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Update September 2018


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Update by Natrakorn Paewsoongnern
 
 
 

Doctor's Consultation  by Dr. Iain Corness

 

September 22, 2018 - September 28, 2018

Your intelligence is in your jeans? (Sorry, in your genes)

Nature or Nurture? What shapes us? In many published studies of human beings, their development and their frailties, it often comes down to a discussion of Nature or Nurture. My doctor son, for example; does he get his academic brilliance from me and his reluctance to fight bureaucracy from being raised by his mother? Nature versus Nurture again. Or how deep is the gene pool?

One area which always interests prospective parents is their likelihood of getting intelligent children or drones. Much has been written about the inherent dangers to the unborn child while it sits, waiting in the wings, so to speak, for that awfully long drawn out 9 months of gestation. Mind you, it could be worse - we could be elephants and have to wait three years to see how a brief encounter in the bush turned out!

Many factors can influence the unborn child in utero, as we doctors like to call that “bun in the oven” stage. Most of these developmental influences are not good influences and may produce children that are smaller than the average - smoking by Mum-to-be being a prime example.

Some clever chaps in Norway sat down and followed around 700 kids from birth to age five. Around half of these children were of low birth weight, and the other half “normal”. So at age five they assessed the children for Verbal Intelligence Quotient (IQ) and Non-verbal IQ.

The results were interesting. While the smaller babies did have a very slight lowering in the two IQ scales measured, it was not much. However, the factors that did alter the results were Mum’s non-verbal problem solving abilities and child rearing style. In percentage terms, this accounted for between 20-30% of the variance in the observed children, while birth weight accounted for 1-2% only.

Now before you rush out thinking that it is all genetic and wonder what you have to do to increase the depth of the family gene pool, did you notice that not only were there genetic factors at work (Mum’s non-verbal abilities) but also child rearing style, which is not genetic, but a learned response from her mother. Definitely “nurture”.

To my mind, this shows there is almost certainly a predominance of effect on children by their mothers. Both genetic and nurturing. I’m sorry, Dad. It might take two to tango, but Mum is the all-important one - especially in the first few years of a child’s life.

Now at the risk of being sent hate mail by the lady liberationists out there, I do believe that this demonstrates a very “normal” behavioral pattern. The male of the species Homo sapiens was the hunter-gatherer, while the female stayed at home to cook sabre tooth tiger burgers and raise the offspring. Of course the mother has a greater influence on the preschoolers mind (and the abilities of that mind).

So in answer to the vexed question of how to get intelligent kids, it’s easy. Simply find an intelligent healthy woman, who wants to stay home and raise your brood of geniuses. The harder part is finding one that wants you for her mate!


September 15, 2018 - September 21, 2018

How to get the best value from your doctor’s appointment

The most common complaint that patients have about their doctor is that they didn’t understand half of what the doctor was telling them!

That is not just in Thailand where there can be language problems, but can happen in the UK where the British patient is in consultation with a British doctor, or in Australia with the Aussie patient and the “Aussie” Indian GP.

Whose fault is this? Sometimes it is the patient and other times it is the doctor. Hopefully after this week we will have made your life as a patient more smooth and satisfying.

The first problem occurs when the patient does not relate his or her symptoms, but tells the doctor what the condition is and will sometimes produce reams of computer print-outs with passages from “Dr” Google highlighted.

Don’t get me wrong, Google is completely accurate if you give it the correct diagnosis, but if the diagnosis is in doubt, then Google will give doubtful results.

Where all this falls down is when the patient gives the doctor the diagnosis (instead of the symptoms) and then expects the medication suggested by Google to be given to them by the doctor. “Just give me the tablets Doctor and I’ll get out of your hair.”

This is where the consultation really falls apart. The patient has suppositions based on incomplete data. The doctor does not know whether to directly challenge the patient’s Google diagnosis, or to try and sway the patient’s thinking away from the computer print-outs. This is often done by suggesting a test which might convince the patient if it is negative (and the doctor knew all along it would be).

Much of this is an unnecessary cost and waste of time.

So much from the patient’s point of view, what is the consultation from the doctor’s view point? The doctor makes his or her diagnosis by getting a history (“When did the pain come on?” or, “Does anything make it worse?” for example) then listening to the symptoms, and then carrying out a physical examination. Finally, there is something called ‘clinical acumen’, a gut feeling that the doctor has after seeing hundreds of these types of condition. The young doctors have to start somewhere, but they don’t have clinical acumen until they have a few years of clinical experience. Note that at no time does the doctor factor in the patient’s Google diagnosis.

All that above is in the ideal situation, but there is another problem often found in the patient-doctor relationship. Verbal communication.

It stands to reason that if either the patient or the doctor has to converse in a ‘foreign’ language there is a very strong likelihood of miscommunication. Fortunately, the Bangkok Hospital Pattaya has a team of interpreters covering the major languages and you should request one if you are unsure of your own command of English. However if your native language is Kituba or something from the tropical jungles of Africa and only discovered last year, be prepared to emulate Marcel Marceau the mime artist.

The doctor has to also use language that the patient understands, and not scientific medical terminology. “How is your urination?” is not the way a patient usually describes the bodily urinary function.

So, to get the maximum benefit, tell the doctor your symptoms, not the diagnosis, get assistance with English if necessary, and don’t be afraid to ask the doctor to explain something further if needed. It is for everyone’s advantage that you leave the consulting room confident in your knowledge about your body and what the doctor is doing to get you fit and well once more.


September 8, 2018 - September 14, 2018

Biting on a bullet!

Surgeons can be the ‘prima donnas’ of medicine, if you like. It is the surgeons who get the headlines in the newspapers. It is the surgeons who are the stars in movies and TV. Who can remember the irascible surgeon Sir Lancelot Spratt (Dr. In The House, 1954) or the young surgeon Dr. Kildare (1961)? Slightly more recent, the American surgeons in M*A*S*H?

However, surgeons have been around for many centuries and have their own Royal College. The origins of the first Royal College of Surgeons go back to the fourteenth century with the foundation of the 'Guild of Surgeons Within the City of London'. There was dispute between the surgeons and barber surgeons until an agreement was signed between them in 1493, giving the fellowship of surgeons the power of incorporation. In 1745 the surgeons broke away from the barbers to form the Company of Surgeons. In 1800 the Company was granted a Royal Charter to become the Royal College of Surgeons in London. A further charter in 1843 granted it the present title of the Royal College of Surgeons of England (of which I proudly say I am a member).

We marvel at the surgical advances in the past century, but while I take my hat off to the surgeons, the real praise goes to the anesthetists. Without the advances in anesthetics, brawny assistants would still be holding patients down while surgeons attacked with scalpels and saws and the patient lay there biting on a bullet.

The first anesthetic agent was ether, dribbled on to a mask to knock the patient out and allow the surgeon to take his time and become meticulous in his approach. The first public demonstration of ether anesthesia took place on 16 October 1846, at Massachusetts General Hospital in Boston. The anesthetist was William Morton and the surgeon was John Warren; and the operation was the removal of a lump under the jaw of a Gilbert Abbott.

While there have been enormous advances since then, I can remember being a medical student and assisting at an operation in outback Australia in 1964. The anesthetic was ether, dribbled on to the patient’s gauze mask by the matron of the public hospital, and it was a Caesarian section for twins. There was no air-conditioning and it was 43 degrees in the theatre, where the fumes were making us all woozy. Amazingly everyone survived the ordeal, mother, twin sons, the local doctor, the matron and me.

Despite outback Australia, anesthesia progressed in the rest of the world. Chloroform was introduced by James Simpson, the Professor of Obstetrics in Edinburgh, in November 1847. This was a more potent agent but it had more severe side effects, including sudden death. However, it worked well and was easier to use than ether and so, despite its drawbacks, became very popular.

The next major advance was the introduction of local anesthesia – cocaine – in 1877. Things definitely did go better with ‘coke’! Then came local infiltration, nerve blocks and then spinal and epidural anesthesia, which in the 1900s allowed surgery in a relaxed abdomen, and is still used today, especially in obstetric anesthesia, where the mother can be anaesthetized without the baby being affected as well.

The next important innovation was the control of the airways with the use of tubes placed into the trachea. This permitted control of breathing and techniques introduced in the 1910s were perfected in the late 1920s and early 1930s. Then came the introduction of intravenous induction agents. These were barbiturates which enabled the patient to go off to sleep quickly, smoothly and pleasantly and therefore avoided any unpleasant inhalational agents. Then in the 1940s and early 1950s, there came the introduction of muscle relaxants, firstly with curare (the South American Indian poison, but not administered by native blowpipe) and then agents less dangerous.

Anesthesia is now very safe, with mortality of less than 1 in 250,000 directly related to anesthesia. Nevertheless, with today’s sophisticated monitoring systems and a greater understanding of bodily functions, the anesthetic profession will continue to strive for improvement over the next 150 years.”

On behalf of all patients requiring surgery in the future I thank the anesthetists. No longer do they have to bite on this bullet!


Update September 1, 2018 - September 7, 2018

Blood group differences – Thai and Farang

A couple of weeks ago, a call went out to the farang population in Thailand for some Rh negative blood. This happens around three times a year, and each time this stimulates some of our more public spirited foreigners to ask why there is a shortage, and what can be done about it?

The basic problem does come down to some of the many differences between Caucasian races and Asian races, and I’m not talking about cultural differences here. Just as there is a difference in hair types and skin types, there are differences in blood types as well.

The question is often asked as to why the blood collection agencies just don’t stock up on the rarer groups, so there is always some to call upon. Unfortunately it isn’t that easy, as the ‘shelf life’ of blood is only around 30 days.

Blood transfusions and blood banks only came about in the 1930’s with Sergei Yudin of Russia organizing the world’s first blood bank at the Nikolay Sklifosovskiy Institute, which set an example for the establishment of further blood banks in different regions of the Soviet Union and in other countries. By the mid-1930s the Soviet Union had set up a system of at least sixty five large blood centers and more than 500 subsidiary ones, all storing blood and shipping it to all corners of the country.

News of the Soviet experience traveled to the United States, where in 1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, established the first hospital blood bank in America. In creating a hospital laboratory that preserved and stored donor blood, Fantus coined the term ‘Blood Bank’. Within a few years, hospital and community blood banks were established across the United States and in 1940 Willem Johan Kolff organized the first blood bank in Europe.

With the discovery of blood groups, generally classified by the ABO system (so we are generally either A, B, O or AB) it was soon apparent that there were differences in their distribution in the world. There are many reasons for this, including susceptibility to disease of various blood groups, population drifts, inter-marriage and others. However, the end result is that simplistically the Asian population has a different distribution of ABO groups from the Caucasian population. For example, blood group B is far more predominant in the East than in the West.

When you look at one of the other blood typing systems, the Rhesus grouping into Positive or Negative, even greater disparities become apparent. The Asian population has very little Rhesus Negative (0.3 percent), compared to the Caucasians (15 percent). For interest, 50 percent of Basques are Rhesus Negative, one of the highest in the world.

Recently there has been the discovery of another blood type called the Bombay group. This is a version of O +ve, that was not compatible with the usual O +ve blood. First identified in Mumbai, from which the group derives its name, so far there have been just 179 such cases reported in India. However, even in India, there have been cases where doctors could not find a donor for transfusion of the Bombay group blood that would have been necessary. Even though it has first been identified in Mumbai, the city is now believed to have just 35-40 people with the group.

Consequently, you can see that when there is a need for blood for a number of injured Caucasians in an Asian country, the chances of there being sufficient blood stocks are virtually nil.

If you are a farang resident in Thailand, please have your blood grouped and if you are Rhesus Negative, go on a register at the local Red Cross, or even the nearest large hospital, so that you can be called upon in emergencies. The Central Blood Register can be contacted at 02 259 7305.

Currently, post disaster (or ‘between disasters’) there is no desperate shortage, but since blood does not keep ‘forever’ there will be times in the future when we will need Rhesus Negative blood, so don’t spill it in the streets, spill it at the Red Cross!


HEADLINES [click on headline to view story]

Your intelligence is in your jeans? (Sorry, in your genes)

How to get the best value from your doctor’s appointment

Biting on a bullet!

Blood group differences – Thai and Farang
 

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