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.
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)|
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.....