Dr Bryan Kek

16/05/2026

(The accompanying image is for illustrative purposes only)

Imagine looking in the mirror brushing your teeth, only to realize one of your pupils is suddenly twice the size of the other.

That is exactly what happened to a healthy 25-year-old lady who rushed into the clinic, understandably terrified.

When a patient presents with unequal pupil sizes (anisocoria), our medical instincts immediately jump to the worst-case scenarios. Is it an intracranial pathology? An expanding aneurysm? A brain tumor? A stroke?

A thorough neurological examination was performed. Cranial nerves? Completely intact. Extraocular movements? Perfect. No headaches, no blurry vision, no limb weakness, and no trauma. She was neurologically pristine, except for that one glaringly dilated pupil.

So, what caused it?

The culprit wasn't a brain emergency. It was her antiperspirant wipes, bought from an online store.

Many antiperspirant wipes contain anticholinergic agents which block acetylcholine, turning off the signal to the sweat glands.

The patient used the antiperspirant wipe on her face and inadvertently rubbed or touched her affected eye and the anticholinergic medication was absorbed locally, blocking the parasympathetic receptors in that eye.

Without acetylcholine to constrict the pupil, the sympathetic system went unopposed, causing the pupil to dilate widely and she was left with striking, unequal pupils.

I advised the patient to stop using the wipes temporarily. At her follow-up review a few days later, the problem was completely resolved. Her pupils returned to normal and symmetric. No expensive scans, no invasive test, just the natural clearing of a topical side effect.

Sometimes, patient may experience relatively harmless conditions which look terrifying. While we must always rule out life-threatening conditions, meticulous history-taking is sometimes the most powerful diagnostic tool a doctor has.

It also highlights a vital truth about healthcare, not every terrifying symptom requires an immediate trip to a specialist or an emergency department.

Navigating the healthcare system effectively means using the right services at the right time. A properly trained General Practitioner (GP) possesses the diagnostic skillset to look at the whole picture, filter out the true emergencies, and solve complex clinical puzzles right in the clinic.

Before rushing for an expensive MRI or a specialist referral, starting with your family doctor can save you unnecessary anxiety, time, and intervention.

10/05/2026

The world is currently monitoring an outbreak of the Andes virus linked to the luxury cruise ship MV Hondius. This vessel departed from Argentina in early April, and cases have since been identified in several countries.

⚠️ Why this matters: The Andes virus is the only hantavirus known to have the potential for human-to-human transmission through prolonged close contact.

😷 THE IMPORTANCE OF MASKING
Because the Andes strain can spread between people, masking is a critical preventive measure.

While there are currently no confirmed cases of the Andes virus in Malaysia, being prepared is the best way to keep our families safe. In our interconnected world, understanding how to spot a potential threat before it spreads is a vital part of modern healthcare.

🔗 WHAT IS AN "EPID LINK"?

An Epid Link is the "How" and "Where" a person might have been exposed. You have a strong link if, in the last 6 weeks, you have had:

✈️ Travel History: Recently returned from the MV Hondius cruise ship or areas with confirmed outbreaks of the virus.
👥 Direct Contact: Close contact with a confirmed Andes virus patient.
🐀 Rodent Exposure: Handled rodents, their nests, or waste.
🏚️ Environmental Exposure: Cleaned dusty, enclosed spaces like old sheds or attics with potential rat droppings.

📋 THE "SUSPECTED CASE" CHECKLIST

We call someone a Suspected Case if they meet both clinical and exposure criteria:

🌡️ Clinical Signs: Sudden high fever (more than 38 degrees Celsius), severe muscle aches (thighs/back), and exhaustion.

➕ PLUS the Epid Link: Had one of the exposures mentioned above within 6 weeks.

🔬 THE REALITY OF TESTING:

It is important to know that there are currently no widely available "rapid tests" for Andes virus that you can buy at a pharmacy. Diagnosis can be very similar to other conditions, and it often requires an experienced doctor to distinguish between the conditions based on subtle findings.

To support early diagnosis, my clinic offers a basic morphology review of peripheral blood smear to distinguish between similarly presenting conditions.

Speak to me to learn more.

09/05/2026

I’ve been binge watching "The Pitt" lately and it’s a breath of fresh air. For those of us in the field, medical dramas are often a cringe-fest of technical errors. But this show? The accuracy is sharp, the stakes feel genuinely high, and the visualization of actual medical procedures is some of the best I’ve seen. It captures that raw, fast-paced reality of clinical life where every second counts.

One scene in Season 2, Episode 8 really hit home. Dr. Robby and Dr. McKay are treating a terminal patient in agony. Robby orders an increase in her morphine to a heavy dose to manage her pain. McKay hesitates, fearing it will suppress her respiratory drive and lead to her death.

Robby’s response? He invokes the Doctrine of Double Effect (DDE). It explains why it might be okay to do something that has a bad result, as long as you were actually aiming for a good result.

Since this is an ethical tightrope in palliative care, I wanted to dive deep into the four pillars that make this doctrine work:

🏛️ The 4 Pillars 🏛️

1️⃣ The Nature of the Act: The action itself must be good or at least morally neutral. In practice, administering medication to relieve pain is fundamentally an act of compassion, not an act of harm.

2️⃣ The Means: The "bad effect" (death) must not be the means by which you achieve the "good effect" (pain relief). We aren't aiming for death to stop the pain. The morphine stops the pain through its pharmacological action: any respiratory suppression is an unfortunate, separate consequence.

3️⃣ The Intention: Only the good effect must be intended. The bad effect can be foreseen, but it must never be the goal. The intent is the alleviation of suffering, not the cessation of life.

4️⃣ The Proportionality: There must be a sufficient reason to risk the bad effect. In terminal cases where suffering is unmanageable, the benefit of a dignified end outweighs the risk of a slightly earlier passing.

💊 Does Morphine Actually Hasten Death? 💊

🧪 This is a question I hear frequently from patients and their families. It is completely understandable to worry that giving a loved one morphine will be the cause of their passing.

🧬 However, looking at over 20 years of scientific studies in palliative care, the reality is clear: appropriately titrated opioids like morphine do not hasten death. When used to manage pain and "air hunger" (severe shortness of breath), patients quickly develop a rapid tolerance to the respiratory effects while still receiving the crucial benefit of pain relief.

⚠️ The real danger is actually the under-treatment of pain. When fear causes hesitation, patients are left to suffer unnecessarily in their final hours. Ultimately, it is the underlying disease (like terminal cancer or organ failure) that causes death, not the comfort measures. The morphine simply ensures the patient is not in distress when the illness takes its course.

🕯️ A Quiet, Heavy Truth 🕯️

🕊️ There is a sensitive perspective here that we often discuss in hushed tones in the corridors. If we follow the DDE and the unintended (but foreseen) side effect is that the patient passes away shortly after finding relief, we have to ask ourselves: Is that truly a "bad" outcome?

✨ When a patient is finally free from a body that has become a source of nothing but pain, that transition, though heavy for us, is often a mercy. If the unintended side effect is a peaceful passing, free from the physical and emotional trauma of suffering, then perhaps we have fulfilled our most sacred duty: to ensure dignity when a cure is no longer possible.

Palliative care is a human right. We are taught to "cure sometimes, relieve often, and comfort always."

The DDE is a rigorous ethical framework that allows us to be compassionate without compromising our integrity.

It’s rare to see a TV show handle these nuanced theories so accurately. It reminds us that medicine isn't just about biology: it's about the heavy, human responsibility of making the "impossible" choice.

22/04/2026

If we do not regulate the cost and quality of hearing health today, our health care system will pay a much higher price for dementia wards tomorrow.

01/04/2026

The silence in our clinics has always been a heavy thing. For close to thirty years, that silence was filled with a quiet, persistent worry that we were being forgotten.

We stood at the front lines while the world changed around us, holding onto a fee schedule that felt like a ghost from another lifetime. We watched the cost of everything rise while the value of our own time remained yesterday's news.

But today, the long wait has ended. The news that the revised fee schedule has finally been gazetted feels like a sudden, deep breath after being underwater for far too long.

This is not a victory of numbers or a win for the balance sheet. It is a victory for the tired doctor who stays late to explain a difficult diagnosis to a worried parent. It is a win for the GP who has spent years wondering if they could afford to keep their clinic doors open for the neighborhood they love. For two decades, we carried the weight of a rising world on our shoulders while our own hands were tied by outdated regulations. We balanced compassion against cost, often at the expense of our own well-being. Today, that burden has finally been acknowledged.

When we talk about this new range of RM10 to RM80, we are talking about the survival of the family doctor. We are talking about the ability to look a patient in the eye and give them our full, undivided attention without the nagging fear of whether the clinic can afford the utility bills or the rising costs of life-saving equipment. It is about the dignity of our profession. It is a signal to the next generation of healers that their clinical judgment matters and that their dedication to primary care is seen by the nation.

We have always been more than just dispensers of medicine. We are the keepers of family secrets, the calm in the middle of a health crisis, and the familiar faces that children grow up trusting. We have walked through the fire of pandemics and stood by our patients through every cough, every fever, and every heartbreak. We do this work because we love our communities, but love alone cannot sustain a practice or provide the modern standards of care our patients deserve.

This gazettement is the recognition we have waited half a career to see. It means that the heart of Malaysian healthcare can keep beating. It means we can continue to be the healers we were meant to be, serving our neighbors with the excellence and empathy they have always deserved. Today, we are not just surviving. Today, our profession has been given the respect it earned a long time ago.

30/03/2026

I visited an elderly lady with terminal cancer, a diagnosis that cast a heavy shadow over her household. They knew her long term prognosis, and they had been preparing themselves for the inevitable.

However, on this day, the crisis was acute. She had developed pneumonia. Her daughter met me at the door with eyes full of conflict. She asked me if this pneumonia was the end. She wondered if they should just focus on comfort, or if there was still a reason to fight the infection.

This is a common hurdle in complex care. Families are often presented with a binary choice. You are either "giving up" or you are "going all out." This is a logical fallacy. Medicine is not a simple on-off switch. It is a spectrum calibrated by the patient’s functional reserves and the needs of the family as a whole.

In this case, my assessment showed that despite her cancer, her baseline functional reserve was still good. This was a reversible problem that could be fixed and give her many more meaningful moments and time with her loved ones.

True stewardship means using the right drug, at the right dose, for the right duration. To do this responsibly, we must replace guesswork with evidence. PCR test was performed which allowed us to move away from broad guesses and toward a more specific treatment

The Outpatient-based Parenteral Antimicrobial Therapy (OPAT) was highly effective. Three days later, her fever was gone and the rattle in her chest was silent. Because her functional reserve allowed for an active recovery, the entire family gained more precious, quality time together.

This experience reinforces my core philosophy. We must treat the patient and the family as a whole unit. Our goal is not just to add days to a life, but to add life to the days.

WhatsApp me at 0168804697 to schedule an appointment for a home visit.

03/03/2026

One final visit.

After more than three years of walking this path together, my patient has finally found peace. Standing in the quiet of the funeral home today, surrounded by the scent of incense, I felt a deep sense of a journey coming full circle.

Three years is a long time. It is long enough to move past being just a doctor and a patient. It is long enough to become part of each other's lives, sharing the small wins and navigating the hardest days. While my heart is heavy, there is a quiet relief in knowing that the suffering has finally ended. To see that long physical struggle replaced by such stillness is a mercy.

I have always believed that care does not end with a final breath. It continues in the way we honor a life lived and in how we stand by the family members who gave so much of themselves. To the family, your devotion has been a privilege to witness. My clinical role may have finished, but my respect and support for you remain.

Rest well. Your journey here is complete, and it was an honor to be there until the very end.

🙏🙏🙏🙏🙏

05/02/2026

Death is a universal destination, but the journey there is different for everyone.

I visited a 63 year old lady. Advanced breast cancer had already claimed so much of her physical strength that she had requested a terminal discharge. She was done with the white walls of the hospital. She wanted the familiar scent of her own pillows and the quiet of her own room. When I arrived, she wasn't keen on visitors, and I respected that. I didn't need her to speak to understand her. One look at her told me everything about the pain she was carrying and the transition her body was making.

I sat with her sons in that quiet, personal environment. We spoke about the reality of the days to come, but we also spoke about things that aren't found in medical textbooks. We talked about looking beyond her physical shell to see her mind and her spirit. In palliative care, our work is to preserve dignity when the body can no longer be mended. There was a heavy, sacred sense of acceptance in that house. They knew it was time, and they were giving her the greatest gift a family can give: the permission to go in peace, in the comfort of home.

The second house visit felt like a different world. It was for an 86 year old man who had been relatively well until very recently. A year ago, he was diagnosed with myelodysplastic syndrome, but it was a series of strokes and a sudden decline that brought me to his bedside. His son called me with a plea for antibiotics, still holding onto the hope that medicine could turn the tide. But when I walked into the room, I heard the unmistakable sound of agonal gasps and the rattle of the final stages.

Breaking that news is a weight that never gets lighter. The son was emotional, his heart clearly not ready to let go of the man who had likely been his anchor for decades. Even at 86, death can feel like a thief that arrives too soon. It was a bitter pill to swallow because the goodbyes weren't ready. This wasn't a peaceful closing of a book; it was a chapter being torn out before the sentence was finished.

These two moments left me reflecting on the many forms death takes. For some, it is a whisper that has been heard from a distance for months. For others, it is a sudden storm that leaves the survivors shivering in the cold. My role in these moments is no longer just about clinical skill. It is about being a witness to the rawest parts of the human experience.

We must learn to look at the dying process not as a failure of medicine, but as a final act of life that deserves our utmost respect. Whether it is the quiet acceptance of a mother or the shattered grief of a son, our presence as caregivers must be rooted in empathy. We cannot always cure the disease, but we must always care for the person. Acceptance doesn't mean the loss doesn't hurt; it simply means we are willing to see the truth of the moment and hold a hand as they walk through it.

Dealing with death is never easy, but there are ways to make the process more meaningful and less frightening.

Speak to me to learn more.

03/02/2026

🏡 HOUSECALL DOCTOR SERVICE | Rawatan Doktor di Rumah | 医生上门看诊

Tak perlu keluar rumah. Doktor terus datang.
Skip the clinic. Get treated at home.
不用奔波，医生直接上门！

✔ Wound care / Penjagaan luka / 伤口护理
✔ Medication review / Semakan ubat / 药物评估
✔ Home therapy / Terapi rumah / 居家治疗
✔ Palliative care / Penjagaan paliatif / 舒缓治疗

📞 016-880 4697 (Dr Bryan)

https://wa.me/60168804397

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Laju. Mudah. Profesional.
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20/01/2026

Acute urinary retention.

But locked in.

Hypoxic brain injury took away his speech, not his ability to feel.

Discomfort still exists. Pain still exists.

But words and expression does not.

He had not passed urine since 11 this morning. Hour by hour, pressure built in silence. Warm compresses were tried and they did not work.

The call came close to midnight.

He could not tell me what was wrong.

But his body spoke.

Restlessness. A tense lower abdomen. Breathing that did not belong to rest.

I listened.

Catheterisation was done.

Urine drained.

Tension released.

Breath slowed.

The room softened.

I left at 1am.

Relieved that the discomfort had eased.

Drained by the reminder that some patients rely entirely on us to notice what they cannot say.

He could not say thank you. But the stillness that followed said enough.

Some nights you leave relieved.

Some nights you leave drained.

18/01/2026

When a loved one is in pain and the "system" is moving too slowly, every hour feels like an eternity.

Often, when curative treatment stops, families fall into the "Care Gap" waiting for referrals, struggling with transportation, or stuck on long waiting lists while the patient's condition rapidly declines.

You don't have to navigate this crisis alone.

I provide immediate, professional, and home-based palliative care designed to catch you when the system can't. I will act as your safety net, ensuring your loved one is comfortable, pain-free, and supported until long-term care can take over.

I believe everyone deserves to spend their final days with dignity, peace, and the best possible medical comfort, at home, surrounded by family.

👇 Message me directly on WhatsApp for immediate assistance

016-880 4697