Wednesday, October 18, 2006

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spiritual treatment vs medical treatment(evidence based medicine)

3 days ago,we accepted one case referred from private medical care for query leukaemia. WBC is 450000.Hb 4.8. Plt 98. Patient presented with lethargy, fever and shortness of breath ++++. We quickly tranfused him with packed cell 2 unit in 2 days time and arrange a echo for him. Hydroxyurea also been given.Echo shows good LV function about 80 %. So the shortness of breath is solely due to anaemia. Antibiotic also started due to worrying of dysfunction of neutrophil. Chest radiograph shows normal lung. Blood C & S revealed nothing. Our specialist proceeded to advise him for bone marrow aspiration and immunophenotyping. Patient and the family agreed for it .Our specialist informed our boss regarding this case(boss is not around). After 4 unit packed cell tranfused in 3 days time and antibiotic, patient no more dyspnoeic and fever. At the day 4 , we planned for bone marrow aspiration days, patient and the family suddenly refused for the procedure to be proceeded . When we ask for the reason, they said it is because they planned to went for spiritual prayer in India before seeking any treatment.
Guess what is the age and educational level of the patient.
The answer is ......Patient is 25 years old (architect students final year in local U) and the family (father retire education officer, elder brother petroleum engineer)
. Surprise or not. I think this is a tip of ice berg in Malaysia. I still remember during university day in my first year med school. One of the reason mention about patient preference in Malaysia and the contents discuss about why patient went for bomoh than doctor. The lecturer told us that the bomoh/traditional healer or spiritual healer more friendly and closest to community . They spoke their language.
Is it very hard for patient to understand for example leukaemia. It is a medical jargon. When we try to explained it is like a disorder/Ca of blood. Patient normally refused to understand it because everyone heard about the treatment, side effects of chemo and the percentage of cure. This is what we do , revealed the truth , broke the bad news amd answer correctly. Unlike us, traditional healer/spiritual healer told people about the miracle. Mr so and so got Ca or some terminal illness. After pray and taking god medicine, the disease went away. No side effects and no risk of mortality.A lot of people who got all this illness will think why not give it a triad. If not works for us, the only went back to doctor. Knowing that we can't reject them due to ettiques. Whereas spiritual healer may reject them stating that patient already try on western medicatiom, god wom't near them.
From this real story, now you know why still got people been cheated for money ,handicapped due to diabetic foot(slow treatment),limping gait due to compartment fracture (mismanage by bomoh), or Ca stage 4 due to delayed in treatment .
Should we need to be more spiritual in our talking or try to understand the patient before break the bad news. Should we stated on successful survival rate rather than mortality rate if failed treatment. Think about that? WE spend so many years in med school end up become second choice and accepting reject patient from traditional healer who may be study till form 3 or form 5.
All the best to doctors and hopefully we are not continue become reject shop!

Friday, October 13, 2006

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Paperless banking?Paperless hospital

Very long time I got exausted for hospital stuff and no time to post my blog. At last weekend comes with no assignment to be done .
Today i tried to open an account in HSBC , to my surprise the service is fast. Another shock for me , HSBC acc is without passbook. In other work is a saving acc with only no. and ATM card so the acc no need to be kept somewhere for banking purpose and monthly statement will be post. Bank nowaday moving towards paperless banking with monthly statement . I think some of the Bank like Maybank and Bumuputra commerece also got some acc practice in this way. Actually ,personally i don't like this idea because although is claimed paperless! when the acc is opened , you still need to sign a lot of documents like personal particular, terms and condition. Legally ,Blank and white still needed whathever it is. I like passbook to be keep because i am very forgetful, secondly ,i don't trusted much for whatever i listen(telebanking) or see (internet banking)when involving money although i am writing blog for recording purpose .Thirdly, i think keeping a monthly statement is very troublesome.
When talking paperless, health ministry also moving towards paperless if situation allowed (fund and technology for hospital). That's a pro and cons. The pro is getting more easily access to the record even on weekend ,secondly no need to strain the eyes trying to figure what our colleague wrote(some dr got very diff to understand handwriting). The bad point is if system down or hospital electricity down,the hospital system may be in havoc (if generator cannot support tthe whole database computer or technician unable to fix the system in time). The Mo, Ho will need more time to key in data unless their typing is extremely fast. Hospital will need to print out the data also in case system infected with virus or down and it ends out more paper to keep.
I think it is good at some point particularly for chronic patient but i don't think asseement for A n E is suitable. The adaptation of both paper and computer is still the best means that a good summary and progress for previous admission in the hospital computer database available for all hospital in Malaysia(ideally government and private hospital) . Daily round with paper to save time .It is the best because when we trace old record we need to know old medication, allergy history (if pt unconscious) , lab results (baseline investigation)and past medical history but no the daily round things and normal findings.
This is what i think government should do . Semipaper with computer to optimise the work.