SCENARIO (Inspired by true events)

Me:   Assalamualaikum Pakcik, apa kabar?

Mr A:   <Silence + frown> Saya nak cepat ni doktor , bagi je ubat.

Me:   Pakcik dah makan ubat harini? Saya tengok gula pakcik 12.5, BP pun 150/100.

Mr A:   Dah. Tinggi ni sebab MINGGU SUDAH ada pergi kenduri.

Me:   Boleh pakcik bagitau berapa jenis ubat yang pakcik ambil sehari <while showing him samples of his medications>

Mr A:   Doktor baca je la dalam nota tu. Ada tulis kan?! Doktor baca la <voiced raised>

Me:   Kalau pakcik makan ubat ni setiap hari, mesti pakcik tau jenis ubat yang pakcik makan. Dah 3 tahun pakcik ada kencing manis ni.

Mr A:   Doktor bagi je la ubat yang sama, saya makan

Me:   Pakcik, setiap kali pakcik datang selama 3 tahun ni asyik tak terkawal je. HbA1C ni asyik tinggi je. HbA1C ni menunjukkan kawalan gula pakcik selama 3 bulan. Kalau pakcik tak ambil ubat tak guna saya naikkan dos ni.

Mr A: Pakcik makan ikut suka je. Rasa pening sikit makan, kalau ok tak makan ubat. Saya makan jus herba Tok Dalang (bukan nama sebenar). Makan ubat ni lama-lama nanti rosak buah pinggang. Saya ada jumpa doktor At***** Therapy, dia dah rawat DNA saya. Doktor bising-bising buat apa?

Me: Pakcik dah habiskan berapa Ringgit pergi rawatan alternatif ni?

Mr A: Ada la nak dekat lima ribu.

I spent a good 20 minutes explaining the misconceptions he has on his Diabetes Mellitus and Hypertension. It still baffling why he continues coming for his appointments and collecting his medications. Why waste tax money if you know you won't be taking the medications anyway? Remember this story? > WASTE OF FUNDS




ISSUES
1. Compliance to medications

One of the best way to find out if a patient is kencing (bluffing) about taking his medications or not is by asking the patient to tell you the type of medications they are taking. For example:

Metformin 1g (two tablets) twice a day:

"Itu ubat biji besar, dua biji dua kali makan" or "Tim liu yeun, leong lap leong pai" (This is Cantonese...I think)

If medication is taken daily, for sure you can know how many tablets you take at the end of the first week. If TWO YEARS take the same medication also cannot remember, how la?

You (medical practitioners) will be surprised at how many patients will kantoi.

2. HbA1C

Basically, in simple terms, HbA1C indicates the level of sugar control of a patient for the past 3 months.

From 2015 Type 2 DM updated CPG

Sometimes, patients tend to mengelat (lie) on appointment. They will make sure they control their diet and take their medications as rigorously as possible a few days before their appointment. On appointment day, their BP and sugar level will be so cantik and get a bagus harini from the doctor. They are actually lying to themselves. Menipu badan sendiri. Most of the time when doctors tell the patients about their uncontrolled HbA1C, they will start to kalut!

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