pass motion does matters!
I have been in medical for quite a long time . One of the most irritating complaint and frightening complaint is about pass motion. Every morning, when i ask my patient are they feel ok.Some of the patient (especially old one ) will tell me they are Ok except they cannot pass motion. Maybe already for one week.So i will need to squeeze my brain to figure out is it the severe intestinal obstruction, or is the stool harder to pass out,or passing less than normal. Do not think i am mad !I got one patient complaint of not passing motion . On further auestioning, the passing motion in a day is less than three.(only two times) . He normally pass two times.Some pass hard stool also give a complaint of not pass motion.
basically unable to pass motion is a tiring business .When you try to get further confirmation they are not happy. They will tell you to just give them laxative. malaysia patient hates diet advice for hard stool. When you ask them to take high fibre diet to get the normal motion after you rule out the potential life threatening causes of unable to pass motion(such as intestinal obstruction,). They will be super unhappy. They will make the statement as below:
Doctor: I have examine you everything is normal.
Pt: why can't i pass motion as usual.
doctor:Maybe you need to walk more and take high fibre food to get the normal motion back .i see you sleeping all the time.
Pt: I have nothing to do so i am sleeping.What is high fibre food?
Doctor:More vegetable and fruit.
Pt: the vegetable in hospital diet sucks. Just give me laxative.
Doctor: Laxative may make you pass too much and ended up diarrhoea.
Pt: Just give me the laxative!
Normally the conversation will ended up with doctor ended up giving laxative after one or two days because it is getting more and more irritated.
After laxative given, i considered my nightmare will begin soon. This time , they will complaint like below:
Pt: Dr, why my passing motion so many times one. today already ten times already.
Dr: you ask for laxative and i already tell you the side effects.
Pt: still it is too many times that i wanted.Dr, you see now i am dehydrated already. Please give me medication to stop it.
Dr:if i give you the medication to stop it . You will be constipated again. I give you ORS (oral rehydration salt) tp hydrate you back.
Pt:(appeared angry) Look i am going to die already by diarrhoea. I hardly got time to sleep . Now you ask me to drink ORS in fact you can stop the motion. Are you kidding?You have to do something!
See, this matters is going on and on. It will trouble you everyday.
A patient come with diarrhoea also will crack you head for diagnosis. There is 101 cause for diarrhoea. Especially those with polypharmacy . A lot of medication can cause diarrhoea. Need to rule out pseudomembranous collitis, thyroidtoxicosis , HIV and etc.
In conclusion , pass motion business does matters. it can be small or can be urgent. The outcome is big headache for the treating doctor.
basically unable to pass motion is a tiring business .When you try to get further confirmation they are not happy. They will tell you to just give them laxative. malaysia patient hates diet advice for hard stool. When you ask them to take high fibre diet to get the normal motion after you rule out the potential life threatening causes of unable to pass motion(such as intestinal obstruction,). They will be super unhappy. They will make the statement as below:
Doctor: I have examine you everything is normal.
Pt: why can't i pass motion as usual.
doctor:Maybe you need to walk more and take high fibre food to get the normal motion back .i see you sleeping all the time.
Pt: I have nothing to do so i am sleeping.What is high fibre food?
Doctor:More vegetable and fruit.
Pt: the vegetable in hospital diet sucks. Just give me laxative.
Doctor: Laxative may make you pass too much and ended up diarrhoea.
Pt: Just give me the laxative!
Normally the conversation will ended up with doctor ended up giving laxative after one or two days because it is getting more and more irritated.
After laxative given, i considered my nightmare will begin soon. This time , they will complaint like below:
Pt: Dr, why my passing motion so many times one. today already ten times already.
Dr: you ask for laxative and i already tell you the side effects.
Pt: still it is too many times that i wanted.Dr, you see now i am dehydrated already. Please give me medication to stop it.
Dr:if i give you the medication to stop it . You will be constipated again. I give you ORS (oral rehydration salt) tp hydrate you back.
Pt:(appeared angry) Look i am going to die already by diarrhoea. I hardly got time to sleep . Now you ask me to drink ORS in fact you can stop the motion. Are you kidding?You have to do something!
See, this matters is going on and on. It will trouble you everyday.
A patient come with diarrhoea also will crack you head for diagnosis. There is 101 cause for diarrhoea. Especially those with polypharmacy . A lot of medication can cause diarrhoea. Need to rule out pseudomembranous collitis, thyroidtoxicosis , HIV and etc.
In conclusion , pass motion business does matters. it can be small or can be urgent. The outcome is big headache for the treating doctor.
posted by M K at
9:03 AM
4 Comments:
I agree. Diarrhoea can be difficult to investigate. Definitely one of my least favourite problem to treat!
Fibrate:seems like got somebody got the similiar view like me. Got one pt investigate for everything. At last , diarrhoea subside by itself. pretty x file. in my ward recently.
Of course, it does! Very much so. Remember the "asshole" is the BOSS.
Actually, my favourite laxatives are bulking agents like lactulose and psyllium/ispaghula husk. These don't usually cause diarrhoea.
Furthermore you can titrate the amount of lactulose given to avoid diarrhoea. Be gentle. :-)
Bernard: good idea and suggestion but pretty scary if patient got diarrhoea with anaemia. Without doing PR won't feel relieved
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