it is. We still don't know what our mode of death would be yet :)




Here is the alcohol unit calculator. Really handy. You can know what you are doing easily.

No kiss, no cold sores and no dementia?

Could a kiss result in dementia?

The majority of people would answer "No".

But according to the latest research in Britain, cold sores, mainly transmitted by kissing, link to Alzheimer's disease, a progressive disabling and irreversible memory problem, which is the second commonest form of dementia. The DNA structure of the HSV-1, a virus causing cold sores, is found in the brains died of Alzheimer's dementia. As this finding is based on a small research , more works are still in need to confirm the discovery.

At this point, we should have an awareness of cold sore, I think. What is cold sore?

Some facts are as follow:

• -a very common illness caused by herpes simplex virus type 1
  
• -characterized by groups of fluid-filled blisters on and around the lips
  
• -transmitted by close body contact, mainly kissing (involvement of private part if having oral sex with infected partner)
• -tender and painful
• -reactivation (recurrence) happened when body resistance falls (as virus could stay inside the body for a long time or for life long )
• -Zovirax cold sore cream helps to some extent

More detail on Netdoctor

Alcohol and bowel cancer risk

Many people believe that a pint of beer is OK, nothing serious problem at all. But it is reported recently that we are at risk of bowel cancer even though we don't exceed our daily allowance of alcohol.

The report, published by the International Journal of Cancer, says that drinking two large glasses of wine or two pints a day increases the risk of this disease by around quarter compared with non-drinkers.

One glass of wine or a pint of beer a day raises the risk by 10 per cent.

"The research shows quite clearly that the more alcohol you drink the greater your risk of bowel cancer,'' said Professor Tim Key, an expert with Cancer Research UK told the Daily Telegraph. Source

This must be recent research result. I don't know how reliable it is.

On the other hand, health authorities normally recommend to enjoy moderate alcohol drinking as it prevents heart problem to some extent (20 units per week for men and 15 units per women) . You may want to know how to calculate alcohol unit. Here is online calculator. I can't remember if beers and spirits available in Burma show alcohol percentage, that is, ABV %(Alcohol by Volume). In UK, most Beers come as 4% and 5%. Whiskies are 40%. Wines are 12.5% , 13% ,,,,,,,

Narcissistic personality disorder

I am not a psychiatrist. But I'd like to post a psychiatry related disorder this time.

That is Narcissistic personality disorder. The characteristic features are as follow:


1-has a grandiose sense of self-importance
2-is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3-believes that he or she is "special" and unique and can only be understood by other special people
4-requires excessive admiration
5-strong sense of entitlement
6-takes advantage of others to achieve his or her own ends
7-lacks empathy
8-is often envious or believes others are envious of him or her
9-arrogant affect.

At least five of the above are necessary for a diagnosis

You may check the poeple around you. Who has got this mental problem?

Born to get cancer

You may know that some cancers are genetically determined, some are not. Some are multi-factorial. Some are greatly influenced by environment. Some are by viruses.

In the following news article, the mother of 3 has been born to have Breast cancer. When she checked her family tree, 31 persons had Breast cancer. It is too much, isn't it? She has also got Breast cancer on one side. Now she had both of her breasts removed.

A mother of three underwent a double mastectomy after discovering that 31 of her relatives had suffered from breast cancer in the past 200 years.

Eleven years ago Alex Best, then 29, decided to look at her family tree, which medical experts have described as one of the most extreme in the country. A week later Miss Best had breast cancer diagnosed herself.

After learning of her family history, she had contacted a genetics expert, Professor Gareth Evans, to find out if she was also carrying the gene. By chance the research team had been studying her family tree but had not been allowed to contact surviving family members. A test confirmed that she was carrying the gene and had an 85 per cent chance of developing the disease. Full story

Basically, breast cancer cure rate has been getting better in this century. But early detection and proper treatment are important factors for the survival rate. You may know Aussie pop star Kylie had breast cancer, still living in normal life and she keeps singing and smiling. Promoting breast awareness and mammography (Breast X-ray) for older age groups are recognised approaches to prevent breast cancer deaths. Of course, health authorities have advised women to examine their breasts while having a shower.

Well, you may be interested in the fact that who the risk persons are. According to the research and literature, risk groups include those who never deliver baby, those with first pregnancy at their over 30, those who never give breast feeding to their children, those with early onset of period, fat ladies, those who have female hormone replacement therapy, those who carry Breast cancer gene (like the lady in the news).

So my suggestion would be: enjoy your life normally,get a boy friend if appropriate, avoid extreme actions, don't be proud of being single or virgin (some ancient Myanmar ladies are crazy for it, I think),examine yourself properly on a regular basis.

Any question or concern? just Google, OK?

A new measure against cervical cancer

"A jab that protects against cervical cancer should be given to all girls aged 12 to 13, an advisory committee to the Department of Health said today."

;;Source;;

In this era when early sexual relationship has been increasingly common,above measure would be most approriate, I think.

Infection with human papillomavirus (HPV), which is transmitted sexually, is strongly associated with cervical and vulvar cancer and is the primary risk factor. Evidence of HPV is found in nearly 80% of cervical carcinomas.

In Britain, all women between the ages of 25 and 64 are eligible for a free cervical screening test every three to five years. GP normally send the letter for cervical smear test. The Cervical Screening Programme has been going on in the UK for years.

This new vaccination programme would be an extra effort to crack down cervical cancer, I feel.

A Cracked Pot and Maggots

The cracked pot philosophy (the previous post) is great, I believe. Again, 100% of people see maggots as disgusting creatures. Now in the field of medicine, these larvae have been used to cure some sort of ulcers. A professor claimed "Maggots are the world's smallest surgeons"




Click here for Full story

If you don't know about MRSA, Click here

An injection appeal in Britain

During the last week, our team had to see outlier patients. Basically I review patients first and I discussed with my consultant if needed. You may don’t know what outlier patient is. For example, if a patient with nerve or brain problem is placed in chest ward for some reason, he or she is the outlier patient of neurology and the neurologist has to go and see that patient as his outlier.

In this hospital, outlier patients are a little bit different. Those who are not medically serious and ready to go home, but still need to be sorted out their social and other issues, are put under the care of outlier team.

Well, on Last Wednesday, 36 year-old-chap who is a known multiple sclerosis came in with some minor recurrent attack. Plan was to give 5 day course of intravenous injection. He is apparently well and no reason to stay in hospital for once a day injection. So I have to organize to get intravenous injection as an out-patient.
I never thought that it was a difficult job. But in the real situation……

In fact, his wife is a sister working in our hospital. But British rules and regulations do not allow doctors and nurses to give medical care to the close relatives and next of kin.

I phoned to his GP who declined to do so. They did only intra-muscular injection in surgery, not intravenous injection.

So I tried the district nurse who normally does home visit for dressing and medication and so on. The same answer was given.

And then I contacted to the Intermediate Care Team whose function is to look after recently hospital discharged patient if needed. They said they don’t have enough capacity to do so.

There is a day treatment centre in our hospital. They said they open only 3 days a week. So not possible for 5 consecutive day injection.

A&E department is out of question. They only deal with emergency patients.

I tried MAU, Medical Assessment Unit. They declined again as they have got a great deal of workload with acute patients all the time. ( I know that fact very well)

Finally CDU in-charge sister agreed to give intravenous injection to my pity patient in her department. CDU is Clinical Decision Unit who takes GP referral. At that department, hospital doctors see patients referred by GP and deicide to admit them or not.

On that evening time, patient went home after waiting for an intravenous injection agreement for nearly the whole day.