Jun 18, 2018

Unpopular Opinion: Medical Issue

I have never discussed any trending topics in the Internet before. I spend most of my times online using Twitter, where most of the top world and local news can be found there from various resources. I don't really like using facebook because people there so blatantly fabricate stories as real-life facts to garner likes and shares it is so sickening to look at. Twitter users, on the other hand, they tend to spill facts as what they claimed, and things like woke-realizations are a thing here. Well, some are superficial, and a few is loathing to read, but hey it's only a tweet of 280 characters. Easier to skip reading.




For the past fortnight this hashtag of ''unpopular opinion'' has been trending globally. Malaysians, as one of the rising addicts of social media, capitalize this by tweeting our own versions of unpopular opinions on a number of issues that is happening in Malaysia. One of them if Unpopular Opinion: Medical Issue.





Well, reading through this sensational thread generated a lot of mixed emotion in me. Mostly anger, a bit of exasperation, but also there's bit of the sense of unfairness. Stories upon stories came out about how government doctors are generally stupid and useless. Things get heated up when several users with healthcare backgrounds replied in defense to the accusations thrown around.


The gist of the arguments made regarding the issues are:
  1. Why Doctor A made a diagnosis and Doctor B made a different diagnosis?
  2. Doctors should never make a wrong diagnosis because:
    • they went to medical school for years
    • their wage is high
  3. Why Doctor A did not do the same investigations like Doctor B so that they can get the same diagnosis?
  4. Government doctors are subpar and irresponsible because of low wage/work load hence missing the right diagnosis.
  5. Waiting turn for a consultation up to half and hour for an actual consultation that lasted less than 5 minutes (LOL ini kelakar)


I think that I am qualified enough to give MY UNSOLICITED VIEWS regarding this whole mess. Just a two-cent worth of opinions. But here it goes:


People think it is easy to make a diagnosis (a.k.a putting a disease name to a patient) where in fact it can be quite difficult. There is no manual instruction to follow. This is not like an IKEA furniture assemble where putting two and two together becomes a four. 


To simplify: doctors make a diagnosis based on a combination or in isolation based on these things:
  1. what the patient tells us and what we can check physically on the patient
  2. blood investigations
  3. imaging like x-rays, ultrasound scan

These are the basics. And mostly patients come with simple diagnosis. There's a saying in Medicine, "common diagnoses are common", which means usually, patients come with common problems. Rare diseases, as the name implies, are not common. Hence, when we stumbled upon patients like these, we will run all the common diagnoses first as the differentials before moving on to the uncommon ones.


A complicated diagnosis will always indicate a more advanced (and expensive) array of investigations. Specific blood investigations, invasive procedures like lumbar puncture for example (taking out fluids from your tulang sum-sum), and imaging modalities like contrasted CT scans or an MRI will be considered, depending on the diagnosis.


So the question asked - why doctors make different diagnosis?


It is actually quite a valid question. If there is a disease name that has been researched and studied by doctors all over the world, why can't we accurately label it to the patient? For all the myriad reasons that exist and have been exhaustingly explained by everyone and anyone, I think it all boils down to a number of issues.


Firstly, we have to know that any disease, even with a well-known name, has a number of faces. Remember when I said making a diagnosis is not like assembling your IKEA chair? Diseases come in stages and often all its clinical characteristics or what we called signs and symptoms do not come out clear enough at the same time for us to recognize the disease for what it is.


It's almost equivalent to this famous story about four blind people trying to recognize what is an elephant merely by touching one body part of the animal. Meaning, one doctor may make a diagnosis based on what is showing to them at THAT time. A different doctor may be showed a different face of the disease as the course of the disease progresses/regresses. What they can and usually do is what we called 'watchful period' or the wait-and-see to catch the disease with a different or added presentation. A good doctor will always think of other differentials at the back of their head, hence, the waiting part, but hey, what's not shown will never be revealed to anyone, right? That's why it is easier to criticize.


Also, FYI, as one of the healthcare etiquette, we DO NOT criticize other doctor's work. We do not say, to the patient even more, that the other doctor is wrong at what they did.  We do not work with blaming others, nor we leave other members of the healthcare team defenseless. We will never know the exact situation of what's really happening during prior consultation and examination so that's why we never judge. Any doctor who criticizes others is a snob doctor and pretty much unethical.


Secondly, different healthcare settings have different resources. Now, resource is a big component of being a doctor. In fact, it is so much so that it is actually one of the four basic ethics of being a doctor: JUSTICE. I once explained briefly what Justice, as a component of ethics, is about, but for those who are willing to read up until this point (haha, this post is lengthy!), justice is about being able to fairly judge who deserves what based on the limited resources at your disposal.


The easiest example I can bring is this: Take one klinik kesihatan (KK) for example. Let's say that said KK only able to do 500 simple full blood test to know whether you are sick with infection or not. The lab only has 500 reagents to perform the said test. Now, let's say there are 800 patients that come to the KK on one day with complaints of fever. The ethical issue of justice here is this: which patient deserves to be tested and which is not?


Next comes the SOP (standard operating of procedures) or what we usually called the guidelines or a protocol. These instructions are usually locally tailored for specific institutions and there are also national guidelines or what we called the CPGs (Clinical Practiced Guidelines). Every country has it. In UK, they are known as the NICE guidelines (of which my uni heavily used on this seeing that it's a UK uni, duhhh) while the Europeans have their European guidelines. So these help us in deciding which patient deserves what kind of investigations and the treatment given.


Justice is also applicable when comes to waiting times and the duration of consultation itself. Is it fair, even if you have waited for an hour for your turn, to have a consultation with a doctor for half an hour over simple condition? Imagine that the attending doctors have 100 patients to see daily (that's an actual estimation, really. Not kidding). If one patient takes half an hour of their time, they can never finish their work. Hence, the longest consultation they can spare you is 10 minutes.


I wish I can talk more about other issues such as differences between a government doctor and a private one, but seeing that I have no knowledge about what being a private doctor is all about, I am definitely not fit to talk about it.


Honestly, I can safely say that whatever you imagined being a doctor is like, it's not. Doctors are not the only job that helps people, doctors are not paid lavishly, and yes, doctors have one of the most strenuous work load in the career industry. But all of those never, ever equate to the level of how we are treating the patients. We don't ever "paid peanuts, do peanuts''. Period. Makan peanuts, yes, but it's high in cholesterol, so eat moderately, yeah?


P/S: Happy Eid to those celebrating! Watch your sugar, watch your pressure!!

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