Saturday, March 8, 2014

People see doctor, people die.

IT is sad that every two or three weeks, we're seeing episodes and episodes of people suffering because the waiting time for special out-patient departments are long. Don't be mistaken - I agree that it is indeed long, what I wanted to say though, is that these high counts of mortality is probably less related to the long waiting time. I believe, however, this is due to patient behavior, as opposed to negligent doctors, failing standards, or poor medical system.

It is, again, a recurring theme that wherever there are poor outcomes, people ask for somebody to take up the responsbility, typically a scapegoat in my humble opinion. People tends to blame the establishment, such as the hospital management, the lengthy waiting time, the lack of medical manpower, or sometimes, it could even be targeting those doctors who are not willing to work too many hours overtime. However, it is very much less common that we see people blaming the patient.

When patients visit their doctor, we call it consultation, and we charge the consultation fee. What this mean is that the doctors are consulted, and to spell it out clearly, if the patients do not visit their doctors, the doctors could do nothing. I think it could be said that our patient population in general has been educated to come to the emergency department whenever their condition changes for the worse.

In this case[1], the gentlemen went to general out-patient clinics for depressed mood. Apparently, what the medical officer did was to refer him for psychiatric evaluation, which, in my books, it means that this patient does not have severe psychiatric disturbances, and there were no signs or symptoms that are suggestive of him being at risk of harming himself or others. Subsequently, he has been evaluated (probably by psychiatric advanced practice nurses -- who are extremely familiar with psychiatric conditions) and was given an appointment ten-eleven months down the road.

What he did was that he killed himself three days after receiving the appointment. At this point it is important to stress on that we doctors works with uncertainty, and are definitely not fortune-tellers who can see the future through a ball of crystal. And for the matter, if any medical graduate could see the future, it's probably better to win a mark-six ticket every now and then instead of working 60+ hours in the hospital every week. 

What is the lesson learnt? If you have got a patient at home, and you see his or her condition changing for the worse, bring them to the emergency department -- this, is the raison d'etre of emergency department.


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