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.

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