Dr Chia Chung King

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Dealing with a diagnosis of cancer is never easy. The big “C” word he calls it. Especially so if he is young, doing well in life and has the whole life ahead of him.

Yet he faced it with such courage it puts me to shame. At some point I even feel that he is trying to make me feel better.

I sat and we chatted. Explained things as best as I could. Making small talks to try to hide my own distress. I want him to know that I will be there for him. I will walk the journey with him and guide him. I ache inside of me.

I was taught that doctors should always emotionally distance themselves from the patient. I could not do that, after many years of trying. I feel for them to the point of affecting my own life at times. My family suffers.

Such is the price of empathy. For me, at least.

, food that many people love. Do you know that you have to chew your mushroom properly before swallowing? You see, our digestive system is not able to “dissolve” the mushroom. If you were the swallow the mushroom whole, it would remain whole in your gut. In severe cases, the mushroom can block your intestine completely and you will need surgery.

I just discharge a young female patient who have been having abdominal for many years and had many investigations that did not find anything wrong. Careful history reveals that she often eat very quickly and possibly swallows her mushroom whole before the current admission.

She is not the only one. I have had quite a few similar patients. Told them to chew their food properly and they never return. I can only guess that chewing their food solved their problem and they no longer need me🤣

So guys, chew your food properly🤣

My updated name card:

We have expanded into 6 clinics but I am based in Mount Alvernia Hospital and Mount Elizabeth Novena Hospital

Just reviewed a patient today. She is completely well and happy with the outcome.

2 weeks ago she had pain in the middle upper abdomen. Pain in this area is usually caused by stomach or gallbladder problem.

Investigations however, showed that the stomach and the gallbladder were completely normal.

Had a long discussion with her and explained that sometimes, patient may have an unexpected diagnosis. i.e. a symptoms that does not correlate with the eventual diagnosis. We agreed to proceed with CT scan abdomen which showed an inflamed appendix. The diagnosis was !

It was atypical in a few ways: appendicitis usually has pain in the paraumbilical area and then the pain migrates to the right lower abdomen. Her pain was always in the upper mid abdomen. Usually patient with appendicitis will have fever, raised white blood cell and C-Reactive protein. She had none. Examination usually would show a "guarding" where the abdomen feels hard. Hers was completely soft.

The reason why her symptoms were atypical was because her appendix is in a different position compared to other people!

Fortunately all the investigation and diagnosis was done in a timely manner and patient had her operation and responded well to treatment.

I learned that it is important to keep an and keep looking for the diagnosis until the mystery is solved. Be willing to accept that sometimes, we may be wrong in the first instant. Lastly, it is very important to explain to patient every step of the way.

Public education

Part of my work is to educate the public. Public education is hard work as we may not be able to reach out to people who do not attend seminars or zoom sessions. I recently spoke at a session with RSVP.

RSVP is a special group of volunteers who have been actively engaging with a large community. The people they are able to reach out to far exceed what a typical seminar can do. Partnership with them is thus far more effective.

A few myths of colonoscopy that I tried to dispel during the session:

1. colonoscopy is painful and dangerous: in expert hand, colonoscopy is a comfortable procedure with very minimal risk.
2. Bowel prep is terrible: Modern bowel prep is easy to take, speaking from personal experience
3. Colonoscopy is expensive: there is a program that offers colonoscopy at very affordable price, fully covered by medisave.
4. colon cancer is not preventable: colonoscopy prevents colon cancer
5. I don't need it: colon cancer is very common: No 1 in male and no 2 in female

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What keeps doctors going...

A smile on the patient's face.

Recently had a patient who came to me for multiple medical problems. Advanced dementia with behavioural problems, sepsis from acute cholecystitis with perforated gallbladder and severe malnutrition from poor feeding. Sweet old lady well loved by family. Had to manage her medical conditions with a team of doctors. After a difficult period where she underwent open cholecystectomy (surgery for the gallbladder), antibiotics treatment and PEG insertion (endoscopic procedure to insert feeding tube directly to the stomach) she was finally discharged.

Today was her review. All is well. She started connecting with her family after months. Started walking with assistance and nutritional status was excellent. She rewarded me with her somewhat shy smile. 😁

All that she could remember about me was the joke I told her in Teochew

Lessons I learned from this case:

1. Do not write off patient with dementia: a big part of the confusion could well be due to delirium (confusion worsened by medical conditions) and can be reversed
2. Be brave and take calculated risk in partnership with the family and fellow doctors. Decision to go ahead with open cholecystectomy and PEG insertion in a patient with advance dementia were no easy decisions but I am glad we took the right steps

and...

I am glad I learned Teochew from my grandfather, jokes and all.

Dr Chia has joined gutCARE

Dr Chia Chung King.
MBBS, MCRP (UK), MMed (internal medicine), FAMS (gastroenterology), FAMS (internal medicine), FRCP (Edin), MSHPEd

Adjunct Associate Professor Yong Loo Lin School of Medicine, NUS
Adjunct Associate Professor Lee Cong Chien School of Medicine, NTU
Associate Dean (2010-2015)
Program Director (2013-2017)

Dr Chia is an experienced specialist in gastroenterology, previously from Tan Tock Seng Hospital.

Dr Chia won many teaching awards and service-related awards while working in Tan Tock Seng Hospital. He was also awarded the Courage Star by President S R Nathan of Singapore, for putting himself at risk, tending to SARS patients in the front line.

Dr Chia Chung King Dr Chia Chung King is a medical specialist in gastroentorology and internal medicine

My new name card.