“Sir, I can’t believe you don’t want to treat that patient! Nobody wants her you know! She is on her own, all alone! She cried just now when I talked to her! I told her I will get you to help her! I can’t believe you can do this! I DON’T WANT TO FRIEND YOU ALREADY!”
And thus was the rapid fire outburst from a student the other day as I was walking towards the male ward, fully intent to take a class for Clinical Presentation!
My immediate retort was:
“Last I checked, you weren’t on my FB friend list, so technically, you can’t un-friend me!”
I said it in jest of course. 
What prompted the unusual outburst was a particular patient in the ward whom this particular student saw earlier.
Unbeknown to the student, a medical officer had already called me on the phone an hour earlier that morning to asked me how to manage the patient and I had instructed the medical officer on what to do.
I confess that what the medical student claimed was true, to a certain extent.
I did make the decision not to treat her.
Now, before I have to endure similar outburst from 700+ readers (that’s the average hits/per day for this blog), allow me to explain myself.
I took the entire group of students aside and spent some time explaining one of the fundamental aspect of being a doctor; which is: Some times we have to make hard decisions.
I found out that morning from the medical officer who called me, that this patient, who has HIV infection and was started on HAART (anti-HIV medications) 3 years ago, decided to stop her medications for the last 2 years on her own accord. She continued to come for her follow up in the clinic and each time when she was seen by a doctor, she would say she is well and that she is taking her medications correctly and on time.
The truth was, as soon as she got home with her bag of precious medications, she would throw them away!
Now, even though the medications were provided FOC for her, because the government absorbed the cost, her action was unacceptable!
Consider this: Each month’s supply of her medications cost the government (or tax payers) about RM 300. In 2 years, she has thrown away RM 7200 worth of medications!
When I first heard the news, my blood boiled!
I could have used the medications to treat so many other patients!
Wait! Before I am accused of being vengeful, I would like to state that I made the decision not to treat her for a few reasons:
1. By now she would developed resistance to the FOC medications she was on.
2. At the same time, she would have developed resistance to other medications in the same class as the ones which were prescribed for her, thus making alternative options difficult.
3. I need to reassess her attitude and willingness to change and weigh whether I should use more expensive second line medications for her.
4. Her chronic diarrhoea has to be investigated first (though I suspect it’s probably due to advance AIDS that she is in)
I remember back in those days before HAART was given FOC in this country (December 2006), I had to repeatedly make very difficult decisions to deprive patients of medications simply because they could not afford them. These decisions weigh heavily on my psyche and I know I will have to answer for them one day when I meet my Maker; but some one has to make the decision.
Personally, apart of breaking bad news about the demise of a patient to the relatives, this is one of the hardest part of being a doctor.
So, if making such unpopular decisions loses me friends, I guess it’s acceptable collateral damage.
Thurs, 300910 @ 0700
