The last time when I wrote the Part 3 of this topic, some of the commentators were saying that I am only talking about the problems/mismanagement of the government sector and not much about the problems in the private sector. Well, I had written about the problems caused by General Practitioners and soon I will be writing about private hospitals in more detail. The issue that I am trying to bring up is not whether a proper diagnosis is made or not. Most of the time, if the attitude of the doctors, especially the frontliners are good, simple diagnosis like what I had mentioned before would not have been missed. It all boils down to attitude. If you become a doctor just to get a paid job and not with the interest of the patients at heart, then you might as well leave the job! In this part, probably my last part, I will expose few more simple but dangerous errors that was made by the frontline doctors.
A 36-year-old lady had abruptio placenta and an emergency LSCS was done in a government hospital. Unfortunately she lost the baby (IUD). She was discharged 3 days later. 3 days after discharge, she presented with fever, diarrhoea and lower abdominal pain. She was brought to the A&E department of the same hospital 2 days later. The doctor in the A&E department just asked her a few questions and discharged her with some medications ( treated as a simple AGE). The doctor did not even touch the patient!! The next day she went back to her GP who referred her to me. On arrival she was toxic looking, febrile with tender guarded lower abdomen. She was immediately referred to our O&G consultant who diagnosed her to have huge rectus sheath hematoma, infected. She recovered well with antibiotics and conservative management.
A 20-year-old Vietnamese lady was admitted to a general hospital with LIF pain of 2 days duration. She was admitted the night before to the Gynae ward but discharged the next morning! It seems only a medical officer saw the patient the next morning and discharged her with TCA 6 weeks while she was still in pain. She was immediately brought to our hospital. An ultrasound showed huge left Ovarian cyst which was already leaking. An urgent laparoscopic surgery was done.
A 30-year-old lady was referred by GP to a government hospital’s gynae clinic to rule out ectopic pregnancy. She had LIF pain with positive UPT. The patient waited at the clinic from morning to about 2pm before seeing a doctor. She was not sure who saw her but she was told that it is all fine and asked to come back in 6 weeks. She went back to her GP who referred her to my hospital. Ultrasound by our Consultant showed a left ectopic pregnancy which was already leaking. A similar case happened few months ago where the patient collapsed at home just the day after she was seen in gynae clinic to rule out ectopic. An urgent laporotomy done at the same hospital for ruptured ectopic pregnancy!
In my Part 2 and 3 , I had mentioned that one of the problems in government hospitals is the lack of proper supervision from good senior consultants. These situations seem to be getting worst day by day. This coupled with poor attitude of the junior doctors is only making the situation worst. If you look at the 3 cases above, even a good medical student knows that something is not right with these patients. Come on, a patient who just had LSCS 3 days ago comes to you with fever, diarrhoea and lower abdo pain? I am sure even a medical student should be able to think of the causes even before you put your hand on the patient. The 2nd and 3rd case above also demonstrates that some doctors are not taking their job seriously. They seem not to be interested in their patients and just wants to keep their load down or shall I say ” don’t want more workload and headache”!
As a doctor, we should always be very suspicious of anything that a patient complains. I use to tell my Monash students before that we should work like a police officer who is investigating a crime. A detail history and a good physical examination will give you a diagnosis almost 80% of the time. A high index of suspicion is needed to make any serious diagnosis. If not, you are of no difference compared to a medical assistant or nurse!!