"Saya nak X Ray Satu Badan!"

8:06 AM

“Doktor, saya mau X ray satu badan. Semalam saya ada jatuh sikit. Kalau doktor tak nak buat kalau apa-apa jadi kat saya nanti saya saman!”

I get quite a lot of demands like these, especially during my stint at A&E. Recently; a mother brought her child to a hospital in one of the northern states. She requested for a chest X-ray but was denied by a medical officer. In typical Malaysian fashion, the name of medical officer was shared on social media and she was accused of being insensitive and kurang ajar. There were some racism secukup rasa thrown into the mix as well. It turned out, the child had some sort of chest infection. In the eyes of the public, if the mother had not insisted on the chest radiograph, the child might have been exposed to deadly consequences.

For now, let’s leave it to the state health department to investigate. If the claims can be substantiated, it is best to be dealt with in a professional manner.

Diagnostic imaging is an essential tool for healthcare staff to diagnose and monitor the progress of diseases. However, nothing can replace GOOD CLINICAL SKILLS. Getting a comprehensive history and pairing it with good clinical examination IS and will ALWAYS be the best tool. Without these two essential skills, you can’t possibly determine which diagnostic tool (laboratory and imaging) to use.  If you just tembak all, it will be a waste funds and resources. Furthermore it might expose a patient to unnecessary health risks.

“The eye doesn’t see what the mind does not know”

Without knowing what to look for, there will be a tendency to misdiagnose or OVER-diagnose.  Just Google the many types of radiographs available. Look at the list of possible angles to take. A single bone may have multiple angles that can be taken. For skull X ray: there's AP view, lateral view, Townes view and Caldwell view. Which is the best view (angle) to take? Will an AP view and lateral view be enough to diagnose an illness? 

Just taking multiple X-ray shots of different parts of the body will expose the patient to too much radiation. There needs to be a balance between risks and benefit. On top of that there is a cost factor to take into consideration. An X ray film isn’t cheap. With the current state of the Malaysian economy, each person has to chip in to preserve whatever public resources we have left. I share with you the rough guide to the effective radiation doses for adults. This list is not complete. Please their site; radiologyinfo.org for further reading. It's not too technical and a layman can easily understand what is written.

Rough guide on radiation dose from radiologyinfo.org

Back to Basics

I plead with the public to help the doctors to help you. Provide us with a good history of your illness and you will get the best possible treatment. I get plenty of cases where parents bring their 2 to 4 year old kids to clinic and expect the doctors to extract the history from their kids.

“Mana saya tau apa jadi, badan dia panas. Doktor tanya la sendiri!”

I have a hard time getting history from a 12 year old boy. You think I can get anything much from a 4 year old who thinks I am a complete stranger? Worse still, he might have been taunted with; “Adik jahat nanti DOKTOR tu cucuk!”, when he was small.

(Don’t you just hate it? You do your work, minding your business when suddenly; “Doktor, cucuk budak ni jahat sangat!” or “Duduk diam – diam, nanti doktor tu marah”. Why can’t the parents just marah or cucuk je budak to sendiri?!)

To all doctors out there, let's get back to basics. I have seen some colleagues get a diagnosis out of the blue. Without even touching the patient. If can get ilham datang dari langit, might as well be RAJA BOMOH DUNIA.

Raja Bomoh Dunia

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