Well, the world is changing! I had written several times in this blog that patients nowadays are not the same as it used to be. This is something that the current budding doctors are totally unaware when they claim that they want to “help” people by being a doctor. Only those in practise will understand what is happening out there.
Today, Malay Mail published several articles regarding ” Dr Belittle“(see below). It was about a Facebook posting which supposedly breached patient confidentiality and made various unwarranted remarks against the proponents of home/natural birth. Actually, I have been watching this ongoing debate among these group of doctors and the supporters of home birth for quite some time now. While both have their own believes , I do agree that certain unwarranted remarks or unacceptable language should not come from professionals like us. We should debate it in a civilised manner with facts rather than emotion. Saying that, I do see a lot of emotional rants in this blog by the younger generations when they don’t agree with my statements. But, do you see me doing the same?
We should understand that patients have every right to accept or deny our treatment. One of the ethics of medicine is “patient’s autonomy”. It is not mandatory for any patients to follow your treatment plan despite all the explanation given. You can scare and scold a patient but they have every right to deny any treatment offered to them. I use to get irritated by these group of patients when I was a junior doctor but after some time I began to accept the fact that our job is just to advise. You advise a patient for mastectomy for Ca Breast but she goes for traditional treatment. 6 months down the line , she comes back to you with metastasis all over the place! Do you scold her? It is her body and her life, you can’t do anything about it! Unfortunately, over the past 18 years, I have one thing which seem to be getting louder by the day. It is the refusal to seek doctor’s advise or treatment. The patient rather trust a traditional medicine practitioner than a doctor, simply because they feel that these practitioners are prescribing and using “natural” treatment rather than chemicals. They refuse to believe that these “natural” treatment are usually adulterated with modern medicine chemicals such as steroids, NSAIDS and antibiotics. But you can advise till the cow come home and they will not listen to you. They will only listen when complications occur and they come back to you for treatment. I had seen enough Addisonian crisis, Liver toxicity and peptic ulcer disease from patients taking TCM. I had even sent some for analysis and showed them the proof.
What do I do when I see such a patient, nowadays? Basically, I don’t give a damn anymore. I tell them right to their face that since they do not want to take any treatment plan from me, please do not come to see me again for any problems. I rather treat and “help” patients who are willing to follow my treatment plan than wasting my time on patients who are never compliant. And for those who do come back to me, I will give them a piece of my mind before treating them.
Unfortunately, that is the reality out there. That’s why whenever a budding doctor tells me that he wants to help people, I tell them that not many patients nowadays really appreciate your help anymore. The real appreciation nowadays are in rural areas and interiors. Unfortunately, not many doctors would want to work in these areas. Just yesterday, I heard another Gynaecologist being sued in court. Together with him, another 2 doctors will have to be involved as they co-managed the complications that this patient had.
Coming back to the articles in Malay Mail today, I find the articles rather depressing. Firstly to the fact that many “unprofessional’ remarks were made by doctors which is not the right thing to do. NO matter what you discuss openly in any public forum/social media, patient’s details and particular should never be released. I see a lot of such pictures and details being written in Facebook which is unethical. Anything that you publish that can directly or indirectly point to any patient’s particulars, where it took place etc can be sued by the patient. Also, please remember that a written consent must be taken from the patient for any pictures or videos taken. On the other hand, the article seem to be supporting home/natural birth proponents, blindly. While home birth is nothing new, it should be done by people who are trained medically. Even in some developed countries like N.Zealand, UK etc, midwives do deliver babies at home. However, these are done to low risk cases only. If they pick up anything unusual or feel that the patient might be high risk, the patients are referred to hospital for delivery. Unfortunately, the proponents of such method in Malaysia are mainly non-medically trained people. Majority do not take any responsibility when complications occur. Furthermore, they provide information that are not true and never disclose the complications that had occurred to their clients. No action can be taken against them as well. Remember, even some of the supporters of such methods had died during delivery.
Unfortunately, as a doctor, our job is to treat any emergency no matter who they are. They can be drug addicts, prisoners, murderers, robbers, snatch thief’s, HIV patients or even patients who refused to listen to you before. Your job is to treat them for whatever emergency they come with. If it is non-emergency, in a private sector, you can refuse to see the patient on a basis that you are emotionally not ready to treat such a patient. BUT, in government sector, you can’t, as you are an employee of the government, paid by the government to do the job.
So, if any of these patients who decided to deliver at home come to you with a complication, it is your job as a doctor to treat them. You can complain all you want, but that is your job. You decided to become a doctor to help people. So, just keep quiet and do it no matter how much anger you have in your heart. You have to accept the fact that it will never be the first or the last such case that you will see. That’s when you will ask yourself why I became a doctor when patients don’t listen to me anyway? And when the mother dies, a full report need to be sent to MOH as maternal mortality is a national index. Subsequently, you will be called for the Maternal Mortality meeting to find out why the mortality happened. I feel in such case, MOH should take action against the proponents of home births. BUT do they have the authority/law to do that?
As for the patients, it is their right. If they want to harm themselves, it is up to them. It is their life not ours. I realised this after few years of working as a doctor. BUT they should realise that they should NOT cause any problems to others as well. Don’t run to the hospital when complications occur. Take the people who advised you to do home delivery to task. Sue them or ask them to pay for the complications. Unfortunately, our society are more than ready to sue a doctor but not a traditional medicine practitioner or anyone else who has been advising them all this while. Do you see anyone suing these people? You don’t! That’s the sad life as a doctor. Not only you get sued for everything nowadays but also get called up by MMC for emotional rants, as you had breached professional ethics!
Doctor’s life is never the same anymore………………… so, It’s time for me to take another holiday on the seas….. ……
Doctors reminded of professional etiquette
By Vanessa Ee-Lyn Gomes
Published: June 3, 2015
PETALING JAYA, June 3 — A government doctor may have possibly breached patient confidentiality by discussing a young mother’s home delivery case over social media, says deputy health director-general (medical) Datuk Dr S. Jeyaindran.
He said the Health Ministry had regularly reminded doctors about Facebook use besides professional etiquette regarding medical discussions over the Internet.
Dr Jeyaindran said a patient’s information was always confidential.
“There is a very fine line because doctors sometimes use social media to discuss a patient’s condition or conduct consultations, but the patient’s name should never be revealed.”
He said there were implications and repercussions from public postings on social media which doctors may be unaware of.
“Unfortunately, a lot of doctors still do not realise that postings on social media may lead to breach of patient confidentiality and ethics,” he said when commenting on a young doctor’s Facebook post which ridiculed a patient suffering a third degree tear following a home birth.
Other medical professionals left mocking comments on the post.
Dr Jeyaindran, who is also a member of the Malaysian Medical Council, said it was inappropriate for medical professionals to post such comments.
“The use of social media to openly discuss patient issues is not appropriate and is definitely not advocated,” he said.
He said the council could investigate the matter if there were complaints from the patient, her family or the public.
“The doctor has to be present before the disciplinary committee to see what form of patient confidentiality has been breached,” he said.
“It does not matter who lodges the complaint because the doctor’s professional conduct will be examined.
“We will also study what information was shared in the post.”
On home birthing, Dr Jeyaindran said the ministry did not advocate it because of the risks that could lead to complications.
It is understood an investigation will be carried out on the direction of the director-general of health to ascertain if there was a breach of professional conduct and patient confidentiality.
– See more at: http://m.themalaymailonline.com/malaysia/article/doctors-reminded-of-professional-etiquette#sthash.y47COpoB.dpuf
MMA: Patient info not for open discussion
By Ida Nadirah
Published: June 3, 2015 07:32 AM GMT+8
PETALING JAYA, June 3 — Social media has given rise to issues regarding patient confidentiality, said Malaysian Medical Association (MMA) president Dr Ashok Zachariah Philip.
With widespread use of social media platforms such as Facebook, medical practitioners are not excluded from using them to channel their experiences, joys and frustrations.
However, Dr Ashok said doctors were discouraged from using social media as a forum to discuss patient information.
He said doctors in general do not reveal patient details, but would sometimes share information with other doctors for discussion or consultation.
“The problem with Facebook and such, even if something is discussed in a closed group, people can still share the information,” he warned.
He said patient information and histories should not be shared in open forums, and should only be done in traditional channels, such as bulletin boards.
Dr Ashok said the sharing of a patient’s photographs could only be done with the patient’s consent. Failure to have consent would be unethical, even if the patient was unidentifiable.
“If found guilty of breach of confidentiality, the doctor may face action by the association as well as the Health Ministry,” he said.
In reference to the recent criticism on a Facebook post where a mother suffered third degree tears during a home birth, Dr Ashok said it was not right for the doctors to use such crude language.
“We, as doctors, are human as well, and we may be angry over the result of a patient ignoring the doctor’s advice.
“However, we still have to treat the patient in the best way possible, and in no way suggest causing more harm,” he said.
He said it was improper for the doctors to comment publicly about the mother, whose medical history was unknown to them.
He said it was not uncommon for mothers to deliver at home.
– See more at: http://m.themalaymailonline.com/malaysia/article/mma-patient-info-not-for-open-discussion#sthash.X9KmQppk.dpuf
Use lidi and yam roots to stitch tear, doctor advises
BY IDA NADIRAH
Wednesday June 3, 2015
PETALING JAYA, June 3 — A young woman who sought treatment for a third degree tear after home birth has become the butt of crude and distasteful jokes from doctors who latched on to sarcastic comments posted on Facebook by the doctor who was treating her before delivery.
In the general tirade againt home birth by 26 others including young doctors, one even went as far as saying that the patient should use yam roots and a lidi (coconut leaf skewer) to stitch the wound.
If that was not rude enough, he went on to suggest in a similarly unprofessional vein that the first-time mother use glue and aloe vera to heal herself.
A Kuala Krai medical officer who agreed to the doctor’s post, mockingly said: “Yes, please repair naturally. No analgesia (painkiller) please.
Another doctor belittled the woman and patients who supported natural birth, saying “I guess positive vibes, giving birth while standing, lots of hugs, etc can’t prevent third degree tear? Hmmm, maybe because it was not natural enough.”
A third degree tear involves a tear through the perineal muscles and the muscle layer around the anal canal following a natural birth.
The person who started the sordid affair, a house officer at the Hospital Sultanah Nur Zahirah in Kuala Terengganu, had posted this on her Facebook page on Saturday night: “Homebirth. refused everything. Came to hospital for 3rd degree tear. Yes doctor, please repair my tear. Keep calm and continue oncall
To add insult to injury, the doctor also included part of the patient’s pregnancy record book in which the woman had said she would not require any medical attention during delivery at home.
The shocking use of unacceptable language and breach of patient-doctor confidentiality has come in for reprimand from the Malaysian Medical Association and the Malaysian Medical Council which took the doctor who belittled the mother and her fellow medical practitioners to task for bringing the profession into disrepute.
A group of mothers who advocate home birth have also expressed outrage over the manner in which the doctors had treated the woman who went for a procedure that had gained acceptance worldwide.
The photograph of the woman has been circulated widely and found its way into other public Facebook postings despite an attempt to erase the patient’s signature.
The first Facebook posting has been taken down but the author and other doctors continue to discuss the matter openly on Facebook.
– See more at: http://www.themalaymailonline.com/malaysia/article/use-lidi-and-yam-roots-to-stitch-tear-doctor-advises#sthash.67D0nPC8.dpuf
Home birthing is here to stay, doctors told
BY IDA NADIRAH
Wednesday June 3, 2015
PETALING JAYA, June 3 — Doctors have been told to wake up to the fact that home birthing is here to stay.
Hypno-birthing educator Nadine Ghows said the phenomena of doctors criticising mothers who advocate home birth had been going on for some time on social media.
She said the language used by the doctors tended to be patronising and condescending, oreflecting a lack of training on basic etiquette.
“Some doctors still see patients as someone to control … this is partly due to the ‘white coat’ syndrome,” she said.
She said the attitude of some doctors towards patients was unhealthy and they lacked an understanding of their role in the patient-doctor relationship.
She was commenting on the case of a house officer who had posted confidential information on a patient on Facebook which in turn elicited rude and crude remarks from a host of others including doctors.
Nadine, in decrying the actions of the doctors, said basic training on etiquette had to be offered to young doctors especially on the strict rule that they could not share any information on a patient with the public.
She said a medical lecturer from Universiti Kebangsaan Malaysia (UKM) had started a basic etiquette course for young doctors last year.
“Maybe we will not see the results soon now. I hope this course will play a role in ensuring that humanity and respect are brought back to medical care,” she said.
Researcher and engineer Nur Firdaus A. Rahim, 31, said every patient had the right to their opinion on matters involving medical procedures and their requests had to be respected by doctors.
“They should not belittle or insult parents who holds their own opinions on such matters,” she added.
“I am affected by their actions. I had initially planned to give birth at a government hospital but will now chose a private hospital that is more natural-birth friendly.”
Flight attendant Zamzilah Fairuz Kamarul Zaman, 30, said she did not mind doctors sharing their experience “but sharing patients’ records goes beyond the limit.’’
– See more at: http://www.themalaymailonline.com/malaysia/article/home-birthing-is-here-to-stay-doctors-told#sthash.v69ph7lE.dpuf
Pagalavan's Avatar 
Well said…..
doctors are highly respected professionals and are expected to behave like one.
Dont forget they are first and foremost human too…
Yes, we are humans but once we enter certain profession, there are certain ethics and professionalism to hold on to. Similar to why we get sued when as human we do make mistakes.
true doc.i also been watching and following all the arguments regarding homebirth/gentlebirth/natural birth.it’s quite saddening seeing by seeing how the birthing process has been romanticize until they don’t acknowledge all the risks that can occur.. perhaps the doctors will keep on educate people on all health issues matters and May God give strength and motivations in facing all kinds of patients with so may kind of problems including the atttude 🙂
I work in NZ where maternity care is midwife-led and public patients only meet the doctor if the midwife is not happy with the pregnancy/delivery. Unfortunately even for a “developed” country like this where they are supposed to be trained professionals, a lot of mismanagement still occurs. (After all, it is the only thing they do, and nowadays midwives here don’t have to do nursing first – they can come from any background and do a Bachelor of Midwifery).
Home birth is a step back to the dark ages. Do we want to go back to the maternal/perinatal morbidity and mortality rates from those times? The public does not appreciate that while childbirth is a natural event that does not mean it is fraught with risk, and as I see every few months with my own eyes things can go from smooth-sailing to a disaster in a split second. One maternal death that could have been avoided by a hospital delivery is one maternal death too many.
If a place like New Zealand has yet to fine-tune their midwife-led maternity service for both hospital and home deliveries, Malaysia certainly isn’t any more suitable. Even a lone doctor would be hard pressed to deal with obstetric emergencies in a home setting, never mind a midwife or doula.
That said, I agree that all you can do is educate the patient to the best of your knowledge. If they do anything against medical advice that is a risk they are taking. The big problem nowadays is that they don’t acklowedge that and expect us to have superhuman powers that can revive a patient in cardiac arrest due to an amniotic fluid embolism or a terminally ill one with metastatic disease that has been allowed to spread due to the refusal of modern, evidence based therapy. We in turn get blamed and crucified for every eventuality that ultimately results from their decisions.
well said, in Bolehland, everything boleh
in my college the lecturers stressed heavily regarding patient’s confidentiality…one time a student posted on fb abt a patient’s case n eventually it reached the management..the whole batch was punished..im actually quite ashamed to be part of this ‘strawberry generation’, the only thing we do is complain complain complain without realizing how small of a burden we share compared to our previous gen.. In this case, i stand with Dr P, if a patient comes with an emergency, just treat them and dont make a big fuss out of it. What did u do your mbbs for if not for treating patients? People make mistakes and its our job to help fix it, but ridiculing others doesnt make things better. All i see among nowadays housemen is incompetency and lack of patient-doctor rapport, its as if their MBBS degree was purchased online…such ease… hopefully the future generation doctors won’t repeat such humiliating mistakes that our generation make..
“And when the mother dies, a full report need to be sent to MOH as maternal mortality is a national index. Subsequently, you will be called for the Maternal Mortality meeting to find out why the mortality happened. I feel in such case, MOH should take action against the proponents of home births. BUT do they have the authority/law to do that?”
MOH does not have the authority to do this, in my opinion. Among issues that will be raised up during mortality meeting are for examples:
1- Why there is no home visit done to visit client and to address the reason why the client does not want to come to clinic/hospital?
2- If client does not wish to see us, we should take proactive steps and visit them instead
p/s: While
1- I respect the client’s autonomy for not seeing me / follow advice given.
2- I follow my job scope and responsibility –> to see and to give appropriate treatment any client (whether defaulter or not) when they visit to hospital / clinic.
–> But I have no autonomy over this and I have to go to their house to persuade, to share medical knowledge, to invite them to follow up under me. (saya yang menurut perintah)
Yes, indeed. Those are exactly the same questions that will be asked! MENURUT PERINTAH……….
Who cares about the doctors?
Let me put it this way…everyone will die. its just the way of dying may differ. If they choose to die giving birth, no one can stop it. It’s a pity that they make a poorly informed judgement/decision.
I am frustrated as TCM claim a doctor tittle in front, even claim to b a professor of medicine, oncology and women health and etc , god knows how they got it. They tend to specialise in multiple discipline and even claim to b able to cure metastasis cancer. I am speechless, frustrated and even angry but I don’t want to sound condescending to them. I can’t do much and just do my job as a doctor, an evidence base medicine. This is so sad ppl tend to trust them more thn us.
Welcome to the real world!
Proper training in ethics and confidentiality is imperative.
Hope we don’t end up like this.
http://www.therakyatpost.com/world/2015/06/16/why-indias-medical-schools-are-plagued-with-fraud/
Now, what makes me think we may be heading that direction?
We are not very far from this!
[…] June 2015, I wrote HERE about professionalism and ethics of doctors. The public view us or use to view us as the most […]
[…] 15-20 years ago, I hardly hear anyone rejecting vaccination. Only a small group of people belonging to a certain religious sect refuses vaccination. Now, we have groups of people who openly rejecting vaccination claiming it is a Jewish plot, causes brain damage etc. We even hear stories that it is a Jewish and Christian plot to poison the Muslin community! Sometimes I do not know whether to laugh or cry but what shocks me further is the fact that there are people who actually believe all these nonsense, even the educated ones. Now, we are beginning to hear cases of Diphteria, Measles and Pertusis increasing day by day. TB will be the next epidemic. Parents are putting their child in danger. Should we create a law to punish these parents? While it is their right to take whatever treatment offered, spreading infectious disease can also be considered as a crime! Some countries have started to remove certain benefits from unvaccinated parents such as reducing tax relief, isolating them in schools etc. Proponents of home birth are another group that is increasing day by day. I had talked about it before. […]
[…] years ago I wrote an article in my blog ” Patient’s Confidentiality and Autonomy” . It was about an article in the Malay Mail discussing on the issue of doctors posting […]