18 October 2007

A ER doctor responds...

I WOULDN’T say I’m actually surprised with the many letters received from our readers in response to the Good, bad and ugly of Selayang Hospital published on Oct 8.

Somehow, I was pretty certain that many out there had encountered a similar experience. Why? Because a public hospital is a place where each of us is bound to find ourselves in at some point, either as a visitor or as a patient.

Official statistics revealed that every year, public hospitals treat 39 million outpatients and 1.8 million warded patients. Some of you have to be among them.

Of the mails received, there were those expressing empathy for what had happened and others sent their wishes and prayers to my Aunt Lucy for a speedy recovery. Then, there were those with similar horror stories about our public hospitals and there was a doctor with his account from the hospital’s side.

Because Tan Sri Dr Ismail Merican’s email address was also published, there were two patients who wrote in personally to the Director-General of Medical Services and copied their letters to me.

Some of the accounts, I think, are worth sharing with you all. Those who are named have given me permission to quote them while others prefer to remain anonymous.

Here are the first five letters to be published. My response, where necessary, follows.

Dr Chew Keng Sheng: I read your article with great enthusiasm that I decided to write to you. I am Chew Keng Sheng, a specialist in Emergency Medicine and also a lecturer in Universiti Sains Malaysia (USM), Health Campus in Kelantan.

I have worked as a house officer in medical wards, surgical wards, O&G wards, etc before taking up emergency medicine as my field of specialization. I have worked in HTAR (Klang), Sarawak General Hospital and Hospital Universiti Sains Malaysia.

Since I have worked in these places, I can identify very well with what you have written. I can imagine what had transpired during your ordeal.

To be honest with you, cancelling or postponing operations is a norm rather than an exception in ALL government hospitals. It doesn't matter whether it is a MOH hospital or a university hospital.

Most of the time, as far as I know, when postponement or cancellation of procedures have to take place, there must be a reason or reasons.

I have not known (in my limited years of experience) of a surgeon or doctor who cancels an operation or procedure just for the sake of cancellation. It is an unpleasant job to tell our patients of the cancellation. It is just not ethical to do that (huh, still got doctor talk about ethical things ah? Actually I don't know whether I am qualified to talk like this or not.)

The scenario in your case is very common. When an emergency case (especially trauma) comes in unexpectedly which requires a emergency surgical procedure and pushed into the emergency department (hah, this is where I work), that's it! Elective cases have to be postponed. No choice. Elective cases mean elective - usually can wait. If it cannot wait (for example, the elective case deteriorates with complications), then we will usually slot them into the emergency list. Being an emergency physician, I would certainly want my patient to get to the OT as soon as possible should an emergency procedure is required.

When I first read the article, my reaction was “what again, another complaint made public, not just to the Malaysian public, but the whole world”. Can't the public understand things are not as simple as it seems. You lodge a complaint just because you are not happy with certain things. The government keeps producing more and more doctors from more and more universities and yet more and more are leaving for the private sector because of the peanuts we are paid (when you pay peanuts, you get monkeys).

As I read further, I get more restless and ask myself. Who is this guy making such a big fuss of things like this. It is common la, you know, in government hospitals; we are not a private hospital where you can get first class treatment but leave with your pocket empty la (trust me, every piece of gauze, every syringe are added into your bill). Here, we have to cater for everybody from the criminals, the poor, the rich, the Datuks, even the royal families.

And one of the things I really hate is when relatives of patients start to pull strings with VIPs, VVIPs, royal families, pengarah hospital, pengarah this, pengarah that, in order to get special treatment like cutting queue to be seen and treated first, special investigations and tests, etc. What about those who do not have a cable to pull? Like the old poor makcik or a young mother who has been patiently sitting in the reception area for hours just for her child to be seen by a doctor for a few minutes. I mean these are the people that I really have special empathy for.

However, as I read further, my focus began to change. Rather than just focusing on the doctor's perspective, I need to see from the patient's perspective too.

Here's what I've learnt from your article:

1 As a member of the medical profession, I am being constantly observed and watched. The public will form an impression of me and also the hospital I work (see how the name of Selayang Hospital came out) based on how I behave. And some people can be very keen observers and I should be reminded of that (like the way you described the sms time of the DG at 6.28am and the sarcastic observation of the junior doctor in front of the computer.)

2 It is irritating and very unfair for patients to be pushed around either physically (from ward to ward - it happened very often) or in terms of appointments, etc (like in your case)

3 I agree, it is not right for Mr B to say what he had said. He should never have said 'maybe two to three weeks'. The public look up to the doctor to give them answers and hope in times of sickness and when the doctor himself is unsure, the patient will lose confidence. I don't know the tone of Mr B when he said that. He may have said that (intentionally or unintentionally) out of anger, out of his ego, out of tiredness, etc. But as a doctor, I must bear in mind that, at any time and at any cost, this does not permit me to be rude to the patient. I must at all times be on my best behaviour when communicating with my patients, no matter how frustrated or how tired I am.

4 A promise made must be kept. An alternative date must be given to the patient, if the promise can't be fulfilled. Having said that, Mr B did give an alternative to your aunt - like referring to the surgeon posted to SGH. However, again, he should not have said 'two to three weeks later.'

At the end of the day, I realise we doctors should be courteous, and remove our pride and ego. Thanks again, you could have gone through the conventional way of going step by step from talking to the sister, to the MO, to the surgeon himself, to the head of dept, to the hospital director, etc rather than blowing it up.

Then again, sometimes it needs a hard knock to wake us up. It is us, doctors, and our attitudes that should change.

(Francis Siah responds: That was a beautiful letter, Dr Chew. To be honest, there are a lot more to what I’ve written. I don't think it is fair to humiliate members of the medical profession and name them publicly - it was really a lot worse but in my more sober moment while writing that article, I toned it down a long way.

Let me also state here that I have the greatest respect and admiration for those of you who stay on in our public hospitals. To me, you are the real heroes who are genuinely true to your vocation. You live up to your mission - a professional life dedicated to showering mercy and compassion on your patient(s), be he a prince or a pauper.

But trust me, some of the senior surgeons and doctors who constantly misbehave, play politics within their departments, bad-mouth their subordinates and other supporting staff and demoralising them in the process - with patients eventually ending up as ‘victims’ - will not escape my wrath if the matter is proven to be true and brought to my attention. This can only be the honest declaration of a true blue Sarawak country bumpkin.)

Hajah Musalmah Shaari: Thank you for sharing with us your ordeal in Selayang Hospital. Lucky that you are a person with knowledge and you know what to do. Just imagine if it is someone who has no inkling as what to do next and accept whatever suggestion given by the hospital.

In fact when I was working as a nursing sister, I used to remind my nurses that it is easy to show respect to all the Tan Sri’s and Datuks but the test of one's character is when one can show the same respect to the student or gardener or cook who comes to the clinic.

Somehow or other, I find a lot of medical personnel become ‘hard boiled’ after working for a while. Of course, one must not become too emotional at every death you come across but one must remain human and see the patient as a person, and not as another case.

One more thing I used to tell medical students and nurses is “If you don't like people, you should not be a nurse or a doctor; you are better off working with machines”.

(Francis Siah: Well said, Hajah Musalmah. It’s unfortunate that people like you have retired. Otherwise, nurses could learn a lot from you. You have made it perfectly clear - if one has no patience with patients, it’s best to spend time with machines.

There must be a reason why God made some people doctors. Why is it that you and I are not doctors? Hence, our good doctors must always remember that they are blessed with such great talent of being able to cure the sick and save lives. Together with nurses who play a very important role in this process, they must never abuse their God-given talent.)

Richard Poon: Hello ‘Country Bumpkin’, I read your piece on the Selayang Hospital. I admire your tenacity in exercising your rights as a citizen of this country. Too often our bureaucrats think all Malaysians owe them a living. I hope the operation went well for your aunt. Hope she will regain her health and live to a ripe old age!

Simon Peter: Read your rather moving article and admire your courage to put the accounts of what happened in writing. Each and every one of us Malaysians have a responsibility to put those ‘bureaucratic practices’ that are so rampant in our society in its place. Your action is highly commended and you have set a good example for all of us to follow.

Hope your aunt is coping well after her surgery!

By the way, do not ‘belittle’ yourself by referring yourself as a ‘country bumpkin’! We may be ‘small’ but come what may, we still have the power and the intelligence given to us by God to put things right if we are victimised as no one was born or should be pushed around like a slave!

Do keep up with your inspiring and thought-provoking articles and rest assured that you'll always have my moral support.

Dr Johnson Symon: It is heartening to know that your experience at the Selayang Hospital turned out for the better. I am a doctor as well but what I want to stress upon you is that, there is no need for such self deprecation. You are first and foremost a human being on equal footing with any doctor or any other professional or even royalty for that matter. If it weren't for people like you, remember, we doctors would be out of a job.

(Francis Siah: Thank you, Dr Johnson, for your letter. The term ‘country bumpkin’ is meant to tell others that even some country bumpkins in this country know when they are being bullied and will not hesitate to stand up and be counted. And yes, I hope you are still gainfully employed as a doctor.)

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