Tuesday, May 24, 2016

NHS Hospitals: Old but Good???

Our NHS was founded on some old but good hospitals that were established in London many years ago.

The Background:

Historically, London Medical Schools were established in the hospitals in the poorer areas in order that medical students could have enough cases to practice on and in return the poor patients had the advantages of free treatment. There is nothing like volume for medical training.

For a very long time, doctors trained in London were one of the most valued. A Senior Registrar (yes, in those days) can easily get a Consultant job anywhere else in the Commonwealth and often a Professorship (British styled ones). In other words London trained doctors are a highly exportable commodity.

“The shape of the London hospital system has also been affected by developments in medical science and medical education. In many ways it has been the activities of doctors which have determined the pattern of the hospitals. The increasing ability to treat disease and improved standards of care shortened the time patients spent in hospital, raised the demand for services and led to an escalation of cost. The development of specialisation led first to the development of the special hospitals and later to special departments within the general hospitals. Advances in bacteriology, biochemistry, physiology and radiology created the need for laboratory accommodation and service departments, so that hospitals no longer consisted merely of an operating theatre and a series of wards. Sub-specialisation ultimately meant that services had to be organised on a regional basis and the very reputation of the capital’s doctors affected the number of patients to be seen. The hospitals of central London have long served a population much larger than their local residents.

It is against this complex background of population movement, poor social conditions, disease, wealth and poverty, professional expertise, critical comment and publicity that the London hospitals developed. A complex institutional pattern emerged. Voluntary hospitals grew up beside the ancient royal and endowed hospitals. A local government service providing institutional care for sick paupers developed alongside the hospitals. A network of fever hospitals, scientifically planned from the outset, was established. Physically near to each other, staffed by doctors who had trained in the same hospitals, and often serving the same people, the different objectives and status of the institutions led them to work in virtual isolation from each other. Each hospital had its own traditions and nobody standing in the middle of a ward could have doubted for a moment the type of hospital he was in. Countless details gave each an atmosphere of its own, and the different methods of administration and levels of staffing set them apart.” Geoffrey Rivett

Royal National Orthopaedic Hospital

Most of my Medical School Orthopaedic Surgeons were trained here.

The hospital treats almost 10,000 patients a year.

Although most patients would not consider travelling too far for a routine hip replacement, which can probably be done as well in their local district general hospital, the specialist clinics at the Royal National Orthopaedic may provide a reason to make the journey.

Specialist clinics deal with bone tumours, scoliosis (curvature of the spine), rheumatology, spinal injuries, specialist hand and shoulder conditions and sports injuries.

National Hospital for Neurology and Neurosurgery

The Cockroach Catcher was there.

So was the MP, as a patient.

If you have a head injury, stroke or condition affecting the brain, such as Alzheimer's, epilepsy or multiple sclerosis, this is the place to go. Along with the nearby Institute of Neurology, it is major international centre for treatment, research and training. The National Hospital for Neurology and Neurosurgery has 200 beds at its central London site near Euston station, and treated more than 4,500 in-patients and 54,000 outpatients last year.

Perhaps not for sale so soon. Or saving it for the needy MPs?

Neurologists wear bow ties in my days.

Royal Brompton & Harefield NHS Trust

The largest specialist heart and lung centre in the UK, the Royal Brompton and Harefield acquired its reputation through the work of Sir Magdi Yacoub, the internationally renowned surgeon who pioneered heart transplants in theUK the 1980s.

The trust attracts staff and patients from across the country and around the globe, and is a centre for research with between 500 and 600 papers published in scientific journals each year. Its 10 research programmes each received the highest rating in 2006.

Each year, surgeons perform 2,400 coronary angioplasties (where a balloon is threaded through an incision in the groin to the heart and expanded to widen a blocked artery), 1,200 coronary bypasses and 2,000 treatments for respiratory failure – so they do not lack for experience.

Other specialist heart units with strong reputations are Papworth Hospital, Huntingdon, where Britain's first successful heart transplant was carried out in 1979; and the Cardiothoracic Centre, Liverpool, formed in 1991.

The Royal Marsden NHS Trust

The first dedicated cancer hospital in the world, founded in 1851, is still the best. With the Institute of Cancer Research, the Royal Marsden is the largest comprehensive cancer centre in Europe, seeing more than 40,000 patients from the

and abroad each year.

It has the highest income from private patients of any hospital in Britain, testifying to its international reputation.

Very ready for Medical Tourism!!!

Royal National Throat, Nose and Ear Hospital

The country's largest ear, nose and throat hospital is also Europe's centre for audiological research, with an international reputation for its expertise and range of specialties, all on one site on London's Gray's Inn Road.

Its services range from minor procedures such as inserting grommets (tiny valves placed in the eardrum of a child to drain fluid from the middle ear) to major head and neck surgery. A quarter of its 60,000 patients were referred from other parts of the UK and abroad last year. The hospital has a cochlear implant programme, a snoring and sleep disorder clinic, and a voice clinic, the oldest and largest in the UK. One in 25 people develops voice problems such as hoarseness, but it rises to one in five among, for example, teachers, actors and barristers.

A measure of the Royal National's success is the fact that one third of patients referred from other clinics or hospitals with voice problems has their diagnosis changed on investigation there. Although there are many other centres where throat, nose and ear problems can be treated, none are pre-eminent enough to be included in this guide.

Wow!

St Marks Hospital, Harrow

Britain's leading national and international referral centre for diseases of the bowel is the only hospital in the UK and one of only 14 worldwide to be recognised as a centre of excellence by the World Organisation of Digestive Endoscopy.

It is a chosen site for the NHS bowel-cancer screening programme being rolled out across the country, which seeks to detect and treat changes in the bowel before cancer develops. Bowel cancer is the second most common cause of cancer in the

but often goes undetected because sufferers can fail to report important symptoms, such as blood in the faeces, often out of embarrassment.

Bowel cancer can be treated via colonoscopy, to find and remove polyps – growths on the wall of the bowel. The hospital's education programme attracts clinicians from across the UK and overseas with the aim of spreading good practice elsewhere.

The hospital is part of the North West London Hospitals Trust.

King's College hospital NHS Trust

The liver unit at King's is the largest in the world. It is one of 31 specialist liver units in the UK, but none can match it for expertise, facilities or state of the art equipment. It offers investigation and treatment for all types of acute and chronic liver disease, which is increasing in the

The unit performs 200 liver transplants a year, and more than 200 patients with liver failure are admitted to its intensive care unit each year.

King's carried out the first successful transplantation of islet cells – part of the pancreas involved in producing insulin – in a Type 1 diabetic, greatly reducing his need for injected insulin. Last month, the Department of Health announced plans to establish six new islet transplantation centres round the country, based on the research at King's.

The Maudsley Hospital

The Cockroach Catcher was there too.

One of

Britain

's oldest hospitals, the Maudsley's contribution to mental-health care stretches back at least 760 years.

Today it is a centre of excellence for the delivery mental-health care. Its addictions centre offers new treatments for drug abuse, alcoholism, eating disorders and smoking, it provides innovative care for disturbed children and adolescents and is the largest mental-health training institute in the country.

It has pioneered new approaches to the treatment of heroin addiction and its specialists have raised concerns over the link between cannabis and schizophrenia which have led the Government to review changes to the law.

Great Ormond Street Hospital NHS Trust

Ignore the bad press, GMC can no longer investigate its CEO as she has de-registered herself.

If you have a child with a rare or complicated disorder, this is the place to come.

And they do and many are from the Middle East.

So the bad press would not matter, good for the Medical Tourist trade.

It is the largest centre for research into childhood illness outside the US, the largest centre for children's cancer in Europe and delivers the widest range of specialist care of any children's hospital in the

Great Ormond Street won't treat just any patient, though: it only accepts specialist referrals from other hospitals and community services – in order to ensure it receives the rare and complex cases and not the routine.

I have done that: see Teratoma: An Extract

Paediatrics is one of the most rewarding areas of medicine for doctors because it has seen some of the most spectacular advances over the past 30 years, especially in cancer, where survival has improved dramatically.

Many of those cared for at GOSH still have life-threatening conditions but they are promised the best care both because of the expertise of its medical staff and because of the trust's extraordinary success in attracting charitable donations, which have made it among the best-funded medical institutions in the country.

Baby P or no Baby P.

Moorfields Eye Hospital

My eyes still well up when Moorfields is mentioned. Honest.

The largest specialist eye hospital in the country and one of the largest in the world, Moorfields was founded in 1805. It treats more patients than any other eye hospital or clinic in the UK and more than half the ophthalmologists practising in the

have received specialist training at Moorfields.

However, in recent years the hospital has relied too heavily on its reputation and grown complacent. Though standards of academic excellence are still high, it has neglected the services it offers to patients, which were rated weak on quality by the Healthcare Commission in its annual health check last year.

The hospital carried out 23,000 ophthalmic operations last year, providing surgeons with extensive experience on which to hone their skills. The reputation of the trust is such that it has started to run clinics in distant hospitals, capitalising on its brand. The hospital employs 1,300 staff who work on 13 sites.

Perhaps it is not so good to be following on commercial branding. Stick to medicine!!!

Despite its recent problems, Moorfields remains

Britain

's most highly-regarded eye treatment centre. No alternative hospitals have a comparable reputation.

For bargain hunters then.

Material drawn from The Independent.

So do you really think that hospitals are not necessary, or not necessary for the average citizen of England. Soon they will be sold and it will be costly to buy them back.

What about medical training? If these hospitals are sold, who pays?

And watch out, someone, your parent, your spouse, your child and even your MP may need a Hospital Consultant one day.

Say something now.

Cassius:
"The fault, dear Brutus, is not in our stars,
But in ourselves."

Julius Caesar (I, ii, 140-141)

Thursday, April 14, 2016

The Cockroach Catcher: On Kindle!

Spring is here:

Kindle comes in very handy, literally. Yes a 3^rd generation gadget that allows you to store and read books and other printed material. You can pack with you thousands of books on this device that weighs less than a paperback.

This has inspired me to launch a Kindle edition of The Cockroach Catcher (yes, the book). More importantly, the Kindle edition costs a fraction of the physical copy. If you do not yet own a Kindle, you can simply download the free Kindle software and read Kindle books on your iPhone, iPad , iPod touch & your Personal Computer. You can read the book within seconds from ordering. US Verson

Amazon Kindle UK £0.99, Amazon Kindle US $0.99

Here are some reviews:

HyperCRYPTICal

I purchased Dr Am Ang Zhangs’ book last November and placed it at the bottom of my ‘to read’ pile – I should not have done so.

Holidaying earlier this year – I decided that ‘The Cockroach Catcher’ would be my holiday read (even though it was still only half way up the pile) – it was a good decision.

Am Ang takes you on a fine journey from his poor beginnings in China to his education in Hong Kong, his life and experience at medical school, his decision to enter psychiatry leading to a post as registrar at The Tavistock Clinic and to his role as a consultant paediatric psychiatrist within the NHS (and many interesting places in between).

Dr Zhang had a common sense approach to the children in his care, intuitively finding the answer to their problems, cases ranging from sleep and toileting problems to those of anorexia, autism and psychosis - although towards the end of his career, red tape and ‘guidelines’ were to impact on his practice.

His book also gives insight as to how we as parents may influence the mental health of our children and how childhood is being medicalised when behaviours are due to lack of parental authority and/or guidance and are not psychiatric illness at all.

Although the back cover summary describes the book as a work of fiction, the contents are based on a good and a very real doctors’ journey through medicine. It is a must read for all those either working in medicine or interested in child psychiatry and indeed childhood itself, and an invaluable read for parents who have concerns regarding their children’s mental health.

It is a fascinating well penned book with references documented in the footnotes and is available from Amazon. Visit the cockroach catcher here

Anna :o]

5.0 out of 5 stars

A Must-read for Students of Psychiatry August 10, 2014

By John Yam

Format:Paperback

We all have stories to tell with regard to our experiences as physicians. Zhang is one of our medical school classmates who took it to a different level by writing and publishing a book. The book details how it all started, from the time his family moved to Hong Kong from China, to his years in medical school, to his experience as a child psychiatrist in the UK. The book is full of interesting case studies of actual patients he saw and the challenges he faced dealing with them.

I was captivated by many of the interesting stories in the book. It’s a must-read for all students of psychiatry. It also makes for good reading material for anyone during their leisure moments.

From another doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice (including me giving up private practice and my wife giving up a promising administrative career ) paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

From Australia:

I have finished reading The Cockroach Catcher and thoroughly enjoyed it.

Zhang, I particularly liked the juxtaposition and paralleling of your travel stories and observations with your case studies, Of course, I could appreciate it even more, knowing the author and hearing your voice in the text. Because I’m dealing with anorexia, ADD and ADHD students I was very interested in your experiences with patients and parents and your treatment. Amazing how many parents are the underlying causes of their offspring’s angst. It was an eminently readable text for the medically uninitiated like me. Keep writing, Zhang

From another doctor:

Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.

I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.

The book is very well written and makes very easy and interesting reading even for the laymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

Fascinating account of child psychiatry cases, including some creative yet effective treatments. Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.

The book makes me realize the difficult decisions with which a doctor is so often faced, the need for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.

Great book. I have bought one to give to my son on his birthday.

From Chez Sam’s:

“And CC, your book is amazing! I am only on page 44 but so far, so wonderful. I think how you turned this anorexia patient around just goes to show what human interaction rather than tick box protocols can do in a short period of time and at low cost too. This is an exemplary illustration on perhaps one of the reasons why a good health system like the one in Singapore can not be fully implemented in Britain. it's the change of perceptions and methodology to suit that's difficult.

And, as a city girl, I found your early life in villages fascinating and very enriching for a bright child like yourself, I suppose, had I been your mother, I too would have not asked you any questions when you were told to leave that school ... but the school supplier of cockroaches! [shiver]Dearime! I run a mile when I see one, let alone catch them and dissect them! boys will be boys after all, now that I know that you weren't joking. you are a cockroach catcher, not only of the soul, but for real! @@

The book is a must read doc, I am really enjoying it :-)”

More here>>>>>>

From the LULU.com website, where you can preview the chapter Seven Minute Cure and if you so wish, order a copy of the book (after creating your own account):

Fascinating! What a great read. Just reading the one chapter made me want to read the whole book. Thank you!

A beautiful opening! A piece written with of all that wit, intelligence and sarcasm! The author has managed to illustrate a boring NHS subject in the most interesting of ways. He has convinced me to read on. The NHS should urgently seek help and advice from this doctor!

Thank goodness for doctors like these!! If the rest of the book is as good as the preview chapter then it will be a fantastic resource for practitioners and the public.

Fascinating preview chapter. I can't wait to read more.

Horrah for the doctor. Chapter 1: The Seven Minute Cure. The doctor overcame the obstacles faced from the establishment and freed a young child from her prison. Great read.

Other reviews and feedback:

Absolutely riveting! Brings me back to working (in NHS psychiatry) when work was really interesting! The tone is quite conversational; it is like hearing you telling stories. I ordered more copies for my family and friends.

I knew it would be very special and it sure is. To us your trainees it is like going back on the rotation to have the joy of working with you again. The difference is that l can now learn at leisure from this book. Congratulations.

The book is very well written and makes very easy and interesting reading even for thelaymen. You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

Fascinating account of child psychiatry cases, including some creative yet effectivetreatments. Anyone who is a parent or around children or really anyone at all actually will find the book surprising, entertaining, thought-provoking, funny and moving.

The book makes me realize the difficult decisions with which a doctor is so often faced, theneed for him to have faith in himself and, coupled with that, the need for continued idealism and enthusiasm. These don't, of course, apply only to doctors but are particularly important for them.

Great book. I have bought one to give to my son on his birthday.

(Note: both father and son are doctors.)

I was in Special Education for many years. I just love the way you dealt with the girl who was bullied, and the boy with Behaviour Disorder. I am buying two more copies, one for my friend who is a psychologist and one for a colleague in Special Education.

I wish I had read your book when I was headmistress. I would have had so much more insight into why some of the pupils behaved the way they did.

I have been a school counsellor for 15 years and we have had regular recommendations on books to read. None of them taught us as much as your book, which would have been very useful for our weekly screening meeting discussions.

Reading the book and his blog, you cannot help admiring the author's width and depth of knowledge, the light-heartedness, the humility, the humane and the human side of people.

You learn a lot about the Health System, a lot about child psychiatry and a lot about the growing up and development of the author.

What a book! I cried a little. I laughed a little. I know I should not.

Your stories are amazing. I really enjoy reading it.

My wife cannot put your book down and I shall not be able to get my hands on it until she has finished.

I was horrified by some of the gruesome cases and agonised at the suffering of some of your patients. But there are moments of laughter and smile at Dr Zhang's wit in handling the cases and patients.

Am Ang, thank you for a wonderful book. You know I could not put it down. My husband is now reading it and he said it is such an easy read as he thought it was all going to be heavy and clinical.

You have such a way with the little ones. What about the 12 year old pretending to be three and a half! My goodness.

Just the village life can fill a book. (Seriously an in-depth version will be much welcome!) Book two can be Life at HKU. And so on... Fascinating!

Having grown up in farming country, I love the Chapter on The Village. I know it is different but so much about village life just clicked with me. Makes me wants to go home to have a look. I would like you to write more about yourself. Just all the little details you are so good with.

I wish I had your book when I was bringing up my kids. I am giving each of my two children a copy. I decided to put down Pillars of The Earth for a while and start your book on a flight. I could not put it down to go to sleep. Wow: it makes so much sense.

I did expect the cover photo to be one of yours – after all, the creative mind needs full exposure, artistic and otherwise. I was just recommending it to some friends.

I never imagine I can have so much fun and gain so much knowledge by reading a book of this sort by, of course, an author with a sense of humour and a deep understanding of human nature. I really enjoyed reading it. Life could be so much easier if we had the chance to do what we like, to let our thoughts be shared by someone we trust, to make sugar pills of nasty encounters and so on and so forth for bearing more positive thinking. Just by a mere short conversation, which hit exactly at the 'dead pit' of the hiccup boy, the hiccup was over. Human nature is just like that. After reading the author's accounts of his cases, I wish I could also be endowed with such wit and wisdom, not so much for curing others, but to let my own body and soul remain healthy and sound always.

Love it. I read it in three days flat. Not only should parents read it; I think all those in the medical profession should read it. There is so much common sense. I am recommending it to my book club. Will you come and talk to them about it?

Review on Amazon