Dr Dunn’s Heart of the Matter: A trip to the Far East

I have just returned from Hong Kong where I was part of a UK team of examiners on behalf of the Medical Royal Colleges. It was a busy and fascinating week.

The exams are clinically based with the emphasis on communication and eliciting clinical abnormalities such as heart murmurs, fluid in the lungs and enlarged organs in the abdomen.

There was also patients with abnormalities of the central nervous system. Neurology was never my strength.

With the passage of time this has not changed.

The quality of the trainees was impressive and of an equal standard to those in the UK. They were well read, courteous and spoke impeccable English. Most of the patients spoke Cantonese and therefore interpreters were required to aid the examiners at the communications stations. My Cantonese leaves a lot to be desired.

Each UK examiner was paired with a Hong Kong examiner. I was impressed by how close the independent marking was.

One of the bonuses of the trip was the quality of the clinical cases. Some took me back to my early training days when rheumatic heart disease was common and we were experts at working out the source of heart murmurs.

Other cases were equally interesting but in a different way. I have only seen one case of Takayasu’s Arteritis or “pulseless disease” but it is a fairly common disorder in the Far East.

It involves an inflammation and then blockage of major arteries occurring mainly in women under the age of 40.

Sometimes it presents as a stroke, eye problems or a difference in blood pressure between the arms.

When I saw the case in Glasgow, I had no idea what the diagnosis was. Hopefully the next time I will be more clued in.

I had not appreciated the popularity of Chinese herbal remedies. Their shops are more popular than Gucci, Armani and Rolex put together.

One of the cases in the exam involved a patient who had steroid related side effects secondary to a herbal remedy for gout.

Evidently a number of these remedies contain steroids and such activities are unregulated. I was not tempted to try any of their elixirs guaranteed to give endless life.

Smoking remains much more common in China, although it is also prohibited from public places.

A variety of types of hepatitis are also common and these infections can lead to liver cancer and liver failure.

There is also an acute awareness of viral chest infections and masks are still commonly seen both among the general public and in hospital.

This is understandable given the devastating effects the SARS virus had in the recent past.

Although Hong Kong is no longer part of the UK, there remains many similarities in relation to health.

Three of the hospitals we examined in were named after members of the Royal family.

Many of the doctors have spent time in the UK either as undergraduates or at some point during their postgraduate training.

I have kept in close touch with Dr Victor Goh, who spent four years living in Riddrie and working at the Glasgow Royal in the early 1970s.

He has been back in Hong Kong since then and in his spare time wrote part of the musical score for the handover of Hong Kong in 1997.

I went to Hong Kong armed with shorts, sun tan lotion and a skip hat.

The temperature for just about the only time since records began was lower than Glasgow and the sun stayed away.

At least Hong Kong was spared two distinctly pale and somewhat oldening legs.