Interview with the Founding President
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Interviewing the founding president of the Hong Kong Institute of Musculoskeletal Medicine, Hong Kong’s first musculoskeletal physician – Dr. Keith Kwok-wai Chan

People in this modern day and age are often stressed out. As a result, musculoskeletal problems that are common among the middle-aged and the elderly are reported more and more by office workers because most of them have to stay working at their desks for long hours every day - many will try to alleviate their back pain by taking rests and to avoid their knee pain by adopting special walking gait, often to no avail.

Musculoskeletal problems have been an integral part of primary health care in Hong Kong since the 1990s and ranked third in a morbidity survey done locally in a primary care setting with 10% of adults seek medical help because of them1 .  Although being tortured by muscle and joint pain, a lot of Hong Kong sufferers tend to ignore their pain at the earlier stages, only to seek medical help when the pain gets unbearable, hence leading to difficulty in treatment.

There are thousands of reasons causing musculoskeletal problems and searching for the primary cause is no easy feat, hence misdiagnoses are common. Consequently, pain sufferers often have to doctor-hunt for well-renowned physicians, TCM doctors and chiropractors for their treatment. Unfortunately, many local general practitioners and family doctors have limited knowledge and skills in handling musculoskeletal problems due to the lack of in-depth study in this discipline in the medical schools in Hong Kong. Often they have to resort to prescribing paracetamol for general pain, non-steroidal anti-inflammatories (also commonly known as NSAID) for inflammation pain, local injections of corticosteroids for serious fasciitis and to refer those slow or non-responders to orthopaedic surgeons or physiotherapists.

“I completely understand the situation here” said Dr. Keith Chan. “I have practiced as a family physician for many years and a while back, I had set up a clinic working together with my orthopaedic surgeon brother. I have been interested in musculoskeletal medicine since but there weren’t any opportunities for me to pursue further studies at that time. Even though there were many published clinical papers, seminars and workshops in this discipline, there’s no medical school at that time that offered a postgraduate degree training course in this field. I was so excited when the University of Sydney offered a Master of Musculoskeletal Medicine program in Australia in 1996 and jumped at the offer to enroll in it immediately.” Dr Keith Chan continued to comment that because it was the first course in Australia offering a Masters degree in this discipline, many ‘true masters’ all over Australia converged in the class. “Since musculoskeletal medicine had been established in Australia for some years, there were many experienced doctors from this field in the class, sharing with me their valuable tricks and know-how’s. This was an eye-opening experience for me and I really had learnt a lot from them!” In actual fact, Dr Chan himself had also contributed his musculoskeletal experience from his work at the rehabilitation department of Mona Vale Hospital in Sydney prior to joining the program.

Dr Chan continued to explain that musculoskeletal pain not only stems from trauma, inflammation, metabolic diseases and cancers, but also from biomechanical abnormalities, which is the case with many patients. Biomechanical abnormalities could be due to the following 3 factors:

In musculoskeletal medicine, the treatment plan is set to address the above factors so as to cure the root cause of the pain. “Human joints are connected like a train. Should there be any problem with any one compartment; the whole train would be affected. President John F Kennedy of the United States of America served as a prime example. He had suffered from chronic low back pain for years and had tried multitudes of treatment but all in vain. In the end, the root cause of the problem was actually a difference in his leg length, a biomechanical abnormality.  In addition, there are some cases that are seemingly unrelated to, but in actual fact cause by musculoskeletal problems. For instance, migraines could actually be a ‘Myofascial pain syndrome’ caused by ‘trigger points’ of neck muscles because of cervical joint dysfunction.

Dr. Keith Chan returned from Sydney to set up his clinic in Tsuen Wan in 1998, pioneering the new musculoskeletal medicine and techniques that are warmly welcomed by the local patients. In 2004, the Medical Council of Hong Kong formally recognized Dr Chan’s MMPhysMed (Mu.sk) (Syd) as a quotable degree in musculoskeletal medicine. Understanding that musculoskeletal medicine is accepted as a discipline by his peers, Dr Chan devoted his time to educate and passing on his skills to other doctors so that more patients could benefit. Subsequently, he set up the Hong Kong Institute of Musculoskeletal Medicine (HKIMM) in July 2005 and chaired as the founding president. Since then HKIMM supported and organized more than 30 seminars in the past 5 years and to date, more than 10 HKIMM members have completed or completing their postgraduate certification courses in musculoskeletal medicine. Dr Chan said that not only is musculoskeletal medicine an answer to many pain sufferers’ prayers, it also brings job satisfaction to many family doctors. “Patients often come in with a sad, weary face and a limp when I first meet them, but after a few visits, they gloat to me saying that they no longer need their walking sticks and are able to go ‘yum cha’ every morning. What more can a doctor asks for, than to see these happy and grateful faces on their patients?” No wonder Dr Chan always wears a kind hearted smile on his face and not showing any signs of tiredness despite all the heavy work in his clinic every day.

Text: Con
January 30, 2010

1. Lee Albert, Chan Kitty, Wun YT, Ma PL, Li Lina, Siu PC.  A Morbidity Survey in Hong Kong 1994.  The Hong Kong Practitioner, Vol.17 No.6, 1995, pp.246-255.



創會會長專訪

專訪「香港肌胳醫學研究中心」創會會長、香港第一位肌胳醫學醫生—陳國維醫生

現代人生活緊張,腰酸背痛已不止是長者和中年人的專利,其中腰腿痛問題一直以來困擾不少人士。上班族從早到晚坐在辦公室工作,也令肌肉關節痛症頻生,很多患者走路時更會以步姿遷就其痛患處,或者途中頻頻休息,苦無對策。

早於九十年代治療肌胳痛症就成香港基層醫療工作的重要部份,高佔第三位;到家庭醫生求診的成年人有百份之十是肌胳痛症1,可知香港人有多受著肌肉關節痛的煎熬。然而香港人「百忍成金」的精神亦促使很多人在痛症開始時未有加以治理,待病情惡化後才求醫,無疑增加治療難度。

肌胳痛症的成因千絲萬縷,找出主因不易,甚至有誤診情況,以使痛症患者要各地尋訪「名醫」。由於大學醫學院對本科生提供的肌胳科知識十分貪乏,一般基層或家庭醫生對肌胳痛症的處理能力有限:痛症處方止痛藥(如撲息熱paracetamol)、炎症則處方非類固醇消炎藥 (Non-Steroid Anti-Inflammatory Drug,簡稱 ”NSAID”)、嚴重的筋膜炎則在患處打類固醇針 (corticosteroid injection)。對進展不大的病人,只能轉介到物理治療師或骨科醫生處埋。

「由於我早年行醫家庭醫學,很明白這個現象,加上與骨科專科醫生的弟弟共同開設診所,對肌胳痛症非常感興趣,苦無進修途徑;即使外國以前已有很多肌胳醫學的研究文獻、研討會和工作坊,但仍未有醫學院提供一個正規的深造學位課程讓醫生們進修。幸而於1996年,澳洲雪梨大學醫學院開辦了肌胳醫學碩士課程 (Master of Musculoskeletal Physical Medicine),我立即前往報讀。」陳國維醫生又稱,由於是全澳洲這學科的一個碩士課程,班內可謂「高手雲集」。「因為肌胳醫學早早已在澳洲興起,就讀此課程時,我的班內高手們已有很多年醫治肌胳痛症的經驗和心得,使我大開眼界,從他們身上學得不少,得益良多!」其實陳醫生當時已在澳洲悉尼Mona Vale Hospital的康復科處理不少肌胳痛症。

陳醫生解釋,肌胳疼痛除了因為創傷、炎症、代謝疾病及腫瘤引起的疼痛,生物力學的問題 (Biomechanical abnormalities) 亦困擾很多患者。所謂生物力學的問題可歸納以下三種原因﹕

而肌胳醫學正是針對痛楚主因而作出治療方案。陳醫生說﹕「人的關節連環相扣,像一列火車一樣,任何關節出了毛病,整列火車亦受影響。長期嚴重的下腰背痛,屢治不愈,最後發覺是長短腳的生物力學問題出錯所致,美國的John F. Kennedy總統便是最好的例子。再這,有些看上去與肌胳醫學無關的病例,其實正是生物力學的問題;如偏頭痛等,亦可能由肩頸的不平衡,引發肌肉產生『擊痛點』(Trigger point)2 ,形成『肌筋膜疼痛症候群』 (Myofascial pain syndrome)。」

陳國維醫生於1998 年從悉尼回港在荃灣從新開業,把新的肌胳醫學知識和技術帶給病人,深受歡迎。陳醫生並於2004年成功向香港醫務委員會申請澳洲雪梨大學物理(肌骼科)醫學碩士成為香港准予引述的專業資格。肌骼科在得到同業的認同後,陳醫生決定把其所學,傳授其它醫生,讓更多病人得益,於2005年7月成立「香港肌胳醫學研究中心」(The Hong Kong Institute of Musculoskeletal Medicine,簡稱 ”HKIMM”)。五年以來香港肌胳醫學研究中心直接或間接提供的講座、工作坊不下三十個。陳醫生並鼓勵同僚到外國深造,至今已有十多位會員完成了或接近完成肌胳醫學的深造文憑課程。陳醫生又稱肌胳醫學不但是各痛症患者的福音,這科目更令家庭醫生在工作上更有滿足感。「病人由第一次到訪時愁眉苦臉,行路一拐一拐,幾次療程後已不需要助行器,更告訴我可以天天行去飲早茶。看到他們笑容滿臉,做醫生的還有別的事比這更開心? 」怪不得陳醫生即使每天處理很多奇難痛症,不但沒有半點疲態,常常掛著慈祥的笑容。

撰文:康
2010 年1 月30 日

1. Lee Albert, Chan Kitty, Wun YT, Ma PL, Li Lina, Siu PC. A Morbidity Survey in Hong Kong 1994. The Hong Kong Practitioner, Vol.17 No.6, 1995, pp.246-255.
2. Calandre EP, Hidalgo J, García-Leiva JM and Rico-Villademoros F. Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition? European Journal of Neurology. Volume 13 Issue 3, Pages 244 – 249.