Instagram

For those who follow me, either on Facebook or Twitter, will know I tend to post my photos through Instagram. For those who don't know, Instagram is mobile app which post pictures so that everybody can search for. I like Instagram more than Twitter in sharing photos, since you can write more than 140 characters - something I find a bit annoying on Twitter. Facebook is fine for sharing photo with friends but if you want a much wider audience, than Instagram is a much better forum.

Like most users, I tend to use Instagram to post photos of holidays and culinary creations. However most of my photos are to promote the dogs I walk at Hong Kong Dog Rescue.

Even though I wax lyrical about Instagram, there are some features and habits which I find annoying:

To the makers of Instagram:
1. Please allow users to post photos from devices other than smartphones/tablets, i.e. computers. Most people will take photos with their digital cameras, because they are superior in quality. It is difficult if these people have to download the photo from the camera to the computer and then transfer the photo from the computer to our mobile device in order to share the picture on Instagram.

Sharing our photos from the computer means we can write much lengthier description of our photos. I don't want to be spending ages writing a description with my mobile device when I can type much faster on a keyboard. Like most users, I had to save a file in my smartphone of all the hashtags I have to use when posting a photo of the Hong Kong Dog Rescue dogs. It would much more faster and convenient if I could do this from my laptop.

2. Please do more to weed out spammers & fake followers. There seems to be millions out there who use Instagram to annoy people. I don't want you to just do the occasional cull. It should be 24/7/365 vigilance. This leads me on to my next group of people

To the spammers, fake follower accounts and "businesses" on Instagram
1. Stop liking my photos, tagging me in your photos or commenting on my photos.

If there are businesses who are just posting photos to advertise their goods, that is fine by me. I follow a lot of dog accounts who buy stuff from companies such as Barkbox. I don't mind users advertising their products (as long as it is not too explicit), just don't shove it in my face.

99% of people of Instagram users just want to see photos, not buy stuff of Instagram. For those spammers who are only liking my photos, tagging me in their photos or commenting on my photos just to peak my interest so that I go to their Instagram account - I will block you and report you. If you like my photo in the personal sense rather than in the business sense, set up a personal account on Instagram rather than using your business account.

For those accounts advertising fake followers - stop it! I'm not here to rack up followers, I just want to share my photos. That is what hashtags are for. I had to cut down the number of hashtags I use for my photos since I notice some hashtags attract these spammers & fake follower accounts.

To the genuine users
1. Please write a description of your photo. I know a picture paints a thousand words but some context will be nice. And just putting emojis is not a description either. Also don't go too overboard on the hashtags. It's annoying that we have to use a lot of hashtags for just one topic. For "dogs" I can use the following hashtags: #dog #dogs #pet #pets #animal #animals. If it is more specific, such as golden retrievers it would be even more: #goldenretriever #goldentretrievers #retriever #retrievers #dog #dogs #pet #pets #animals #animals #golden #furry etc.

2. I would like it if the comments were much more specific. Just saying "nice", "amazing photo" and "that's sweet" just means you are not paying attention to the photo or even the description. I remember one of the photos posted by another Hong Kong Dog Rescue volunteer of one of the dogs with some injuries. One comment by another user just said "Nice!". Obviously that user was either somebody who didn't really look at the photo, read the description or was another of those business accounts.

99% of users are mostly good. It's that 1% of shit which sours the whole crop.

Professional procrastination

One of the traits which has been going away from me has been my motivation. For particular things -  especially regarding my family medicine higher training - they have been put off so many times. Even this blog entry has been put off for several weeks, maybe even months. It has come to the stage that my psychiatrist had to add bupropion (Wellbutrin), an anti-depressant usually used to help people quit smoking, to improve my motivation. Although this has helped a little, there is still stuff left to do.

So why am I so unmotivated to do anything about my family medicine higher training? Probably it is the lack of drive which is a factor. My family medicine higher training is not compulsory to be completed. I can still practise in Hong Kong without it. My level of pay won't be as much as doctors who have completed the family medicine higher training and passed the exit examination but the money is still nothing to scoff at. It is comfortable to live on, I have no debts and no-one that financially depends on me. My chances of promotion within the department will be zero without the resident specialist title but I'm not worried about that - I would hate the added responsibility and doing stuff such as seeing patients in specialist clinics and attending meetings.

Even getting up in the morning, knowing I have to go to work and see patients, requires serious willpower and motivation. There are many times I lie in bed thinking if I can pull a sickie today and then I realise the reason I have gone part time is so I don't want to do this.

To be honest I fulfilled most of adult ambitions in becoming a doctor. When I was a teenager, I was naive to think I could fulfil most of my goals: 16 A*'s at GCSEs, 6 A's at A Levels, get into the University of Cambridge to study medicine, get married at 25 years old, have children by 28 years old and win the Nobel Prize for Medicine and Physiology by 40 years old. During my depression years, when I was deferring studying and repeating years, all I wanted to do is graduate and become any doctor. Now that I've achieved that, what is left to do in terms of big goals? I don't expect even to have sex, let alone hook up, get married or have kids.

There are other goals which I want to do, which strangely I am more motivated to prepare for: take a 3 month European trip, get a Diploma in Tropical Medicine and Hygiene so I can volunteer for Medicins San Frontieres and, finally, do the research so I can emigrate to Australia or go back to UK. But even then the motivation is not immediate.

For my family medicine higher training, I have still got to record my consultation videos. This is the part I am most dreading, since it requires me to converse in Cantonese at length, something I'm not comfortable doing. I have to enter 600+ patients' data for my clinical audit and I've only done 100+ patients. I have still got to prepare for my practice management assessment, which I haven't even started. This requires me having to fix any problems with my clinic settings, such as making sure the cardiopulmonary resuscitation drills and fire drills paperwork is in order, which it isn't and I have been sitting on this for the past year. The lack of drive goes in hand with the lack of consequences - there is no punishment if I don't fulfil my higher training.

I think it is an effort related matter regarding my motivation. There are some things I don't want to do. Going out to gatherings on Meetup such as "British Born Chinese and Friends" and "Social Scrabble Club" requires me to hop on to public transport for one hour or more, which I find hard to do. Yet going to volunteer for Hong Kong Dog Rescue is something I do regularly, probably because it is only a 15 minute drive from home and I can park for free.

Probably I should give in and say, "Look, I don't envisage me staying in Hong Kong in the near future. Completing my higher training and taking the exit examination, which I will probably fail, will be pointless."

At a crossroad

Back in February, I was in a poor state psychologically. My depression was still in remission but I kept on having acute episodes of depression. I would feel low for a few days and then, in the morning, I would wake up and was depressed plus anxious about the day ahead and challenges that it would present. I would become more depressed plus anxious, having my arms ache, my chest tighten, having difficulty breathing and feeling that my heart was racing. That situation came to the point I was taking sick leave one day every month. I didn't want this to continue, as it was unfair for the colleagues who had to deputise in my absence  the community in general since they paid my wages.

Something had to change - I discussed my problem with my family and then my boss about what I was going through and brainstormed some options. I decided to go part-time, which I only started recently. With the time off, I hope to sort out the rest of my higher training in family medicine and decide what my options are regarding my future.

The main reason why I have gone part-time is that I don't like my job as a family medicine doctor in the Hospital Authority's general out patient clinic. There are a lot of problems, from patients, other doctors, the health care system and society itself. I will elaborate about these issues at a later date, most likely when I leave Hong Kong since I will be burning a lot of bridges when I do that.

That's another problem I have as well - I don't like living in  Hong Kong. Or rather I feel I don't fit in here. Whether it is still the language problem (I'm not very fluent in Cantonese) or the cultural integration is still being resisted by me, I still spend a lot of time at home and not want to go out. Appearance wise, I'm Chinese but culturally, I attach myself to Britain - I enjoy British cuisine (stop sniggering, there is actually good parts about it), I follow mainly British sports and I watch mainly British TV shows.

I have gotten a lot of grief and ridicule when I describe myself as English or a "banana" (yellow on the outside, pertaining to my Asian looks, while being White on the inside, as I think like a Westerner). Mainly this comes from my parents, who often say "Why do you want to be British? They hate Chinese people and they don't want you as a citizen!" and some of my colleagues, who find it funny I like things like British food and the way of life, such as shops not being open on a Sunday - a totally foreign concept to them.

So with this time off, I'm hoping to finish up my family medicine higher training, although I may not need it. If I was going to stay in Hong Kong, it would be probably best to complete the training and take the Exit examination but it is not absolutely necessary. It just means I get paid less than the people who have passed the exam and I'm already well paid in this job already - why do you think I have the luxury of going part time?

I'm trying to find out if I can go back to UK or head off to Australia to practise medicine. I know I can go to Australia, since I'm already a Fellow of the Royal Australian College of General Practitioners, which means it would be relatively easy to work there. For UK, I might need to take a language proficiency examination and a medical knowledge examination but I don't think that is too much of a hassle. My only worry is that I need to pass my Exit examination here in Hong Kong in order to be able to practise in the UK. If that is the case, I'll just head to Australia instead.

Another option is doing my dream job and heading off to volunteer for Medecins San Frontieres for a while. I know that entails needing a Diploma in Tropical Medicine - again, another excuse to get out of Hong Kong.

I know I'm not going to make a lot of people happy about my decision and remarks - parents, friends, colleagues - but this is my life, my opinion and if they do like me, they respect the choices I have made in my life.

"You're not a specialist..."

I'm going to say something that I feel should be said:

"Family medicine doctors and general practitioners don't get that much respect, especially in Hong Kong."

So where do I start? Let's begin with my own family. My father has non-alcoholic steatohepatitis or in laymen terms fatty liver. He needs to cut down his fat intake (he already has hypercholesterolaemia or high cholesterol for those who don't know) and also his carbohydrates. He's doing this part adequately through his food intake but he's still drinking alcohol. He drinks about one bottle of beer or one glass of wine per day - not enough to be an alcoholic but he should try to reduce his consumption. I keep telling him that but he keeps saying, "there is no carbohydrate in alcohol" (which there is) or "the alcohol doesn't contribute to my fatty liver" (which it does).

My dad is not the only member of my family who doesn't listen to my medical opinion. My aunt had some blood tests done about two years ago and the results showed she had a blood sugar. I told her to get more blood tests done to see if she actually had diabetes mellitus and whether or not she needed to start medication. She "claimed" she went to see a doctor (not immediately as I suggested) and "claimed" she was told she just needed to control her diet. So what has she got know? Diabetes mellitus, and she is now on medication. 

It doesn't stop there with my aunt. My grandmother was admitted to hospital with confusion a while back and was diagnosed to have neurosyphilis. She had her treatment and when the internal medicine doctor thought she was stable and there was nothing else to do, the doctor discharged her back to her family medicine doctor in the general out-patient clinic to continue her follow up. She said, "why do I have to get sent back to my family doctor? He can't take care of me." When I heard that, it took me all of my willpower not to shout at her for disrespecting my fellow doctors.

I think my grandmother's attitude sums up the view of family doctors in Hong Kong. We are not considered to be specialists, despite that we have our own society which regulates our professional training and examinations. Every time I say I'm a doctor, the first question I'm asked is, "which hospital are you working at?" When I say I'm not working in a hospital but a general out patient clinic, the next question is, "When you have finished working in the clinic, what are you going to specialise in?" It doesn't help that the medical body in Hong Kong doesn't regulate the professional training of doctors that stringently. Once you have finished your internship in Hong Kong, you are allowed to set up your own clinic and do whatever you want, without any prior or current training. At least in the UK and Australia the system is more regulated. So general practitioners (that is what people in Hong Kong call doctors who practise family medicine in private) can prescribe and investigate whatever they want, in contraindication to their medical education, practice guidelines or current medical evidence - as long as the patient is willing to pay for these measures. This situation leads to over-prescription of drugs, unnecessary investigations, patient confusion and doctor shopping.

Patients just consider family doctors as dispensers of drugs. Frequently in my consultations, I'm asked for medication for cold symptoms, eyedrops, antacids and pain killers. They expect me to prescribe them these drugs without any questions. When I do ask them questions about serious symptoms that I have to exclude, some of the patients look at me with the expression "Of course I don't have those symptoms, are you stupid?"

They also consider family doctors as stepping stones to see specialists. I'm often asked, "Can you write me a referral letter to a specialist?" This question just displays the view that family medicine doctors are not able or competent enough to handle your medical complaint. I wish there was a secret code we can use when write a referral letter to specialists to say, "All they want is a opinion from a 'specialist'. Just give them the furthest date you can for their initial appointment." 

I had two patients like this the other day (which is why I'm having a mini-relapse of my depression and calling sick off work). Firstly there was a young nurse (A NURSE) who asked to be referred to a dermatologist (skin doctor) for her eczema on her first consultation with me. She previously had seen another general out patient clinic doctor and was referred to a specialist before, and hadn't receive much treatment. I wrote a "routine" referral to the dermatologist saying she wanted to "be referred to a specialist" - my way of saying to give her low priority. Another patient had presented with De Quervain's tenosynovitis (basically wrist pain) and tennis elbow. She only consulted us once before a few months back and wanted a referral to a specialist. When I asked why she wanted a referral, she just said, "I wanted a specialist's opinion", meaning my opinion was worth JACK SHIT. Then I asked how she expected the specialist to help her, she said "I don't know, he/she is the specialist, I'm asking for his/her opinion, again implying "You can't help me, you're are JACK SHIT." In the end she genuinely said with a hint of contempt, "If you don't want to write me a referral letter, that's fine."

It doesn't help that the Hospital Authority doesn't give us the resources to help our patients. The department has a doctor over from the UK working for one year here and she said our resources are limited - a very narrow spectrum of drugs we can prescribe, we can't order more advanced imaging such as ultrasound, CTs or MRIs and that the waiting time to see a specialist was far too long.

It doesn't help that there is a disdain from specialists about regarding our referrals. They consider are referral letters as having too little or too much information. When the Hospital Authority standardised the referral letter templates for common complaints, the specialists said they don't like the template. I wish I didn't need to write referral letters. I'm only referring if something is needed to be done - to prescribe a medication we don't have in the general out-patient clinic, to investigate a condition with investigations we don't have or to perform a surgery that we cannot do (not that we can do any surgeries at all - not even a basic incision and drainage, another thing I don't like about the rules and regulations governing general out patient clinics). If I write, "Patient asks for a referral to a specialist", that is my code in saying to give this the lowest priority you can.

There are some specialist who think we are not competent in handling cases. One patient was discharged from a specialist clinic to a general out patient clinic for a lung condition. After a few years of being very stable, the family medicine doctor tried to reduce the dosage of the medication as the patient was already taking a lot of medication. Coincidentally the patient had an exacerbation of the lung problem and was admitted to hospital. There was a letter from the specialist clinic saying, "Don't try to adjust the medication. If there is a problem, refer the patient back to us." The lung problem is pretty common and most cases can be handled in the general out patient clinics. The patient was only referred to the specialist as we had exhausted all our drug options and the patient needed a more specialised drug. Basically the specialist was implying we were incompetent and our only job is to prescribe the drugs.

So family medicine doctors don't get any respect from the population, the patients, the Hospital Authority, specialists and even their own family. Are you surprised that I want to leave to somewhere that has a bit more respect from my specialty (Yes, it is a specialty) such as the UK or Australia. I might even Médecins Sans Frontières - at least the target group appreciates doctors more.

Arsenal's summer 2015 - who we need to get, keep and get rid off

It's the end of the season in regards of football. Players are all going off on their summer holidays, fans have to console themselves with other sports such as cricket and tennis while clubs are trying to plan for next season by sacking managers and deciding which players to keep.

I know Arsene Wenger or Ivan Gazidis won't be reading this but if they are, this is what you need to do this summer.

Goalkeepers
Wojciech Szczęsny - keep
David Ospina - keep
Damián Martínez - keep

I like Szczęsny - he grew up at Arsenal and is great in the behind-the-scenes videos on the club website. However he is far from being a world class goalie at the current time. He is still prone to the lapse of judgement which was why Wenger dropped for Ospina in the second half of the season. Yet the Pole has great potential and loves the club. However the club still needs a world class keeper to challenge for the title next season.

The availability of keepers will depend on other clubs. Will Chelsea sell Cech to a title rival? If De Gea goes from Manchester United to Real Madrid, will Casillas be sitting on the bench? Will Pepe Reina continue sitting on the bench at Bayern Munich? If we do get another keeper, we will be able to keep all of them happy?

Right back
Mathieu Debuchy - keep
Hector Bellerin - keep
Carl Jenkinson - sell

Like Szczęsny, Jenkinson is a player I like. He's young, full of potential, vocal and an Arsenal fan. However he has been squeezed out by Debuchy and the form of Bellerin. If we knew how good Bellerin was, Arsenal didn't need to buy Debuchy last summer. Now it seems Jenkinson will be moving on.

Centre back
Per Mertesacker - keep
Laurent Koscielny - keep
Gabriel - keep
Calum Chambers - keep
Isaac Hayden - send out on loan

One of the few areas where there was stability and a lack of injuries. Arsenal may need another back-up centre-back if they push on four fronts.

Left back
Kieran Gibbs - keep
Nacho Monreal - keep

I was surprised on the form of Monreal, that he was so good in replacing Gibbs. It is fortunate that Arsenal are blessed with two quality players in this position.

Central midfield
Mikel Arteta - keep (barely)Jack Wilshere - keep
Aaron Ramsey - keep
Mathieu Flamini - allowed to leave
Abou Diaby - allowed to leave
Francis Coquelin - keep

Require a defensive midfielder

I was surprised Arteta were given a contract to continue his career at the Emirates Stadium. He has hardly featured in the past year but that has been mainly due to injury. I am wondering if he can contribute anything next season. Wilshere has to stay fit and improve, otherwise his place in the team is also under threat. Even with the find of Coquelin as a defensive midfielder, the Gunners need another option. Options include Sami Khedira of Real Madrid, as he will be available on a free transfer, and Bastian Schweinsteiger of Bayern Munich, who has been told he can leave the German giants.

Attacking midfielders
Tomáš Rosický - keep (barely)
Mesut Ozil - keep
Alex Oxlade-Chamberlain - keep
Santi Cazorla - keep
Serge Gnabry - keep / send out on loan

Require a winger

Like Arteta, I was surprised Rosicky was allowed to stay on. He's a great servant for the club but his appearances will be rare next season. What Arsenal do lack is width, with Oxlade-Chamberlain, Walcott and Sanchez being the only true wingers in the team. Will Wenger try for Raheem Sterling (please don't).

Forwards
Lukas Podolski - sell
Olivier Giroud - keep
Theo Walcott - keep
Alexis Sanchez - keep
Yaya Sanogo - sell
Danny Welbeck - keep
Joel Campbell - sell
Ryo Miyaichi - sell
Chuba Akpom - send out on loan

Require a world class striker

It seems Podolski's career is over at Arsenal, which is a pity since he is very likeable, but there will be many suitors for him. Sanogo, Campbell and Miyaichi are all 22 years old and should be playing regular football but I don't see that the Emirates Stadium. Wenger highly rates Akpom but he needs a run of games and it will be probably at a Championship side. Hopefully Walcott and Welbeck will be injury free to contribute more goals. Giroud is a good striker and will contribute 20 goals per season but Arsenal need more. Wenger might play Sanchez in the middle next season but the better option is to find a world class striker to play up front. Klass-Jan Huntelaar is available on a free transfer, Edinson Cavani doesn't seem to be wanted by Paris Saint-Germain and there's the possibility of Jackson Martinez from Porto but they are older than the targets Wenger usually aim for. More realistically Arsenal should aim to get Karim Benzema, since he is being progressively pushed out by the likes of Ronaldo and Rodriguez at Real Madrid.

Human stupidity, or is it ignorance? The vaccination question

Let's face the fact - the normal human being is stupid. Society doesn't apply nature's law of "survival of the fittest". Human nature is not natural - we allow the most stupid people to survive long enough for them to procreate, passing on their genes. Granted, the offspring may not be as stupid as their parents but that is in the minority.

Even stupidity can manifest itself in the "well educated". Take, for example, my father. He's a professor in chemistry and is a great cook. Yet he has difficulty taking public transport and has times called my mother or I about which bus to take to a certain destination. He also has difficulty in following basic instructions when doing household chores. I have doctor colleagues who I can't believe can survive this long without knowing how to perform household chores such as cooking or using the washing machine. This maybe more ignorance, believing they have somebody else to do these menial tasks, rather than being dumb.

I encounter stupidity/ignorance everyday in my job as a general practitioner. Whether it is not taking medication due to some idiotic reason, believing a remedy recommended by a friend will cure his or her ills or thinking their symptom is due to some weird disease, it is a constant task of me not trying to bang my head on the table, rolling my eyes up in search for the god who created these people or doing a facepalm.

The recent measles outbreak from Disneyland probably shows most people are incapable of making medical decisions. The vast majority of children infected with measles from this outbreak were unvaccinated. In the USA, parents have the option to opt out of vaccination for personal or religious reasons. Some parents believe (I was going to put 'think' but that would be stretching the definition of think too far) will hinder the child's development.

The link between the measles vaccine and autism was debunked long ago. The one study this link was based on has been proven to be wrong and, even worse, was made up by the doctor, who has been struck off the registry and can no longer work as a doctor in the UK. There has been no concrete evidence to show any vaccine has any effect on your child's development. Let's put the fact in another way - if doctors or the health service believe that vaccination had any long term significant side effects, in that the risk would outweigh benefits, would us doctors still offer the vaccine?

Remarkably the majority of the parents who make the decision to not vaccinate their kids are the middle class and are reasonably educated. They are arrogant enough to think, with their college degree, reasonable income and searching the internet for 10 minutes, that they are smarter than the doctor who spent the whole of his or her adult life dedicated to medicine plus the weight of 150 years of modern medicine and scientific research. Please, give me strength!

Parents of the unvaccinated children have been saying, "This is my child. I should have the personal choice of what to put into my child." True, the parent have that choice. However a personal choice should also only have personal consequences. Unfortunately this personal choice has public health consequences. There are people who cannot be vaccinated for a variety of medical reasons - they are allergic to components of the vaccine or to the vaccine itself, they are suffering from a medical condition where their immune system is compromised or taking medication to suppress their immune system due to another medical condition. These people rely on "herd immunity", where the other people in society are immunised so that the micro-organism is wiped out and cannot infect unvaccinated people, for protection. Measles is not a trivial disease where it is just a rash - it can cause encephalitis, pneumonia and even death.

I read one comment on Buzzfeed: It's also incredibly indulgent and oh so very first world to deny your kid vaccinations for whatever perceived reason, while third world people would literally give anything to have their kids have these vaccinations.

There are some people who are revolting against these decisions. Certain paediatric practices in US are explicitly not accepting patients who are not vaccinated. They can, quite rightly, justify this as they have to protect other patients as well. Personally I don't think this decision goes far enough. If you choose not to vaccinate your child, you should not be allowed to go to areas where children congregate. The Disneyland outbreak shows this rule should be put in place. Your child should be home-schooled, so that they don't pass on the virus to other children at school. They should play at home and not with other children at nurseries or play groups. If a child was sick with an infection, would you want that child repeatedly turning up at your school? Exactly.

In short - get your children vaccinated. If you don't and your child becomes ill, don't come to me for sympathy.

Breaking down physiologically

I mentioned before I don't make New Year's resolutions. It is no point make promises you can't keep or can't even remember within one month, let alone by the end of the year. Yet I had tried to promise myself I wouldn't take so much sick leave as I did in 2014, when I think I took seven days off. That figure was not good considering my average for the previous four years was two to three days of sick leave per year (I'm excluding my period when I broke my finger for obvious reasons).

Unfortunately I didn't last very long, taking a sick day for my depression on Monday. It is not a good start to the year and I don't think the situation will get better. I've tried to analyse what is wrong with my life, through a doctor's perspective - physiologically, socially, psychologically.

Physiologically

I know I'm growing old and my body is deteriorating. I know my exercise tolerance is decreasing. I try to maintain my stamina by volunteering to walk rescue dogs every week for around three to four hours. At least this maintains my fitness at the current level.

Despite this, I get tired very easily. I take weekend afternoon naps on a regular basis and for too long. I don't mean twenty to thirty minutes naps - it is more like three to four hour naps, on both Saturday and Sunday. I don't know if it is due to tiredness, boredom or not wanting to face the problems, that I nap so long and so frequently. I know I'm fat and snore, so that may contribute to the problem. Yet I've been a person who can go to sleep very easily and I've been snoring for a long time, even before I gained weight.

Talking about weight, I know I'm obese by Asian standards. I'm currently at 73 kg and my ideal body weight should be 65 kg. In the past I have been 75 kg but I know I can get down to 68 kg. I really need to take up more exercise, to help reduce my weight and decrease my crankiness. At this moment, I will be happy just to maintain my weight at the current 73 kg. 

Food wise, I've been trying to cut down on my carbohydrates to prevent me from getting fat. Most of the carbohydrate cutdown is at dinner times, when I don't eat rice if it is a Chinese dinner. Yet it doesn't help I have a typically Chinese mother, who worries I don't eat enough and tries to stuff me full of food. It is not uncommon for our fridge to be filled with leftovers. Our household usually does overcook lots of stuff. Other ways I have been trying to cut down carbohydrates is by not eating too much dessert. However this has the undesirable effect of make my depression worse and making me cranky all the time. Lunch is difficulty to manage, since I'm out with my colleagues. If my colleagues and I are sharing food, it is usually up to me to eat the leftovers and get fat. In the morning, I've stopped stuffing myself with McDonald's breakfasts and just having my usual grande chai tea latte, skimmed milk, from Starbucks. I get this drink so often at the Sai Kung Starbucks' that a) I have a Starbucks Gold Membership and b) the baristas know what I want and usually don't have to ask me.

I use to order coffee but nowadays my bowels are not what they use to be. I've been suffering from irritable bowel syndrome for a long time. Yet recently it has crossed from being psychological to being more physiological. I have taken too much sick leave last year for abdominal pain and diarrhoea after eating very trivial food. I'm at the stage I have to keep medication in my office just in case something happens. I have to take an Imodium pill before eating any food which can irritate my bowels. I've tried to cut down any irritating food, such as milk and cold drinks. I haven't dared eat any sushi and sashimi, my favourite food, since my clinic's annual Christmas dinner - when I got ill and had to take a day off the next day.

Other parts of my body are starting to get on. My right shoulder has been killing me for the past year. Most of the pain is due to overuse - I'm constantly using my right arm for operating the computer mouse, typing on the keyboard and operating my iPhone plus iPad Air. A massage relieved it in September but it just recurs. What I need to do is rest the arm or try to use my left arm more, which is difficult.

Unlike my patients, I know and willing to accept my body is growing old and decrepit. It's just a matter of managing my physical breakdown without it affecting my life and especially my work.