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If I am the Minister for Health, I will immediately enforce a mobile medical apps software that can be easily downloaded to every phone for the citizens here effective medical sickness reporting and treatment.

The rationale for this mobile medical apps is due to my observation that doctors are spending too much time taking down (or rather scribbling down data) for common questions that could have been answered while the patients are in the waiting room, idling.  In fact, many doctors are language challenged and not able to converse well in Mandarin or Tamil where most of the foreign workers are from and this takes longer service time.  Likewise for parents with this mobile med apps, they can fill in data for their children and sent to the clinic without needing to take time off or during a emergency.

For this mobile medical apps, which I would term, RSF (Report Sick Form), for simplicity, it will have the followings:

Language Preference:

a.  It comes in different languages like English, Mandarin, Tamil, Hindi, French, German etc to cater to a mulitcultural society that Singapore is aspiring.  This is essential if we want to handle infectious disease fast in times of outbreaks.

General Data Like:

a.  Fever (number, frequency, duration etc)

b.  Cough (dry, wet, whooping etc, frequency, duration etc)

c.  Phlegm (white, yellowish, reddish etc)

d.  Pain (location, frequency, duration, intensity etc)

e.  Rashes (location, frequency, duration)

f.  Headaches (frequency, location, intensity)

g.  Sore throat (when started, describe)

Medication Taken:

a.  Western – describe

b. TCM – describe

Infectious Diseases Suspected

a.  Disease suspected:  Dengue/Malaria/Chikungunya/SARS

b.  Reasons:

c.  Suspected Locality or Cluster:

Others:

a.  Food Poisoning suspected

b. Location:

Etc Etc Etc

Conclusion

The above is only a general format that, of course, will be improved with time and usage.  This allow the doctor to focus immediately on other important aspect like helping to derive disease or outbreak clusters like dengue by asking further question to what had been duly filled up at the waiting area. Presently almost all the doctor time is wasted trying to communicate with the patients which can be worsen if there is a language barrier.  This is further complicated by temporary or part-time doctors who have lost the ability to keep up with emerging disease symptoms and cannot ask proper questions while relying on patients to describe. Often the patients are either too sick to remember and perhaps the medical apps with its structured approach can help the incompetent doctors to follow a standard format to derive what is the root cause of the sickness.

Our problem is not that there are not enough doctors but rather the inability to use mobile apps or even pre-filling of forms at the waiting area to reduce doctors workload and move on to more incisive diagnosis, not only to treat the patient properly but to contribute to a national medical database that can effectively derive where the disease clusters are from and will be.

Take Care

Shananarocks

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I find that our private medical clinics around the various housing estate can improve their efficiency and effectiveness by providing a checklist for patients to fill while waiting for their turn to see the doctor.  This will shorten the need to overall waiting period as the common questions like “Fever”; “Cough for how many days”; “Yellowish or White Phlegm” can be answered ahead of time.  When we see the doctor the pre-filled form could be scanned or even scanned earlier to save time.

Here I want to recount a bad experience the I had yesterday when I visited a “xxxxxxxxxx” Family Clinic in Marsiling area where the resident doctor Dr Tan was away on holidays.  The temporary doctor seemed to be totally out of touch with reality or in possession of any courtesy or diagnostic ability, when  I visited the clinic on 3 Jun 2013 morning with symptoms of cough and flu.  When I enter his clinic after being called by my Catholic name and which also appear in my IC, this doctor Chong asked what is my name. I replied with my Catholic name “xxxxxxx”.  He asked again “what is your name” and should it not be “Tan Ah Kow” (changed intentionally here).  I told him the nurse already addressed me as in my Catholic name.  He said “no!” you should say your name as “Tan Ah Kow”.

Nevertheless, this is not his main problem.  The PROBLEM IS HIS INCOMPETENCY IN DOING simple diagnosis.

This temporary doctor, Chong, asked me what do I have? I replied I have flu. He then asked me to describe my flu.  I said “runny nose”.  He repeated after me like a school kid and wrote it down on his white card and said somemore. I already feeling very groggy and though why could he ask the questions since he is the doctor and know why questions to ask to come to a conclusive diagnosis.  I then said “cough” and my phlegm was whistish and yellowish.  I remember only seeing he write “white” in the card.  I said I got fever and he checked my temperature which confirmed that I had fever at 37.5 degree.

Then I requested for some ringworm or rashes cream due exercise like badminton when I have to wear the same outfit for a while.  He asked to show him the spot behind my back and I said it was red in colour. He was very sacrastic and asked me how do you know it was red in colour. I looked at him in amazement and say of course my wife told me so.

When I went to collect my medication after leaving his office, I was only given panadol and cough medication.  I then requested the nurse to inform him that I require lozenges as I was having a bad sore throat. I thought I said that to him and wondered why he did not go through a checklist like any normal competent doctor would have done so.

When I reach home I realised that he did not give my any antibiotics for my flu that included fever and yellowish phlegm. I called the nurse and requested that she speak to him.  The nurse then came back to say “yes” you can come now to get your antibiotics.   I have to travel back to his clinic again due to his incompetency, often not looking at the patient to do diagnosis but keep looking at his white card to scribble.

The fact that for a simple diagnosis like flu with yellowish phlegm and fever, I wonder why he could have run through a standard checklist given the patient could be very sick and groggy and not able to think clearly.

In fact just before my turn to see him, an Indian patient went in and everyone can clearly hear him say sacrastically “see I can pronouce you nammmmmeeeeeeeee ………..” in a derogatory manner.  However for the earlier Caucasian lady that  he attended to, he was all smiles sounded so polite that could be overheard in the waiting room and in his  best  submissive configuration.  I wonder why this clinic is not sound proof and let everyone hear what the doctors are saying inside.

Anyway, I sure wonder what is truly wrong with this temporary doctor – was he forced to work overtime in the absence of Dr Tan or was he just simply out of touch with the current practise that require the doctor to be more sensitive and alert to patients’ needs. By going through a proper checklist even before going into clinic maybe it helps to alleviate his or her workload.  I truly wonder how many misdiagnosed cases he seen over the years.  I shuddered at that thought.

CONCLUSION

To save time for such incompetent doctors, it is best to have a standardized checklist for common diseases like flu, cough and fever etc.  The doctor can thus save time from questioning these symptoms to the patients and instead focus on asking further questions that can better diagnose the disease. In the case above, it showed the lack of knowledge from a temporary doctor who insisted a groggy patient to tell him the symptoms when he should be in a better position to ask the right questions to come up with a proper diagnosis.

Likewise with some many Chinese and Indian national coming to Singapore, it would be good if the checklist can have both Mandarin and Tamil that will facilitate the patient to check the correct boxes in their languages. The doctor can run along the same column that commensurate with the English version and understand the symptoms ticked accordingly.  Likewise, the groups of patients can consult each other or view a demonstration video tape in the waiting area.  This will greatly reduce the treatment time with doctor and allow the doctor to attend to more patients.  Likewise, the patients need not wait to long and can report back for work or return home if necessary.

No wonder he is only a temporary doctor.  I wonder how many of such doctors had been strike off from the medical list. They are not committed and have no interest in treating patients.   Our medical profession should only select those who have the aspiration to serve others and not to make money in this profession.

Take Care

Shananarocks

I woke up late this evening and could not make it to our Catholic Church for the evening mass.  Somehow strangely I decided to try an online mass.  The first result that greeted my online search is what?  – President Obama (a non-Catholic) attending a Catholic service?  Oh, it was the interfaith prayer service to honor the victims of the Boston Marathon bombings from Boston’s Historic Cathedral of the Holy Cross. It was held on 18 Apr 2013.     It came three days after  Boston Marathon bombings was a terrorist attack during the Boston Marathon on April 15, 2013.  It came two days after the “Three Mile Island Emergency Preparedness Drill held on Apr 16, 2013, a day after the Boston marathon bombing.  The atmosphere was indeed very tense during that period.

I watched the online interfaith service held at the Catholic church and somehow noticed that Psalm 147:3 was used instead of the predetermined  Catholic Daily Reading for that day which should be Psalms 66:

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Psalms 66: 8 – 9, 16 – 17, 20

8 Bless our God, O peoples, let the sound of his praise be heard,

9 who has kept us among the living, and has not let our feet slip.

16 Come and hear, all you who fear God, and I will tell what he has done for me.

17 I cried aloud to him, and he was extolled with my tongue.

20 Blessed be God, because he has not rejected my prayer or removed his steadfast love from me!

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Psalms – 147 – 3

1 Alleluia! Praise Yahweh — it is good to sing psalms to our God — how pleasant to praise him.

2 Yahweh, Builder of Jerusalem! He gathers together the exiles of Israel,

3 healing the broken-hearted and binding up their wounds;

4 he counts out the number of the stars, and gives each one of them a name.

5 Our Lord is great, all-powerful, his wisdom beyond all telling.

6 Yahweh sustains the poor, and humbles the wicked to the ground.

7 Sing to Yahweh in thanksgiving, play the harp for our God.

8 He veils the sky with clouds, and provides the earth with rain, makes grass grow on the hills and plants for people to use,

9 gives fodder to cattle and to young ravens when they cry.

10 He takes no delight in the power of horses, no pleasure in human sturdiness;

11 his pleasure is in those who fear him, in those who hope in his faithful love.

12 Praise Yahweh, Jerusalem, Zion, praise your God.

13 For he gives strength to the bars of your gates, he blesses your children within you,

14 he maintains the peace of your frontiers, gives you your fill of finest wheat.

15 He sends his word to the earth, his command runs quickly,

16 he spreads the snow like flax, strews hoarfrost like ashes,

17 he sends ice-crystals like breadcrumbs, and who can withstand that cold?

18 When he sends his word it thaws them, when he makes his wind blow, the waters are unstopped.

19 He reveals his word to Jacob, his statutes and judgements to Israel.

20 For no other nation has he done this, no other has known his judgements.

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Although only excerpts of Psalms 147 was read, which is Psalms 147-3 “ healing the broken-hearted and binding up their wounds “, there are other words in further down the passage of the entire psalms which I fear will be wrongly interpreted and employed by certain people, some knowingly, some unknowingly to assert the power of horrendous weapons to maim innocent people.  Catholic religion has always preaches peace and tolerance and it has always been the cornerstone for peace.

The mass is subtly telling us that there are extremely powerful worldly figures behind the scene manipulating the world and killing innocent people.  Even Obama may be powerless to do anything about it.  Hope that peace will prevail eventually and that the Catholic church will do its best to bring about peace and justice to all.

God Bless Everyone

Take Care

Mikey

Angels Don’t Play This Haarp: Advances in Tesla Technology

I read with concerns about Swenson Tan, 22, who lapsed into a coma three weeks ago after being hit by a van. He was declared brain dead by doctors at Changi General Hospital (CGH) on Friday (Mar 8), but his traumatised parents refused to accept the outcome. The full-time national serviceman, who had studied Mechanical Engineering at Ngee Ann Polytechnic, was riding a motorcycle near Hougang Ave 7 when he collided with a van. He suffered serious head injuries and underwent a six-hour operation. (link)

What bothers me is that there are reports of many accident victims who were declared as brain-dead by doctors woke just in time before their life support system were removed.  In 2012, a 17-yr old Steven Thorpe’s parents refused to give up hope – despite four specialists declaring that the 17-year-old was brain dead and wanted to switch off his life support machine. He woke up after a 2-week coma (link).  I thought about it and remember that in 2012 that was an experiment that showed that severed nerves could repair itself quickly in a calcium-free environment.  (link)

This appear to me that it is about time for our doctors here in Singapore to try this on accident or trauma patients with brain injuries, meaning when the accident patients  first admit to the emergency ward, they should be exposed to as little calcium as possible.  This will allow the important nerves in the brain to quickly heal themselves.  Maybe earlier some brain-dead patients who recovered were those who were on heart medication that on calcium-channel blocker medication.  In fact there were some experiment done on this in 2003.

Calcium channel blockers for acute traumatic brain injury. (link)
Langham J, Goldfrad C, Teasdale G, Shaw D, Rowan K.
Source : Clinical Effectiveness Unit, Royal College of Surgeons of England, 35 – 43 Lincoln’s Inn Fields, London, UK, WC2A 3PN. Abstract
BACKGROUND:
Acute traumatic brain injury is a major cause of death and disability. Calcium channel blockers (calcium antagonists) have been used in an attempt to prevent cerebral vasospasm after injury, maintain blood flow to the brain, and so prevent further damage.
OBJECTIVES:
To estimate the effects of calcium channel blockers in patients with acute traumatic brain injury, and in a subgroup of brain injury patients with traumatic subarachnoid haemorrhage.
SELECTION CRITERIA:
Randomised controlled trials in patients with all levels of severity of clinically diagnosed acute traumatic brain injury.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently assessed the identified studies for eligibility and extracted data from each study. Summary odds ratios were calculated using the Mantel-Haenszel method.
MAIN RESULTS:
Six RCTs were identified as eligible for inclusion in the systematic review. The effect of calcium channel blockers on the risk of death was reported in five of the RCTs. The pooled odds ratio (OR) for the five studies was 0.91 (95% confidence interval [95%CI] 0.70-1.17). For the four RCTs that reported death and severe disability (unfavourable outcome), the pooled odds ratio was 0.85 (95%CI 0.68-1.07). In the two RCTs which reported the risk of death in a subgroup of traumatic subarachnoid haemorrhage patients, the pooled odds ratio was 0.59 (95%CI 0.37-0.94). Three RCTs reported death and severe disability as an outcome in this subgroup, and the pooled odds ratio was 0.67 (95%CI 0.46-0.98).
REVIEWER’S CONCLUSIONS:
This systematic review of randomised controlled trials of calcium channel blockers in acute traumatic head injury patients shows that considerable uncertainty remains over their effects. The effect of nimodipine in a subgroup of brain injury patients with subarachnoid haemorrhage shows a beneficial effect, though the increase in adverse reactions suffered by the intervention group may mean that the drug is harmful for some patients. (link)

Comments:  The 2003 experiment were on “acute traumatic brain injury” meaning those patients were still alive and not brain-dead.  Maybe their experiment totally missed the entire point, which is, to ascertain whether a traumatic patient would not become brain-dead if calcium channel blocker medication were rendered immediately  together in a calcium-free environment for the patient to survive pass the brain dead stage and help immediate nerve repairs as demonstrated in the 2012 rats experiments.  Our doctors here should keep abreast with latest developments, especially in traumatic brain  injuries that is so common among the motorcyclists.  Here one motorcyclists dies every two days.  The ministry of health should publish data whether most of the organs harvested were from these pools of dead motorcyclists and whether if our brain-dead procedure should be revamped for progress and ethics reasons.

Take Care

Mikey

cc:  Dr Goh Siang Hiong and Dr Chua Hoe Chin (both my dear secondary four classmates who went on to become good and dedicated doctors in the A&E and Neuro Recovery departments)

1.    I often see an elderly woman who uses a common market trolley as a walking aid

Easily available at most supermarket and hardware store but cannot be seated

Easily available at most supermarket and hardware store but cannot be seated

to move slowly but surely across a traffic light junction.  Sometimes I walk beside her to ensure her safety as the green light timed-out.  Nevertheless, most motorists are very considerate here.

However, I would like the authorities to:

a.   Promote cheap and functional “elderly marketing cum seating trolley” that can serve dual function as a marketing trolley, walking aid and in particular those that can be seated to allow others to ferry them easily at traffic crossings.

b. Make available at most supermarket and convenient store (it is also where most of the elderly get their marketing trolley as a walking aid).  Many do not know where to get such specialized trolleys.

Should make available at supermarket and hardware stores in housing estates.  At traffic lights the elderly can be seated comfortably to let others push them safely across the traffic lights before the green light time-out

Should make available at supermarket and hardware stores in housing estates. At traffic lights the elderly can be seated comfortably to let others push them safely across the traffic lights before the green light time-out

2.    Using such “elderly marketing cum seating trolley” allow others to participate:

a.  As it easily allow anyone to ferry the elderly across the traffic lights or zebra crossings since they can now be seated comfortably in such trolleys.

b.  Promote a caring culture when it is within our reach to help the elderly rather then hinder their movements or just walking by their side.

Take Care

Mikey

Ref:

a.  Common Market Trolleys used a (desperate) walking aid by the common folks as it is cheap and easily available and dual usage.  However, mobility still remain painfully slow at traffic junctions but nevertheless it still aid in their balance.

Common Market Trolley As Walking Aid - 2

Common Market Trolley As Walking Aid

The tragic death of the Indian girl who was brutally raped by her assailant could become a catalyst for massive strikes in India as the following events unfolding”

a.  Full Moon – 28 Dec

b.  Peru Jicamarca Haarp

c.  Peru Quake on 29 Dec – 47km (29mi) E of Huaral, Peru

d.  A Haarp direction that cuts across central to northern India

Comments: Although the protest intentions are noble, hopefully they would not exploited to create utter chaos like in the Arab Spring that could result in much hardship, chaos and death.

Take Care

mikey

 

 

 

 

 

 

 

 

 

It seemed that two US most intelligent states in New Hampshire and Oregon are still resisting the powerful forces behind their government to dumified their population by adding fluorine to their water supply.  Oregon has already succumbed this month but New Hampshire remained optimistic to protect their babies at least.  This is what happens when there are too many foreigners in US who are out for profit and hijacking their citizens’ health and mind to live the elusive American Dream.  In the end every one loses including the immigrants as well.

Portland approves adding fluoride to water

USA Today (16 Sep 2012)

PORTLAND, Ore. (AP) — The City Council has voted to add fluoride to Portland’s water, meaning Oregon’s largest city is no longer the biggest holdout in the U.S.

The ordinance approved Wednesday morning calls for the city water to be fluoridated by March 2014.

Health experts say fluoride is effective against tooth decay. Opponents of public fluoridation say it’s unsafe and violates an individual’s right to consent to medicine.

Voters in Portland twice rejected fluoridation before approving it in 1978. But that plan was overturned before any fluoride was ever added to the water.  (link)

New Hampshire Passes First State-Wide Fluoride Warning Law

NEW YORK, June 20, 2012 /PRNewswire via COMTEX/ — Beginning August 4, 2012, New Hampshire will require notification that 6-month-olds should not be routinely fed infant formula mixed with fluoridated water to avoid discoloring babies’ unerupted teeth (fluorosis), reports the Fluoride Action Network (FAN).

Battle over fluoride warning intensifies in New Hampshire

Thursday, March 29, 2012 by: Doug Cragoe

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IQ averages in US States – best estimate available

from actual SAT and ACT

adjusted for the fact that the IQ’s  of these test takers are about 10 points above average

104 IQ  New Hampshire

103 IQ Massachusetts, Oregon, Wisconsin

102 IQ  Colorado, Connecticut, Illinois, Iowa, Kansas, Minnesota, Montana, Nebraska, North Dakota, Oklahoma, Vermont, Washington

101 IQ  Alaska, Maryland, Michigan, Missouri, New York, Ohio, Utah, Wyoming

100 IQ  Arizona, California, Idaho, Maine, Nevada, New Jersey, Pennsylvania, Rhode Island, South Dakota, Virginia, West Virginia

99 IQ  Delaware, Hawaii, Indiana

98 IQ  Arkansas, Florida

97 IQ  Alabama, Georgia, Kentucky, Louisiana, North Carolina, Tennessee, Texas

96 IQ  New Mexico

95 IQ District of Columbia

94 IQ Mississippi, South Carolina

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Take Care

Mikey