Another Gift Card – Refer a GP 

About 6 month’s after receiving my own $250 worth of gift card for using the patient education tool, HEALTHSHARE, early February 2017 I received another gift card.

This time, it is for referring a colleague. $25 (10% of the original gift card value) – not bad, eh ><
Totally forgot about it, until my colleague (working in another clinic) enquired about it.  Few weeks later, someone from Healthshare contacted me verifying my details, and there it was in my email!
So, we both received gifts this time – referrer & new user.

What a lovely way to encourage GPs to use an online patient education tool. I continued using it after the first 3 months & reaping the promised reward. Not because any the carrots, in fact the gift is a once off thing. I genuinely found it useful.
It is still one of my must open pages when logging on to my work computer for the day.

Good, quality material, mostly compiled from other reliable sources, which are relevant to Australian protocols/GP setting. Instead of patients going to Doctor Google, it is always nice to give them a print-out of part of the ya-da-ya-daa we have bombarded them with in those few minutes of consultations.


My $250 was well spent while my family was down on year end holidays – food, gifts, and some stuffs for a party I hosted last Spring!

Planning to spend this one on something more lasting – a keepsake of sorts 😀

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OPOF – Review

My concise 1 paragraph review of this book:

“OPOF is a light read, filled with a lot more than merely one pint of frustration – wit, truth, humor, sarcasm. An entertaining bittersweet compilation of truth in the form of storytelling by MOFrust (the blogging doctor) accompanied by cartoonist doctor(s), One Pint Normal Saline (OPSN).
Overall, this is a beautiful artistic collaboration by talented Malaysian doctors, that all Malaysian doctors can relate to. An easy-read of 150 pages, this handheld book should be available in all medical school & hospital libraries.”

Now now, I wasn’t paid to write any of these. Just a fellow colleague sharing honest opinion here 🙂

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One Pint of Frust – I got my hands on this book yesterday. Was hooked onto it from the introductory page written by One Pint Normal Saline (OPNS), thinking to myself I’m definitely going to revive my blog with a review of this book.

OPNS : I have to say, your wit & talent has always made me (like many others) laugh & reminiscence my own HO days (about a decade ago) & MO days. Been your fan for some years now. Especially as I am hopeless with drawings, loved to see our experiences in that form. Not just National, but your work has reached International Level long time ago! 😀

I can proudly say I’m the first overseas recipient of OPOF in person (yeayyyy), from MO Frust himself, who was in Melbourne for the past few days. Apparently the first copy that made its way to Ozzieland too. Precious ni! 


As for MO frust :
Little did I know upon knowing you as my HO that you will one day be the MOFrust and eventually the founder of Medical Mythbuster Malaysia. Wishing your dream of realizing the MMM as a TV show becomes a reality.


I started reading the book in the Metro train, on the way back from Melbourne to my suburb, halfway through the journey as soon as I got a seat. As I mentioned before, was hooked onto it from page 1…and upon reaching page 49, just before the last subchapter of chapter one, I had to get off & head to work. What a bummer….

Thanks to the lovely namecard-cum-bookmark (which I accidentally dropped while standing in train earlier & only realized as I wanted to close the book), I could bookmark the page. Phew, it is a wonder nobody trampled on them!

Would have completed OPOF yesterday night itself as a bedtime story, but had a full  on weekend away planned ahead of me, so I put it on hold. Was planning to read it on Sunday night, at the end of my last full weekend off ahead for the next few months.

*

Unfortunately, I cancelled my weekend away and was in bed mostly today 😦

Finished the rest of OPOF within few hours this evening, while still in bed. It was indeed a ‘Chicken Soup for Soul’ that every Malaysian doctor will find themselves nodding away to. Page after page of wit & sarcasm that is very close to our daily experiences. Although the disclaimer on hakcipta (copyright) section says these aren’t true stories, I’m sure we have all faced many similar encounters ><

Personally, it was nice to read some paragraphs in Bahasa Malaysia (as handheld book/ hardcopy) after ages too.
Though for non-Malay speakers : Fret not, as mostly they are almost immediately translated.

A book that evoked an array of emotions in me. I laughed, winced, snorted, almost cried, and as I reached the end, I was just grateful for the kind of housemanship training that I had.

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I reminiscenced my own HO days in Hospital Frust which was the setting for Chapter 2 on Emergency Department (ED) by MOFrust. Though often we find people lamenting about the HO days, I myself had mostly lovely memories of my housemanship, although there were many a crazy day and nights. But at that young age of 24+ and 25, lack of sleep, and food was nothing for 18 months of training. And definitely the tagging was no biggie, though in postings like O&G I didn’t see the sun for 2 whole weeks as we entered the Labour Room way before sunrise & went home close to midnight, if not past, on some days. But all that groomed and equipped my generation (and many before and after mine) to doctor patients as we have managed over the years.
I have to rub in about this tagging issue, as this is the current in-thing among Malaysian doctors, where a yet to be HO has written a letter to Editor to one of the leading newspapers in Malaysia, complaining about the tagging practice!

I was blessed by lovely colleagues & superiors (MOs & Specialists) mostly, which puts a smile to my face when I think of my HOdays.

So much so, although during my time we had no ED rotation, I ‘graduated’ from housemanship to MO-ship, equipped with arsenals to run a whole district hospital with a team of MOs, Medical assistants, and nurses, with no in house specialists. That was where my confidence grew….in that disctrict hospital, before I returned to work with specialists and house-officers in the Paediatrics department where MoFrust did his housemanship.

I digress. Enough of my reminiscence.

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I found it funny the author had to explain himself after the sarcastic comments, but knowing our society, I know it is a must! Or they will quote “This particular doctor said so-and-so”, not realizing it was meant sarcastically. These are the kind of people who take everything at face value, but when we give evidence based opinion, they would challenge us – go figure!

My only grouch is that the comics should follow immediately after or just before the relevant topics. Some of the layouts were a few pages away.


To both the authors of One Pint of Frust:

Hope to see more printed work from you both. Keep It Up & Don’t Give Up on your good work, MoFrust & OPNS – both in workforce & in the art-form.
Don’t let the online communities that often use annoying phrases like “Kipidab, Dongibap” to spread half-baked information or myths about health.

Cheers & Well done on a beautiful work in OPOF. Looking forward to more collaborative effort from both of you!

For someone who started blogging during medical school days, I concur with MO Frust, WRITING IS THERAPEUTIC! 🙂

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I know not only my medical friends, but even some non medical mates follow/like both MO Frust & OPNS’ pages. If you are either of their fans, even more reason to get a copy of OPOF. Artists need encouragement. Especially when they are busy doctors come blogger/writer and cartoonists. As it is, we don’t have many doctors who write/draw.

P.S: I wouldn’t be surprised if OPOF serves as a shoulder to lean on for other frustrated and disillusioned Malaysian doctors. Keep it your good work! If you are one of those whiners though, buck up!

Posted in Malaysian Doctor's Woes, Public Service Message | 2 Comments

The one with that patronizing relative

Sometimes you are just too exhausted to tell them off, knowing fully well it is going to create another angry-patient-shouting-at-me day if I decided to exercise my authority in chasing out that relo from my consult room, so I can proceed just with the patient alone.

Here goes, True Story from 23rd March, just one day after the fiasco with ‘the-patient-who-heard-the-name-wrong’


A patient I’ve never seen before, Y.
She came in with X, whom she verified as her step-sister. Funny that after all that concern & seemingly so authoritative to demand to drill and grill me in regards to Y’s issues, X claims that she’s Y’s friend.
Yes, after some high strung statements and questions from X, when Y appeared more calm and accepting of what I was trying to convey, I just had to ask “Sorry, you are X’s?? Friend? Relative?”

*
Okay okay, let me start from the beginning…

My colleague had ordered some imaging that morning.
Y has returned for her results. And I was seeing her for the first time.

After I explained the result to her regarding her CT cervical (neck) spine, and tying it up with her presenting complaint that morning, I asked if she suffers from a few other relevant symptoms?

Y was answering me when X butted in (Oh how I hate it when they do that) :”Are you sure she doesn’t have cancer? Because someone I know did have spine cancer, and no doctors picked it. All those tests they did didn’t pick it up. Her problem was back pain too”.

X : Why then, does Y have pain in her middle and lower back too?
Me : Do you, Y? (scanning through her previous records, I couldn’t see anything about those)
Y : Lower back is an ongoing problem since I was pregnant. Mid back just started this morning.
X: She is a single mom of 5, always puts herself last. I can’t stand to see mothers in pain. Even when my own mom suffered from pain, it made me so sick till I was vomiting.
Even now, thinking of driving Y home and leaving her in pain, I feel I could get a panic attack.

On the topic of cancer, upon further history taking (which refers to all those questions your doctors ask you), no constitutional symptoms identified.
X : You should send her for tests to make sure she has no spine cancer. I think she might. She is in so much of pain. You need to give her something that will take away her pain.
Like…send her for the most thorough & accurate test.

I had to stop myself form rolling my eyes.

For the records, I’ve already extablished that Y doesn’t take any painkillers, hardly even Panadol or Nurofen, even though in severe pain. Exception was today when she took panadol just before coming in to see me.  I’d already discussed about optimizing analgesics earlier – a discussion which has a lot of interjections from Y’s well-meaning step-sister! 

Me: Look. Firstly, she needs to be taking her painkillers.
By right, we should do an Xray, and if needed, CT scan later on for the lower backache that hasn’t been investigated before. The mid back pain just began, most likely it is referred pain or muscular origin.
If you want MRI for whole spine, it isn’t bulk billed. If you are happy to pay, I will refer you. Bone scans are not routine.

X: S0, someone might be dying, and you can’t bulk bill the tests?

Me: Everyone might think they are dying for one reason or another. Does that mean you do head to toe tests for everybody?
Look, I don’t determine if imagings are bulk billed. The government and imaging centres do. If you want any specific tests you are happy to pay for, I’ll give you the referral.
For now, since you are very anxious, I’ll give you the best tests under bulk billing – CT scans, which are more specific to look at cut section of the bones.

And while I could have thrown her out of the room, using my authority as a doctor, as I found X distruptive to my consult with Y by being patronizing, I didn’t.

Instead I ended up ordering CTs for both thoracic and lumbosacral spine. The later was probably justified by intermittent lower backache which began during her pregnancies…but my action in ordering CT T-spine with 1 day history of mid backache, sigh….I am guilty of over-investigating.
But honestly, it was either that or paving my way into another ugly night ahead if the relo turned angry and aggressive.

And I was too exhausted from yesterday’s drama, accompanying insomnia & the busy day that it already was and still was going to be for the rest of the night. I already had one colleague who stayed an extra hour to help out with walk ins, and I was going to be the only one left for the next 2 hours till closing time…


This is the trouble when we have a generation with entitlement mentality.

God be with us to handle these kind of characters day in day out _/_ I’m glad there were none in the same vein tonight…Tak larat dah!

P.S : X is a young lady probably in late 20s.

Posted in All in a Day's Work, Down Under, Oz GP | Leave a comment

The patient who heard the name wrong…

This is a true story that happened on March 22nd.

Been toooooo busy with work this whole week, leaving the clinic close to midnight (while we officially close at 11pm) 3 out of 5 days. Been meaning to share this on my blog since then.
As I’ve got my last full weekend off ahead, before the upcoming few months of voluntarily working every Sunday, FINALLY spending some time updating my Mad Med Journey – as this one encounter definitely fits the ‘mad’ part!
Inspired to do it today itself following a comment from a friend visiting from my homeland asking why I haven’t written for a while, and requesting I continue writing to share my experiences & stories… 🙂

On Handling a Rude & Ridiculous patient, here goes:

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When someone ‘potong trip’ (jumped the queue) due to similar name when she was waiting for 5 mins & the supposed patient was waiting for 40mins & another patient for 20mins before her.
I noticed upon calling her itself that something was wrong as I know I’ve seen her before, whilst the patient whose name I called, I’ve never seen (according to her records). I politely told her she heard wrongly due to similar first name. She refused to wait out for her turn, admitting it was her mistake & said “It is just a quick one for my results”.
I confirmed the quick part with her & said I’ll have to run through as it is unfair for the other 2 patients & she was agreeable and kononnya so grateful.

And then the nightmare began!
Cutting my sentences, demanding why some tests weren’t added (my reply in justifying my colleague’s decision not to order the test made her angry, complain about my colleague & when I refused to let her go on complaining…she raised her voice at me). Backed by previous results that I had on screen in front of me versus her claims of deficiencies….and then complaining she has bone pain, joint pain & demanding to know why. When I asked her to make another appointment as it was almost 10 mins & I needed time to explore her other concerns, while reminding her that she said this was a quick one & I have 2 people before her still waiting.
She even had the cheek to tell me “You can’t expect me to go out and wait now and see you again? I’m already here you should listen to me”.

She raised her voice higher and started blaming me of being rude, not listening to her & rushing her – this has never happened before to her here as a regular all these years.

At this, I sternly pointed out I don’t tolerate rudeness and shouting. Showed her the door & even opened it up for her.

She walked out shouting she wanted to lodge a complain by filling up feedback form. I said “By all means please do.”
And I strode on right behind her to invite my next patient, whose turn she conveniently robbed.

*

She to my receptionist, still shouting “X…I want feedback form. She’s rude. I’ve never been treated like this all these years.Make sure this complaint goes to higher authority. I want it dealt with.”

I ignored her. Called the patient who was already waiting 45mins who had similar name to that still shouting woman. Everyone, especially one little girl who was my next patient’s daughter, looked scared. They were all glued to their seats, looking from her to me.
Turning to the ~10 patients in waiting room, that woman shouted complaints of how it was her mistake due to similar name, but I was rude and refuse to address her problem.

I calmly turned to my receptionist and said if this behaviour goes on to call security.
That woman gave me the challenging look, “No you can’t. I’m going to make sure this feedback goes through”.
Me to her : “I can”.
Me to receptionist : “I’m taking my next patient in. If she is still abusive, call the police, k”.
My receptionist nodded.
And…I walked away like a boss, with my next patient and her family, with profuse apologies for the delay and drama. They were so understanding saying “That ain’t your fault. Hope you are okay”.


An hour later, another receptionist updated me about 2 issues.

1/ The sweetest thing : As I left the waiting room, apperentlt the 4th patient I saw after that fiasco actually walked up to the woman/counter & said “I don’t care what you or anyone says, she’s one of the best doctors I’ve had”.

That was the same patient who asked me “Are you okay, darl?” when I invited her into my consult room today.
Appreciate the few other concerned patients who were concerned.

2/ The craziest thing : That abusive woman rang later asking to see me again tonight to ask further about her results. Receptionist said “sorry no..you are too angry, come another day”.
And then she asked to see any other doctor.
Receptionist talked her out of it saying we didn’t have appointments available please come tomorrow.


No doubt, that incident was weighing on my mind the whole night. This was a day I didn’t even have time for a cuppa at work – we were full on!

I didn’t even stop and calm myself for a proper breather as we were packed…suppressed my emotions till the end if the day when I typed typed away my notes for her in essay form. Writing IS Therapeutic!

Whoever said being a GP was boring? :p

#zerotoleranceforabusivepatients
#allinadayzwork

Posted in All in a Day's Work, Down Under, Oz GP | 3 Comments

The nice things patients say that brightens our day…

Two nice comments from patients in one day.

1/ New patient 7 yo child. I’ve seen the little sister before. 

While walking to my consultation room, overheard this conversation:

Patient mumbles

Mom : She’s a nice doctor. That’s why I’m taking you to see her.

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2/ A patient I saw for the first time said to me before leaving the consultation :

I’ve seen so many doctors. But you actually tell me what you see & bother to explain. Most don’t even listen to you. Thank you.

(And she had URTI = Upper respiratory tract infection!)

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And I did tell them I appreciated their kind words. 

***

The best compliment when I returned from 2016 year end holidays, from another regular patient who sees me:

“Oh…I’m so glad you are back. I’ve had to see someone else the other day. With you I feel more at ease. You make me calm. And you’ll be pleased to know my new year resolution is to NOT GOOGLE!”

My google-queen patient there had been keeping up that promise for the last few months of 2016 towards medical issues, but this year I’m pleased to say she has applied it to dental stuffs too. And she never fails to update me about her progress with that resolution 😉

***

The comment of the year (2017 is just 1 month old,  I know) from a regular patient of mine who was waiting for close to 30mins, when I apologized for the wait:

“That’s okay, darl. 

You are worth the wait.”

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You, my dear kind appreciative patients, are what makes us doctors keep going on out bad hair days. We strive to deliver only the best #Qualityservice #doctoringiscaring        # towardspatientducation
Thank You!

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Medicos on board? Dramatic flight

The most eventful flight ever!

The announcements during safety demonstration was awesome…this Air Asia dude has a good sense of humor. At the end of it, half the people in my compartment were clapping – including yours truly😂


After a crazee day at work was trying to unwind in the flight with a snoring man to my 8o’clock & a baby screaming (probably frightened by the darkness)…1.5 hours since we took off from Melbourne.

Announcement was made looking for any nurse, paramedics, doctors or medical personnel on board to identify themselves to the crew. I noticed an air stewardess was fanning a passenger in the cubicle in front of mine. I stepped forward. Another guy dr too..and a nurse stepped forward too.

Firstly I introduced myself to the crew and was asked if I have any credentials on me? Well…can’t blame them with fake doctors & you tube dentists on the rise I guess. Told them I should have something, can I show it later? That went fine. 

Man from Adelaide to Shanghai..solo traveller. History of 2 stents…experienced chest tightness & apparently fell outside the toilet but didn’t loose consciousness. He had already popped a GTN. GCS full. BP was slightly low most likely GTN effect, improved with hydration. His tongue was super dry.

History. Physical examination.

Interesting emergency kit on board…but no pulse oxymetry or glucometre though😁 Good that the traveller had a paper with details of his condition on it (which was viewed by the other person).

*

Back to credentials. I rummaged through my handbag and found 1 namecard in my phone pouch & MMA life membership card. 

Now now…this is why I should carry around the little tear-off card that comes with Ahpra registration document I guess (which I received in mail few days ago – my general registration).

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The crew had to fill up a form & get our details for it too. I was asked to sign as witness as the other doctor completed the document. Of course I read through before signing it. 

To which one of the crew members went like “Why are you signing as witness, aren’t you the one who attended? ” 

Me : “Ape-pe je la. Since the other doctor completed the form”.

Glad all was well🙏


640am : How wrong was I in assuming the adrenaline rush for this flight ended with that! After the most turbulent descent due to unfavourable weather, clouds & heavy rain at KLIA2…many a steep dips accompanied by ladies’ & kids’ screamings…many a sinking feeling in my tummy…and feeling like my ears are going to pop right through….and people vomiting & retching all around me….I was calmly muttering prayers in my heart.

Finally we landed! 15mins after schedule….but, AT SUBANG AIRPORT!

Refuelling.

Awaiting all clear to ‘patah balik’ & land in KLIA2! 


825am : Safely touched down and ‘parked’ at KLIA2!

835am : Awaiting the ground door to be open. As usual, people queeing up on both aisles…ever the kiasu eh hahahaaa…I don’t understand the mentality!  Me…I’m patiently seated knowing standing up won’t hasten the door opening in any way :p 

I can hear the metal stairs being moved around the plane. We should be released soon! After 10 hours plus in here…phewwww.

*

845am : As I was walking out, saw the ‘uncle’. He is fine. His THANK YOU & the staffs’ byeee with an acknowledging smile and extra conversations took away my tiredness. Now…I.could so use a good cuppa coffee!! Been on coffee-fast past 1 week thanx to the flu.

But firstly, to complete this morning’s exercise of walking down these looooong loooooong corridors! 🙂


Good morning Malaysia! ! 

Your prodigal daughter has returned…once again, for a short trip (to what now seems like second home). Enough drama to kickstart the trip. Pleaseeeee let the rest of it be a sweet & drama-free one. 

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Everyone Matters…To Comfort Always

Day in and day out, Healthcare professionals from every level do face abusive patients or their family members. That’s why dealing with angry patients is a typical scenario in counseling stations since undergraduate days & even at workshops! 
This you tube video captures it beautifully…some of the common scenarios are highlighted. As much as we wish, we can’t just ignore and become totally numb. We learn to handle it with less negative reaction from our end though in facing the situation. Each of us cope with it differently in our own ways at the end of the day. With the herculean task of having to care for and give undivided attention to many more, what right do we have to wallow in the abuse/anger we have been subjected to? Sadly, often our own health and needs take a backseat. 😧

The day we become numb to the negative outbursts,  watch out, world! That will be the day empathy dies a bitter death too. Amen.

Watch “Everyone matters” on YouTube 


On crazy busy days like yesterday & today, I’m truly grateful for the patience of my patients. I try my best to still greet each person with a smile.
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But you know what is tougher than listening to long winded stories on a really busy day?

Listening to complaints! Especially when it is about other doctors. 

I try to be empathetic but be careful to document without implicating other doctors…part of the art of defensive medicine to mention patient was angry or upset about whatever issue they mentioned while being discreet enough not to document names. 

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So, 2 days in a row now I had patients booked in to see me, when the doctor they saw earlier in the very same day is still on duty. 

That alamak feeling rised again early on during today’s shift. 

While yesterday I was very stern as the patient’s wife was hurling abusive statements about my colleague (one of the seniormost doctors here) at the front desk & I was already running super late….today’s patient was well behaved. 

I spent almost 20 mins with him before my next patient arrived, starting from square 1 as I was confused about a few things and believe there had been misunderstanding between him and his treating GP (who was my supervisor)! It was very unfortunate that the Specialiat he was referred to by the other doctor was uncontactable! Some comment made by people at radiology centre didn’t help. All in, he was super frustrated and irritated, to say the least. Luckily he was calm with me (I was seeing him for the first time) & I reciprocated and tried to leave no stones unturned. 

I reminded him the only reason I had all the luxury to clarify things and spend more than half an hour with him in total today was merely because the other patients were late. 


I was defending both doctors to both patients, yesterday & today…a very draining process, I tell you! 

Just like how in exams we need to forget about one station as soon as we finish it, in practice too I try my best to tie up loose ends about a patient there and then. Brooding over things doesn’t help.

Patients need to understand we try to do our best in the limited time we have with them as GPs! It doesn’t help with the type of patients who gather 10 issues over time and sees a doctor with a 10 minute appointment slot and expect us to fix all their issues ><

I always believe if X badmouths Y to me, it wouldn’t take X long to badmouth me to everyone else from A-Z! Lessons learnt at a young age that one :p

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Today’s patient walked out saying “Thank you for listening to me. You have brightened up my day. I was feeling very frustrated today & losing faith”.

Sigh…if only all we do is handle clinical concerns alone. Medicine is as much (if not more) of an Art, as well as Science too!

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