Specialoid: When Patients Become Specialist

6:48 AM


Specialist:  "frequently refers to an expert in a profession"
-oid:          "of similar form to, but not the same"

When the two words combine, SPECIALOID is formed. In my profession, a specialoid is a

patient who thinks that he or she is a specialist and all other medical staff should bow to his or her every need and wishes

Of course this is a rubbish definition I coined myself. But some how, Malaysia is churning more and more of these specialoid instead of specialist! It is reasonable for patients to engage in proper discussions regarding the management of their illness. I love patients who can recall their medications and exact dosages. I appreciate when patients and their relatives try to understand their illnesses. It helps in the management a lot.

Specialoids are unlike these good patients. I encountered one such patient today. Consider this scenario:

Middle aged gentleman with cough and runny nose for ONE day only. No fever, no shortness of breath. Vital signs was stable, no fever. Examinations were unremarkable. Lungs clear, throat not injected. 


I kindly explained to the gentleman that it is most likely URTI and most cases are viral and there was no indication for antibiotics.

"Ini saya sudah tahu la doktor. Saya mahu antibiotic. Lepas makan dua kali mesti ok punya. Kawan saya pun bagitau antibiotik ni bagus"

Here is the dilemma that many first liners encounter, especially in GPs. Do you still give antibiotics even though you know that:
1. It is not indicated
2. The compliance to complete the course will be very poor ("...ambil dua hari")
3. You will contribute to bacterial resistance
4. He paid SATU RINGGIT and you are his SLAVE and have to follow his orders!

In this case I have tried to explain to the best of my abilities and he still insisted. I was lucky that he was the last patient of the day and I can spend a lot of time explaining things properly. I think that patient stopped short of saying

" I know Dato' X and he's gonna screw you tomorrow if you don't give me the medications"

These are very difficult times for doctors. When patients think they know everything and won't listen explanations which are based on facts. I once inquired on Facebook regarding a medication which was promoted. I asked nicely how they got the facts. Whether there was any trials. What I got was:

"Saya bukan doctor macam awak tapi saya tahu ramai kawan-kawan saya dan doktor yang pakai. Benda ni dan sangat berkesan"

I didn't mean to boast that I am a doctor, but I just needed facts. Sometimes it is painful to see how other patients listen to Specialoids. In any given day, there will be so many cases of patients getting wrong advice and having to deal with it for the rest of their lives.

1. Intracranial bleed secondary to hypertensive emergency secondary to non compliance to medications.

ICB
A CT brain like this is considered 'OK'. A brainstem bleed is fatal. The most common history from relatives are "Dia dah sebulan tak makan ubat darah tinggi. Dia ambil ubat herba XXX". Sometimes you wonder, if patients can sue doctors for mismanagement, why won't patients sue the Specialoids?

2. Uraemic encephalopathy
There are so many fliers out in the public advertising alternatives to haemodialysis (HD).
"Anda tidak perlu HD lagi. Jangan percayakan doktor, kami ada cara lain"
It is very important for ESRF patients to get HD. Most of the time, by the time the patient reach ED it will be too late. I remember having to perform CPR on non compliant ESRF patient in the lift on the way to the dialysis room. That patient never made it.

3. Close fracture converted to open fracture secondary to urut
Open fracture tibia (image from Google)
I had a patient in orthopaedic. Came with close fracture of tibia. He was planned for POP  first but refused and discharged at own risk. He came back the same day at night after going to a Doktor Urut with the same condition as in that picture.

So, how do we deal with these patients and their specialoids?Do what's right and get screwed, or just do what ever they wish us to do? Your wish is my command.....


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33 comments

  1. salam....i couldn't agree more with all of your posting....it's just that i couldn't put it in proper sentence(s).....it's the reality of our malaysian attitude....as pepatah would say.....hope we can change the attitude of ourselves and also the malaysians all over malaysia....chaiyok to us...

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    1. thanx ruth...its part of being Malaysians :)

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  2. haha, specialoids!! I like the term :)

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    1. do use it as much as you can....no trademarks :)

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  3. I know some doctors (GP) who have turned into specialoids as well--- promoting clinically unproven treatment like ozone therapy, plasma rich platelet, vitamin c infusion, and making it compulsory for all locuming doctors to prescribe antibiotics for EVERY patient including those with mechanical back pain. These doctors should be blamed as well.

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    1. it does happen. its just gonna take one thing to go wrong and the whole thing will explode

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    2. yup , antibiotic for 3 days for almost all conditions .... wait la for sumone gets anaphylactic shock... baru tau

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  4. camne kalu xmkn ubat darah tggi sebab darah dah xnaik

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    1. it does and did happen to one of my patients. I gave TCA in 1 month to review again just to make sure

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  5. Sometime our bureaucratic admin. Layan them too much oso.. Tats y.. This guys think and talk like tat

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    1. nowadays its difficult to get support from admin....PATIENTS ALWAYS RIGHT

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  6. A patient who suffered from TIA went to see bomoh, symptoms resolved, then had a full blown stroke went to the hospital, did not recover. Bomoh wins!

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  7. Just have a stock of placebos i.e tick-tacks for those insisting for antibiotics :P

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  8. well said. i just stick to NOT giving in. get screwed, i'll screw back. then we'll see who's clinical judgement is better..

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  9. I dont give in to their demand.I just tell them , I am a doctor , bukan pharmacist. When patient walk in and tell me " saya nak ubat x y and z " I tell them off in a nice way.Usually along the line of "Sorry , saya bukan tukang dispense ubat, anda beritahu problem anda, saya tahu ubat yang sepatutnya dan saya bertanggung jawab atas preskripsi saya.". Especially when it comes to antibiotic. I DON'T prescribe medicine unless there is indication. Worst case scenario, I ask them detailed stuff , e g , " what are the common causes of pharyngitis ? Or the difference between virus and bacteria or the best " could you explain to me the pharmacological pathway and indications of antibiotics ?".The last question spared for arrogant ones who swallow antibiotics like hershey's choc.

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    1. sometimes I just give in out of frustration...imagine its 7.55 am and your shift ends at 8. After a long night, you just want it all to end!

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  10. When I was a houseman some years ago, I remember one case where the patient & his family were very fond of alternative medicines and had taken 'at own risk' discharges many times in the past. He ended up at our ward yet again one day, and at that time, things had gotten really bad and there was nothing much we could do to help him anymore. After seeing the patient, my boss just shook his head & while dictating the plans of management, he said "refer bomoh" (and being the innocent houseman that I was, I looked up at my MO to confirm whether to write it down or not...)

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    1. ...i wrote it down once....I became the laughing stock

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  11. -hmmm typical of our patients attitude ... tau sikit berlagak banyak , and in chief complain must have some intro on they know Dato X , Dr.Y and bla bla bla....

    -ya , as far as i know in GP practice antibiotics is the most commonly abused drug !

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    1. I had one patient who insists he has the YB's number. He was drunk and absconded after dressing of wound

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  13. bro i understand it...like term as well "specialoid"...

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  14. I salute you all Doctors out there... For having all the patience. May god give you all the strength you need to carry on doing your job. I love hearing stories from my sis everytime she comes home from work. God bless all of you...

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  15. have some respect for your patients. although almost every tom dick and harry in Malaysia can 'qualify to be a doctor', the medical line isn't for everyone.

    if you don't like facing people of every background, then maybe you should just quit your job.

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    1. I don't mean any disrespect to patients but I just like to point out how life is like. We WANT to do out our job in the best interest of the public. We don't ask for anything in return. Would you like to be treated like rubbish & waste 5 years of studies just to let others who don't understand how medicine work tell you what to do?...thank you for reading my blog

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    2. We dont go around dictate architects how to create d buildings, we dont dictate engineers how to build d roads, we dont dictate pilots how to fly ..we can however enquire and request politely..and let d real specialist decide..dat is what these doctors means..

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    3. Thank you Mrs Mama...perfectly said

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  16. Hai, Doktor, apa nak buat jika doktor Houseman jadikan anak saya eksperimen? Anak saya dah straight 7 bulan duduk hospital sejak lahir. Semalam 5 kali cucuk,, hari ni bengkak, kena cabut dan cucuk lagi. Semua yang buat Dr. Houseman. Kalau Dr. MO yang buat elok je. Mereka ini pandai pandai atau dapat arahan daripada Dr. MO? patut kalau tiga kali tak dapat cucuk boleh panggil MO. Atau sebelum nak eksperimen pilih pesakit, tengok sejarah pesakit.. dan kategori pesakit. Teringat kes budak katil sebelah nak pergi IJN, sampai IJN habis semua salur darah kena belasah dengan Dr. Houseman sampai IJN geleng kepala. Dr. Houseman semuanya malas membaca sejarah pesakit dan nota pesakit ke?

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  17. erhh bengan betullah semalam 5 kali, hari ni 10 kali, baby prem kot, dah lah berat kecik. kenapa tak cucuk baby lain? banyak lagi baby prem lain yang baru masuk. Kenapa Dr. Houseman ni sanggup siksa anak. Sedangkan dah request Dr. MO yang buat.... harap besok tak bengkak lah... kalau tak kena cucuk lagi banyak kali.. antibiotik ada 5 hari lagi. Camana cara betul nak komplen Dr? kang kalau komplen disindir pula...... Dr faham tak apa masalah saya ni?

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  18. Hi En Izhar. Maaf jika kandungan blog ini ada mengguris hati en izhar81. Tiada bapa yang mahukan anak nya sakit dan lebih perit lagi melihat anak menangis kesakitan.

    Saya pasti jika tiada keperluan untuk ambil darah, doktor tidak akan cucuk anak encik sewenang wenang nya. Semasa saya bertugas di Jabatan Paediatric dulu kami akan kerap kali menukar branula untuk mengurangkan risiko thrombophlebitis atau jangkitan salur darah. Keputusan darah seperti full blood count, blood culture & sensitivity juga perlu untuk membantu doktor membuat keputusan rawatan yang sesuai.

    Apa yang saya boleh cadangkan adalah untuk berjumpa pegawai perubatan atau pakar perubatan yang bertanggungjawab (person in charge) ke atas wad dan berbincang dengan mereka dengan menggunakan kata kata yang sesuai.

    Agak lama juga anak izhar81 berada di wad. Mungkin ada masalah kesihatan yang lebih besar dari hanya premature baby. Boleh bawa berbincang dengan pakar kanak kanak dan bertanyakan apa diagnosis sebenar dan apakah cadangan rawatan (plan of management).

    Saya harap anak izhar81 akan cepat sembuh, InsyaAllah.

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