In the ever-evolving world of medicine, new discoveries and new cures spring up every so often, and yet there is a field which evades attempts to cure it, due to both complicated pathology and the incurability of many of its diseases. Neurology. Neurology is an important field of medicine, dealing with the brain, which deals with the rest of us. An ever-expanding field, it deals with a large range of disorders, including but not limited to neurodegenerative diseases such as dementia, amyotrophic lateral sclerosis (ALS) and Parkinson’s disease; strokes; epilepsy; multiple sclerosis etc. It’s one of the fastest evolving fields of medicine, not just because of the increase in neurodegenerative diseases and strokes brought on by the ageing population, but also due to the high frequency of new discoveries.
Dr Gary Lau, Clinical Assistant Professor at the Division of Neurology, Department of Medicine of HKU, fondly remembers his switch in specialties. Previously having completed his Master in Research program in cardiovascular medicine, he switched to neurology after discovering his passion during his first clinical rotation. During said rotation in neurology and rehabilitation medicine, he was exposed to patients with a range of neurological conditions. Many of these patients had strokes and incurable neurodegenerative diseases and he wanted to understand more about them and make an effort in better preventing and managing patients with these conditions. Understandably, he was then sucked down the rabbit hole and never looked back. He reflects upon his training and research in cardiovascular medicine, citing it as helping him in his research. Although the areas are largely different, his intricate knowledge of the two systems assisted him greatly in his work, and his skills were not wasted.
Making the Decision
After completing his neurology specialist training, Dr Lau had the opportunity to pursue a PhD programme in Clinical Neurosciences at Oxford. It was an eye-opening experience for him, and he greatly enjoyed the academic environment there. At Oxford, he met many researchers and experts of their fields, as well as academics from all over the world. Dubbing it “a once-in-a-lifetime opportunity”, he also reflects on why he chose to be a clinician-scientist instead of purely a physician. He shares his childhood dreams of being a physician, citing his desire to directly help and alleviate the suffering of patients. However, as he grew into his role as a physician, he slowly realised some of the limitations he had -- as a physician, there were illnesses he could not heal, things he could not understand. This realisation, coupled with his own burgeoning interests in neurological areas, such as dementia and strokes, and his passion for research, drove him to pursue a career as a clinician-scientist rather than just a physician.
Dr Lau’s research
For Dr Lau, one of the main focuses of his research is stroke and neurodegenerative disease. Strokes are one of the most common neurological conditions, with one in 4 adults being at risk of suffering from a stroke. Stroke is currently also the number one cause of death in China. There’s a lot of research to be done in prevention, in reducing patient disability, in better management of them. While Dr Lau was in the UK, he involved himself in research of comparisons of the brain health of stroke patients of different ethnicities, for example, people from the west and people from Hong Kong. By studying the MRI scans in detail, as well as the clinical characteristics and subsequent long-term outcomes of these patients, Dr Lau was able to compare the differences in ‘brain health’ of patients from the UK and from Hong Kong, and was able to better understand the risk factors leading to their strokes, as well as how their ‘brain health’ may influence their outcomes after the stroke. In particular, his research has shed light as to some of the underlying ethnic differences in strokes and provided insights as to why Asians are more prone to hemorrhagic strokes (bleeds in the brain) compared with Caucasians. Although the reasons for this are still unclear, his research has opened up many new directions for further research. Currently, his team is engaged in seeking better strategies for stroke prevention and treatment, through understanding the different ethnic backgrounds and patterns of the stroke. Furthermore, the road to recovery after a stroke is long and arduous, and Dr Lau’s team is also engaged in seeking improvements in management through technology and artificial intelligence, as well as improving the overall wellbeing of the patients and their caregivers.
Furthermore, Dr Lau is also engaged in research on dementia. In our rapidly ageing population, the problem of dementia is ever growing, and the expected growth of the elderly population has led to a projected prediction of dementia cases tripling by 2050. The implications of such a large scale of patients is quite significant, as dementia not only has a huge burden on the patients, but also their caregivers. Unfortunately, the triggers of downstream cascades of dementia, Parkinson’s and other neurodegenerative diseases are still unknown, and we do not have a clear understanding of why certain people are more susceptible to these diseases. In many of the cases above, a cure has not yet been found, and medication and care are merely able to treat the symptoms, reduce the effects of the disease, and slow down the progression of the disease. The root cause of the disease is often not addressed. There is a significant amount of research to be done on neurodegenerative diseases, including searching for cures, improvements, even ways to restore degenerative neurons in the brain to make it healthier again. By understanding the triggers of the disease better, better preventative measures and cares can be carried out.
However, although globally research is being carried out on anti-dementia medications, trials have failed miserably. Dr Lau believes that with the fast progress of the field and increasingly improving and broadening research, and with time and understanding, we’ll get there one day. He also encourages us youngsters to pursue our passions in research, and he believes that the younger generation, with more neuroplasticity and being more creative and ‘less rigid’, will be able to come up with innovative solutions.
So how does Dr Lau fare in the face of such incurable diseases? He believes that there is a delicate emotional balance to be achieved. It’s important that doctors do not become overly attached to such patients, as that can have an effect on their own mental health. However, one of the most important qualities of a doctor is to be compassionate. There are things that we have to accept, like death, disease, etc, but he believes that apart from accepting them, we can also learn from these situations and better understand the factors contributing to the end. The question he most frequently asks is: Is there something we could have done better? It’s ok to become upset, of course, but we should not be over-attached. When we encounter the next patient, we see how we can use that as a driver to improve our management, to reach better understanding, to develop better prevention systems, etc. There is a lot of research currently striving for better understanding and care in the neurological field, for instance the Human Connectome Project. He believes that with the increased knowledge, we will be able to refine and develop better systems of care and prevention.
WeRise program
Dr Lau is also involved in running the WeRise program (風起航) for patients affected by stroke and their caregivers. “WeRise is a medical-social initiative, where the sectors of medical doctors and social workers in HKU have joined hands to see how we can better manage and empower stroke patients, as well as their family members,” he said. After discussions with both academics and social workers, Dr Lau recognized the need for caregiver acknowledgement and social support, as well as a proper recognition and support system for caregiver burden. They realised how a stroke might fundamentally change a family’s dynamics, from affecting the roles in the family to the financials of the family, especially the increased burden on the family member who must care for the afflicted. The reason behind the establishment of WeRise was the realization that medical professionals needed to work together with social workers and social caring counterparts to manage families and patients as a whole, not just the physical or medical side, but also the social and psychosocial side of things. WeRise has invested into videos and e-learning platforms to improve the understanding of strokes by caregivers, as well as increased research on psychosocial care and traditional care. WeRise always welcomes volunteers and researchers, so to those interested, feel free to reach out on their website (https://www.we-rise.hku.hk/). The WeRISE App will be launched very soon in early 2021, and aims to provide a one-stop platform to manage various needs of stroke patients and their caregivers in the community setting.
Being a Doctor
On the topic of actual doctoring, Dr Lau thinks back onto the evolution of doctors’ call hours. Although the infamous 36-hour shifts are intimidating and exhausting, he reckons that the conditions have improved greatly over the years. Although it is not easy to go through many shifts, he says that the shifts have greatly improved his and others’ medical ability, as well as sparked their passions in various areas. The long hours may be gruelling and painful, but being able to directly encounter patients and heal them is an amazing and rewarding experience.
He also discusses the link between the fields of neurology and psychiatry. Neurological conditions involves those that affect the nervous system such as strokes, neurodegenerative diseases, epilepsy etc. and psychiatric conditions are those relating to mental illness such as depression, bipolar disorder, schizophrenia etc. However, many neurological and other medical illnesses bring with it psychological and psychiatric complications, and similarly, psychiatric conditions might be able to be further understood with neurology. Indeed, there are instances where patients with a primarily neurological condition (such as autoimmune encephalitis – ‘encephalitis’ being inflammation of the brain), may present to the psychiatrist first as psychosis may be one of the initial presentations.
Dr Lau reminds us the importance of working in teams -- we all have our own limitations, but by working in a team, the different areas of expertise each person possesses make up for each other. Oftentimes, neurologists and neurosurgeons consult each other, because even as a doctor, as a team, there is a heavy reliance on other health workers, for instance nursing colleagues, physiotherapists, occupational therapists, dieticians, Traditional Chinese Medicine practitioners, social workers, etc. Even seemingly less important people, such as healthcare assistants and porters, are crucial to ensure the smooth running of the hospital and the proper care of patients. It’s important to have mutual respect for others in the team, and to be able to work together well.
Lastly, Dr Lau shares his own insights on how to be a good doctor: it’s important to learn from others, remain humble and be compassionate. Dr Lau says that he has been inspired by countless mentors over the years, and that he has also learned from patients and his previous mistakes. Moreover, he stresses the importance of empathizing with patients. To be a good doctor, it’s important to step into the shoes of others and understand their sufferings and what they’re going through. This also extends to caregivers, where we should try to understand the caregiver burden they have. By having empathy and compassion and understanding what they’re going through, it gives them extra support and makes quite a bit of difference as a doctor. This empathy also extends from being a doctor to other aspects of his life, as he says that having empathy has helped him better understand how to be a better teacher, a better person, as well as shaping many of his endeavours over the years.
Equally as important, Dr Lau stresses upon the importance of trying. Without failure, we would not be able to mature and learn, and after multiple failures, we would finally succeed. A lot of students are afraid of trying, but as he always says, citing his admission into the Oxford program, if you don't try, your chances will always be 0. If you try, your chances will definitely be larger than 0, so even though it’s very small, you never know!
