Medical Mismanagement or Hopeless Communication?

Here's the original article on Malaysiakini, about a Dr whose father recently passed away in Hospital Taiping http://www.malaysiakini.com/letters/141502 .

In short he is saying there was mismanagement, poor conduct by the hospital staff & the doctors involved.

A 94-year-old Indian male with Acute Coronary Syndrome (ACS,minor heart attack) and possible chest (lung) infection who was progressively deteriorating in the ward, developed respiratory distress & hypotension (low BP). His son a Dr, believes he should've been in ICU/CCU, and that he should've been intubated and actively resuscitated whe he started to deteriorate. In fact, he (the son) started to do CPR and asked if he could intubate his father. The following day, the doctors asked if they could perform an autopsy to determine the cause of death.
It was a painful article to read, because it captured the father's final moments very vividly.

Responses to the article commented (more like complained) on everything : going to a Govt. hospital is a death sentence, Malaysian doctors & healthcare system is hopeless, too many medical schools resulting in mediocre doctors, the need for meritocracy in deucation, the country is going to the dogs...etc.

Let me be frank about something : the hospital & healthcare system is not a 5-star hotel with a menu where you choose the ward you should be in, or which specialist from what field should be treating you. This is not my response to the article per se, rather my feeling toward the more educated patinets out there, especially those who can afford the $$$$. Just because you have a chest pain does not mean you need a cardiologist. You may think your funny looking nails are due for a manicure, but don't be surprised if your GP sends you to a hematologist, a cardiologist or a hepatologist. Yes, a patient has a right to his choice of treatment, but treatment as counselled or recommended by doctors...not wikipedia

Sorry for the tangent. Here's an objective response to the article, by an Ida Bakar :
"I am writing in the hope to lessen your pain at the loss of your father. If your father had been admitted to a hospital in the UK, I doubt the outcome would be different.
1) it is highly unlikely that a 94-y.o. would be admitted to ICU
2)the diagnosis of ACS alone does warrant admission to CCU
3)presence of dentures can ensure the upper airway remains patent, detures are remained in situ during bag-mask resus
4)intubating your father will only prolong his agony; his heart and lungs have failed and his body was shutting down
5)the request for a post-mortem is not unsusual in a hospital death
It does appear here that the problem was one of communication. A Do-Not-Resuscitate decision was made. Perhaps a decision to keep him comfortable in the last hours of his life was made also. You mentioned the lack of monitors and drips, but the presence of a cannula may indicate that appropriate drugs were given"

Here's a snip of another comment, by a Tyrone, a doc with ICU experiencr :
"You father should have been given an opportunity to pass away with dignity and without suffering, hence no active resuscitation. A morphine infusion should have been started to alleviate any pain or discomfort; this is where the hospital staff should have acted promptly. You shouldn't have taken an active role in treatment because emotions would have clouded your medical judgement. Nonetheless, staff should have sttended to your concerns or explained to you why they did what they did".

OK. I'll be the first to say that in Govt hospitals, communication with patients leaves a lot to be desired. This is where we differ from UK, where patient counselling cn take up to an hour...if that were to happen here, we'll get a new letter in the newspapers saying that the waiting time in hospitals is too long. So patient education takes a back seat and usually delegated to nurses, monthly talks/briefings and to junior doctors. And in most instances, only the basic info of the disease, prescribed treatment is given...not much attention is given to alleviate concerns n giving patients peace of mind...

keyword here is PATIENTS....not relatives or mother-in-laws. And so far, for me as a student, this is where i come in : the bridge between the hard-core clinical stuff and the layman's perspective. Also, this is where private hospitals & clinics have the upper hand...there are no 'junior doctors' or specialized nurses, so the task of addressing the concerns falls solely on the consultant....which is also why some private docs give out their personal handphone number. This is actually why the general perception of 'doctors in private hospitals are better'. In terms of medical care, any Govt hospital wins hands-down. NEWSFLASH : if anything goes wrong in a private hosp, or a case seems complicated, they WILL refer to a Govt Hosp, any Hospital Besar. You will never see a govt. hosp, no matter how small, refer a case to a private hosp....unless it is because of a patient's request.

I guess another point to learn from the story is, never underestimate the role of emotions, and how grief (or worse, impending bereavement) can affect somebody. Everyone has a hard time when witnessing death. Doctors may see it more often, hence dismiss it in another day at the job. But when it his home, when it stares you in the face, you WILL feel compelled to do something, ANYTHING, because afterall you were trained to 'rectify' any state/condition that is not functioning normally. This is why we have a lecture, Diagnosing Death....to know when to let go. Any person on the street can tell you if someone is alive or dead...it doesn't take a genius. But how do you tell when a person has death in line?

I guess that's enough for now. Back to school.