Thursday, 7 July 2011

retrieved notes - irresponsible patients

this is some of the notes that i managed to retrieved back from my old blog

this was written on the Saturday, June 18, 2011 
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overall this week such a peaceful week for me….but as i was about to embrace the wonderful week as there were reasonable number of patients (just nice..not too many to cope with.. and the fact that i manage to see lots of interesting cases which is brain-stimulating), on thursday, majority of my colleagues including myself experienced difficult patients.

as usual, came this 40 y.o indian lady into my room. as she sat on the chair, she started off by saying she had a chest pain. she told me that she was just recently admitted for fainting at her workplace in Jusco and was then diagnosed with a heart problem, planning for an operation soon. so she described her pain as a typical of acute myocardial infarction kind of pain with radiation, nausea which is not relieved by sublingual GTN. she said therefore, with the chest pain she had, she cannot go to work today as she is worried that she might faint again at her workplace and “So, doctor, can i have an MC today???” [there's a hint there]

so i asked her again how many GTN did she take, so she said to me that she already tried taking 4 of them but still not relieved. i tried to assess her understanding about her disease “so did the doctor/ pharmacy advise you on how to use the GTN?” she showed to me the bottle, saying “No”. I told her, if you have taken the 3rd GTN and the pain is still there, you should be sending yourself to the casualty, not taking the fourth and come to outpatient”. i showed to her the instruction written at the bottle. she kept quite. whether she made it up saying that she swallowed 4 of them or she did not swallow at all. other that GTN, she was not discharged with other medications even aspirin. so i sent her off to do one ECG which turned out to be normal.

so i asked her again, how’s the pain and she said it is still there. so i decided to send her to emergency for observation. i mean, though there is a bit of thought telling me that she just came for an MC, but i must not be so judgmental about it, i need to be safe as she herself seriously told me that she had a heart problem. no matter what the ECG tells me, she still need at least some time for observation especially regarding the pain. she quickly said to me that she wants to go out to the waiting area to tell her son first before going in an ambulance.

i waited for her for quite sometime but she did not turn up until lunch time. she absconded, i thought. and i would have guess she just came for an MC.

This is something intolerable. i mean, i don’t know whether she truly has a heart problem or not, but if she does, that does not mean she can use her illness to manipulate people for sympathy and a free MC. this is totally unacceptable and irresponsible. most of patients, if they have chest pain, they would be worry off and wanting to be referred to casualty, but that was not her case. she absconded. if she really takes he illness seriously, she would take my treatment seriously too.

but i wasn’t sure whether it was out of my curiosity or because i was worried that she might collapsed somewhere else and that was why she did not turn up… or more of medico-legal issues. if something bad happened to her, her relative can simply point the finger to me as i did not make an effort to call her back asking where she was, i would be top in the morbidity/ mortality thingy. so a bit of mixture there, i decided to “chase” her by calling her.my conversation goes like this

me: hello. mrs so and so, this is doctor D calling from KKS. why did u not turn up after seeing your son?

lady: i went back home. (started to raise her voice)…i dont want to go to emergency. if i go there, the same process will happen, they will prick me, take my blood, do a lot of stuff. why i should go thru  these all over again when i already know what my problem is.

i mean, if she really dont want to go to the casualty, she should have just confronted me, even though it would not change my mind of sending her to emergency, but at least i know her issues and concern.

lady: (in an angry tone)…and some more, when i asked for MC, you REFUSE to give me MC.

me (losing my patience): puan, your are being irresponsible. i told you that i MC will not be given to you because you need to go to emergency first. once they sorted you out, and if they let you go home, only then they will give you an MC. what? u think i am so “jahat” that i dont give my patients’ MC? your problem is not settle until you go to emergency, therefore, MC cannot be given. i am not that “jahat”, if patients are really sick and they deserve to get an MC

lady: you dont understand. i already told you that i have a heart problem which i was admited at damai hosp. ii have this chest pain and that i’m scared if i faint again at work. why didn’t you believe me? you are not concern about my problem.

me: puan, BECAUSE i am CONCERN about you, i take your problem SERIOUSLY, that i am WORRIED about your chest pain and your heart problem, that was why you should go to emergency and not staying at home. because i BELIEVED you when you say that you have a heart problem, that has alerted me. dont you understand? what, you think once you are diagnosed with it, then you dont have to go to the hospital anymore? it means that your problem can just get worse that it is.

lady: but if i go to emergency, who is going to take my son home?

me: why do you have to worry about that? when you should be more worried about your heart. you know that i am CONCERN about you. what if you go home and collapsed somewhere and had a heart attack? what is going to happen to your son then if something bad happened to you? do you want that? think of the consequences. you know, if i am not concern about you, i would not make this effort to call you and asking where you are. i would have just let you “go”

lady: please doctor, you make me want to cry.

me: i’m sorry that i dont mean to be angry at you but you should know this. I AM VERY CONCERN ABOUT YOU. THAT IS WHAT DOCTORS’ ARE. soo sorry again. i’m sorry but i’m concern about you. ok. take a rest, and come back here ok. if anything, i’ll be around until five and i’m in room P”

lady: sorry doctor. thank you. i want to take a nap, then i wil come back in the evening.

my friend heard the argument i had with the patients. she told me i should have not call her. i guess…curiosity kills the cat….so my day was put off just like that. in the evening, i hardly able to concentrate well.

before i left the room for lunch, after the phone call, she got me again thru’ the phone.

“doctor, can i go to seremban 2 since i am staying near there? and they have my record everything?”

“hah, youre staying there? yes, go there if anything”

“yes i am in S2, doktor tak perasaan my address kot”

[since you are already staying in S2 and they have all her records, why did you come here KKS in the first place?..duhh.....be more responsible, go to your designated KK lah....my goodness....memang sah nak MC....most probably there they have her records of getting lots of MC kot]

so that was just one example of it in which patients manipulating their illness to get benefit for themselves. this also includes patients who made up stories to get socso claims what so ever. my colleague told me some patients also decided not to take their medications on that day to exacerbate their illness like asthma patients etc.

please, i am trying to convey this message to all patients out there to be more responsible. please dont make a fool of yourself and your treating doctors when they are trying to treat you seriously and giving you the best care. stopped making complaints saying that doctors are not concern enough about patients, doctors are less empathy, doctors are not good listener what so ever when you yourself are not responsible to yourself. you must take care of yourself first. must be respossible of your illness.

dont be like the folk story of the shepherd boy who create lies and making fun of the villagers about having a wolf coming to eat his sheep, in the end, when the real thing comes, nobody wants to believe him.

and dont be manipulative as Susan Mayer (now known as Delfino) in Desperate Housewives acted by Teri Hatcher where in one of the episodes, she manipulated people around her with her kidney/ dialysis problem.

and yes, lastly, stopped asking for MC…..some of you patients, the moment you sit in the consultation room, the first word they say to you, doctor, i want an MC…. i have patients coming in saying..” doctor, i have fever already one week, MC doc!!”

this kind of patients usually i would definitely scream back at them. other people would be worried asking us doctors to sort out why they are having prolonged fever, and you…more concern about your MC… really stupid and ridiculous.

patients out there, please be more reasonable.

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