TGIF.Not!?

Post 3 hours’ sleep (again, I had initial insomnia…sighhh) but amazingly energetic WITHOUT a dose of caffeine, I came to work happily this morning. After an hour’s drive through a reasonable KL traffic (thanks to school holidays), I reached my locum clinic in a cheerful mode. Sempat tahpau idli for breakfast lagi on the way 😉

This is one of my busiest locum clinics! And one with a lot of foreign patients!!

However, I love this clinic’s staffs. Though there have been a few occasions of misunderstandings…Overall, the staffs are courteous, very capable and reliable, in short – gems. After my horrifying experience as a permanent doctor at Klinik N, do trust me when I praise any clinic nurse/support staffs!

***

Was just thinking this might be a TGIF, despite 12 hours of work
I was looking forward to my lunch from the Chinese vegetarian shop later…and etc etc.
BUT
My good temper was short lived!

*

Within the first 2 hours, I had my first irritant! A young Malaysian couple came in with their 2 children. I completed my history taking and physical examination of the 1 year old boy & came up with the diagnosis of Acute tonsillitis. This is their first episode of seeing a doctor in the past 3 days. Afebrile as was given syrup paracetamol (stock at home). All was fine until, when I started explaining about my treatment plan…

The man was RUDE! Arrogant even…his TONE of Speech & Body Language – Ggrrrrr…still, I hid my ‘claws’.
Then his wife started. “Both my kids don’t respond to the medications taken here previously. We go to this Paediatrician everytime, and they will definitely recover. All I want is for you to give me a referral letter. That is all, doctor. Last time we were under Panel A, and can visit the Paediatrician directly. But since the company changed to Panel B, we need a referral letter. Just give us one.”
OBNOXIOUS!

By now, my claws were ALL out! I snapped…but retracted my claws back &
I summarized by saying “THIS IS NOT THE RIGHT WAY! We GPs are not clerks to carry out your order, but since this’ what you want – wait outside. I’ll give a brief letter. I have many more patients waiting outside.”
What I meant was ‘Get Out!’ Grrrr…and told the staffs if anyone else comes with this kind of ridiculous request today, I am not going to see them.

But guess what, I did give a proper, complete letter…for the child’s sake. And for my credibility; Stating that parents refused treatment and demanded specialist referral as first line treatment. I pray the Panel will REFUSE reimbursing them!

Dear Public:
Kindly take note that you are free to seek treatment anywhere you want. If you only want a specialist treatment, by all means go and see your regular specialist DIRECTLY!
Kindly do not treat us GPs as your coolies! We are not here to be insulted. We didn’t study medicine for (a minimum of) 5 years, go through internship & gain all these years of work experience to FOLLOW Your Orders of writing a referral letter without any intervention on our part. Especially if the patient’s condition is stable!
Of course any private specialist would welcome you with open arms for any problem, though not warranted for specialist referral, as it is business for them. BUT Don’t BULLY us for your ‘benefit’! If we were to refer stable patients without treatment to a (esp in Public setting) specialist clinic, we can expect an earful…

If I was the boss, I would have told off the patient! But now, I might be blamed for ‘spoiling someone’s bussiness’ – SIGH!

***

Denied a few MCs today, without any second thought. Come on larr, PERKESO health screening and G2000 complete medical checkup aren’t entitlements for MC!
The funniest was this one guy who just before walking out, said nonchalantly:
“Doctor, MC (sick leave) today yeah”. As if he was ordering teh tarik & roti canai at a mamak stall!
Me: Medical checkup is not due to you being ill. It is a routine screening. Sorry, MC is not warranted for you.
Patient: (sudden spontaneous obviously very pretentious) *cough cough COUGH* – I have cough, doctor!
Me: (trying hard not to laugh) *shook heads*

Didn’t waste time exploring and examining his MC-cough, as it was sooooo obviously faked!

Do I appear like a dumbo?

*

I am not an ogre when it comes to MCs. If it is reasonable, and warranted for, I myself will offer.

On the other hand, I was touched at the work-dedication of some patients today, who declined the MC I offered.

The HERO of the day is a young man who had infected ingrown toenail. Post nail avulsion, he REFUSED MC & wanted to return to work today itself!
Doctor, even if you give me an MC, I will still go to work.
So, I decided it is best to go Green and save the trees 😉

***

The AWARD for the most ridiculous patient/companion for the day goes to this pair!!

Day 10 post circumcision. On daily dressing for infected wound. I examined the wound – it was clean. Informed patient Clean. To continue normal saline dressing, and to complete his antibiotics.

I carried on seeing other patients, amidst a lot commotion from the treatment room next door…the patient (Nepali) & colleague (Malaysian) VS nurse who was doing dressing.

I am glad I wasn’t dragged into the fiasco.

And so, this is the story: First the colleague was complaining “while doing dressing in this clinic, there was pus. After 2 days of not coming for dressing, but applying traditional ointment (minyak gamat) over the wound, it has almost completely healed!  What wrong medications are you all using to cause infection!??

Dear reader, the patient has been compliant to his antibiotics during the time he defaulted follow up for daily dressing. IMHO, the ‘magic’ behind wound healing is most likely due to the additional antibiotic action, kicking in.
Today they mainly came in to complain that – jeng jeng jeng : the doctor (boss) who circumcised it did it without patient’s consent!!!

Me: *blink blink*

*

Seems that the first time patient presented, a non-nepali/hindi speaking locum doctor attended to him. With the assistance of one of the nurses who is of Nepali descendent, and speaks the language fluently, they discussed his condition, and ascertained that the patient wanted a circumcision as part of the treatment. An appointment was fixed for the boss to perform the circumcision.

On that fateful day, patient claims the doctor entered the treatment room & without any consultation, asked him to lie down (assisted by the Nepali-speaking nurse), covered eyes with ‘patch’ – the reason he claims he didn’t know what went on…injected painkiller to his manly organ – the reason he didn’t feel anything…and next thing he knew his foreskin was removed, and he has been suffering for post-op infection etc…

*

To me, a lot of things didn’t make sense. For instance:
1. Why didn’t the patient complain to the Nepali-speaking nurse who did his dressings every time he came before this?
2. How many homo sapiens would allow a doctor to handle with & meddle their private parts, without a question, and ‘sleep’ peacefully during the process? I know that in some cultures, doctors are akin to God. As such, they would bare it all out of sheer Trust. But still…when he was informed earlier that the procedure plus medications would come up to a cost of almost half a thousand, HOW can he claim it was done without his consent?
3. The patient’s companion (alleged colleague cum friend) wanted to observe the procedure the day it was done, but his request was denied on privacy grounds. From his arguments, seems like he has been observing the wound progress himself.
According to the nurse, he wasn’t present during previous dressings. But today, he sat in during the dressing. How many people would be comfortable having their friend or colleague see their private part? *blink blink*

I stop here on this story & my speculations. Will leave the rest to your imagination :p

If only all my patients were this co-operative when it comes to examination of intimate parts of the body, more accurate diagnoses can be made and the most accurate treatment administered!

***

Amidst all these trying situations, there’s some good news to celebrate! 😀
YEAYYYYyyy….a friend shared the good news of clearing his English test today.
And my couple friend had their registration to practice approved!!!

Here is a very valid reason that brought a smile to my face & say made me say, ThankGodItsFriday afterall.
All of us Malaysians from my VMPF Class of July-Sept 2012 are almost there! 😀 I am NOT a racist, but very much a Nationalist! I admit it. Hopefully this trait won’t make me bias, and I am on the pathway to becoming a Globalist 😉

***

Left that locum clinic at 5pm…and checked in at another clinic at 6pm for another 3 hours before I can call it a day.
Realtime : Another patient to test my patience just left my consultation room!! The only thing missing difficult patient issue for me today Fulfilled!
It was someone demanding antibiotics, and this lady asked me as if she was asking for sweets from the grocer’s! *roll eyes* I counselled and lectured her -Out of it! ;p

*

I’m hoping to get some cute kiddos to make me feel like it IS TGIF day afterall! Well well…even if I don’t get any, I have something to look forward to – a kiddo to meet when I get home in an hour’s plus time! 😀
Like yesterday, I was soooooo tired while driving back, only until the moment I entered the house. When an innocent little child lights up upon your arrival, is excited to see you, and starts entertaining you with her antics…how can one remain tired? I too lit-up! 😀

image

HOW TRUE! 😀

***

I was having a problem with my wifi past 2days. My laptop’s Wifi indicator was always ON & steady (not blinking) BUT the desktop icon shows NO NETWORK FOUND under wi-fi. I can connect to all networks from my phone. And…Yup, I tried more than 2 different Wifi spots even! Same result 😦

I am NOT sure what was the problem…didn’t install anything new, antivirus is up and running well.
Finally as my ‘diagnose’ wizard keep failing to detect the problem, I tried ‘system restore’ to the date of 2days ago….and hey presto!
MY WIFI IS UP (full strength) & RUNNING! 😀 Thank God, indeed!
Guess I’m not so bad at techie stuffs afterall 😉

*

Not only TGIF…but Thank God for Every Single Day! 😀
CHEERS & Happy Weekend, Folks!

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