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Case 1:

2 weeks ago, a 60+ year old man came to see me. He came with 4 days history of inability to open his mouth completely, unable to protrude his tongue, stiff neck muscles and upper back. He denied taking any medication such as Maxolon. He has a chronic venous ulcer of the RT ankle area over the last 1 year.

I examined him and found a locked jaw, inability to protrude his tongue with stiff muscle of the neck. His venous ulcer was dirty and full of slough. As a benefit of doubt, I gave him stat dose of IM Kemadrine but after waiting for more than an hour, no response was seen which excluded oculogyric crisis. A diagnosis of TETANUS was made. Since I did not have Tetanus Immunoglobulin in my hospital and the patient unable to afford admission, I referred him to the general hospital. I wrote the word “TETANUS” huge enough in the referral letter that any “monkey” can see it . I thought everything would have been taken care.

Today, I heard the horror story of what happened to this patient. He was seen by a doctor at the GH who did not even bother to read and take note of my letter, not sure whether he/she even examine the patient, did a TMJ Xray and referred for an appointment to see a dental surgeon!!! The patient then decided to go to another nearby private hospital despite his financial constraints, to get admitted and be rightfully treated as Tetanus.

Case 2:

A 3 months year old baby was brought to a district hospital for recurrent jerky movement of the limbs and up rolling of eyeball to left. He was seen by a doctor and discharged claiming that FBC was normal as thus nothing to worry about!! The baby was brought to our hospital the next day with almost persistent on and off jerky movements and my pediatrician said that it was a clear-cut seizure. A diagnosis of meningitis was made but unfortunately, it is probably too late. The seizure was resistant to anti-seizure medications and had to be intubated and sent to general hospital for ventilation. Most likely the baby might have developed hypoxic encephalopathy and may develop CP in the future.

Case 3:

A 86-year-old man was admitted to a GH for fever, cough and lethargy. He was diagnosed to have Left basal Pneumonia and treated with antibiotics. He was discharged after 2 days and given appointment 2 months !! We all know that a simple pneumonia can cause death in an elderly man. He was brought to see me today with worsening condition.

Has our standard of healthcare gone this low? Is this going to go into a vicious cycle of mediocrity? The first case is a blatant disrespect to the physician who referred the case. I presume the decision was made by an MO who probably would not have seen a single case of Tetanus in his/her life! Probably, he/she do not even know what is tetanus!! If you don’t know, please ask a senior or call and ask a specialist. Worst come to worst, just admit the patient based on the diagnosis given by the private physician. I find this as a serious attitude problem which is affecting some of the current generation of doctors. No respect to other doctors or colleagues, especially if the referral comes from a private doctor. I have seen many cases like this but I am just giving an example.

I don’t know what to say about the second case! How can a recurrent jerky movement of a 3month year old baby can be normal!! This was exactly what Dr Wong YO was saying in his letter yesterday. Doctors nowadays depend on investigations then taking proper history and examining the patients. Just because FBC was normal, the patient was sent back home!! Do you know that FBC can be normal in sepsis? Whenever a medical student tells me that the WBC is normal and thus infection is excluded, I will tell him/her to fly kite!

The 3rd case just proves that there is lack of empathy to elderly patients. A pneumonia can kill an elderly patient. This is a well-known fact. It is one of the commonest cause of death in the elderly. How can you discharge the patient and give an appointment after 2 months!! Even if your bed is full and need to discharge this patient, you should have arranged an appointment to see him within the next 4-5 days or even earlier.

I have a feeling that the situation is only going to get worst with the glut of doctors that are emerging and lack of good trainers. What Dr Wong YO said will come true that doctors nowadays do not have the passion, empathy and genuine interest in treating patients. I feel for the patients.