Monday, January 26, 2004

4-12 in resus on a Monday following the long Chinese New Year weekend. The big surprise: resus is busier than consultation! How can this be?! The odds of this happening are almost nil, and yet, even with 2 seniors and myself in here, we've been on our feet the whole time, sending patients for CT scans, calling ortho down for a referral, ringing the ICU...

I saw 2 patients with fits today -- one an undiagnosed diabetic who presented with his first seizure, another a known epileptic with breakthrough fits. Interestingly, both cases were almost identical in terms of seizure manifestation -- generalized jerking, mildly uprolled eyes, stiffening of the neck and facial muscles, YET remaining fully alert throughout. Tap them on the shoulder and they'll talk back. "Are you okay?" I asked. "I'm fine. Can you stop this shaking?" IV Valium did the job nicely. :)

Added a new link to my blog list today. I titled it "An American ER Experience", 'cos it's maintained by a 2nd year ER resident from the States. She writes well, and has a keen eye for details despite the fast pace and constant hassle of the job. A recent entry that caught my eye can be found in the Jan 22 post, which describes a Non-Accidental Injury case ( ie. a child who has been physically abused ). A harrowing, heartbreaking account.

I almost forgot to watch this year's Golden Globes. Woke up feeling as if my head weighed a tonne this morning, but at least I caught Peter Jackson's acceptance speeches for his Best Director and Best Motion Picture ( Drama ) wins for "LOTR: The Return Of The King". No-one deserved it more, and I hope ROTK will sweep the Oscars come March. Boy am I glad I joined the LOTR tours when I visited New Zealand! What an experience! :D

I met a rather annoying patient yesterday in consult, but for some reason, I failed to put this in the blog. :P It was a man in his 30s, well-educated, courteous, and part of the hospital staff ( administrative side, I think ). He came in with classical flu complaints, so I prescribed him the usual symptomatic treatment and wrote out a medical certificate. End of story, right? Far from it. The fellow then asked if he could have some antibiotics. Nothing unusual, so I had an answer prepared.
"This is a viral infection, so antibiotics won't make any difference. Just let your immune system fight it off. You'll be fine in a couple of days."
When I dispensed this advice to my other patients in the past, I rarely encountered any problems. But a few did require further explanations before being convinced, so I patiently reassured him a few more times.
"But Doctor, I NEED the antibiotic." he implored. "It helps me recover faster. If I don't take it, I'll get worse!" He seemed so sure he'd deteriorate without this "magic drug" that I noted a mildly crazed glaze in his eyes. An image of my patient bashing me over the head if I refused him once more transiently flashed through my mind, but thankfully I managed to suppress it.
"Okay, I'm not going to argue with you over this anymore." It was hard to keep my voice even, but somehow I succeeded. "I've already explained that this is a viral condition. There are no signs whatsoever of any bacterial infection, so I am NOT going to give you an antibiotic."
His comeback was immediate. "Then can I see another doctor?"
"If you register again, sure." I replied.
"But does that mean I have to queue and pay for another consultation?" he asked.
"I'm afraid so. And the other doctor probably won't prescribe an antibiotic either, because 95% of colds are caused by viruses."
That stopped him for a moment, and he hesitated, pondering his next move. So I swooped in for the kill.
"Look, trust me on this. Just take the medications as instructed, get some rest, and I promise you'll feel better in a few days' time. IF you get worse, just come straight back and we'll consider starting antibiotic therapy then."
That did the trick. "Okay doc. Whatever you say." Then he was gone.

Once he left the room, I realized my mouth was dry. The consult, which should've taken 3 minutes at the most, had swallowed up 10 minutes of my time, due to repeated, tedious explanations of the mechanism of action of antibiotics and the epidemiology of a simple flu. In all likelihood, this man represents only the tip of the iceberg. General practitioners and even some polyclinic doctors freely dispense antibiotics for colds on a daily basis. In fact, this same patient used it as a reason for me to do the same! I bluntly told him that such indiscriminate use was wrong, and that I wasn't going to follow suit. After all, I'm not the only doc in the entire country. If he really wants an antibiotic, I'm sure someone somewhere will give it to him.

It's 10pm, and I just attended to my 2nd diabetic ketoacidosis ( DKA ) patient for the day. 2 more hours / 120 more minutes to go. I miss my bed...

Shall leave you with the promised link to Kurt Nilsen's mug shot. He's 24, and already a father of two! Boy do I feel inadequate. :P

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