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Sometimes I really get annoyed and pissed off with some of the junior doctors and the frontliners. If they are not into treating patients and care for patients, then they should just quit and find another job. Over the last few weeks I have come across few cases that was mismanaged even after being referred by a consultant (obviously from a private sector). Some how, some of these frontliners are arrogant and feel that they should not take any ideas/opinion from private specialist. I will give you these examples:

1) A 60-year-old man who has Mitral stenosis, AF , Diabetes and Gout came to see me for frequent attack of Gout. He is being planned for valve replacement surgery soon. His diabetic is being followed up by a Klinik Kesihatan(KK) and under insulin therapy. I noticed that his diabetes is not well controlled despite being planned for surgery soon within the next 2 months. This is a well-educated english speaking patient. His FBS was 15 and HBA1C was > 10%. Thus I advised him to adjust his insulin dose by himself by educating the patient to monitor his blood sugar at home regularly. I also managed his gout accordingly. 2 weeks later, he came back to see me and what he told me really irritated me. It seems that the MO in the KK refuse to see him since he had seek advise from a private consultant. He claim that the patient must only listen to him!! I wonder why is the blood sugar not well controlled then? Then I realised another stupidity that this MO is doing! When I looked at the little green book that all diabetics carry, I noted that his so-called “FBS” was always between 4-6.0 mmol/L while his own home GM monitoring was above 10 mmol/L all the time.

So I asked the patient ” Do you go fasting when they take the blood? ”

Answer: ” Yes and I also take my insulin before I go to see them???? WTH!! no wonder his blood sugar is low when he goes to KK. Sometimes, he even gets hypoglycaemia symptoms while waiting to take blood.

Is this arrogance or stupidity?

2) A 38 weeks pregnant mother was noted to have IUGR by a KK MO. She was referred to the specialist clinic of a GH. Patient’s referral letter was seen by a MO at the clinic and given appointment in 2 week’s time!! WTH, by then she will be 40 weeks pregnant. Even me, who had not done O&G for 15 years, knows that IUGR need to be delivered by 38 weeks! The patient was shocked and came to my hospital for opinion.

3) A 30 weeks pregnant mother was diagnosed by a private consultant to have Placenta Praevia Type 2 with previous scar, possible placenta accreta was considered. She was referred to a GH after spoken to the MO on call. Now she is 36 weeks pregnant and no proper plan has been made for her. In fact, she has not even seen or followed up by any specialist up to today. Only once it was written ” discussed with DR so ….so” . Such a high risk patient being followed up by MO with no proper delivery plan??? what the hell is happening?

4) A 20-year-old boy who became paraplegic after a MVA was admitted to our hospital for UTI sepsis (Pseudomonas MRO organism). He was on halovest. He was started on Sulperazon and the fever settled on 2nd day. He had appointment at GH the next day for removal of halovest. Our Ortho consultant wrote a letter to the GH doctor to admit this patient and con’t the antibiotic for atleast another 4 days. When the patient saw the doctor at GH, the letter was read but just thrown to the side. The halovest was removed, T unasyn was prescribed and the patient was not admitted. 3 days later, fever spiked again and readmitted at my hospital. Despite a letter from a private consultant, the opinion was ignored! Now, the patient has to spend more money!

Some how I feel that the newer generation of doctors and even specialist are becoming more uncaring and only interested in finishing their work and going back home. This, along with arrogance is screwing up the system. However, they don’t seem to realise their stupidity and the fact that patients are getting smarter. Sooner or later, lawyer’s letters are going to reach their doorstep!