Sinseh Can, Doctor Cannot!

2:08 AM

A while back, a lady came to the clinic complaining of a skin lesion on her left ankle. She had a fall a week prior to the visit and claimed to have had a fracture actually she said...

"Retak ke patah, saya pun tak tahu doktor tu cakap macam mana"

I have no idea what that means either. Retak = crack. Patah = break. Break or crack, still fracture la kan? Anyway, a cast was put in place by the doctor and she IMMEDIATELY took it off and went to a Sinseh. The cast was removed and a concoction of herbs was wrapped around the injured area.

Any of this tulang can patah, retak or whatever you call it!

"If I had used the cast, I would not be able to walk at all" said the lady. I could see that she was walking but she was clearly limping. Her ankle was still swollen and I saw some resolving bruises around the ankle. The skin was bad too. It was dry and excoriated. Skin were peeling off. It is most likely due to contact dermatitis with the herbs.

Me:              "Was all these worth it? The swelling. The skin lesion. The limp."
Ms. A:         "Yup. See doctor, I can walk. My friend had a broken arm and had to use the cast for                             months. I don't want to be like that!"
Me:              "Are you happy with the management?"
Ms. A:          "MESTI la. I am not so fond of Western medicine. I came here just to get an opinion and                       maybe some cream for my skin"

That was the end of it(.....or so I thought). This lady won't change her mind about medicine regardless what I say. I spent a few minutes telling her about the healing process of a fracture, hoping that I can help her do something better for her ankle. As expected she said:

"I totally trust this Sinseh. He treated my broken arm a long time ago. OK je!"

Time for me to get a new job

So I write a prescription for aqueous cream and let her be. At least I tried to help. But before she left, she dropped a BOMBSHELL!

 "Doctor, do you have a medication to help me slim down. A doctor gave me a pill a while back.  Its for diabetes but can use for slimming down one! Its round and white. Can you give me ah?"

I suddenly had a surge of swear words running in my head. WHAT THE.....? You trust your Sinseh so much and expect me to give you METFORMIN (it is a commonly used diabetes medicine)! Why don't you run around your Sinseh's house a few miles, that will make you lose some weight!

This lady clearly thinks that I am an idiot. I would be an idiot if I prescribe her with metformin. Yes, there are instances where doctors use it to reduce weight WHEN THERE IS A CLINICAL INDICATION. In this instance, its completely unnecessary. She wasn't morbidly obese, and worse off; how am I supposed to follow her up?

Want to use cast for 3 months also she don't want! Aiiyyyah!

It would be suicide for me (and maybe her). Who knows, she might just consume 5 tablets of metformin and end up comatose due to hypoglycemia (low sugar). And when they trace the records, there goes my doctor title!

So, what can we learn from all this?
1. Some people have ridiculous priorities in life
    The lady didn't have the will and patience to use a cast for a few months in order to walk normally after         that. For her, it was better to walk with a limp for THE REST OF HER LIFE than to not walk for                 THREE months.

2. I don't trust Western medicine but I trust the man who sells a product at the sidewalk
    Enough said here

3. Compliance is tough
    Its really hard to ensure that a patient is compliant to a treatment. It is even worse when they have their         own preconceived ideas. Its best to try to convince the patient but if they can't accept it. Its best to let           them be. As a doctor, you need to strike a balance between risk and benefit. In this case there is a clear       risk of harm if metformin was given.


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  1. hi there! i'm not a doctor, never studied medicine in my life. took Bio only in form 4-5 in high school. i recently followed your... writings after my mom was hospitalized for her very first time in her entire life.

    well, not the hospitalization process brought me here, but all those things i've seen in that entire week accompanying her during she was warded made me wanted to know (at least) how it is on medical team & rescuer side.

    so, i totally agreed on your 1. in the summary list. well, i heard from both sides now rather than what i usually heard, "the doctors didn't feel the pain, easy to say la. the one suffering here is me... bla bla bla". honestly when these words came up, i'd shut my mouth n stay in silence until the mood is cleared, back to normal. it's, undeniable, patients in pain are much more sensitive than they usually are, while healthy, i got it. but, even the docs n nurses n caregivers didn't actually in pain, physically, they're also humans, have lives outside clinic/hospitals. they might not sick or ill, physically but who knows, what's really going on in their heart or head yeah? well, it's too hard to be rational when conquered in pain... maybe. especially the elders who are usually active & independent. like that woman in your entry, i bet she can't wait that long for her to do her normal activities.

    the point is, i'm not really taking sides. it's between awareness n education we all have towards ourselves n others, both. the trust came from them.

    hang in there doc, as long as you can! all we have to do is keep on create awareness n educate people n though seriously, it's easier said than done, but we have to keep on trying.


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