Difficult Patients Case 1 (out of countless others)

1:27 AM

Working in Emergency Department and clinic setting can be really tiring and stressful. But it is rather interesting. Interactions with some patients can get really interesting...when you look back. During the first encounter, you just have to grit your teeth and 'WHOOOOSSAAAA"

Here are some of the interesting conversations:

With a forced smile on my 'Kami Sedia Membantu' face:

" Selamat pagi pakcik, apa masalah pakcik harini?"
" Mana la pakcik tahu masalahnya, doktor la patut bagitau saya!" he shouted.

Now, there is a thing called a "Patient-Doctor relationship". A lot of people don't understand this. Maybe this pakcik has been seeing too many bomohs lately.
DOCTORS ARE NOT BOMOH and CAN'T READ MINDS!
Our thought process are like this (Kids, please pay attention)
1. Get the basic info like comorbids, drug history etc
2. Patients are supposed to tell us the chief complain i.e. sebab apa datang...sakit kaki ke, demam ke apa! (patients are supposed to have that in mind upon entering the clinic)
3.Physical examination. We have to check the relevant systems. If you come for shortness of breath, cough or chest pain, the doctor has to listen (auscultate) to your lungs and heart.
4. Come to a diagnosis and treat accordingly.

If at any point patients are uncooperative, we can't get a diagnosis and we can't treat you. If you can't commit to telling us the truth and giving full cooperation, don't hope (jangan harap) to get a proper treatment. There has been countless episodes whereby patients do not disclose everything about their history. A patient might be in denial about their disease but it is of utmost importance to let doctors know.



Example:
Relatively young patient told staff at A+E he has no illnesses, just came with 2 days history of cough.
Doctor:  "Encik ada sakit apa-apa sebelum ni?"
Patient:   "Takde la. Semua ok je. Datang sebab batuk je, nak ubat demam je"

The doctor noted he has a big wound over the foot. Dirty, foul smelling with smelly discharge. On further questioning he, has Diabetes and has defaulted treatment for 2 months. Claims to be taking traditional medicine. Dextrose stick was HI, VBG was acidotic and Potassium was 6 with ECG changes.

This patient was lucky to be alive. Let's look at the issues ONE by ONE
1. Comorbids
    During my student days. I was taught to ask "open ended" questions. But now, patients expect us to ask;       do you have hypertension, diabetes, TB, cancer, COAD, asthma and so on. In situations where you have     10 patients to see in one hour, we can't possibly ask the whole list. Apparently this patient was didn't want     to tell the medical staff because he was scared his foot might be amputated.
2. Default treatment
    It can be very stressful when patients just refuse to comply with their medications. Why do you bother to       come to see a doctor when you don't bother to follow our instructions. This is especially stressful when we     encounter difficult parents.
     "We went to a GP already but our child still have a fever. That doctor is stupid."
    On further history, the mother just gave paracetamol TWELVE hours ago despite the label on the PCM       bottle clearly indicating that it is FOUR times a day.
     Personally, I don't mind patients taking traditional medicine but ONLY as a complement. Don't miss the        conventional medications.
3. Family members
    Some family members tend to not cooperate as well. The whole kampung will come to make noise but         NOT ONE actually knows the full history. There also a lot of incidences where family members just dump     patients in the hospital. The hospital is not a nursing home. Plus, don't expect your relatives to be given           meals at the Emergency Department. Remember, ONE RINGGIT does not cover food. Go get your             own.

I might have missed out on some other issues. I appreciate any other comments to top things up. Sometimes, I just feel like giving up on patients. Just let them be. They are in that situation because of their failure to follow our advice. But DOCTORS CAN'T REFUSE TO TREAT. No matter what you did, even criminals and killers, no matter how much hatred we have. It is a doctors duty to treat and DO NO HARM. It can be hard to professional sometimes. Sometimes I just have to look back at my name tag. That Dr. title in front of MOfrust comes with a great responsibility.

I AM DR MOfrust (bukan nama sebenar).

 

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6 comments

  1. im addicted to this blog. i want moarrr ! ah~

    ReplyDelete
    Replies

    1. - Thu.

      Trong tay dấu tay mạnh mẽ biến đổi, theo vô thượng chân hỏa đột ngột biến mất, trước người khỏa linh dược kia trực tiếp rơi vào trong tay Nhạc Thành.

      - Rốt cục thành công sao.
      đồng tâm
      game mu
      cho thuê nhà trọ
      cho thuê phòng trọ
      nhac san cuc manh
      số điện thoại tư vấn pháp luật miễn phí
      văn phòng luật
      tổng đài tư vấn pháp luật
      dịch vụ thành lập công ty trọn gói
      http://we-cooking.com/
      chém gió
      Nhìn chăm chú hộ anh đan này trong tay, trên nét mặt Nhạc Thành lộ ra một tia vui sướng.

      - Lúc này ta còn phải luyện chế mấy khỏa biến hóa đan dược cùng thú vòng mới được.

      Nhạc thành lẩm bẩm nói, trên người chính mình biến hóa đan đã không còn, Hạo Thiên tháp lại có sáu đầu thất giai ma thú, Nhạc Thành lúc này quyết định thu phục chúng cho mình sử dụng rồi.

      Khiếu Thiên hổ, Tử điện mãng không có ở tại bên người, Nhạc Thành thật có chút không quen. Sáu đầu thất giai ma thú thực lực so với Khiếu Thiên hổ, Tử điện mãng, Yêu cơ, Thông thiên thử còn mạnh hơn một chút, giữ chúng ở bên người, cũng có lúc có tác dụng.

      Khiếu Thiên hổ cùng tử điện mãng không có tại bên người, Nhạc Thành thật đúng là có

      Delete
  2. wow.. Dr Bane has turned into a blogger...

    my first time reading your blog, find it interesting. Will be a follower to your blog starting from today.

    Dealing with mentally ill patient is better than treating patient with a sound mind. when a mentally ill said or do bad things to me, at least I understand that his/her mind is sick. No hard feeling, but feel more empathy. But to the 'healthy minds' saying bad thing for petty things, it is so FRUSTRATING... Can I join your company MOfrust?

    the experience you had at your place and the experience I had at mine is more or less the same even though we are hundreds kilometres away. anyway it is Malaysian that we are dealing with.

    ReplyDelete
  3. msmy25: I am more than happy to have you on board and comment on my posts. Pardon the Bahasa Rojak used :)
    powerplayguy: Just wait for more :)

    ReplyDelete
  4. Hey guys, I just celebrated my big 30! pictures up on my blog. www.tillhiskingdomcome.blogspot.co.uk

    ReplyDelete
  5. I tot these frus will end when i open my own clinic. It has been worse. I really feel like giving up n dying

    ReplyDelete

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