What The Public Doesn’t Know

I’m writing this based on my own experience, and the stories that my friends related to me. I’m writing as a government medical officer in a busy tertiary center hospital, which means I’m not a specialist, and neither am I a junior doctor/house officer. It also means that I have no power at all for decision making about human resource, buying of drugs and equipment, hospital bills, the service of other departments, my own pay or even the food I eat when I’m on call.

The only contribution I make towards the care of my patients is to care for them, with my knowledge and experience, as much as I can, with the most empathy, manners, efficacy and quality that I could give.

The only contribution I make towards the training of junior staff is by training myself rigidly, and then teach them all I know, with the little time I have in my hands (in addition to the job description – treating patients), be a good leader and example to them.

When I said “only”, it basically means there are others who could give greater contribution, or in other means. When I said “only”, it means that the hospital, the ministry of health, have their own responsibilities towards better care for the public.

It basically means that there are so many things out of my control, our control.

However the complains always landed on us, our juniors, the nurses and medical assistants (MAs).

So here you are. What the public doesn’t know.

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You may not know, that the doctor you waited for 2 hours in the clinic, is likely the very same doctor that has to attend the emergency department (ED) because of a case of heart attack. Or sometimes two or three cases of heart attack on one go. The thing is, this doctor may need to attend to another case who’s collapsed in the ward.

You may not know, the doctor that made you wait for two hours in the cold ED, breathless with asthma, before admitting you to the ward, may be the same doctor who is attending a pregnant lady, breathless with asthma too, about a block away, in the maternity building.

You may not know, the doctor that is attending your father who’s having a heart attack, did not even sleep last night, has been working since 8am yesterday, running around until 10am today and still running around. Furthermore, he’s expected to run around with a perfectly functioning mental state until at least 5pm.

Do you know what kind of mental capacity does a person have with not sleeping for more than 24 hours? Apparently it’s like someone drunk trying to drive. Imagine that before you complain to the doctor, “why are you so slow?” when perhaps that’s the ONLY doctor who’s available at that moment to attend to your father.

You may not know, that doctor who’s patiently explaining and teaching her junior doctors in the middle of the night, has not taken a rest since 7am today, is actually expecting a phone call to inform the results of another ill patient, who might collapse soon.

You may not realize that the doctor in front of you is trying to decide, which one among the four emergency cases that he has to attend, is the most urgent case to be seen. They are probably 500m apart from each other, in different wards, on different floors.

You may not even try to imagine, when that bus in Genting crashed and killed 37 people, a few medical officers were on their way back after their shifts, but had to come back to the hospital because of the disaster. Did you ever wonder, maybe one of these doctors may have had a flight to catch, to visit his own ill mother in another state of the country?

You may not realize, that doctor you saw eating his dinner at 5pm (which, by your standards, is too early to have dinner), probably is eating his first meal of the day. Or the first meal after his breakfast at 8am yesterday.

You may not realize that the five phone calls that interrupted your 10 minutes conversation with your doctor, are urgent phone calls, and the doctor is trying to decide whether to stop the conversation and attend to the other patient too.

You may say that the “taxpayers money” was used to buy that state-of-the-art MRI scan machine. But do you know how many people are lining up for that machine?

You may say that “taxpayers money” was used, many many years ago, to buy two radiotherapy machines in oncology department. But do you know that the machines are used to maximum extent, from 8am to 10pm, almost non stop which results in its frequent breakdown? Do you know how many cancer patients line up for that two radiotherapy machines, before you even mention “taxpayers expect the best out of the money they forked out”?

The public may not notice that certain specialties are only available in certain hospitals, and people come from all over the country to get treatment.

Do you know that even with RM1 fee for ED, health clinic and outpatient department visits, and RM5 for specialist clinic fee, there are many people who cannot afford healthcare? So the tax you pay is going to help these people.

The public may not notice that with paying RM5, they get specialist (or future specialist) consultation, with medications that cost up to RM200 per month (often more), and they don’t even get charged for the expensive medications.

You may not notice that there are 50 other patients in the ward you mother was admitted in, 10 of them are very ill, but there are only 5 nurses. You may say that not attending to your mother who had just passed urine in her diapers, is not acceptable. But is it acceptable to not do CPR on your friend’s mother at the end of the ward there, who’s in the brink of death, just to change your mother’s diapers? Erm…can you do it yourself?

You may not know that the doctor who’s working on a Saturday morning, her mother had just called up and ask “are you coming back for breakfast? I made your favourite fried noodles”, while she has another procedure to do, another two letters to write, five house officers to supervise.

You may not realize, by saying “doctors are human beings, they need rest too” will cost your waiting time in clinic to increase up to two hours. Because if one doctor takes leave for one week, the rest of the unit may need to compensate and that’s when emergencies tend to happen but only one or two doctors around, trying to handle them all.

But if the doctors work like robots, not being able to take days off to spend with family, they will become frustrated people, higher risk to leaving the government sector, higher rates of divorce perhaps, mental illness, and the list goes on and on.

It may not cross your minds that it needs repeated education, counselling for patients, emphasising that it’s important to control their diet, stop smoking, exercise more, teach them how to use thei insulin, how to monitor, before patients actually follow our advice. By the time they decide to follow, often it’s too late.

These consultations, to be done properly, will take at least 30 minutes, to cover ALL aspects. There are usually at least 120 patients (can be up to 200 in health clinics, no specialist), 10 doctors (or maybe just 2 in health clinics, no specialist), so one doctor sees 12 (or 100). You do the maths. You expect waiting time of less than 90 minutes? Like, seriously?

Stretch the resources? So, patient come in, say hi, how are you, your sugar is not controlled, add medications, and bye bye. That’s 5 minutes, if the makcik doesn’t decide to say “doctor, I have runny nose, I have knee pain, I burp too much” or “doctor, where are you from? Are you married? Why are you not married? Are you choosy? Where did you go back to during Eid?”

Perhaps the public didn’t notice that the medications don’t work if they continue smoking, continue eating to their stomach’s content, sit around watching American Idol being a couch potato.

The public may not have seen a doctor working hard to CPR a patient who had a major heart attack, send the patient over to IJN for emergency procedure, discharge the patient WELL, and guess what, come back after one year with another heart attack, because he did not stop smoking and did not take his FREE (yet expensive) medications. All paid for by “taxpayers”.

Perhaps the public doesn’t know that the auntie occupying that “paid by taxpayers money” hospital bed, had just been discharged two weeks ago, after being admitted in a coma because of extremely high sugar level.

Guess what, she’s back in the ward because of extremely high sugar level, and a stroke, because she conveniently took the durian crepes her daughters bought at home, and conveniently “forgot” to inject that expensive, paid-with-taxpayers-money, insulin prescribed with a good heart by her doctor two weeks ago. The common excuse, “I can’t stand it, doctor, my daughters bought them so I just have to eat them.” Yup, that’s taxpayer’s money well spent for you.

What the public doesn’t know is most of us, medical officers, treat lives the same. Whether they are teachers, ministers, Bangladeshi petrol pump attendant, Indonesian cleaner, local waiter, when it comes to emergencies, we try our best. Ambulances pick up those unconscious drug addicts on the roadside and send them to the hospital. When they end up in our wards, in our EDs, we do x-rays, expensive blood tests, and diagnose them with TB, HIV and all sorts of other things.

What you may not notice is, perhaps that CPR that the doctor did at 3am just now, was on someone whom she does not even know his name, and none in the hospital knew, no family members ever visited him, not someone who could give her any good recommendations or acknowledgement when he walks out of the hospital alive. Not someone who will recognise her when he woke up to say thank you.

You know why? Because all of us are human beings. A life is a life, no matter who you think that life is. When we know that it’s futile, we will stop trying, but we will make a difference through other means. Till then, while we’re still standing, breathing, this is what we’ll do. No matter how public misunderstood us.

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I’m not saying everything the hospital, the doctors do is right.

Mistakes are sometimes made but a lot of times they are caught early.

It’s alright to complain or to advice, to remind, if you think that something wrong is going on, if you think the medication you mother is receiving is different from what she had yesterday. It’s good to ask for explanation because that’s what we all are obliged to do for you.

It’s even better if it’s done in a polite way, not in papers, not in social media. Not by taking photos of a nurse reading the newspaper at the counter when, actually, she has nothing to do as there are only a few patients in the ward and all things are done.

I’m not trying to be defensive, it just hurts to have people commenting, complaining, or even trying to sue our other colleagues in other hospitals, when in reality, we are all in the same shoes, trying to do our best with the little resources that we have. The only reason I emphasise RM1, RM3 and RM5 is because, basically those are the bills that most people pay, and healthcare cost is heavily, very heavily subsidised.

My family may have noticed that I’ve sat for 7 papers for my professional exams, each paper costs RM2500-3000 depending on the UK exchange rate, and I paid those with my own money. I did not claim a single cent from the government. Yes, I pay tax too. Oh, and my financial analyst brother said those money I spent, I can’t deduct my tax for it. So…yeah.

For those who has the experience of seeing a rude doctor, nurse or MA, do make a complain. Make a report. That rudeness, is never acceptable.

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An orthopedic surgeon might not understand a gynaecologist’s job. A neurosurgeon may not understand a physician’s concerns. A pathologist may not understand a surgeon’s struggles. Even amongst us, we can’t fully understand each other. How can I expect the public to understand us?

I guess in the end, what matters most is that we do our best, to the best of our knowledge, our skills, power and even leadership qualities. What matters is we know God is watching (for those who believe), and He alone could appreciate us in the best way that no humans beings ever could.

The only thing we ask from you, the public, is to control your diet, stop smoking, drive carefuly, take care of your loved ones, remember to take your medications, get to know about your disease and please please please don’t be rude to us.