Jul 31, 2012

True/False: HOs Have No Responsibility

There's a famous Malay phrase "Sediakan payung sebelum hujan" (Prepare the umbrella before it rains).

The matching Chinese phrase goes in line of something along, only when you feel like going to defecate, only starts to dig a hole.

Chinese phrase as usual is more mean and give you a much better perspective.

The consequences from the Malay phrase would suggest along being wet and soaked, while from the Chinese saying, one would either have a whole lot of shit to hold in the rectum or let them out to their pants and sliding down the legs while one is busy digging the much needed hole.

That's a graphic thought. a graphic shit thought.

A department going through tough times will only get tougher, mainly because of the department's unpreparedness to face such shit and the tension rises will break the positive spirit, or whatever left of them.

A frequent reminder to everyone is "House Officers have no responsibility".

And when someone at higher rank re-phrased that reminder as "House Officers are not Doctors."

Dome Apple
One of the fellow house officers who is close to me shared with me his total disappointment and how this phrase really break his heart. Not only his. There are a few more who share the same sentiment.

Nevertheless, there are also a few of them who are happier to hear this tune.

I can still remember vividly when I was in Operation Theatre last month.

They came unprepared and late.
I had to do their job. I diluted the antibiotics.
I put in the details of the patients.
I put up the CT films.
I prepared the post op notes.
I did my work and also did the work of house officers.

The surgeon was being exceptionally joyful that day and was outstandingly forgiving.

Yet, although the house officer was given a whole half an hour to cut and paste the preliminary post op notes, she did almost nothing.

Sitting there idle, simply taking any other surgeons' post operative notes.

It was as if she was pushing the limit, trying to get herself being excused from the OT.

The surgeon operates almost every week and although the op findings may differ, the op procedures and post op orders are much or less the same.

Templates are there.

Every week, house officers enter the OT will prepare the necessary, but that week, the house officers are exceptionally appalling.

And this is not their first posting, mind you.

Then, on another day, during ward rounds, another polite specialist reminded the house officers to familiarize with postnatal reviews and stressed the importance of counselling for contraception in the most gentle word.

I even briefed them everything and gave them simple reference materials to read on. 

Yet, the week after, nothing changed.

Last Friday, as the Gynae ward was filled up to the brim.

As I went through my rounds at night, I could see 2 of my Night Shift House Officers struggling to complete all the passover work from before 5pm.
Tracing results.
Reviewing Ultrasound result before 5pm and informing me.

All this unnecessary passover was creating major inertia in finishing their night rounds.
Plus there were patients coming in as well - to be clerked, seen and treated.

No CME that Friday, both Gynae team and Periphery team, plus few tagging house officers of around 8 house officers should be in the ward.

Yet, they decided to finish up whatever in the 'To-do-list' rather than knowing the patients in the ward and recognizing what is left to do.

When I enquired about reason behind such incompetency with 4 times as much people in ward, the verbal answer given was simple.
First of all they do not know about the routine discharges for the patient on Chemo.
Secondly, the Periphery team does not about what is happening in the ward.  (No one in the ward is stopping anyone to find out about the patient and learn)

I still await their written explanation letter.

I think whatever evil flooding the public hospitals with house officers is rather out of my control, but I think at certain level, I had the responsible to tell the House Officers that they have responsible and they are real doctors. (Or else why would they deserve to be paid)

The house officers have responsibility to learn.
The house officers have responsibility to be prepare to learn.

They should find out what are they doing.
If they know they are going to this OT, or this ward, they should have the decency to find out what that is necessary in full details.

Not 'let's go in and experience how it feels like'.

Personally, it is an extreme turn off whenever taggers comes in to see a procedure which they had never read about.

They came in just to flaunt their presence and get me to sign their pathetic tagging logbook sheets.

Take ERPOC (evacuation of retained product of conception), for instance.

They do not know about the patient.

They do not know about the procedure and its other indication.

So, my conclusion, is they come is just to attend a circus show... oh, wait.. a free circus show where I am the clown.

- medical officers - 

The best is when some of them actually requires us the Medical Officers to invite them to the blardy FREE CIRCUS SHOW and one of colleague was being reprimanded by someone of higher rank about this - over and over again.

Hence, a simple notice was being put up in Labor Room by my colleague, which essentially has what I am trying to tell them.

One can imagine how shock I am when one told me 'Threatened miscarriage' as one of the indication of ERPOC.

Essentially, "house officers have no responsibility" does not hold water.

They have a duty to learn and the department have a duty to keep them learning and not strip them off their responsibility.

They had to learn to do their job and strive to do the job of Medical Officer, because after their housemanship, they will be one, right?

Isn't this simple logic?

And it is the sole responsibility of the department to instill such responsible in them.

It would be a crime, a sin and a grave mistake to do otherwise.

Sadly, now, it is the Medical Officers doing the jobs of House Officers.

I would like to quote what my respected ex-Boss, DrK once mentioned to me.

"If the HO have the capacity or chose to learn thing slower than the rest, then, we'll keep him/her longer in the department to learn what he/she should know in the department."

Without instilling a proper culture and habit among the youngest and largest member of the department, the whole repertoire of a functional unit is indeed internally a joke.

Fingers crossed.

I would be devastated if the house officers from the department, one day, turn out to be medical officers who essentially receive referral on symptomatic pregnant lady at term with high blood pressure, albuminuria with gross pedal oedema and decide that lady requires an ultrasound KUB (kidney,ureter,bladder) and antenatal clinic follow up a week later. 

P.S. To see a 'retrospective added correction' by a house officer into a 'high profile' patient's medical record today really had me wondering...

P.S.S. Whenever there is any doubt why number of MOs in the department is declining...

Jul 28, 2012

Rises from Dark after 5 years! (Not Dark Knight)

The unique thing of practicing medicine is we need to conform to the belief, religion and usual practice of the community.


Currently in the fasting month of Ramadhan, there are few matters in medicine differ.

The main headache used to be adjusting the insulin administration for diabetic mothers who is fasting.

The second obstacle is to defer the essential examination of the genitalia to detect potentially dangerous disease. Many or should I say, most of my patients would rather postpone it as they seriously believe it would break their fasting practice as would sexual intercourse.

Usually, everyone in the department (from various religions and faith) are happy to accept that they are happy deferring the essential examination, unless the patients are in dire state of collapse.

Somehow I was in the dark and continued to accept to believe that such examination is to be avoided in order for the patient to continue their holy practice of fasting.

Till this year, I stumbled upon an outdated Islamic review which was then further echoed in Facebook. I realized those vital examination does not break fasting.

I guess part and parcel in this profession is to impart the correct information to the patients..

Unfortunately, for the past 5 months of Ramadhan, I had given the less accurate information and many patients had chosen to defer the essential examination and live with a certain degree of anxiety till after Raya before complete assessment can be made.

Learning is indeed a lifelong process. 

P.S. Perhaps local medical schools should add in a class on practicing medicine with consideration on different faith and religion in Malaysia.


Keputusan Seminar Feqh Perubatan ke 9, yang diadakan di Casablanca, Maghribi pada 8-11 Safar 1418, bersamaan 14-17 Jun 1997 :

(Anjuran Institut Kajian Sains dan Perubatan Sultan Hassan II dengan kerjasama Akademi Fiqh Islam serta WHO -World Health Organization)

Ahli majlis/peserta seminar tersebut telah sepakat bersetuju bahawa perkara-perkara berikut TIDAK MEMBATALKAN PUASA.

1. Ubat titis mata, titis telinga dan basuh telinga

2. Ubat tablet bawah lidah yang digunakan oleh pesakit Angina (Jantung). [contoh: Sublingual Gliceryl Trinitrate]

3. Memasukkan ubat melalui faraj, memasukkan alat perubatan, membasuh, memasukkan spekulum dan jari doktor atau bidan semasa pemeriksaan vagina (sebelum bersalin) [contoh: vaginal examination, speculum examination, cervagem]

4. Memasukkan teropong ke salur kencing lelaki atau perempuan untuk penyediaan x-ray. [contoh: cystoscopy]

5. Menampal, mencabut, mengorek dan mencuci gigi atau menggunakan alatan dan berus gigi, dengan syarat TIADA apa-apa bahan yang memasuki perut dari prosedur tersebut. [contoh: Dental procedure]

6. Suntikan melalui kulit, otot, sendi atau pembuluh darah, KECUALI memberi makanan melalui pembuluh darah. [makanan i.e Total Parenteral Nutrition regime. Not sure about IV drips, vitamins, glucose, but if needed for therapeutic purposes, then it is Harus]

7. Penderma atau menerima pemindahan darah

8. Oksigen dan gas bius

9. Semua jenis bahan yang boleh menyerap ke dalam badan melalui kulit seperti krim, jelly atau plaster berubat

10. Mengambil sampel darah untuk ujian makmal

11. Sesalur dan bahan perantara untuk arteriography (pemeriksaan x-ray khas jantung) atau organ lain. [contoh: Angiography, contrast for imaging]

12. Teropong dalam rongga perut (endoskopi) untuk mencari punca penyakit.

13. Membasuh mulut, berkumur atau semburan mulut, dengan syarat tiada bahan masuk ke dalam perut. [contoh: Ear Nose Throat examination]

14. Teropong ke dalam salur peranakan atau memasukkan alat kedalamnya, (contoh: Intra Uterine Contraceptive Device)

15. Mengambil tisu (biopsi) hati atau organ lain.

Sementara iu majoriti peserta (terdapat minoriti yang tidak bersetuju ) menambah perkara berikut TIDAK MEMBATALKAN PUASA [No 16 sehingga 20]

16. Ubat titis hidung, semburan hidung dan ubat sedut

- Bagi penyakit asma atau lelah, amalan penggunaan inhaler tidak membatalkan puasanya kerana yang disedut itu ialah gas dan untuk tujuan perubatan. Ini adalah fatwa kebanyakan ulama masakini seperti Sheikh Ben Baz dan merupakan pendapat majoriti ulama yang bersidang di Seminar Feqh Perubatan ke 9.

- Keharusan penggunaan inhaler bagi pesakit asma juga harus berdasarkan fatwa umum dalam masalah ini oleh Syeikhul Islam Ibn Taymiyah. Keharusan ini meliputi teknik perubatan yang tidak menggunakan makanan atau minuman. Jika dari jenis debu maka diharuskan.

- Imam Ibn Hazm al-Andalusi (Kitab al-Muhalla) juga berpendapat tidak batal puasa dalam urusan perubatan termasuk suntikan atau menghirup serbuk.

17. Suntikan ke dalam dubur, teropong dan pemeriksaan digital ke dalam dubur.

18. Pembedahan yang melibatkan bius sepenuhnya jika pesakit mengambil keputusan untuk berpuasa

20. Penggunaan teropong perut, dengan syarat tidak memasukkan apa-apa bahan cecair atau bahan seumpamanya ke dalam perut [tidak pasti: saline for washout]

Which medications/actions are permitted whilst fasting?
The following is a summary of shar’i research presented to the Islamic Fiqh Council during its regular meetings:
The following things do not have any effect on the fast:
- Eye drops, eardrops, ear syringing, nose drops and nasal sprays – so long as one avoids swallowing any material that may reach the throat.
- Tablets or lozenges that are placed beneath the tongue for the treatment of angina pectoris etc., so long as one avoids swallowing any material that reaches the throat.
- Vaginal pessaries, douching, use of a speculum, or internal digital examination.
- Introduction of a scope or coil (IUD), etc., into the uterus.
- Introduction of a scope or catheter into the urethra (male of female), or injection of dyes for diagnostic imaging, or of medication, or cleaning of the bladder.
- Drilling of teeth (prior to filling), extraction or polishing of teeth, using a miswaak or toothbrush, so long as one avoids swallowing any material that reaches the throat.
- Rinsing, gargling or applying topical treatment in the mouth, so long as one avoids swallowing any material that reaches the throat.
- Injections, whether subcutaneous, intra-muscular or intra-venous – with the exception of those used for purposes of nutrition.
- Oxygen.
- Anesthetics, so long as they do not supply nutrition to the patient.
- Medicines absorbed through the skin, such as creams, lotions and patches used to administer medication through the skin.
- Introduction of a catheter into the veins in order to examine or treat the vessels of the heart or other organs.
- Laparoscopy for the purpose of diagnosis or surgical treatment of the abdominal organs.
- Biopsies of the liver and other organs, so long as this is not accompanied by the administration of nutrients.
- Gastroscopy, so long as this is not accompanied by the administration of nutrients.
- Introduction of medicine or instruments into the brain or spinal cord.
- Involuntary vomiting (as opposed to self-induced vomiting).

It is however preferable to postpone the above-described treatments and procedures until after he has broken his fast, if it is safe to do so.

Jul 20, 2012

Msians: be Jason Bourne or moribund

We are not Treadstone operatives. We should not be expected to change our travel routes everyday. We should not need to eye each person in a crowd as a potential assassin. Public safety is the responsibility of the federal government. Do not expect each of us to be Jason Bourne.

I believe Yia Hua Jern's comment above about the newspiece on the unfortunate death of a snatch theft victim really awesome. Where are the writer's conscience when he/she write and spin such a sad story...

The Star, Friday July 13, 2012

Love for strays caused snatch theft victim’s death

MALACCA: Snatch theft victim Tang Mui Choo would be alive today if she had not used the same village road in Balai Panjang to go to work every day just so she could feed stray cats at an abandoned house beside the road.

The 35-year-old animal lover never broke her routine – and she did not know that a group of snatch thieves calling themselves “gang Suffian Bulat” had been watching her every day.

They pounced on her last Saturday and Tang fell from her motorcycle when the gang snatched her handbag. She died the following day.

The police got an insight into the case with the arrest of the gang’s 24-year-old leader, nicknamed Gemok.

State deputy CID chief Supt R. Gunarajan said the gang was also believed to be responsible for a spate of snatch thefts involving women and foreigners in the city.

Two other accomplices were also detained later, crippling the gang.

The four suspects, aged between 17 to 20, were detained at separate homestays in Merlimau and Semambok here.

Supt Gunarajan said the suspects, who were high on syabu when arrested, confessed to targeting women and foreigners travelling on secluded roads and back allies around the city.

Jul 14, 2012

Friday the 13th

Yesterday was Friday the 13th.
Didn't realize that till it was around time to leave the hospy.

I wished my on call colleague good luck, which I don't think she need, anyway.

Mainly because from my recollection of 5 years experience in this unfortunate date and day, usually only the day after(sat 14th), all hell breaks loose.

Probably it's because we're Asian.
Sat 14 in Cantonese is Sat sat sei.. Or sure sure die.
Yeah, I know. Lame joke.

Workwise, I was unharmed, physically and mentally.

There were few wild accusations thrown at me in the beginning, but I never regrets the way that it had happened because my clinical judgement was the most appropriate for the patient.

Plus, most of close colleagues trusted, supported and knew me for the exact person that I am and not the misguided misfit that was being portrayed.

Bad luck-wise, later in the day, it was rather unfortunate to see a patient running into a completely deranged course of management thanks to incomplete assessment, over-reaction, exaggeration and the silence of my junior colleague who knew it all along.

Sad, really.

Friday the 13th Phobia Rooted in Ancient History
John Roach
for National Geographic News
Updated August 12, 2004
This Friday some people will be so paralyzed with fear they simply won't get out of bed. Others will steadfastly refuse to fly on an airplane, buy a house, or act on a hot stock tip. It's Friday the 13th, and they're freaked out.

"It's been estimated that [U.S] $800 or $900 million is lost in business on this day because people will not fly or do business they would normally do," said Donald Dossey, founder of the Stress Management Center and Phobia Institute in Asheville, North Carolina.

Symptoms range from mild anxiety to full-blown panic attacks. The latter may cause people to reshuffle schedules or miss an entire day's work.

When it comes to bad luck of any kind, Richard Wiseman—a psychologist at the University of Hertfordshire in Hatfield, England—found that people who consider themselves unlucky are more likely to believe in superstitions associated with bad luck.

"Their beliefs and behavior are likely to be part of a much bigger worldview," he said. "They will believe that luck is a magical force and that it can ruin their lives."

Wiseman found that one quarter of the 2,068 people questioned in a 2003 survey associate the number 13 with bad luck. People with such feelings, he found, are more likely to be anxious on days like Friday the 13th and thus more prone to have accidents. In other words, being afraid of Friday the 13th could be their undoing.

Ominous Number

So how did Friday the 13th become such an unlucky day?

Dossey, also a folklore historian and author of Holiday Folklore, Phobias and Fun, said fear of Friday the 13th is rooted in ancient, separate bad-luck associations with the number 13 and the day Friday. The two unlucky entities ultimately combined to make one super unlucky day.

Dossey traces the fear of 13 to a Norse myth about 12 gods having a dinner party at Valhalla, their heaven. In walked the uninvited 13th guest, the mischievous Loki. Once there, Loki arranged for Hoder, the blind god of darkness, to shoot Balder the Beautiful, the god of joy and gladness, with a mistletoe-tipped arrow.

"Balder died and the whole Earth got dark. The whole Earth mourned. It was a bad, unlucky day," said Dossey. From that moment on, the number 13 has been considered ominous and foreboding.

There is also a biblical reference to the unlucky number 13. Judas, the apostle who betrayed Jesus, was the 13th guest to the Last Supper.

Meanwhile, in ancient Rome, witches reportedly gathered in groups of 12. The 13th was believed to be the devil.

Thomas Fernsler, an associate policy scientist in the Mathematics and Science Education Resource Center at the University of Delaware in Newark, said the number 13 suffers because of its position after 12.

According to Fernsler, numerologists consider 12 a "complete" number. There are 12 months in a year, 12 signs of the zodiac, 12 gods of Olympus, 12 labors of Hercules, 12 tribes of Israel, and 12 apostles of Jesus.

In exceeding 12 by 1, Fernsler said 13's association with bad luck "has to do with just being a little beyond completeness. The number becomes restless or squirmy."

This fear of 13 is strong in today's world. According to Dossey, more than 80 percent of high-rises lack a 13th floor. Many airports skip the 13th gate. Hospitals and hotels regularly have no room number 13.

On streets in Florence, Italy, the house between number 12 and 14 is addressed as 12 and a half. In France socialites known as the quatorziens (fourteeners) once made themselves available as 14th guests to keep a dinner party from an unlucky fate.

Many triskaidekaphobes, as those who fear the unlucky integer are known, point to the ill-fated mission to the moon, Apollo 13.

As for Friday, it is well known among Christians as the day Jesus was crucified. Some biblical scholars believe Eve tempted Adam with the forbidden fruit on Friday. Perhaps most significant is a belief that Abel was slain by Cain on Friday the 13th.

Phobia Cures

So, what are triskaidekaphobes to do?

Dossey said "practical" cures are as simple as learning to refocus one's thoughts from negative feelings to positive. His mantra: "What you think about, you begin to feel. What you feel generates what you do. And what you do creates how you will become."

In other words, those stricken with negative thoughts about Friday the 13th need to learn how to focus on pleasant thoughts. Those, in turn, will create pleasant feelings that make one's fears less overwhelming, according to Dossey.

"They haven't lost their mind. They've lost control of their mind," Dossey said of triskaidekaphobes. "They are focused in the wrong direction. In their mind they have a big, large, looming picture of something horrible that could happen."

Wiseman, the University of Hertfordshire psychologist, offers similar advice to those stricken with the fear of Friday the 13th.

"They need to realize that they have the ability to create much of their own good and bad luck," he said. "And they should concentrate on being lucky by, for example, looking on the bright side of events in their lives, remembering the good things that have happened, and, most of all, be[ing] prepared to take control of their future."

Folklore offers other remedies, however. One recommendation is to climb to the top of a mountain or skyscraper and burn all the socks you own that have holes in them. Another is to stand on your head and eat a piece of gristle.

So if you fear the 13th, take your pick of remedies and let tomorrow bring its luck—good or bad.


Friday the 13th Christian Origins
The fear of Friday the 13th stems from two separate fears -- the fear of the number 13 and the fear of Fridays. Both fears have deep roots in Western culture, most notably in Christian theology.
Thirteen is significant to Christians because it is the number of people who were present at the Last Supper (Jesus and his 12 apostles). Judas, the apostle w­ho betrayed Jesus, was the 13th member of the party to arrive.
Christians have traditionally been wary of Fridays because Jesus was crucified on a Friday. Additionally, some theologians hold that Adam and Eve ate from the forbidden fruit on a Friday, and that the Great Flood began on a Friday. In the past, many Christians would never begin any new project or trip on a Friday, fearing they would be doomed from the start.
Sailors were particularly superstitious in this regard, often refusing to ship out on a Friday. According to unverified legend (very likely untrue), the British Navy commissioned a ship in the 1800s called H.M.S. Friday, in order to quell the superstition. The navy selected the crew on a Friday, launched the ship on a Friday and even selected a man named James Friday as the ship's captain. Then, one Friday morning, the ship set off on its maiden voyage... and disappeared forever. A similar, entirely factual story is the harrowing flight of Apollo 13.
Some historians suggest the Christian distrust of Fridays is actually linked to the early Catholic Church's overall suppression of pagan religions and women. In the Roman calendar, Friday was devoted to Venus, the goddess of love. When Norsemen adapted the calendar, they named the day after Frigg, or Freya, Norse goddesses connected to love and sex. Both of these strong female figures once posed a threat to male-dominated Christianity, the theory goes, so the Christian church vilified the day named after them.
This characterization may also have played a part in the fear of the number 13. It was said that Frigg would often join a coven of witches, normally a group of 12, bringing the total to 13. This idea may have originated with the Christian Church itself; it's impossible to verify the exact origins of most folklore. A similar Christian legend holds that 13 is unholy because it signifies the gathering of 12 witches and the devil.
The number 13 could also have been considered pagan because there are 13 months in the pagan lunar calendar. The lunar calendar also corresponds to the human menstrual cycle, connecting the number to femininity.

Other Friday the 13th Traditions
The Christian perspective on F­riday and 13 is the most relevant today, but it's only one part of the Friday the 13th tradition.
Some trace the infamy of the number 13 back to ancient Norse culture. In Norse mythology, the beloved hero Balder was killed at a banquet by the mischievous god Loki, who crashed the party of twelve, bringing the group to 13. This story, as well as the story of the Last Supper, led to one of the most entrenched 13-related beliefs: You should never sit down to a meal in a group of 13.
Another significant piece of the legend is a particularly bad Friday the 13th that occurred in the middle ages. On a Friday the 13th in 1306, King Philip of France arrested the revered Knights Templar and began torturing them, marking the occasion as a day of evil. Check out this site to learn more.
Both Friday and the number 13 were once closely associated with capital punishment. In British tradition, Friday was the conventional day for public hangings, and there were supposedly 13 steps leading up to the noose.
Ultimately, the complex folklore of Friday the 13th doesn't have much to do with people's fears today. The fear has much more to do with personal experience. People learn at a young age that Friday the 13th is supposed to be unlucky, for whatever reason, and then they look for evidence that the legend is true. The evidence isn't hard to come by, of course. If you get in a car wreck on one Friday the 13th, lose your wallet, or even spill your coffee, that day will probably stay with you. But if you think about it, bad things, big and small, happen all the time. If you're looking for bad luck on Friday the 13th, you'll probably find it.

Jul 13, 2012

Health Clinics - manned by humans or robots?

Encounter with poor quality service at Klinik Kesihatan Dato Keramat
by Farah Aishah Hamdan on Monday, July 9, 2012 at 11:19am ·
A copy of the complaint letter I sent to the MOH portal this morning:
I am a medical officer doing my masters in family medicine in PPUM. I started having URTI symptoms last night and had a very bad sore throat, for which I was unable to speak properly, as well as a bad headache. I decided to seek treatment at Klinik Kesihatan Dato Keramat this morning (9th July 2012 around 9am) as it is the nearest government clinic to my house, according to Google Maps. PPUM would have been a much further drive.
The registration process went smoothly and I did not have a long waiting time. I did not reveal myself to be a doctor as I thought it might show bias or preferential treatment. I was asked to fill in the REAP form while waiting. Eventually I was examined by a medical assistant (I didn't manage to take note of his name) and I am dissatisfied with his manner of consultation.
Despite me writing down in the REAP form that I have bronchial asthma, he did not ask me if I had shortness of breath or even anything about my asthma nor allergy history. He examined my throat and chest very briefly. When I asked him if I could get a medical certificate, he behaved very dismissively and said that since my symptoms were mild (which he did not even ask about the severity and its impact on me!) and I was not febrile, I was not eligible to get an MC. I explained that I am a doctor, and I felt unwell for work, added to the fact that I cannot speak properly with this sore throat and hoarse voice. He asked me to get my medication first.
When I returned to the consultation room, there were a few other medical assistants in an adjacent room. One of them very clearly and loudly said, "Doktor pun nak mintak MC ke?" in a very condescending tone of voice. That struck me as being rather rude. He did not realize I overheard this comment. In the end another medical assistant wrote me a timeslip and handed it to me, also in a dismissive manner. I would like to point out that throughout the whole consultation, I was very polite and did not raise my voice (I had very little voice anyway thanks to the sore throat). I have encountered much more demanding patients and I would not want to liken myself to them.
Firstly, I would like to point out that doctors are human as well and are also prone to falling sick. Secondly, even if I was not a government doctor, is it fair to dismiss someone like that? Perhaps they assumed that I was one of those MC seekers since it is after all a Monday morning. It is regrettable that they are dismissive of a person's complaints and concerns, and also behaved rudely and unprofessionally. That, to me, is worse than being medically incompetent.
I can understand that the doctor in charge, Dr Rosalind, was obviously busy as she had appointment cases to see. However the general patient load this morning was not overwhelming, supported by the fact that the medical assistants were free to hang around at the back of the clinic. I would think that it doesn't take much time to get some further history from a patient, or even to show some empathy. I didn't want to waste time arguing with anyone there, as I was feeling very unwell, so I have decided to highlight this incident to you via online means. In contrast, the nurses, pharmacist and PPK in charge of the front counter were quite cordial and helpful, which I was pleased to see.
I hope this incident does not repeat itself, as I believe we are entirely capable of providing quality health care with compassion in a government setting.
Thank you for your kind consideration.
Dr Farah Aishah Hamdan
MMC no: 46290

My incident happened few days ago.

I was down with URTI symptoms as well as chesty cough.
After dragging myself through 1 whole day of bad Oncall continuing with the 2 days of weekend of courses, sitting through 9 lectures per day, on the fourth day, my illness escalated to headache and my voice was almost robotics.

I was grateful for the day off granted by my Consultant, but I knew I need to get some antibiotics, a Medical Certificate and to look out for Dengue with my past horrible history of admission for Dengue Haemorhagic Fever.

I went to the nearest health clinic and did not reveal my identity.
I just dropped my IC and told them I came here for cough and cold in my robotics voice.

I waited patiently for 45mins till I got to see a Doctor in Room 8.

He was extremely polite to me, then I found out why as I saw my clinic card was written my occupation.

In my original robotics voice plus the few occasional cameo chesty cough, I gave out my history including my usage of antipyretics round the clock.

He just put the electronic temperature machine to my left ears and explained to me that I do not have fever, showing me the reading of 37 degrees Celcius.

Examination on my throat, tonsils or lungs were non-existence.

He just order a blood test and explained to me that he needed to rule out dengue.
I followed his charade of primary care and got my blood taken.
Sent the bottle of my own blood to the lab next door myself.
Sat there quietly, semi-meditating while waiting for my full blood count result.

I went back with the result and straightaway, he exclaimed a finding from the result as if it was Eureka.

"Your haematocrit is high. You're just dehydrated, you need to drink more water. Otherwise everything normal, including Platelet, you don't have Dengue."

Even with my grossly dysfunctional brain due to my illness, I was surprised he advocated water. For a moment, I thought he was practicing homeopathic medicine.

I was terminally shocked that he did not refer raised haematocrit as one of the early sign of Dengue illness. The shift of monitoring platelet to haematocrit in Dengue was well known since I was doing my final posting 4 years ago.

Never knew this vital piece of information regarding such a high profile illness was missing in the practice of this fellow healer. Shame on the Family Medicine Specialist in charge? Shame on the District Health Officer? Shame on our Infectious disease team? Or shame on him?

He proceeded to giving me Papase to relieve my sore throat, cough syrup, and some vitamins.

As my second wave of chesty cough returned, I restrained myself to vocalize my request for antibiotic.

"Usually, it is caused by virus, so no need antibiotics. But since you asked, I give you."

Then, another previous patient of his came barging in asking for vitamins.

He politely wrote extra vitamins on the prescription and told that uncle to seriously stop smoking and those vitamins will make him fat.

I smiled, enjoying the little interluding drama or rather, comedy.

And as I was leaving, I asked for Medical Certificate for the day, but he rejected outright.

His reason was without a raised temperature, if he issue, he will be called up by his superior to answering give explanation letter.

He further elaborated that only he and another colleague can issue. The other four doctors also can not issue because of strict order from above.

He further attempt to gain sympathy from me saying that today's workload was heavier all because 2 of his colleagues took MC.

Despite me telling him about my recent ingestion of paracetamol, he insisted on giving only a time slip and offerred to countersign if MC was given by private clinic.

There was no point in debating with his incompetence as my every verbal reply only made my throat hurts more and almost a liter of phlegm was welling up in my throat.

I thanked him as I exited the consultation room, mainly for giving me such an eye opening experience. Truly enlightening.

I knew I was not able to work that day and my body could not tolerate me to take another trip to another medical clinic.

My dad came and fetched me from the clinic as I was unable to drive and I collapsed on my bed as if I had undergone a week of back to back on calls.

Going back to work and spreading the germs to the preggies in the ward does not sound like an ethical move either.

The dignity and intelligence of doctors had been reduced to status of slaves to groundless rules and regulations.

A well-dignified place of treatment is no difference to a vending machine that spit out MC based on the reading of a raised temperature.

The full or selected medical examination is reduced to a simple temperature taking followed by blood investigation.

Sad really.

I did not think sending a letter to MOH portal gonna make any major difference, because proper policy making and training of dignified thinking doctors will require much more than an apology reply or explanation letter.

We don't even have the political will to plug the great financial loss of going through middlemen for the purchase of our medications.

All CKLPS only.

Jul 7, 2012

Cheap, Uncivilized, Despicable!

The state assembly immunity is a precious "sword of immunity", as well as a double-edged sword. It should be used for the people's interests instead of as a protection umbrella shielding the acts of insulting and killing political opponents, because such a practice is too cheap, too uncivilised and too despicable!

Immunity is a double-edged sword
Opinion  2012-07-07 10:15
Translated by SOONG PHUI JEE
Sin Chew Daily

A disturbance was triggered in the Malacca state assembly sitting after MCA chief Datuk Gan Tian Loo brought up the recent rumour claiming Penang Chief Minister Lim Guan Eng's his wife had assaulted his former staff member because of an alleged relationship between the two. Lim and his wife Betty Chew referred the allegation to a political conspiracy and character assassination. Five DAP state assembly members were also suspended for six months after staging a ruckus.

The incident continues to ferment and even the sex video clip scandal involving MCA president Datuk Seri Dr Chua Soi Lek has once again been put under the limelight, setting off a fierce online war of words filled with foul language.

Is it appropriate to bring up a rumour yet to be proven true and has been denied by the persons involved in the sacred hall of the state assembly? The answer might not be absolute. It depends on whether it relates to public interests and whether it is an emergency.

Indeed, Gan did not breach any parliamentary rules and regulations, but he had obviously abused the Malacca State Assembly privilege and immunity when he took the advantage of it to attack a state Chief Minister, his wife and another woman and questioned their characters and morality.

Indeed, Gan is the chairman of Malacca's Chinese Single Mother Support Group and he used to assisted 200 single mothers outside the state assembly hall. However, defending the interests of single mothers outside the state assembly and blindly attacking two women in the state assembly hall based only on online rumours are two different matters.

Regardless of whether his words and deeds are insults to women, it is absolutely absurd and unacceptable when he used his "merit" of assisting single mothers outside the state assembly to rationalise the harm caused to two women in the hall, and dared not to repeat the allegation publicly, but just said that the state assembly is a symbol of democracy.

Politics is indeed full of attacks and plots, but there are still differences in standard. Instead of not smart enough, politicians are actually too clever. However, if they are too clever to the extent of not letting go even a single opportunity to attack their opponents, and blindly turn their opponents into a sacrifice to gain their own political interests, once they sense a little signs of trouble, without having a further investigation and confirmation, the approach is then too lousy. When politics deteriorates to such an extent that only personal and party interests are concerned, but not universal values, it will then lose its nobility and only frustrating sorrow is left!

The state assembly immunity should not be used in such a way. It is not meant to allow lawmakers to spread gossips and rumours or attack against opponent's personal matters. Instead, it is meant to allow them to fearlessly expose various misconducts involving the country's and its people's interests like corruption, fraud and abuse of power.

The state assembly immunity is a precious "sword of immunity", as well as a double-edged sword. It should be used for the people's interests instead of as a protection umbrella shielding the acts of insulting and killing political opponents, because such a practice is too cheap, too uncivilised and too despicable!