Doctor, doctor

As I awaken at 2am from my slumber, realizing I haven't done the presentation slides of my ICU patient, I sat on my desk and turned on my laptop. I then proceed to Facebook and Farmville, harvested my crops, commented on walls, and read a few posts. So ingrained is my routine of delaying unpleasantness, i now function my best once the world has gone to sleep. Not to mention i have grown disturbingly comfortable and skilled at churning out just-enough-for-passing-grade academic assigntments in a matter of hours. Perhaps it is now evident that i am no workaholic.

Anyway. I've been wanting to lay my opinions on the recycled issue concerning doctors : that there aren't enough doctors in Malaysia.
http://www.bharian.com.my/Current_News/BH/Wednesday/Mutakhir/20100127125427/Article/
Pure hogwash. The statement was probably true a few years back, but now with more than 20 medical schoold in Malaysia, plus the many more studying overseas, pretty soon Malaysia will be flooded with doctors. Even now, there are too many students-per-teacher, and in the working world, too many House Officers per ward.

What we need are better doctors, or perhaps more doctors with better mindsets. Ask the question, why does it seem we never have enough doctors?

Number 1, its the massive amounts of patients. Not just the usual Monday crowd (MC-seekers.) Its not that Malaysians are a sickly bunch, but most Malaysians are not medically-literate and come in too late, usually from very preventable complications. It is obvious that they have no idea what is going on with them especially when they come thinking 'angin' is the root of all evil. Headache= angin, abdominal pain = angin, chest tightness = angin, shooting nerve pain down the leg = angin. But, one good thing with these patients is that they are more likely to stick to one doctor, although by no means are they more compliant to medication and therapeutic advice.

Number 2, the certain bunch of demanding patients. Not every headache is a brain tumour, and most headaches dont need a demand for a CT scan. Dont believe everything you see on Spektra or House or Grey's. Doctors in private hospitals would probably entertain such requests, because they dont have a long waiting list plus the extra money in their pocket, justified as "for the patient's own ease of mind". Wouldn't it be better if these resources are used for the people who actually need it? In government hospitals, the doctors would tell you to go fly kite...then doctors get the bad press. These bunch of patients are the ones who go 'doctor hopping', which is not good. One visit to a doctor who didnt 'cure' them, they find another doctor a few days later who can give 'better medicine'. This is potentially dangerous because without existing records, there is no continuity of care.

Here's an example of unrealistic expectations of a patient :
http://www.themalaysianinsider.com/index.php/opinion/sazlin-daud/47633-doctor-doctorcant-you-see-im-waiting-waiting

But of course, doctors are not without faults. More often than not they are too focused on what they need to do for/to the patient that they forgot that they have not explained much to the patient what is going on. I've read somewhere that doctors overestimate the time they spend with patients by 900%. Now as a student, that is where i come in. Whenever i speak to my patients, young or old, i try my best to talk to them as friends. Hopefully if they are receptive, then they feel more at ease and open to ask me stuff, and I will gladly explain what i know about their condition.

For example, my Gynaecology patient was admitted for heavy periods, but she was also desperate to conceive and she asked me to help her understand the various methods of assisted conception. Then there was this man at the ENT clinic whose wife was having her ear examined & cleaned because an insect flew in it. We were both looking at the monitor (along with many other nurses & medical students) and i just asked him what happened. Then i just pointed to the screen and told him that the white thing was the eardrum, and that was where the insect was attached too. The a big ooooOOhhh came from him, learning a bit of trivia, almost with a hint of amazement for seeing an actual eardrum for the first time. Also like my uncle, curiously listening to his son's heartbeat with my stethoscope. Then there was this man back in Klang who had a heart valve condition (if i'm not mistaken) and having students flock around him day-in and day-out to have a listen at his heart. His daughter was there when it was my turn, and I told them that because of his condition his heart sound was different from the norm, and as students we had to learn to differentiate. I also demonstrate how it was different, and if i remember correctly i even offered my stethoscope.

PATIENT EDUCATION. Get them interested with their own health and illness. No time to counsel? Provide useful reference or websites. In short, i completely disagree with extending compulsory government service. I also believe that as long we provide f.o.c healthcare, peeple will not wise-up and take responsibility of their health, because they do not understand the cost of the medications & equipment used. I am of the opinion that the resources should be focused on patient education and more community outreach programmes. Don't even get me started on medical tourism. Look inwards and improve the health of Malaysian citizens first before offering 7-star treatment to foreign patrons. To paraphrase a Malay proverb : dont go breastfeed baby monkey in jungle while your own baby dying of hunger.

Time to get back to calculating my patient's potential death risk.... (does anybody know how to work the APACHE score??)