Uncaring

It’s personal policy that I do not let know that I am a doctor whenever I deal with anyone in the hospital. So, I take my number just like the bloke next to me, I wait my turn, I listen to the instructions given, I fret and get annoyed, just like the next twenty or fifty people waiting to be seen by the doctor. Call it a kind of social experiment.

I simply wanted to see how people are being treated. I didn’t want to be accorded artificial special treatment because of my ‘status’.

Several weeks ago, my wife took my 10-year-old son to the hospital for his ENT appointment. Atopy runs deep in my children’s genes (inherited from the maternal side – I’m allergic to nothing except extreme stupidity) and so Ryan was afflicted with allergic rhinitis, albeit mild. Although they were there early enough, it was past noon before Ryan was eventually seen by the doctor. By then, my wife was anxious to go to work and asked me to take over. Thankfully by then, my routine of morning rounds, seeing referrals and taking medical students for bedside teaching was done and so I quickly made my way to the clinic.

“The doctor said he needs to take his puff twice a day now. Just wait near this door for the prescription. His next appointment is in 4 months. I’m off to work now. Bye!”, my wife said hurriedly as she left Ryan in my care while we waited patiently in the clinic packed with more than a 100 people.

It took another 45 minutes for the nurse, an elderly woman, to appear at the door and shouted Ryan’s name. I quickly informed her that I was Ryan’s dad and may I have the prescription.

“Oh, you must be Dxxxxx”, said the nurse, addressing me with my wife’s name, after peering at me over the rim of her golden-frame glasses, and handed me the slip of paper.

I didn’t bother to correct her. Instead I took the slip of paper and exited the clinic with my son. On the way, I happened to look at what was written on the paper. I was surprised to find that his appointment was scheduled for 6 months later while the prescription for the nasal puff was amended to be administered once a day instead of twice and the supply was written for only 4 months.

I stopped my son, who by now was hungry and told him we needed to go back to the clinic to sort out the discrepancy. We went back to the clinic and I knocked at the door of the room where the nurse appeared from before. After a while, she opened the door and peered out and asked me what was the problem.

I explained to her that my son was advised to take his puff twice a day instead of once because his symptoms were not controlled and that his next appointment was supposed to be in 4 months.

“There are too many people in this clinic, so we had to extend the appointment to 6 months”, she explained, with a little annoyance.

“Ok, fine”, I said, “but the prescription is only for once a day and for 4 months only”, I pressed my point.

“Well, the consultant do not think he needs it twice a day”, she barked at me, raising her voice a notch.

“But the doctor who saw him said he needs it twice a day”, I persisted. “And 4 months is not enough, what happens for the two remaining months after the medication has run out?, I asked.

“That, you will just have to take care of yourself”, she said dismissively. I took it to mean I would have to source the medication from elsewhere until my son’s next appointment.

By now I got a little miffed. “You can’t do that! I would never do this to my patients”, I said determinedly.

By then, something must have flickered in her mind and she asked, “Are you a doctor? What doctor are you?” although she was quite oblivious to the the name tag I was wearing which suggested that I am a doctor.

“I’m a doctor at the MOPD (Medical Outpatient Department) and I always make sure my patients have enough medications”, I explained.

“Well, MOPD patients are different from ENT patients. MOPD patients have to take their medications. ENT patients don’t need to. They can skip medications!”, she retorted, looking smugly triumphant.

By then the medical officer who saw my son earlier had appeared having heard the commotion we were creating, and asked the nurse what’s wrong.

“This doctor here wanted bd dose of the puff but the consultant struck it off and only signed for daily dose”, she informed the medical officer.

“No, he needs it twice a day, and it is for 6 months, please make the changes in the prescription”, he ordered the nurse.

“Dr XXX (the consultant) is not going to be happy about this”, the nurse murmured spitefully while making the changes to the prescription.

I thanked the medical officer profusely and left the clinic with the re-amended prescription.

The whole incident left me with a sour taste. The nurse displayed a woefully uncaring attitude and in my opinion has no place working in a healthcare setting. The consultant was careless and flippant in simply striking off the prescription written by his/her medical officer without discussing it with the MO to find out the justification behind the double dosing needed and he/she did not bother to inform the patient (or in this case, me, as the carer of my son) regarding the dosage change. It was also highly irresponsible of them to short change patients with regards to their supply of medicine.

Things could be better. A whole lot better.

Too Busy

There are so many thoughts in my head that I’d like to pen (or type out as the case may be with a blog) but I’m just too busy. About this time every year I see the office emptying with people making plans to lay back and let things flow at a slower pace.

Not me… for some reasons, each year at around this time I find myself stressed to the max with work, chores, assignments, projects, papers, patients, students (and the list goes on and on and on).

This is not good.

I don’t even have time to pen my annual Christmas wish list to Mrs Santa (I want an iPhone 5 this year, Mrs Santa, in case you are reading this).

I swear this scenario shall not be repeated next year. It’s my end-of-year resolution.

Jimbo out!

Cat-astrophe!

 

Encountered this (and a whole load of others) along the hospital corridor on the 8th floor! My first thought (other than trying to hold my breath because of the stench!) was CEREBRAL TOXOPLASMOSIS!!!
How did a cat manage to get up to the 8th floor and do its business?
Because we allow it.
Because we are apathetic.
We even have a word for it. It’s called: TIDAK APA….

 

Religion without power

We decided to visit another church for Sunday service today – mainly for a change from what is fast becoming a stifling routine in my church (a lot of people will take offense at what I write but at the moment, I’m too tired to bother).

One thing that the charismatics can do well (we went to a charismatic church you see) is that they can really sing! And God, in His goodness, has always blessed charismatic churches with talented musicians and wonderful singers. It is this part of their Sunday worship that draws many people (especially the young and not-so-young anymore) flocking to church every Sunday. We, or at least, I did, enjoyed the praise and worship immensely. If one could look beyond the one or two people on stage who weren’t actually worshiping (yes, it IS APPARENT, in ANY church), the needlessly prolonged echolalia (others call it speaking in tongues), the repeated calls for the church members to give ‘clap offerings’ (something not entirely biblical – I still haven’t found any reference to clap offerings in the Bible) and the almost-compulsory-thingy-charismatic-churches do all the time which is the altar-call; I would say the praise and worship was perfect. Altar-calls always make me squirm in my seat – I’d almost felt leprous in comparison to those who flock to the front week in and week out in response to the call. I almost always do not feel the need to step to the front week in and week out. I’m not saying I have never done it but those few rare times that I did, they were meaningful, precious and more importantly, private.

How I wish fervently that my church is blessed with such talented musicians and singers! And sound system! And lighting!

One thing that charismatic churches don’t do so well is the sermon.

Sigh…I’m not gonna elaborate beyond saying that ‘One congregation’s manna is one man’s annoyance’.

The other is rudeness. Encountering a particularly rude Sunday school teacher didn’t help. For heaven’s sake, we are your guests!

Anyway, it was all sorta good. The speaker-of-the-day even offered his maiden book to the congregation for free during his sermon. Naturally a lot of people got hold of a copy of the book once the service ended. I didn’t, mainly because I have too many books that I have yet to read at home and I didn’t need one more to weigh in on my guilty conscience.

And so we made our way to the car park, having retrieved my son from the Sunday school (he was delighted to be in Sunday school because he had friends there whom he had not met for a long time – but he did say the Sunday school songs were “pretty lame”), we were walking behind a woman who was clutching her free book (the title, if I am not mistaken, was “The road to Kingship”) in one hand while she blew her nose into a piece of tissue held with the other hand.

And before one could exclaim “Hallelujah!”, she promptly deposited the defiled tissue onto the grass near the walk way!

I was stunned!

Actually I was livid. I whispered to my wife, “So, Christians behave like this huh?”, to which she replied, “It’s not the religion, it’s the person”.

I beg to differ. IMHO, If one’s religion fail to change one’s poor social habit, then all the praising, lifting of hands, echolalia-ing, crying and wailing would be just that – A whole lot of noise and very little substance. A lot of BS-ing if you ask me.

As we drove out of the car park, we witnessed yet another church member driving his/her (it was so heavily tinted I couldn’t see the driver of the car) white SUV into a road with a no-entry sign (it was a one way street) and proceeded to make an illegal turn onto the opposite side of the road! Two willful traffic offenses committed right after church! How do I explain to my kids why Christians drive like that?

Maybe they call this ‘Kingdom Driving’!

Enough said.

So, exactly how different are Christians from the rest of the world?

Are you unhappy with what I have written? Was it because I wrote ‘bad things’ about the church? Was it because ‘a visitor should not be so ungracious and write such terrible things? Or was it because deep down within your heart, you know what I wrote is true.

Good, think about it for a while and you can see why religion fails miserably.

And oh yes, before anyone should point an accusing finger at me, I am well aware of the ‘log in my own eyes’. Very keenly aware of it, in fact and I am immensely sorrowful about it. Tqvm.

Under the coconut

During a lull in my clinic last Friday (my patients tend to take their own sweet time coming to the clinic), I had a little chat with a few medical students who was in the room with me. The topic of conversation eventually drifted to politics – specifically Malaysian politics (read: DIRTY).

I was dismayed to discover that almost all of them had not registered themselves as voters! When asked why they have not registered, my dismay turned into disbelief!

One said, “I don’t need to vote because the guy who is in my hometown will sure win the election!”

Another said, “I do not have transport to go and register myself”.

Yet another said, “I don’t know where to register”.

One of them lamented, “Actually, we IMU students are not in touch with politics”.

That’s really sad.

I think my political awakening started when my ‘kertas am’ teacher back in secondary school said this to me:

“Be careful….for the day will come when the land you stand on will be taken away from you and you have no place to call home”!

As a student, I have always been very attuned to the local politics as well as international politics. When I was a medical student in India, I could name you the chief ministers of almost every Indian state, their political ideologies and their hanky-panky stuff.

While I was in Melbourne last year, I was keenly following the politics in Victoria – I could even engage in politic-talk with any Aussies there. I knew who was who and what they do or did.

Why? Because, politics, whether you like it or not, will impact our lives, sometimes and eventually in ways beyond our control. If bad politics are not nipped at the bud, it can grow into a 56-year-old uncontrolled corrupt beast!

Over the weekend, in Malaysia, we had the largest act of ‘Ahimsa‘ similar to the non-violent resistance practiced by Mahatma Gandhi. Malaysians from all walks of life gathered in large numbers in many major cities in Malaysia and around the world, demanding for electoral reforms and a clean election. Unfortunately, the Bersih 3.0 sit-in-and-protest took a violent turn in the end. (At this point, politicians are doing everything from blaming everyone else to scrambling at damage-control). Ironically, the mainstream media hardly breathed a word about the event!

The crux of the issue is this: why would decent folks (about 250,000 of them, according to some sources), spend a Saturday weekend, all dressed in gaudy yellow, go for a sit-in-protest (and get gassed and shot at with tear gas canisters and chemical-laced dirty water)?

It’s because these people care about what is happening around them. They want a better future, if not for themselves, then, for the next generation to come. They want to see a better Malaysia.

One vote may be insignificant.

But many one-votes can become a formidable force.

Therefore, I urge you, my students, exercise your right as a citizen of this country. Do not allow apathy to rob you of a better future. You cannot stay under the coconut forever!

Differential diagnoses of a dirty toilet seat

Dear People-contemplating-to-visit-Malaysia,

To my eternal shame, a common sight, regardless of where you go, which will greet you in my country (if you happen to stop over in the land between Singapore and Thailand) is this:

My differential diagnoses for the drops of urine on the toilet seat are:

A. Hypospadias
B. Benign Prostatic Hypertrophy
C. Vertical Diplopia (seeing double vision making it hard to aim straight)
D. Micturition-induced-seizure
E. Urinary incontinence

But the underlying sinister pathology for this malady is really this:

DEEP APATHY AND SELFISHNESS!

People who can’t clean up their own mess should just pee at a tree outside or use a rubber band.

Oral Bacterium

 

I was a little miffed this morning to discover the house officer working in my cubicle (yes, the same one who made me lose my cool a while ago), wrote this in the prescription for a HIV-infected patient, for prophylaxis against Pneumocystis jiroveci pneumonia:

T. Bacterium 11/11 OD

For non-medical people, to prevent infection with Pneumocystis jiroveci, we often prescribe HIV-infected patients two tablets of oral BACTRIUM daily.

What miffed me most was the apathy of this guy – who either did not know there is no such medication called Tablet Bacterium or he really couldn’t be bothered to ask.

I’m feeling all angry again.

Bullies

Recently I was chatting online with an ex-student of mine who is now a house officer in a public hospital. He was lamenting about the working condition in his current posting (the department where babies are delivered!).

“My department is crazy! HOs are getting extended for the most ridiculous reasons! One was told he was over-confident and thus extended for 3 months. Most of those who were extended weren’t told exactly why!”, went his lament.

I could emphasize with him very well. When I first reported for work in the same department (but in another hospital) as a house officer, we were curtly informed by a particularly nasty consultant that we were all extended for 2 months unless and until he said otherwise!!!

Imagine that! Extended without even working one day in that God-forsaken department! No reasons were given for the extension. The idea just blows your mind!

We were stunned! And then we got angry and we decided to do something about it!

We wrote a letter of complaint to the hospital director and carbon-copied it to the head of department. An enquiry was initiated and eventually the consultant had to back down and we were all de-extended.

Because we refused to bow to injustice, we took action and we won – and made an enemy for life! Later on, the same consultant deprived me and my wife of a honeymoon because he cancelled my leave at the very last minute! Again no reason was offered. As a result, I had to return to work immediately after my wedding!

Since then I have come across the consultant a couple of times in scientific meetings. I never greeted him. I have forgiven him for his inhumane actions but I have not forgotten his deeds and in my opinion, he does not deserve any respect even if he is now the head of department in another hospital.

I have also worked under a hospital director who, when he was in power, took great pleasure in belittling the doctors working in the hospital. During the weekly assembly, he would call out the names of doctors and publicly berate them for minor offenses such as not punching in or out on time. I personally received a show-cause letter from him asking me to explain why I did not punch out on one particular day and did not punch in on the following day! I explained that I was stuck in the OT on that day and was still in the OT until the next day and that it was impossible for me to punch in and out anyway as the punch-clock machines was locked in his office and was inaccessible after office hours.

This hospital director abused his power by allocating all the houses in the hospital quarters to his cronies who were administrative staff, laboratory staff and their relatives, while doctors who are constantly on call were told to look for accommodation outside the hospital. He also placed himself as the ‘radiologist on call’ 365 days a year although he was not qualified, just so he could claim the on-call allowance for a specialist. In addition, he deprived doctors from extra income by writing all the medical reports himself instead of distributing to the relevant doctors. For each report written he earned between RM 40-80. When a medical officer threatened to expose him to the Anti-Corruption Agency, he tried to shut him up by allocating almost 40 medical reports for him to write in a day! This man was also responsible for downgrading the annual assessment marks of medical officers in order to deprive them of the outstanding rewards from the Ministry of Health and marked up the assessment of his cronies so they would be rewarded instead.

So, when we read letters of complaints in the media written by junior doctors lamenting the cruel treatment they received from their superiors, they are not without justifications. There are indeed rotten apples in our profession. Unfortunately these scum-of-the-earth and poor excuse for a human being are often  in positions of power and often abuse those under them, simply because they can.

My advise to these people is, take stock of what you do, reflect on your deeds and change while you can. Have a heart!

Call it Karma, or call it retribution, I believe that God in heaven sees and He will not remain silent. I met the now-ex-director many years later in another hospital. He looked like a shell of his former arrogant and proud self. I asked him what he was doing in the hospital and he told me this:

“I am here to see my daughter. She has leukemia”.

Education gone awry

Come January, my daughter will be going to a new school to start her secondary education. Yesterday we made a trip to the school to purchase all that are needed for the new school year – books, uniform, wrappers, etc.

What greeted us at the entrance of the school were these 3 gigantic signboards:

Good grief!

These signboards epitomize what is ailing the education system in this country. Do you agree with me?

Anal-lyze this

I received this email from a Semester 6 student who voiced his concern regarding one of the patients he has been following up: (edited)

A young female patient who has underlying SLE, Autoimmune hemolysis, takayasu disease of left subclavian artery and now being hospitalized for treatment of her pneumonia.

She has a significant risk for Thrombosis -and the ward Dr have issued the blood sample for it on the 1st of this month – but it was recently rejected under grounds of “insufficient clinical picture”. I haven’t seen the lab form myself, but I think anyone could have seen that having SLE, AIH, and recent stenting of subclavian artery has sufficient justification for a blood coagulation study right?

Does this happen often?
What is the reason for the lab personnel to become so anal about the “clinical picture” that was supposedly “insufficient”?

It pains me to see that her test results get delayed and she has to be pricked again – its hard enough to obtain her blood, and recently she has been very reluctant to have her blood taken due to the fact that there needs to be many attempts until the HO succeed. Is there anything we could do to curb the pain?

Herein lies a very common problem that I have often encountered. Unlike those days when a doctor can just fill up a lab form ticking off the investigations the doctor wanted, nowadays, for some blood tests, the ‘lab people’ wants some kind of history or ‘clinical picture’ to be entered into the form as well! And per chance that this was not done, the blood sample would be rejected outright!

For instance, those days, when I wanted a CD4 cell count level, I just fill up a form, write the diagnosis as RVD (retroviral disease – a synonym for HIV infection), sign it and shoots it off with the blood sample.

Nowadays, in addition to the above, I must also do the following:

1. Write a short description of the ‘clinical picture’ and in the description, the word ‘HAART‘ must be written. I had a number of samples rejected because the word ‘HAART’ was not written! Nowadays I either write “an RVD patient on HAART” or “an RVD patient NOT on HAART” in the form, just so that the sample will not get rejected. It’s pointless to try to point out to the lab people that not all HIV infected patients are on HAART and but ALL of them need their CD4 count done regularly.

2. The form must be written in duplicates!

Frankly I seriously doubt what I write for the ‘clinical picture’ part is ever read by anyone and personally, I feel a little offended that a lab personnel who does not see patients nor have the training to decide on a patients’ management has the authority to reject your lab request based on a ‘technicality’ and cause so much of problems and discomfort for the patients.

On the flip-side, these added requirements such as writing ‘case histories’ and requiring forms be in duplicates or triplicates may be measures instituted to curb wanton and unnecessary blood investigations requests and perhaps to cut cost but surely there must be a better solution that this than to allow a lab personnel to overwrite sometimes life-saving lab investigations requests simply because some details were not filled in!

The student sent me another email later on to lament the fact that the rejected lab investigation cannot be repeated now because it has become irrelevant because intervention has been started for the patient. In his word:

“It’s like doing blood cultures after antibiotics have been started!”

Personally, I think they are just being anal.