Revised suggestions for BBC Sports Personality of the Year

As an obsessive compulsive person, I like making lists. Especially regarding BBC Sports Personality of the Year. Yes, I know it is not the highlight of a sportsperson's career but it does add some recognition.

The last time I did the list, it was midway through the Olympic Games. Now that the Olympics is over, that list can be revised. It is difficult to select ten nominations. The last time there was an Olympics during Sports Personality of the Year, the nomination list was extended to twelve, which included the Paralympians. Even with just the Olympians, picking fifteen would be difficult.

So with that in mind, I had to cull a few from my previous list. Out go Bradley Wiggins (his Olympic gold came in a team effort, plus he's already won before), Katherine Grainger (despite winning medals in five successive Olympics, this time was only a silver)

So in no particular order, here we go.

1. Adam Peaty
- Olympic champion in the men's 100 m breaststroke, becoming Britain's first Olympic swimming male champion since 1988 (Adrian Moorhouse, 100 m breaststroke).
- European champion in 50 m and 100 m breaststroke.
- Broke his own 100 m breaststroke world record twice during the Olympic Games.

2. Jason Kenny
- Olympic champion in the men's sprint, keirin and team sprint.
- Kenny has tied with Chris Hoy as the British Olympian with the most gold medals (six).
- World champion in the men's sprint.

3. Laura Trott
- Olympic champion in the women's ominium and team pursuit.
- Became the British female Olympian with the most gold medals (four).

4. Mo Farah
- Defended his Olympic 5000 m and 10000 m titles (only the second athlete to do so).
- Became Britain's most successful athlete in track and field.

5. Max Whitlock
- Olympic champion in men's floor exercise and pommel horse. Also won bronze in the men's all round.
- Became Britain's first Olympic gymnast to win a gold medal.

6. Andy Murray
- Became Wimbledon champion for the second time.
- Became the first British male to win multiple Wimbledon singles titles since Fred Perry in 1935.
- Olympic champion in men's singles tennis.
- The only player to win two singles gold medals and to defend a singles title.

7. Nicola Adams
- Olympic champion in women's flyweight boxing.
- First woman to defend Olympic boxing title.
- World champion in women's flyweight boxing.

Here on after, the rest are maybes.

8. Justin Rose
- Olympic champion in men's golf.
- Could also help Europe win the Ryder Cup.

9. Charlotte Dujardin
- Olympic champion in individual dressage. Olympic silver medallist in team dressage.
- Successfully defended her Olympic individual dressage title.

10. Nick Skelton
- Olympic champion in individual jumping.
- Great Britain's oldest Olympic champion since 1908.

11. Liam Health
- Olympic champion in men's K1 200 m canoe sprint. Olympic silver medallist in men's K2 200 m canoe sprint.
- Became Great Britain's most successful canoeist at the Olympics (one gold, one silver, one bronze)
- European champion in men's K1 200 m canoe sprint.

12. Alistair Brownlee
- Olympic champion in men's triathlon.
- First triathlete to win two Olympic titles and defend the Olympic title.

13. Jade Jones
- Olympic champion in women's 57 kg taekwando, defending her title.
- European champion in women's 57 kg taekwando.

Post Olympic thoughts

Since Rio 2016 finished a few weeks ago, two issues have been occupying my mind:

1. The (questionable) success of Team GB
Team GB enjoyed it's most successful overseas Olympics, winning 67 medals. Yet there were many countries questioning their success. Sportspeople from France and Australia wondered how the British cyclists performed averagely in the World Championships earlier this year but roared to success in Rio. Even I was wondering how on Earth did Team GB become so good and hoped there wasn't anything else other than hard work, discipline and the will to win - such as hidden motors or doping.

There have been articles on why Team GB has been more successful than in the last Olympics. Most of the success has down to lottery funding. The poor performance at the Atlanta Olympics in 1996, with just one gold medal won, changed the way British sports was administered. UK Sport was established in order to manage the proceeds from the newly established National Lottery. It used the money to target which sports were the most successful and would benefit from funding. The funds went to sportspeople so they could dedicate themselves full time and provide the infrastructure (such as training centres, supporting staff, etc.) to help the sports people be in peak condition. UK Sport is ruthless in the funding - if you don't obtain your target, your funding will decrease. The only targets were Olympic medals, so World Championship medals wouldn't have benefited British Cycling in terms of funding.

The medal target incentive seems harsh but the evidence suggests this plan has worked. Team GB have increased on the medal count at the Olympics ever since Atlanta - a total of five Olympiads. Compare this to the French Olympic team, which has roughly the same amount of funding but even distributes the wealth amongst all sports federations. That system is fairer but not necessarily more successful.

2. Why aren't Olympics sports not covered or celebrated more?
I have been quite tired of football recently. I have been following football less as I grow older. I still follow my team, Arsenal, with their results and highlights but with less enthusiasm. A number of things have disenfranchised me from the sport.

a) The overexposure of football
Football seems to be the top story in most sports media outlets throughout the year. Most of the stories are inconsequential. They include transfer speculation, injury news, reports on the manager's job safety and so on. I reckon most of the stories are made up or at least have bent the truth.

It doesn't help that the football seems to be always on. Out of 380 games during the English Premier League 2016-17 season, 168 games (44%) will be broadcast live. How can you have an uniqueness for a match when one out of two games are shown on TV?

To ensure there is maximum coverage of all matches, fixtures are regularly moved or played at times which are ideal for TV audiences. This has alienated fans who travel to games. These fans have to re-arrange their schedule and rebook travel tickets, which can be more expensive the later the match is re-arranged. Sometimes you can't arrange travel for some matches, such as Friday night, Saturday evening and Sunday. With all this money from TV broadcasting rights, have the paying fans benefited? No, which leads me to another point...

b) The amount of money being thrown around
The TV broadcast deal, for domestic and international rights, will earn the Premier League £10.4 billion over three years. The Premier League and its clubs will also earn lots more in sponsorship. Yet this hasn't trickled down to the paying punter. Single game tickets range from about £22 to £52 for the cheapest seats. If you want luxury, that will cost you £32-97. Unfortunately, with the popularity of the English Premier League, there are people willing to spend that money and these aren't always "true" football fans, rather people who view the game as a day out or an experience, rather than the drama, theatre and emotions true football fans view the game.

In order to stay in the Premier League, or become successful in it, clubs have thrown ludicrous amounts of money into players. The latest transfer window has seen the English Premier League spend more than £1.7 billion on players. Eight figure sums have been exchange for relatively unknown and seemingly average footballers. The average Premier League footballer will earn around £32000 per week or £1.7 million per year. This is just the basic salary and doesn't include their bonuses.

The amount of hype and money thrown around has disenfranchised me from the sport. So where else can I turn to? With the new found success of Team GB, why aren't these sportspeople more revered or paid better? The media should focus on sports which actually create success. Yet they seem to put the spotlight on the England national football team, which seems to limp to the second round of every major tournament before being knocked out by lesser teams.

If the sporting federations of Olympic sports want to capitalise , there's no better time by riding the wave of success. Encourage youngsters into taking up the sports by offering free introductory lessons, offer cheap tickets to sports events and get the Olympians to turn up to promotion events. Because I rather see a medal winning Olympian rather than an average Premier League footballer.

Early suggestions for BBC Sports Personality of the Year

I know many disregard BBC Sports Personality of the Year. Since the BBC lost the coverage of significant sporting events, their end of year of review hasn't been as good as it use to be. A lot of people tend to focus on the word "personality" and seem to exclude who don't think are exciting enough to be a "personality". Remember the term "personality" has many different meanings (I remember the podcast "No Such Thing As A Fish" defined personality as a special person and used the term "TV personality" as a comparison).

However SPOTY (the acronym for Sports Personality of the Year) gives rise to the intrigue of trying to compare different sporting achievements. With Rio 2016 halfway through, most of the focus will be on athletes who have excelled at the Olympic Games. Here are just a few suggestions for names that will be in the hat in December:

1. Adam Peaty
There was a lot of pressure for Peaty coming into these Games. He was the world record holder and world champion for his marquee event - the 100 m breaststroke. He showed he can handle the pressure by breaking his world record in becoming Olympic champion and giving Team GB their first gold medal of Rio 2016. He is also contributed in the 4 x 100 medley relay, helping the British team gaining silver.

2. Jason Kenny
Kenny moved into a tie with Wiggins and Redgrave as male Olympians with five gold medals, after winning in the individual and team sprints. He was already world champion, having won the individual sprint earlier in the year in London. If Redgrave and Wiggins can get knighthoods for wining five gold medals, surely there will be a Sir Jason Kenny coming soon?

3. Bradley Wiggins
Wiggins returned to track cycling after finding success on the road in the Tour de France and the Olympics. He won the madison with Mark Cavendish in this year's world championship and he gained his fifth Olympic gold with the win in the team pursuit. With that medal he becomes the most decorated sportsperson in British Olympic history. And for the people who are fickle that the winner of SPOTY has to have personality, Wiggo has plenty in abundance.

4. Laura Trott
The other half of British cycling's celebrity couple, she is no slouch herself. Going into Rio, she had already world champion at the scratch and omnium. Trott added the team pursuit to those accolades and became the only British female Olympian with three gold medals.

5. Mo Farah
I have no idea why Farah has not won a Sports Personality of the Year award. In the non-Olympic years of 2011 and 2013, he won both the 5000 m and 10000 m world championship. He already has won the 10000 m in Rio, despite falling down and he could retain the 5000 m later in the week. Surely his time is due.

6. Max Whitlock
If Louis Smith had been Team GB's gymnastic star in 2012, Max Whitlock has been the sensation in 2016. He helped Team GB win the team bronze and then going on to win two individual gold medals (Britain's first in gymnastics) in the floor and pommel horse.

7. Katherine Grainger
By winning a medal (silver) in the double sculls, Grainger became Britain's most decorated female Olympian with five medals (one gold, four silvers) and doing this at the age of 40 years.

8. Justin Rose
There were several golfers who shied away from the Olympics. Rose fully embraced being an Olympian. He attended the opening ceremony, despite it being six days before the start of the golf tournament. He carded the first hole-in-one on the first round and it got better from there. On a thrilling last day, he edged out Henrik Stenson to win the first Olympic golf gold in 112 years. He could further improve his odds of winning SPOTY by helping Team Europe retain the Ryder Cup in September. A honourable mention should include Danny Willett for winning the Masters in April.

9. Andy Murray
I have to declare my bias as I'm an Andy Murray fan. He won last year after helping Great Britain win the Davis Cup, where he really should have been someone else and the team win just Team of the Year. However it is difficulty to ignore his achievements this year. He has reached the finals of the Australian and French Open, becoming only the tenth player to reach all Grand Slam finals. He won WImbledon again in July and now he has become the first tennis to retain the single's title and win twice in the Olympic tennis tournament. He still has the US Open, the Davis Cup and the World No. 1 spot left in his calendar. Could this be the first time SPOTY has been won in successive years?

We still have half the Olympics plus the whole of the Paralympics to look forward to. Let's hope Great Britain's sporting achievements continue.

(N.B. Team of the Year should be Leicester City, defying the odds of 5000-1 to win the Premier League title.

Haters gonna hate Andy Murray

It has been announced the flag bearer for Team GB at the 2016 Rio Olympics will be Andy Murray. Naturally there are people who thinks he deserves the honour. Nonetheless there will be other people who think the responsibility should go to another sportsperson. Both sides have their arguments for and against, and all are valid. Yet somebody has to miss out. The most compelling argument is one I read from a reporter on Twitter. Of the 26 flag bearers for the British summer Olympic team, 23 have been white males. If you had argued on that fact, I wouldn't mind the flag bearer being Nicola Adams or Jessica Ennis-Hill.

However Andy Murray does deserve to bring in the Union Jack for Team GB. He has played at two Olympics, is current Olympic men singles champion and also won a silver medal in the mixed doubles. He competed in Beijing as well and stayed in the Olympic village there.

(However he did not stay in the village in London, as did most tennis players as the complex was very far from the tennis site of Wimbledon. Andy Murray won't be staying in the village for Rio, as he will be staying with the British tennis team in an apartment. I'm slightly disappointed with the decision but I've heard many well known athletes get hassled for autographs and photographs if they stay in the village.)

There has always been detractors regarding Andy Murray. It all started in 2006, when he joked he would "support whoever England were playing against" during the World Cup. Most people thought he was serious and took the comment the wrong way. I was on the opposite end of the spectrum. As a Scotsman, Andy Murray is allowed to make that joke. It has always been a joke every Scot has made about England's participation and Scotland's lack of participation at the World Cup finals. All Brits laugh at this joke, so why would we treat Andy Murray differently? A prime example of "being Scottish/British" joke is when Alex Ferguson was asked if he would take the England manager job. Ferguson replied he would make England worse if he did. Nobody was angry at Ferguson then (probably because they all fear him).

At least Andy Murray was trying to make a joke. Most sportspeople are a vacuum for humour. That is what you get if you dedicate your life to being the most successful sportsperson - your personality seems to go. Roger Federer has his admirers but I just find him bland, along with Rafael Nadal. At least Novak Djokovic is great at doing impressions of other tennis players. Those big three tennis players may have more Grand Slams, been men singles tennis No. 1 and have other accolades but I will admire Andy Murray more.

The only other controversy I can think Andy Murray has been in was his tweet regarding the Scottish independence referendum in 2014. He tweeted "Huge day for Scotland today! (The) No campaign negativity last few days totally swayed my view on it. Excited to see the outcome. Lets do this!" He got a lot of abuse online for that and I cannot see why. He's entitled to his opinion about any affair, whether it is informed or ill informed. As a Scotsman (although not living in Scotland), he has more of vested interest in that referendum than the rest of Great Britain. And anybody thinking he can summarise his own view of Scottish independence in 140 characters is in loony land themselves.

As you can see, I'm a great supporter of Andy Murray. He may have a monotonous voice when giving speeches or interviews but that is the way he is and he's not going to change that. He hasn't done any media training and I hope he stays that way. Nobody remarks how bland footballers sound when the give post match interviews.

People often confuse his dourness for a lack of humour. That is far from the truth. He poked fun at himself at the 2015 Sports Personality of the Year Award, when he said:

“I didn’t expect this. A friend actually sent me a message the other day with an article from a newspaper which said ‘Andy Murray is duller than a weekend in Worthing’, which I thought was a bit harsh... on Worthing.”

He shows that he doesn't mind being ridiculed. He has had to bear the annoyance of the kids from "Outnumbered" for Comic Relief. He was actually funny with Richard Ayoade for "Stand Up To Cancer". Yet the best example of his humour is his appearances on "Mock the Week". He has appeared in 2012, 2013 and last month. All come after recent successes at Wimbledon. He is brave enough to face seven comedians and let them have a dig at him. The point of ridicule must been on his second appearance, where one round of Scenes We'd Like to See was dedicated to him - Unlikely Things For Andy Murray To Think. Gosh that must be excruciating for him to watch but a delight for the rest of us.

As a supporter, I naturally follow him on social media. He posts on Twitter and Instagram semi-regularly but if you really want to see him more, you should follow his Facebook page. It's the usual you get from a sportsperson - mention of sponsors and charities, behind the scenes of his preparations. He does keep a lot of his personal life private and I don't mind that.

The snippets of his personal life I do know make me love him even more. He has two dogs Rusty and Maggie May. Rusty was named after Lleyton Hewitt, while Maggie May has her own book published and her own Twitter account. He has a great wife in Kim Sears. She is an artist but she stays silent about that and doesn't use her relationship with Andy Murray to promote her work. She is always by his side at matches (and at Mock the Week - surely she gets tired of that?) and you can occasionally hear her, like in the 2015 Australian Open (look it up).

Andy Murray may not be the best tennis player in the world, or the funniest or most exciting. But he is the sportsman I relate to. He know he's dour, he love his dogs and he like watching Mock the Week - sounds familiar to you.

On a last note, he geeks out about the BBC TV show "Sherlock". After winning this year's Wimbledon, he got a chance to talk to Benedict Cumberbatch. You can see he is a fanboy of Cumberbatch, and fist pumps when he hears that Series 4 of Sherlock is being filmed. Who doesn't love that?

Top Gear

The recent series of the revamped Top Gear has ended and with it the tenure of Chris Evans. It was inevitable the Radio 2 DJ would leave the show. Since the first episode, he has been described as the weakest link of the car programme.

The BBC didn't want this situation but it had no choice. When Jeremy Clarkson punched Oisin Tymon for not producing hot food after a day's shooting, the BBC were put in an unenviable position and had to fire him (technically his contract was not renewed but the outcome was the same). I know many Top Gear fans said the BBC would be losing out on a lot of money if they sacked Clarkson but what else were they going to do? If they didn't sack him, it basically means that Clarkson or any big star at the BBC could get away with murder. Let's put the situation in another way - if you punched a colleague, what would happen? Your employer would say goodbye to you and your wounded colleague would sue the arse out of you.

When Clarkson, Hammond and May left, the BBC had to pick up the pieces and see what they can salvage. They still had the name "Top Gear", which has worldwide brand recognition, and the Stig. All they needed were appropriate hosts. Unfortunately they got Chris Evans. Even though he's a good radio DJ and car enthusiast (especially regarding Ferraris), he has divided opinion and it showed in the news series. Most of the time, he is trying to drum up the audience too much and being way too shouty. He was known to be difficult to work with, represented by the lack of banter with his co-hosts.

All is not lost on Top Gear. Matt LeBlanc has done very well with presenting Top Gear and doesn't mind being picked on being American. The same goes for Sabine Schmidt - she doesn't mind being the butt of jokes and adds pedigree with being an actual racing driver. Eddie Jordan adds some lunacy to the picture but he wasn't on often enough and didn't present any of his own segments. The new guys had their good and bad points. You can see that Chris Harris is a petrolhead and he can present to camera well. He is also well opinionated, which adds to good conflict with his presenters. Rory Reid is well knowledged about cars but comes across as too nice.

At least the new producers tried to revamp certain segments. The "Star In A Reasonably Priced Car" needed a makeover and turning the lap into a rallycross segment was good. However pitting two celebrities against each other wasn't that great. Comparing the celebrities' cars wasn't that brilliant either. They really need to go back to the natural chat that Clarkson had with the guests.

They still maintained the standard with segments and challenges. All they need to build on is the on-screen banter. 'A' for effort, 'B-' for actual content.

Death is hardest to deal with when it hits close to your heart.

It seems death has been a predominant theme for 2016. I'll go into celebrity deaths and the rest in a later entry.

In the early hours of Sunday 24th April 2016, my friend Aaron died. His death affected me in more ways than one.

Aaron and I have never met face to face. We come to know each because we enjoy the same radio programme, "Fighting Talk" on BBC Radio 5 Live. We have been friends for about two years, finding out that we have much in common. We both reminisce about the 1980s, especially about TV shows. He was great to engage online, chatting on music and movies. He loved quizzes and he got me playing "QuizUp" on my smartphone. He had a similar sense of wicked humour to mine.

The similarities don't end there. We both suffer from depression. We both been through trying out different anti-depressants to see which would fit us the best. We both had our up and downs. We both expressed our depression to our online friends without being afraid of what people think, that we were not afraid to ask for help. We both conversed with each privately about our depression, supporting each other through the rough patches.

Ultimately it was his depression that killed him. Although the details have been sketchy, primarily because the news I have been hearing has been delivered by proxy. Aaron had been going through a bout of depression in March. I had noticed it and had been conversing with him during this period. There was some time he was not online, around three weeks. I didn't notice, maybe because I was dealing with my own troubles with depression and work, and had gone on holiday. Only in mid April did I hear the news from a common friend that Aaron had been admitted to ICU for alcoholic necrotising pancreatitis. Apparently he had tried to commit suicide by consuming a copious amount of alcohol. This didn't kill him but caused the pancreatitis I mentioned before plus multi-organ failure. Most of his online friends thought he was pulling through, being on the mend. In the end, it seemed the damage was too much.

This is the second friend who has died at a young age. My friend from secondary school, Theola, died of complications of IgA nephropathy (a kidney disease) in early December 2014. I had written an entry into blog at that time. For some reason, I didn't post it. Both died in their 30s - Theola at 32 years old, Aaron at 36 years old. Both had died from complications of their primary disease. Their deaths had come our of the blue. I was chatting to Theola on Facebook only two weeks prior to her death, planning to meet up and crash at her place. We were joking I had to share a bed with her two cats if I was going to stay overnight at her home. I'm going to miss conversations like those. With Aaron, he had already been ICU for a few weeks. He had been planned for surgery, with family and friends visiting him.

As a doctor, I always feel I could have done more. For Theola, she was diagnosed four months prior to her death. She traveled back to Hong Kong to see if an expert nephrologist could do anything to help her but to no avail. With Aaron, the guilt is more so. As a friend, I could always talk to him and give my support, even though I was thousands of kilometres away. As a fellow depressive patient, I know the struggles he was going through. As a doctor, the guilt is even worse. I should have noticed Aaron had disappeared off online. I should have recognised the signs, since he was putting up posts on his Facebook wall of being down in the dumps. Other friends have said we have done everything possible and he would still have killed himself. Apart from being attached to Aaron, 24 hours and 7 days a week, we couldn't have prevented this but the guilt is still there.

Don't get me wrong, it's a tragedy more for his family, his closer friends and everybody around him. For Theola's death, it was horrific for her parents, her younger brother (who was going to be married a month after her death) and her husband (they had been married for less than two years).

With Aaron, there is always something I identify in his situation and always thinking, "that could be me". In the past, it would have been - I've lost the number of times I have tried to commit suicide or the number of times I have been hospitalised for my depression. Nowadays I know there is an alternative. I can always quit my job. I could always go back to England or go to Australia. I could always go into research or switch to public health. I've got enough money in the bank to last a few years (as long as my mum doesn't kick me out of the house).

As we grow older it will be inevitable we have to be more accustomed to death. It's not easy to deal with - it never is - but with the support of family and friends, it will get easier.

The lack of drive

I touched upon the subject of my lack of drive in a previous post back in August 2015. I thought the situation would change but the lack of drive continues to persist. Even trying to sum up the will to write this post took several months. Only because I want to write about another subject that I have to write about the lack of drive so that the next post makes any sense.

I looked back at my previous post and found nothing has really changed. My reasons for the lack of drive is the same. I still haven't done what I am supposed to do for my higher training: my consultation videos, my notes for the practice assessment, my clinical audit. Even the fear of being left behind, having fellow doctor friends or doctors who are younger than me being resident specialists, associate consultants or consultants, doesn't motivate me into trying. Here I am, still pondering about emigrating to another country or planning my epic months-long holiday (I've added a cross country trip of Japan into the lexicon, either as a rail journey or a road trip). I've excluded my ambition to join MSF as I know my depression will get in the way. When I'm really unmotivated to do anything, I become very obsessive-compulsive about doing meaningless tasks, i.e. planning my epic North American / European / Japanese trips, despite them being at least 2.5 years away. I watch / listen to TV/radio programmes I have watched / listened to before, instead of engaging into new stuff.

I've tried to find other reasons why I'm not motivated. Is it the fear of the stress that will be entailed if I do my Exit Examination? I've seen other doctors go through the endeavour and the whole process frightens me. I fear of relapsing into a major depressive state, something I never want to happen again. There have been many senior colleagues who have said the Exit Examination isn't hard but they didn't rule out the process will be stressful. I have learned I cannot handle stress well (hence why I won't be apply for MSF). One recent event has made me quite sombre lately (which I will write about later).

So what am I doing to help my motivation. I've agreed to participate in a clinical trial, to see if repetitive transcranial magnetic stimulation will help. Basically it is using a device to produce magnetic waves so it will stimulate my brain into being happier and more motivated. I'm in week 3 of 4 into the treatment and I don't think anything has changed. I know with this method of treatment that the results may not be seen immediately.

However in the end I know most of the motivation has to come within. But how do I motivate myself to become motivated?

Celebrity deaths in 2016 - actually more or just a selective memory?

2016 seems to be a year when the number of celebrity deaths have risen. In the global sense, the likes of David Bowie, Alan Rickman, Johan Cruyff and now Prince have passed away. USA have lost Garry Shandling, Doris Roberts, George Kennedy and Harper Lee. Britain said goodbye to Terry Wogan, Paul Daniels, Ronny Corbett, George Martin, Frank Kelly and recently Victoria Wood.

The BBC have a great article on this matter. However I was thinking if we have a selective memory and we think the number of celebrity deaths have risen. I looked at 2015 and it seems we don't have a selective memory. The only celebrities that jump out to me from January to April 2015 are Leonard Nimoy and Terry Pratchett.

According to the BBC, it seems that the trend of celebrity deaths will continue. Now as a doctor I don't wish ill will or death on anybody, but I'm just suggesting to God that he should take out somebody which everybody hates.

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.

By plane, train or automobile?

I have a conundrum. Well it's not really a conundrum but more of a dilemma. And when I mean a dilemma, it's a First World Problem.

I have planned to do a small tour of the southern United Kingdom some time in the middle of 2015. Being the obsessive compulsive person, I have already mapped out my trip in advance. After landing at Heathrow, I embark to Newbury to see a friend, followed by stops at Stonehenge, Bath, Cardiff, Abergavenny (to take in the majesty that is the Brecon Beacons), Oxford before finally seeing another friend in Cambridge.  That will be six towns (UK doesn't really have cities) in eight days.

The quandary here is my method of transport. I didn't have this problem when travelling in USA earlier this year. With the American public transport system being so poor and automobile travel being so popular in the United States, choosing a road trip was an absolute no-brainer. In UK the railway system is considerably better to make travelling by train a viable option, although a bit expensive. Also adding to the equation is that renting a manual transmission car is cheaper than automatic in UK, and I haven't driven manual since I passed my driving test over ten years ago.

So the logical part of me, researched the problem and come up with the pros and cons of travelling by car or by train

Pros of travelling by car / cons of travelling by train
1. The journey time will be quicker - 10 hours 30 minutes compared to 12 hours 31 minutes by train. And the car journey time is including a trip to the Stonehenge, which is not feasible if I go throughout my whole journey by train. If I was going to include Stonehenge in my train journey, I would need to travel to Salisbury and get a bus from there to go to Stonehenge, and that is not something I want to do.
2. I have more freedom of where I can go and I am not limited by public transport. That would definitely help for certain places where public transport is not great, such as Abergavenny and going to St Fagans Castle in Cardiff.
3. I am not limited to train timetables. I can leave and arrive by car whenever I want.
4. I can select hotels or bed & breakfasts in the outskirts of town If I was travelling by train, I would have to select accommodation near the train stations or near the city centre.

Cons of travelling by car / pros of travelling by train
1. Cost: the cheapest price for an automatic car for the dates I have selected is £190.83. That figure doesn't include additional costs like petrol and parking. If I was going by train, it would be £159.80.
2. I would need to get a satnav for the car. If I get the system through the car rental company, it's going to cost £100. So the car rental companies can F.R.O. A better option is to get a prepaid SIM card for my smartphone and use Google Maps or Waze to navigate. At least that is a cheaper option of about £10 and I was going to buy a SIM card anyway.
3. I need to find hotels or bed & breakfasts with car parks. If the parking is free, that would be even better.
4. With a train journey, I don't have to drive. I can sit down and enjoy the view. I can take a lunch on to the carriage. I can catch up on my sleep on a train. When I drove in USA, I got sick of driving at the final days of my trip. I didn't note how many kilometres I drove when I returned the car in San Francisco but I've gone back and calculated I drove a minimum of 2400 km in eight days. For the same time period, I will be driving about 800 km. Not so bad this time but I still would like to keep my driving experience to a minimum.

My problem is basically convenience over cost. If I was stretching this journey out over a longer period, I would consider going by train. With the tight schedule I'm having, I think I might opt to travel by car.

Patients, and my lack of patience with patients

If you have been following my blog, you will know I'm a general practitioner working in Hong Kong. Like with all people, I get frustrated with my work, from the limitations of how I can help my patients to the absurdity of the bureaucracy I go through. Recently, the thing that makes me question why I chose to be a doctor are patients.

There are various traits of certain patients which get me sighing out loud and leaving me in despair. I really wish I could write specifically about my encounters with patients. Unfortunately doctor-patient confidentiality gets in the way of revealing how idiotic some members of the human species are. Other jobs have horror stories regarding over-demanding customers, ignorant clients and just plain stupid people. Patients have a right to complain about the health care professionals they encounter for being rude, incompetent or unhelpful; so why can't it be the other way around as well?

I have been restrained in writing about work, mainly to appease my immediate family. A while back, my parents and my younger brother read my entries and were worried I might get into trouble for my comments due to the sensitive nature of my work. I reluctantly accepted (but did not agree with) their views and have kept any negative writing about my job to a minimum.

If I do write about my job nature, there is no way I would breach patient confidentiality. I have not, do not and will not divulge any details of my patients, such as name, identification number or exact details of their illness, that will identify them to the average internet surfer who glances across my blog.

Recently my frustration levels have been peaking. Finding other avenues of expression are difficult. Talking to my colleagues over lunch has not been able to alleviate any frustrations. We are all in the same boat and pretty much cannot do anything. Sharing my stories with my parents (without the details) only gets a sympathetic nod, because it is difficult for the lay person to understand what a doctor goes through. Eventually the tipping point has been reached and hence this entry.

I know I'm not the only family medicine doctor to feel this way. Ages ago, a blog site "The Moderate Doctor" (which has now become defunct) published an article "The rules of consulting a GP", which were based on the rules of cycling. Naturally it caused quite a stir on the internet before being withdrawn but not before I saved a copy.

I did not make the rules; I'm just going to comment on them. I'm not condoning or denouncing the rules. These are my opinions only and they do not represent any other doctor, my colleagues, my department or my seniors. My opinions are not perfect or intend to offend anybody in anyway...

1. Turn up on time

If you feel your illness warrants an appointment with a doctor, please turn up on time. When making a booking, the time you are given is not simply for guidance - it is the time of your appointment. Latecomers should not, and will not be tolerated. It is of no relevance that your doctor usually runs at least 30 minutes late .The doctor has trained for over 8 years as a minimum and has earned the right to run a bit late - if you can’t accept this you should find another doctor.

I do have some sympathy with my patients on this one. My clinic hours are 9 am to 1 pm and 2 pm to 5 pm. However the appointment times are every 15 minutes, between 9 am to 12 pm and 2 pm to 4 pm, and the last registration time is 12:30 pm and 4:30 pm. This is to ensure that patients do turn up on time and doctors have enough time to see their patients. People who have booked a 9 am appointment are more likely to wait less than patients who have booked a 12 pm appointment. It is not fair but it is the way the system works. 

Another quirk of our system is that if a patient is booking through the automated telephone system, he/she cannot select a time he/she can come. You are either given a morning or afternoon time slot for the next day and the next day alone. If you are booking a follow-up at the shroff in our clinic, there is more leeway in booking the appointment but even with this there are certain times of day when you can be followed up. There are patients who want to be seen earlier so they can get back to work and their are children who want to finish school before seeing the doctor. Yet the constraints with our system cannot make this happen. I really wished they could fix that system to allow patients to book what time of day they can book and what day they can book. 

Nonetheless there are people who will arrive late for their appointment, either through no fault of their own or intentionally. I know if they were in any other system, they wouldn't be attended to. In our current system, as long as you have registered you will be seen by a doctor. This creates the situation in where a patient might register early and just sod off to do something else. If you are not there when I call your number, I will move on. I will go back to calling your number later. If you have to do certain procedures before you have to see the doctor, such as measure your blood pressure or take your temperature, arrive earlier so these are finished before you see the doctor.

If you are a person who has a lot of time on their hands and nothing urgent to do, either retired, unemployed or going to take the day off due to the illness you came to see the doctor for, I think you can afford to wait a few minutes to see the doctor. If you think your time is more important than your health, then go see a private doctor who probably will attend to your immediately.

Turning up on time applies with anything in life. Nobody likes to be kept waiting, whether it is your friend or your colleague. It is basic courtesy and should be extended to everybody you interact with. During my medical school days, I hated any of my peers who turned up late to lectures and especially those who make a chronic habit of doing so. You're just saying to the world that the only timetable that matters to you is your own.

2. Get to the point

The doctor will not be interested that your tummy pain / sore throat / headache started “last Thursday - no wait, I think it was last Wednesday as I was coming back from the shops after having my hair done and I always do that on a Wednesday as that is when I have the time because on Fridays I can’t do it because I have my toenails done that day etc.”. In fact, the doctor may not be that interested whatever you say but your best chance is if you get to the point - fast.

Our seniors and trainers like us to ask open questions when interacting with patients, such as "What brings you here to see the doctor?" and "Can you tell me more about your symptom?" This type of questioning will probably yield information the doctor probably wouldn't have asked and gets the patient to be more involved in the consultation process.

That is in the ideal world. For most doctors, I think the general consensus is patients never get to the point. I don't mind them rattling off information, as patients will not know if the information they provide is relevant or not. I can see patients are anxious and might not remember they've mentioned they had chest pain for the fifth time.

What I would like my patients to do is actually answer the question I've just asked. No patient seems to answer a Yes/No question with the appropriate response. Sometimes I will ask "Do you have any chest pain when you are running?" There are many responses that will frustrate a doctor, such as "I have difficulty breathing" - that is not what I asked, a simple "Yes" or "No" will suffice. If I wanted to know if you have any difficulty breathing, I would have or will about to ask that. There are patients who respond with "Yes, I do", which my immediate follow up question is "Is it really chest pain when you are running?" and most of them reply "No, it is just a difficulty in breathing."Again, this is another response which makes me want to tear my hair out.

The worst scenario is when I ask "How long has this been going on for?" and the answer is "Oh, a long time." This doesn't help me as 'a long time' can mean a few days to a year, depending on the patient. I rather you say "let me think" rather than "a long time".

The above situation is why general practitioners are taught to think about "RICE":

Reason: why they have come to consult their doctor. This could be a particular symptom or a fear of a certain disease

Idea: what they think might cause their symptom or problem.

Concerns: what are they worried about. This could be a particular disease or be more social / psychological.

Expectations: how they (the patients) want us (the doctors) to help them, either through reassurance, treatment or investigations.

All that I am saying is get to the point and answer the questions relevantly. If you do this with your doctor, you can probably cut down any time wasted and the consultation will be more efficient. You will have more time to spend doing what you want instead of waiting in a clinic seeing a doctor.

3. Lists

Do not bring a list. Do not refer to a list. Do not say you have forgotten your list. Do not mention the word, list, in a doctor’s surgery. If you have a catalogue of ailments requiring them to be listed, you should probably be seeing a psychiatrist rather than a GP. If you are unable to remember your symptoms and have to write them down, they are unlikely to be of great significance.

I don't mind if a patient makes a list, as long as there aren't too many items on the lists. A list allows the patient to remember what he/she has come for and gives the doctor a framework to deal with. I rather have a patient come to me with the phrase, "I have three problems I want to see you about today" rather than a patient who says, after I spent a lot of time sorting out his/her first problem, "Another thing, I want you to take a look at this..."

There are situations when a patient says, "There was something else I needed to see you about but I can't remember." If you genuinely can't remember what you came to see a doctor for, then it isn't important.

Remember also doctors have a set time frame to work with. The doctor has only a finite amount of minutes to sort out your medical problems. Don't accumulate your symptoms and then see a doctor. There are people who don't see a doctor for several years and when they eventually come for a consultation, they have four problems which have lasted for ages. If you think your symptom requires somebody to see it, don't delay and book appointment as soon as possible. Don't wait until "you have time" to see a doctor, otherwise it might be too late

4. Alternative therapy

Do not ask your doctor what he/she thinks of homeopathy. They may be too polite to tell you - but I doubt it.

I don't mind patients going to seek alternative treatments. If you think your flu symptoms can be alleviated by herbs, then go see a Traditional Chinese Medicine practitioner. If your back ache is improved by a chiropracter or a bone setter, then continue to go see them. Western medicine has its limitations and cannot cure everything.

Just don't ask a Western medicine doctor's view on alternative therapy. We have no frame of reference and the concepts from other fields of medicine don't apply to our field. I get a lot of patients asking me if their ailment is due to "yeet hay" (熱氣), which translates to English as "hot air". This is a Traditional Chinese Medicine term. It doesn't apply to Western medicine, so stop asking us. It is the equivalent of asking who is a better sportsperson - Cristiano Ronaldo or Michael Jordan. They are from different sports and different eras, so they can't be compared. 

5. Man up

Life is tough. We all get ill. Usually we get better. Sometimes we die. There will be a lot of people considerably worse off than you. You are not living in a displaced refugee camp. Consulting your doctor should be a last resort, not a first resort. Look after yourself, prepare to feel unwell occasionally and... man up.

There are legitimate claims to be off work due to illness: when you are afflicted due to a work injury, you are recovering from major surgery or you are battling a significant illness such as cancer. On the other hand, there are times when patients come to my clinic with just a runny nose and ask for three days' sick leave. To avoid kicking up a fuss, I give them the sick leave but only for one day. There are times when I wanted to say to that same patient, "I went back to work with a broken finger and you want to take time off when you have a sniffle?"

I want employers / companies / organisations to limit the amount of sick leave a person can take each year. Somebody should examine the number of days each employee takes off for sickness and analyse how much sick leave each person can take. I'm proposing 6-8 days per year. After that amount has been succeeded, you should get pay docked off. The above amount would be for small things such as common colds or diarrhoea. Bigger stuff such as major surgeries and injuries will come underneath a different banner and I still haven't thought of a good system for that.

Before anybody says I'm a hypocrite for taking time off for my broken finger, I would have happily accepted (and I had expected it) my pay to be docked for the time I was off. It is only fair for my colleagues who pick up my slack and for the patients who have one less doctor to see.

6. Newspaper clippings

These are useful for lighting fires and wrapping up fish and chips. They are not to be brought to the doctor. Never ask your doctor if he has read a particular article - doctors do not make a habit of picking up evidence based medical breakthroughs from the national rags. Any doctor writing for a newspaper clearly has lost touch with reality and cannot be relied upon to provide a sensible opinion. If you mention the Daily Mail, you can expect to be thrown off your doctor’s list.

The more patients who present to me ideas they have read in the newspapers / magazines or watched / listened to on TV / radio programmes, the less I believe in the media. "Advertising is legalised lying", as H. G. Wells put it and I'm inclined to believe him. It's the reason why general practitioners in Hong Kong government clinics hate the Hirudoid adverts on TV. The ads claim Hirudoid cream can help with muscle pain or varicose veins, where there is no scientific proof of it. It is also not helped that specialist doctors such as orthopaedic surgeons don't follow this evidence and prescribe Hirudoid willy nilly to every patient they see.

The basic principle - don't believe in everything you see in newspapers. Not everything in the lay public media is true. Newspaper articles are not fact checked and peer reviewed by an independent body. That is what happens to medical evidence. If there is a miracle cure or a new wonder drug, the doctors would have already known about it.

7. Moaning about hospitals

Do not moan to your doctor about the delays in the hospital system, not receiving appointments, or having to wait months for an operation. Your doctor already knows this so do not waste his time telling him. Complain to the hospital or your MP - or write to the Daily Mail.

If you think there is a problem with the health care system you are in, whether there are not enough doctors or nurses to see patients, the clinics should prescribe better medication to their patients or the long waiting times to see the specialist, don't moan to the general practitioners. We already know there are fallacies with the system. The people responsible for these problems know there are problems. There are always issues with fixing these problems, which are always time, money and not enough qualified staff. I want my patients to have the medication that is most appropriate to them and want them to see the specialists as soon as possible but complaining to me won't make it happen. Write to your local politician or to the head office - that is most effective way of getting your point across. General practitioners are just too busy seeing patients.

If you are whining about the long waiting times or the lack of care in the public sector, go private. If you think your health is that important to you, spend money on it instead of spending it on that new electronic tablet you just brought that is just replacing the old one you just brought a year ago. Prioritise where you spend your money.

8. Bugs

Yes there is a bug around. Do not ask this question - ever. There are always bugs around, life is full of bugs, you will get your fair share, your illness is almost certainly caused by one, there is no treatment available, you have wasted the doctor’s time. Again.

People get ill - that is a fact of life. Even if you exercise and eat right, you will have a common cold one day. You are not totally immune to all germs out there in the world, even if you are the healthiest person in the world.

And don't ask me why your kid is always ill. It is not uncommon for kids to have a common cold every 2 months, especially if your kid sneezes without covering his/her mouth or picks his/her nose and eats the contents. Children are not the best obeyers of hygiene rules and it shows.

9. Referral

Never say to the doctor “I have just come to get a referral”. If this is the case - refer yourself. If you discover you are unable to do this, you will realise that this is because you will need to seek the opinion of a suitably qualified medical practitioner (your doctor) to ascertain whether your mystifying collection of symptoms justify the expense of spending taxpayer’s money on a specialist opinion. If you would like to shortcut this process - enrol in medical school. If you have private insurance, it is quite likely your doctor will refer you just so they can shorten the consultation with you, freeing up time for an extended coffee break.

The general practitioner is not a stepping stone. In a pubic health system setting, he or she has to decide whether or not your problem requires specialist care. There are a lot of situations where the general practitioner can sort your problem without the need for the specialist. If you want to see a specialist just because you want an opinion, you are wasting the time of the general practitioner and the specialist, and the finance and resources of the public health sector. Again if you think it is so important that you see HAVE TO see a specialist, go private (a recurring theme). If you are asking a referral just because you want to see a specialist, don't be too surprised if your referral is stratified into the low priority group.

10. Tiredness

If you complain of feeling “tired all the time”, you can expect your doctor to glaze over, look far in to the distance and turn to his iPhone to check for any updates to his large collection of apps. Feeling TATT is not a medical condition - it is simply what happens in life to everyone at some stage. The fact that you have felt the need to consult your doctor about it is a very worrying sign and further confirmation to your doctor that you need to need to consult #5.

I have a little bit more sympathy for patients in this category but only just a little. Tiredness is a valid complaint to come and see a doctor about. It is an easy symptom to be dismissed by a lot of doctors. It's the same with dizziness, numbness and headache. They are symptoms that are very vague, happen a lot, are difficulty to describe and have a hundred different reasons why they occur.

What most patients don't accept is that there might be a psychological element to them. Problems with work, family and relationships could contribute and stress can manifest itself in the form of physical problems.

11. Turn off your phone

It is generally considered to be polite to silence your phone when in a consultation with a doctor. It may be frowned upon if you consider it necessary to answer a call when in the middle of a consultation. However, this is more acceptable than walking in to the doctor’s room whilst in the middle of a telephone conversation and sitting down without acknowledging the doctor’s presence.

I don't mind patients have their phones on during the consultation. I have my phone on during office hours and when my phone rings, I look who it is via caller ID. If it is nobody I know, I end the call. That takes about a second or two, and it doesn't disrupt the consultation. If a patient's phone goes off and the patient ends the call or takes the call to say they are busy and will phone back, that is fine. If you take the call to have a conversation, don't be surprised if I grab the phone and chuck it out of the window.

12. Own your own health

Your health is your responsibility. Do not try to pass this responsibility to anybody else - including your doctor. They will try to help you achieve good health but it is not their fault that you are overweight/smoke/smell or suffer from natural hair loss - please accept this gracefully and deal with it. If in doubt refer to #5.

If you are worried about your own health, take some responsibility and take care of it. Doctors are there to help you. We can't force your to take medication or undergo operations. Don't be surprised if you are suffering from hypertension, diabetes, high cholesterol, heart disease, alcoholic liver disease and chronic bronchitis if you continue to eat poorly, become a couch potato, smoke a pack a day and down several pints of beer per night. Don't be surprised if a medical condition worsens if you don't take your medication or don't go to your follow-ups. This is why there was a vocal opposition from doctors not to give lipid lowering drugs to everybody, even for people with a low risk of having cardiovascular disease. People wouldn't adopt any lifestyle modification if they knew they could take a pill for all the medical ailments.

It is your responsibility to remember to come to your appointments for follow up, blood taking or other assessments. It is fine if you miss the occasional appointment - we all do. People will have to miss their appointments for work or other events. Nobody is perfect to remember all their appointments in life. However if you continue to miss your appointments, don't be surprised if the rebooked date is a long way off.

13. Depression is an illness

Do not confuse depression with feeling a bit down. Depression does not last a few hours or a few days - those are the natural fluctuations of mood that we all experience. We all have bad days. Do not bore the doctor with your mundane stories of life being unkind to you - see #5.

I think this should cover all mental illness. There are a lot of people, most of them in the elder generation and of the lower socioeconomic class, that are resistant to the fact they might have a mental illness. Depression, anxiety and psychotic disorders can affect anyone, young to old, male and female, from the normal guy in the street to the millionaire in his/her penthouse. There is a biological factor to the psychiatric conditions, which is why doctors prescribe medication for this illnesses.

The only way I can get people to think about psychiatric illnesses like medical illnesses is with this analogy: if your blood pressure is too high or too low, it is a medical condition which needs to be treated. It is the same with blood sugar and temperature. So why can't it be the same with mood or anxiety? If you mood is so low that it is affecting your sleep, appetite and your functioning capability, don't you think we should treat it?

And don't think mental illness is a rare disease. 10% of the population will suffer from depression during their lifetime. The current prevalence of depression is about 1-2%. It is likely you will know somebody who has depression.

14. Entitlement

The NHS does not owe you a favour. You are not entitled to anything. The NHS and your doctor are there to help in your hour of need - not because you feel you deserve a payback. Don’t even think of starting on the “I pay my taxes" routine.

Just because something is there, does not mean you are entitled to it. That is why public health care systems don't offer breast enhancement surgeries. And don't think, just because you don't use the health care system often, that when you get an illness you get the best drugs. You will get what everybody else is getting.

15. Scans

Do not request scans under any circumstances. You are not medically qualified and scans will not unearth every medical problem. If you request a scan, it may alert the doctor to a deeper, more important, underlying medical problem - such as complete lack of insight and grandiose ideas of thinking that you have a medical qualification. It is likely to lead to you being assessed under the mental health act.

I am bemused the lay public think science has progressed so far that ordering a simple blood test or ordering a scan will uncover what illness you have. If that is the case, do you think we would still have doctors around? Wouldn't the government just get rid of doctors and set up vending machines so the public can just order which investigations they want? Investigations are just a tool to aid doctors in their diagnosis. Most of the time, the investigations are there to confirm what doctors already know and to exclude other causes.

There have been cases when I have ordered investigations for a patient, the results come back as normal and the patient is disappointed as there is nothing to explain what is wrong with them. There are things that science and medicine cannot always explain. If doctors had an answer to everything, do you not think the medical community would have cured all known illnesses by now?

16. Breathe normally

Try to behave in a normal fashion when your doctor asks to examine you. If he is trying to listen to your chest with a stethoscope, he is attempting to hear the movement of air through your lungs. To enable this you will need to open your mouth and inhale deeply. You will then need to exhale - do not forget this part otherwise you will go blue and feel faint. When inhaling, you should not try to touch the ceiling with your shoulders by shrugging hugely - just simply breathe in a normal manner.

If your doctor is listening to your chest with his/her stethoscope, just breathe normally. If he/she cannot listen, he/she will ask you to breathe deeply/slowly depending on the situation. Also your doctor cannot hear you talking through the stethoscope.

17. Dress appropriately

Please try to consider the most appropriate clothing for the weather conditions and the body part that might need to be examined. A purple satin thong might look great on the Copacabana, but not so good on the doctor’s couch if you have a painful testicle. You might also wish to consider removing some of your 23 layers of clothing prior to entering the consulting room - it’s amazing what you can cram in to 10 minutes but there is little point in spending this precious time turning your clothes the right way round.

If you know you are coming to get your knee examined, don't wear jeans.

18. Use normal English

Your doctor will not expect you to use full medical terminology, but do at least try to use recognisable words and phrases. “I did toilet this morning” is not an appropriate way to describe a bowel movement. “Thingy bob” is not a helpful description of anything. It is perfectly reasonable to use the correct anatomical words to describe sensitive parts of your body. Do not confuse the word “stomach” with “abdomen” – they are not interchangeable. If in any doubt, simply point and ask.

This may not be applicable in Hong Kong but this rule basically implies just to use simple language. Doctors don't expect you to know medical terminology but we do expect you to actually tell us what is wrong with you. Don't say "I have a cold" when you actually mean "I have a runny nose".

19. Medication

You may find yourself needing to take medication on a regular basis. Try to familiarise yourself with the preparations and the reason for taking them. Keep a written list of your medication on you at all times. Under no circumstances should you try to pronounce any of the tablets without referring to your list. Do not attempt to spell these medications to a doctor over the phone - this seems to induce an acute attack of dyslexia even in the most competent of patients. There are approximately 2547 different types of “little white pills” and this is not a helpful description.

If you are taking medication and want to refer to it, bring the drug's name along to your consultation. Doctors cannot always identify the drug from the appearance alone. It is like asking you to identify sugar and salt from the appearance alone. Also don't say "the previous medication" either. If you want to be exact, bring the name of the medication to the consultation.

Having said this, I have had to learn the appearance of most of the common drugs I have prescribed. Our department has also tried to make it easier by photographing all of our main drugs and putting the photos on our internal website to help with situations like these. Yet it doesn't help that the Hospital Authority continually changes the supplier of the drugs, which will affect the appearance as well.

20. Symptoms

Do not confuse symptoms with a diagnosis. It is your role to describe your symptoms to your doctor, and his/her role to try to formulate a diagnosis. This will not always be possible as patients often present with normality, believing that they are unwell. Avoid phrases such as “I have an ear infection” when in fact you simply have a painful ear, or “I have a chest infection” to mean that you have a cough.

The two symptoms I hate the most are numbness and dizziness. It's because patients expect that numbness and dizziness is the same with everybody, when there are variations. Numbness can mean loss of sensation, pain, pins and needles sensation, ant-crawling sensation and being wrapped in cotton wool to name a few. Dizziness can mean vertigo (the world is spinning around), unsteadiness, giddiness and lightheadedness. If the doctor asks you to describe something and you can't, he/she will give you some options. It is best to try to select at least one instead of saying "it's just numbness/dizziness".

21. Vaccinations

You should take up all offers of vaccination or immunisation. If you decide not to, you should never darken your doctor’s door again. Do not come bleating to the doctor when your child goes down with measles - where’s your dandelion munching NCT practitioner when you really need them? 

If doctors didn't think vaccinations were helpful, would we still be offering them? If you are of ill health or are genuinely concerned about catching an infectious disease, get yourself vaccinated. If you still think the measles vaccine causes autism, please go read the literature again. Don't come crying to the doctor if your child gets an infectious illness that could have been prevented by immunisation.

22. Bodily secretions

Do not bring these in to the doctor’s room unless specifically asked to. If the doctor wants to see your baby’s 2-day old nappy he will ask you. Do not offer this, and continue to unravel the package in the doctor’s room even after he has told you it will not help with the diagnosis. Listen carefully to instructions on how to collect a specimen if one is requested - use the appropriate containers. Stool should be in a pot, not deposited freshly in a plastic bag and put through the letterbox. You would think that this would not need to be pointed out, but sadly, in our experience, it does.

Thankfully I don't see this much in my practice but I do get the occasional patient blowing his/her nose into a tissue and showing me what the nasal secretions look like.

23. Gifts

It is perfectly reasonable to offer a gift to your doctor. Do not expect anything in return.

 Actually not many doctors want gifts. Doctors are adequately paid. Just your appreciation is enough.

24. Bloating

This phrase should not be heard in a doctor’s surgery. The exception is in some females over the age of 50. It should not be heard from anyone under this age, and never in a male.

I think the complaining about bloating is a British cultural reference. I get patients presenting to me about bloating and I think it is a legitimate complaint. It can cause distress and there is medication for it. 

25. Requesting letters

Your doctor’s NHS role is to provide you with appropriate health care. It is not to provide letters for you to any organisation that requests one. This includes airlines/car hire companies/gyms/drama schools/insurance companies/beauticians/housing departments/solicitors/trichologists or bed manufacturers. Any such requests are likely to be met with a guffaw, a long delay and a suitable bill.

Unfortunately this is never the case. If there is a claim that requires a letter from a doctor, then we need to issue one. I think requesting letters regarding one's health is reasonable.

26. Over dramatisation

Try to avoid over dramatisation. Phrases such as "the worst sore throat ever" or "I thought I was going to die", will undoubtedly be met with a confused look from the doctor as he is faced with a normal looking pharynx, or leave him scrabbling around searching for even the slightest remnant of a significant clinical sign on examination. The doctor will certainly have come across many, many more severe clinical cases than yours, and he is likely to point you towards #5. 

Thankfully I don't think this happens at all.

27. Cancel if you are better

If your symptoms have improved significantly prior to the appointment with the doctor, it is perfectly acceptable to cancel your appointment. Interesting as it may be to you, the doctor will have no interest in an historical set of symptoms that have now miraculously disappeared. Time, as they say, is a great healer - if it has done it's job then give yourself and the doctor a 10 minute break.

There are a number of people who make appointment but don't come for various reasons, either they are too busy with work or their symptoms have resolved. If you can't come to your appointment, cancelling will free up a space for somebody who genuinely needs to see a doctor. 

28. Dental problems

If you have a dental problem, please consult a dentist not your doctor. Your doctor is not a shortcut to antibiotics or pain relief. He will very likely have less dental experience than your vet who would probably be a better option for you. Just because the doctor is "free" does not mean that he can manage all of your problems - dentists are there for a reason, we believe. The lack of easy access to NHS dental provision is not your doctor's fault - he has enough problems to deal with without trying to sort out the shortfall in other areas of the NHS.

It's the same problem with the Hong Kong health care system. There is not a public dental care system and everybody has to go private. I will get a number of patients who want me to refer them to the dentist in the public sector for their dental problems, and the public sector only deals with certain tooth problems such as teeth injuries (chipped tooth, etc.) or civil servants. The whole system needs a revamp.

29. Familiarity

The doctor/patient relationship is a complex one - let's try to keep it that way. Some doctor's will not take kindly to being addressed by their first name - particularly if they have not met you before. It might be sensible to ask the doctor if it is appropriate to address them by their first name - as a rule of thumb this might be considered after you have been consulting them for a period in excess of 25 years.

Again, something that doesn't occur in Hong Kong (thank goodness). However it would be nice to be called "doctor" instead of "mister".

30. Furniture

Do not move the furniture in the doctor's room. This has been carefully placed to ensure the doctor can see, hear and examine you in an optimum fashion. Moving the chairs can disturb this ecosystem and upset the very heart of the consultation. Do not encroach on the doctor's desk, borrow pens without asking, or assume that your children can turn the room upside down and leave without a passing comment.

I haven't encountered patients dramatically moving seats but I have had children fiddling with stuff on the desk. Kids will be kids - they will want to muck about with stuff. I'm fine with that, as long as they don't break anything. And most patients who want to write something down will ask if they can borrow a pen. It's better than waiting for them to find a pen in their own bag, which can take ages.

31. Appointments

Your appointment is for you. The doctor will be expecting to discuss with you any significant problems that may need medical intervention. He will not be expecting to discuss your child's illness, or to see your partner at the same time. Unless specifically mentioned at the time of booking the appointment, there is unlikely to be a "book one, get one free" offer. Just like tickets for the cinema - book for two people if you need to. If you find yourself starting a sentence with " I know I shouldn't do this but" , you are probably not going to get the response for which you were hoping.

I have had this problem only a few times and I always keep saying, "I can't help this person unless I can see him/her and ask about the details." I just had a patient bring his mother's investigation report to look at and I said the same thing. I need to know the concerned person's full medical history, the current condition and to perform a physical examination before I know what is wrong with him/her.

I've also have relatives come in for patients for various stuff, such as to collect medication or to ask for investigation results. This situation breaks all kinds of rules. What if the patient has low blood pressure already and I continue to give him/her the anti-hypertensive medication which could cause a whole lot of problems? What if I the patient didn't give the relative permission to see his/her investigation results, which would breach doctor-patient confidentiality? There is a reason why telephone consultations haven't taken off in Hong Kong yet; it is fraught with issues.

32. Urgency

The urgency of an appointment is defined on medical grounds - not based on upcoming events in your social calendar. The fact that you are flying to Barbados in 2 days does not open up a new range of treatments to enable your doctor to manage your minor symptoms relating to a viral infection or the common cold. In addition to this, there is no medical evidence to support the fact that if you have an impending holiday / wedding / birthday your common cold is more likely to turn in to life threatening pneumonia. The doctor is still perfectly correct in these situations to point you in the direction of #5.

Every patient thinks their condition needs urgently seeing to, requesting the best medication or to see the specialist right away. It's not going to happen. If you are in the public health care system, the medication prescribed will be based on effectiveness and cost. If you are in the public health care system, your referral to the specialist will depend on your symptoms and not necessarily on severity. Everybody thinks their back pain is the worst, but you've got other people to contend with.

I really wish these issues were in a minority of my patients but to be honest, at least everybody shows some issues that have been mentioned. I understand that patients are not knowledgable in medicine and are worried about their diseases. Yet patients also have to have realistic expectations of what a publicly funded health care system can provide and that medicine cannot provide a cure or an answer to everything.