Friday, May 25, 2007


One of my crucial task is to discern what a patient really wants, their real intention of seeing me. Are they out to genuinely seek treatment from me or do they have some ulterior motives? Their body language,facial grimaces and vocal intonations, all contribute to aid me in my daily chore. But of course, a doctor must not have any pre-judged ideas about their patients!

One of my main difficulties is to explain to them when an antibiotic is necessary and when it's not. Some, who are overly 'informed' regards antibiotics as a definite no-no and refuse them even if it is very much indicated. When a bacterial infection is at an early stage and sensing that a patient is a staunch proponent of 'anti' anti-biotic, I'd skip prescribing them to safe time and energy getting into a futile debate.

Even more difficult is to convince those who think antibiotic is the treat-all medicine and request antibiotics for the slightest ailment or even worse, for a non infectious disease! I get frustrated when after telling these people that they or their kids suffer from viral infection and antibiotics won't help, they'd put on a face that says: "Don't tell me you're not giving me any antibiotics when that was my essential intention of seeing you?" So how do you tackle these people who won't take the word of a doctor?

Truth is, it's sometimes difficult to convince a patient regarding certain line of management. How many times have I encountered patients who would interrupt me whilst I am deep into explaining the crux of their treatment. Exasperated, I would usually lose interest to continue advising them.

Another distinctive impediment I face when treating patients , is their inability to relate intelligently their symptoms to me. Most of the time, they have limited words to express or describe their pain. Even when I suggest descriptive words like collicky (memulas), sharp (tajam) or boring (senak) for them to chose, they'd end up looking blank and persistently says 'sakitlah".

It's important for one to be able to describe their pain precisely and locate the exact site. One classic example is to differentiate a cardiac and a gastric pain. Both can originate at the same site i.e. epigastrium or centre of the chest. A learned person would be able to say whether the pain is a central crushing pain, associated with sweating and shortness of breath which is typically being described by an ischaemic heart sufferer. Or if he had acute gastritis, he would convey that the pain is sharp or burning in nature, which is accompanied by lots of belching, nausea and even vomiting. He would know that the discomfort is pertaining more to the abdomen than the chest.

Most annoying is when I get tangential answers to my direct questions. "How many days have you experienced those symptoms?" I would ask. "Two weeks ago, I had the same symptoms. They subsided and now they have recurred" Or "My kids also have them", they would answer nonchalantly. And these are not answers from foreign workers, mind you!

Patients have all the right to chose doctors who treat them but not vice versa! Doctors are deemed to treat everyone in need of their professional help, even when these people irritate them to their bone! At times, you see your name or your colleague's appear next to a patient's name, meaning they have requested to see a specific doctor. Once, a patient had to wait long as the doctor she had chosen to see was spending hours on another patient. Finally she gave up and requested to see me. So did I smirk at her? Of course not, hehe. I acted civil and brushed aside when she became apologetic towards me.

So perhaps it's best you prepare yourself (vocabulary-wise) the next time you see a doctor. And if you have a personal opinion against taking antibiotics, tell the doctor early thus sparing her the time form prescribing them.

Quotable quotes: A thought that came through whilst driving home from work, annoyed with the selfish attitude of many road-users : As long as there are reckless lorry drivers and careless motobikers, Ops Sikap should be renamed Ops Siakap


Queen Of The House said...

DITH, looks like doctors also have to be mind readers. Banyak kerja ek?

One suggestion for educating the anti/must-have anti-biotic patients - put up large posters in the waiting area explaining when antibiotics are necessary/not necessary. I suppose some people are just not informed enough to make an informed decision.

zyryx said...

Thank you for sharing this. Entries like these are really helpful for me to get a picture of what working would be like in the future. Hopefully Malaysian patients will become more educated in health-related stuff like this, and maybe I should get a medical Malay vocab book myself too..

Mama Sarah said...

Queen, do you really think that they would be reading the large posters on antibiotics?

DITH, when they persistently say "sakitlah", did you get the message that all they want is m.c.?

ikelah said...

it obvious that they mc when the pain started to migrate from 1 part of the body to another. The initial complaint may be just a stomachache with 5 x diarrhoea.

it is not a generalised bodyache but... "siku pun rasa macam terseliuh minggu lepas dan kebas."

"kepala lutut kiri kadang kala ada bunyi bunyi 3 hari lepas"

"kejap tadi cuping telinga pun ada rasa panas"

" mengapa dr, tangan kanan saya rasa ringan je macam boleh gerak sendiri."

when you cannot relate 1 complaint to the other, the it is obvious he wants mc. the pain will disapper if you offer 2 days. if 1 day, "sempat ke baik dr? banyak tempat yang sakit ni? tangan kanan bertambah ringan rasanya."

dith said...

QOTH- masyallah ! You can say that again. These couple of weeks patients come in droves and I can hardly breathe!! Posters may be helpful but I doubt it would work for many...

zyryx- Or you should just pretend you're an imported surgeon from Russia and they have to get you an interpreter, hehe

Nisak- When I ask sakit macam mana? They say: sakitlah bukan memulas, pedih atau senak just plain sakit. Get it? I dont. No these are not MC seekers. They simply cant describe the pain.

iKelah- That reminds me of my colleague in SB dh, hehe. Dia letak stethoscope dia kat merata tempat including the scalp!!! hahah

P5 said...

heh heh heh....

i had a friend, that would spend sipping hot horlicks while waiting to be seen. so when the doctor put the thermometer under the tongue, sometimes the temperature would reach 40C!!!

that was like 10 years ago when thermoscan was not widely used.

ikelah said...

after writing all the above, kalau mereka demam, batuk, selsema dan mereka rasa tak daya nak kerja. i'll just go with the MC, at least they are sincere and wont cause me initial headache trying to relate the 1001 complaints or symptoms to impress me which eventually i know it malingering.

namun always smile... ye ... ye ... ye... it will do them some good at least the self confidence is maintained.

Anonymous said...

talk about deja vu. my gp n i were discussing this problem yesterday and here i am reading about it.

ive seen so many patients requesting abx despite having viral infections (commonly - sorethroats, coughs and colds). And it's really difficult trying to break the vicious circle because most patients think abx does the trick.

My gp usually gives them the script, but ask them to hold on to it for 2-3 days. If it's not getting any better, only then should take the abx. and surprisingly this method does work. hehe

afie911 said...

Wah. Thank you dith. This is an eye-opener for doctors-to-be. It's not at all easy peasy lemon sqeusy once you get the title MD. It's gonna be a whole lot challenging in its own way. Hehehe. Tapi mcm tak sabar nak jumpe patients2 mcm ni, just to get the feel. =P

QOTH said...

Hmmmm .. Ye lah DITH & Nisak, the posters won't work unless you get many patients like me who spend the time waiting to go in by reading everything on the wall! Maybe subliminal messages transmitted below the audible level will do it ... Hehehe macam cerita spy pulak, brainwashing your patients.

P5 said...

dith, i was thinking that you might want to start prescribing patin asam rong to your patients as it seem asam rong is speeding up ikelah's recovery at breakneck speed.


so when are you going to muse on the asam rong dinner at boogey's?

red said...

tell them that you'll give a ring to their bosses to negotiate for a lifetime mc.

mynn said...

regarding antibiotics:
antiobiotics therapy in the UK is undergoing a change. some doctors used to be "trigger happy" prescribing antibiotics even for vague symptoms, but with the prevalence of clostridium difficile - an antibiotic induced diarrhoea, people are keeping their antibiotics distribution in check. so like you said, it's crucial to make out who really needs antibiotics - i belong to the camp who would require on paper evidence of an infection (raised temperature, consolidation on CXR, growth of specific bacteria on blood or urine cultures) before starting an antibiotic.

regarding vocabulary:
what an eye opening read, really gives me an idea of what working in malaysia is like. I have to say: people in the UK are VERY good at describing pain and their illness. they are normally very articulate and it is normally relatively easy to get accurate history.

Has said...

DITH, but then, you don't have to be annoyed. Patients memang macam tu. Imagine if I get annoyed with my patients, among whom ada yang datang clinic with the thought that they are actually treating the doctor, he he he.

hiyoshi said...

I'm going to keep this in mind as I go about studying medicine. Thanks for sharing :)

JoKontan said...

IMHO, it's similar with my work. The Major Part of it is still trying to convince the other parties.

It can be fun and worthwhile, if we have the times and means.

Tapi kalau tengah nak cepat nii, kira lantak laaa korang... Nak dengor,. dengor . Tak Nak sudah !! Tak Koser..

Technical and technicalities Part of it is always the easier ones. Spend 5-6 hours going thru the Manual and,. Voila ! we got it covered.

It is Always the Human Part that is Hard...

Mostly,. I take it as a challange.

Terimakasih for sharing.

Tangential Answers. I could use that also huh ? Ha ha haaa..

Umor Berapa ??
Doc, saya baru kawen satu, anak enam..

dith said...

P5- close friend eh??! hehe

Ikelah: :p

Anon- good that you have such rapport with your GP

Afie- tak sabar ek? Wait till you're there! hehe

QOTH- yes, most patients can't even bothered to read anything. They'd rather play with their handset!

Red- and what disease shall I write as the diagnosis?

Mynn- you can't be that strict here as you dont have the time and means to do all the tests!

Yes, a friend who used to work in Sheffield said that her patients over there articulates well with regards to describing their aches and pains. That helps a lot I would say! Overhere, most of the time, you have to fill in the blanks

Has- hehe, but your set of patient have all the 'right' to behave the way they do. Maybe I should send my difficult patients to see you guys eh? :p

Yoshi- there are many peculiar things more about these people but I'd spare you the details, :p

Jo- re tangential answers. A classic irritating example : Dah berapa lama masaalah ni? Sejak saya bersalin anak yg nombor dua. (*&^%%#@????! What the ...?)

P5 said...

i remember some time ago, people were saying some doctors at the gov hospitals prescribed pil KK for every ailments.

personal experience: a doctor at one gh finished writing my prescription BEOFRE i finished describing my illness. guess what i was given? pil KK, 2 biji 3 kali sehari.

simah said...

alli can say... u dont want me as a patient ehehhe

memang susah betul yea sebab u have to deal with many types of people... semua banyak perangai..tapi overthe years...u dah terbiasa ker or it still gets to u?

after all these years in the profession... u pernah tak buat mc sendiri (ie..ada hal tapi u have to work but u have to do that thing etc..etc)?

Ikelah said...

I have a patient today.

" tangan saya bengkak dan sekarang sakit"

"baru 3 hari, sebelum ni tak pernah"

"saya kerja guna tangan, ia terus jadi sakit"

"tak ada trauma pada tangan, bangun tidur terus bengkak"

" pernah terjadi, sekejap ada sekejap hilang bila sapu LMS"

"tiap tiap bulan ada bengkak ada surut"

".... aaa... tak boleh grip, aaa.... sikit sikit je boleh"

"first time 6 bulan dulu"

"jadi macam tu juga, tak kena apa-apa"

"bila saya mula kerja, lepas qualified"

So, i told her to rest the hand and give her some NSAID. there was no obvious swelling, no warm, just slight tender over the second metacarpal, slight limitation in opposition and making a fist.

"tak mau X ray ke dr?"

it took 10 min to get to when the problem started but eventually "tak mau X ray ka?"

what the patient really wants is for you to agree that there is swelling, pain and then do the X Ray. To her X ray will reveal everything. FYI, she is actually our new OT staff. :)

i asked her to come back in 3 days, maybe i'll do the X ray to satisfy her of just send her for physio(splint and US therapy) with more NSAID.

Has said...

ikelah, hantar gi physiotherapy ler, celup wax.

small joints tu kalau sakit orang tak nampak, tapi rasanya amat sakit dan limiting function, he he nak basuh berak pun susah oii.

Ikelah said...

memang nak hantar fisio mulanya. nak suruh US dan biasanya sebelum US memang dia waxkan dulu, then pakai splint. thanks Has.

ezzuramd said...

it's really hard to satisfy ur pt without breaching ur professional ethics...they thought a/biotics are just simply wonder drugs...some "real educate" pt will teach u what to do/what to give them and they thought they know much better than u...malaysian pts are just too berlagak pandai more than docs...and it's hard to educate them...

dith said...

P5- KK ubat miracle, hehe

Simah- Why wouldnt I want you as a patient? :p. MC sendiri? WTH?? hehe

ikelah- send that pt to Has

has- I still think that pt needs to see you, :p

ezzura- the angst of a family physician eh? hehe

Damelehrer said...

I always like doctors who ask me questions, who would explain to me what and why they prescribed a particular medicine/antibiotic, who draw diagrams to explain to me what is going on in my body, etc. But the problem is I have met with a few who doesn't do all of the above. Hmm...may be I should consider going to see you the next time I need medical help!

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