Wednesday, 26 September 2007

Observation: Emergency Room Trend?...



I just wanted to share something here, and see if anybody has either experienced the same thing, or has an explanation to this somewhat weird phenomenon...



I am all for going for treatment to Government (General) Hospitals, as I believe that the doctors there (the specialists, at least) are very experienced and medical treatment is not governed by how much something costs…After all, the costs are paid for by the government…

In short, the top specialists will always give you the best, unless there happens to be a quota about how much can be used in a month, for say, expensive treatment like Botox (Wah...Very expensive, but it has worked wonders, I tell ya!)…



Morover, GH doctors see all cases, and not just those from higher income groups, which means they have seen the worst of cases (especially those from remote villages who seek treatment late), and the not-so-bad ones too...




Unfortunately, the Accident & Emergency Department seems to be pretty funny, which brings me to this weird phenomenon I am hoping someone can help explain...


Let me share a few actual cases with you:-




CASE ONE


A few years back, my grandfather, an 87 year old, was taken to the hospital because he complained of tightness in his chest and breathing difficulties. Because of his age, he was immediately taken in and made to lie down in the ‘Zon Kritikal’…An ECG was ordered, in which the results were said to be ‘not right’…

After that, the MO asked that he be observed in the Observation Unit, and he ended up lying there for nearly 10 hours…TEN hours…




By that time, the old man was restless and grumbling…I was sitting with him in that freezing ER, and by the time the 10 hours was over, I could barely walk myself! After all, my grandpa was lying down, had a blanket, and was asleep most of the time. I only had a chair, and no blanket…

I told the doctor: “You’re going to have 2 patients by the end of this observation, you know”…






They finally agreed to admit him at 11.45 pm. He was finally admitted by another doctor, and not by the one who saw him when he first came in.



I wonder, why so long to decide if such an old man should be admitted or not? Why observe for so long if you already can see from his ECG something is wrong?







Note: My grandfather later passed away on the 19th of July, 2004 after a major stroke left him in a coma for 5 weeks...May you continue to rest in peace, dearest Ah Kong...




CASE TWO


A close friend of mine, 19 year-old S, was found to have a resting (sitting) blood pressure of 150/105, with no other symptoms by a specialist in GH during a checkup for another reason. The 150/105 reading was consistent for almost an hour, with S sitting down throughout...



The Specialist immediately wrote a letter of referral for S to be seen at the ER (Stamped URGENT), as the specialist considered the condition to warrant immediate attention, and that S should not wait at the KPP (Klinik Pakar Perubatan) to be seen by a physician.

On arrival, Triage asked if she was feeling anything, to which S replied ‘Not really’…

She was being honest…


She was made to wait for almost 2 hours outside of the ER, after which she already began to get a headache going down one side of her head, and down her neck...

When she finally got in, she was hooked to the ECG, and the results were said to be ‘a little funny’…


The doctor put the girl under observation during which her BP was taken every half an hour. All the readings (this time lying down) were noted to be between 140~150/90~100. A second ECG was ordered after 2 hours, and the results could not be read because the doctor was ‘busy’.


2 hours later, the MO discharged S, with a prescription of Panadol!! and asked her furious parents to bring S back should she get a headache later.



To which S’s mother retorted: “For what? For her to wait another 2 hours outside, observed for over 4 hours and told to go home with Panadol?


The next day, the specialist who sent S to the ER happened to see S, and the first thing she said was: “Oh My! What are you doing walking about? I can’t believe they are letting you walk around with that blood pressure...You are too young to have such a high blood pressure




Note: S had no family history of young hypertension and had a BMI of almost 20, which means she wasn't obese...




CASE THREE



Guys, remember Adrian?




A 28 year-old, Adrian was taken to GH because he had a stroke. He was taken to hospital by a passer-by who saw my friend alight from his car and collapse by the side of the road. The passer-by (on a motorbike) was so sweet. He stopped his bike, carried my friend into the car and drove him to the hospital.


Guess what? He was put under observation (it’s a trend in the GH, is it?) for a few hours…

A young man, paralysed on one side, and you just observe him huh?


The father, panicking that nothing was done, later discharged him (against the doctor’s order) and checked him into a private hospital, where they immediately did the necessary, and found there was a blood clot…


UPDATE:-



Adrian Shisman, one month after his stroke...




Guess what guys? I just met Adrian about an hour ago! He had a stroke exactly a month ago, and look who is sitting here looking at me? We had a nice, long chat, and he thanks everyone who sent prayers his way....


Woohoo!


*Update over*



***


My wonder here is, how do you get admitted into GH? How bad must you be before you get admitted? Do they only admit you if you're vomitting blood and severely unconscious? Paralysis in a young person also does not seem important, by the looks of it...


And Panadol for Hypertension?!?


I doubt anything would have been done for S if she had come in later with a headache and a high blood pressure reading...After all, stroke also they sent for observation...If a stroke that has already happened is not treated as urgent, I doubt an imminent stroke would count for much...


And this with a letter from the specialist stamped URGENT...



41 comments:

mott said...

Sadly, it happens on a daily basis.

I believe not just in our hospitals, but in hospitals worldwide...where staff are limited.

One can wait for days..if one doesn't complain. Just don't go in during festive holidays......it's really bad!

winniethepooh said...

yeah emergency trend happens even in sg. Sis had a bad case of high fever, tummy cramp, looking as pale as a ghost and when we brought her there in the middle of the nite, we had to wait for almost 4 hours to see a doc. She had food poisoning..

to ur ah kong, may he rest in peace, the nurses dont even give him a blanket..so mean. The case of ur young friend, S, that is very interesting, with such a high blood pressure reading, she's still feeling fine? i thought with such high reading the docs should be very worried, isnt it? how is she now?
and

PrincessJournals said...

i agree w mott. when we were in philly, i was in the ER for at least 5hrs on a sunday (not many patient ard) for sciatic pain. not to mention tht the place was damn cold and u kno how much i hate cold!

of course thts not an excuse for our GH to ignore cases tht u presented. back to the tak-apa attitude. sigh...

Anonymous said...

This is a terrible phenomenon. I dont know why it is happening but must it must stop!
Interestingly, out of the 3 cases you share, I am fascinated by the 2nd case of the 19 yr old girl.
How come S's bp is so high?
Such a high bp is very dangerous. I really pray her bp that day was a fluke. Is she ok now?

Daphne Ling said...

Hi Mott,

Yes, sadly it happens on a daily basis...

Actually, sadly is an understatment...It should be scary...

I don't know what people are suppose to do, especially in cases of accidents...

If you go to private hospitals, there is a chance they will send you to GH...

In GH, they make you wait!

So what do we do?

Daphne Ling said...

Hi Winnie,

Oh, your poor sister...How is she now?

As for my Ah Kong, the nurses did give him a blanket...

I think you tersalah baca...It was me accompanying him who was freezing crazy...And I had aon a jacket!

As for S, interesting allright...I'll answer her problem in the next, next comment...

Erm, did your question get cut off halfway?

Kerp (Ph.D) said...

Daphne Ling,

I’m not going to be too critical on GHs but as most of us might have known already, being very much part of the gomen, they tend to be extra complacent. This is bcos they know people will still throng the hospital, no matter how bad their services are, they’ll still get paid by the end of the day.

I myself hv had a couple of experience at HKL but don’t need to get into it, suffice to say that it is never pleasant to deal with rude staffs.

Hey, so that’s Adrian? Are u sure this is the same Adrian who was down with stroke just a month ago? Get outta here, daph. I mean, look at him. he looks healthy as a horse! Has he fully recovered btw? or this is a different Adrian, right? RIGHT? Hihi..

boy, that was fast, huh. Wonderful news, nonetheless. Warmest regards to him.

I always believe that mental strength plays a major role to kick-start one’s bum in getting him/her back on track to recovery. Physical only comes 2nd, are u not with me on this, O Daphne Ling?

Daphne Ling said...

Hi Princess,

Huh...US pun sama yeah? And it looks like all ER are cold gila...

Tidak-apa-thy is very much around these days...This jangan jaga-tepi-kain-orang thingy has been taken too far...

Daphne Ling said...

Hi Anon 12.04 pm,

S is feeling better now, due to a huge load of antihypertensives...Without them, the headaches are a killer...

Unfortunately, her bp is still hovering higher than most people her age...

Nobody really knows what is wrong with her actually...And I hope they find something soon...

Living with high bp for the rest of her life, with such heavy meds, is not a joke...

Daphne Ling said...

Hey Kerp,

Yeap, that is the same Adrian!

Amazing huh? He still has weakness in his right side, and when he walks, it's a little heavy on the right side, but he's doing great!

Looking at him sitting there grinning at me when I came in, I did a double take, and had to ask my mum if that was the same guy, or if he has another brother I didn't know about!

He can even sit on the steps and wear his own shoes now! I offered to give him a hand, but he told me he could do it...

And he did!

Oh Thank God, he's ok again...

And yes, I agree that mental strength is important...That, and a lot of support from family and friends...But most importantly, is faith in God...

I guess age helps too!

tokasid said...

Dear Daphne:

Its good to know Adrian is recovering well. With continous physioRx he'll gain most of his muscle tone and power. Thank god he didn't give up on himself last month.

As for the ER cases, I noticed this observation for several hours have become a compulsory trend in most GH.

I remember back in early 90's the ER doctors were admitting cases like a pasar borong dealer.That action brought a reaction from the wards or units.
I remember in GH Melaka btwn 92-94, the surgical unit was very critical of the ER( for the ER will admit most abdominal pain for suspected appendicitis), the officers will call ER and demand for an explaination. When junior medical officer were assingned to ER( after completing internship)they became easy targets fo officers from the wards. What happened soon was predictable, cases were sent home with few Panadols etc and told: Kalau tak baik atau makin teruk datang semula ye..

When the new hospital was built it had an observation ward(10 bedded) at the ER. Now we see lots of several hours observation cases before asked to go home or getting admit.

The problem is, while in observation ward, rarely were the patients being observed closely. If a patient had had a stroke or a heart attack, keeping them several hours without active management in observation ward will only make them worse( just like keeping them at home).

And as your had stated, those funny ECGs warrants a second opinion from the medical unit( can always call the medical MO on call to come a re-read the ECG) or warrants an admission for active management.Just because a doctor doesn't know how to read(in ER you are supposed to be an expert in ECG, like it or not)doesn't mean a patient have to wait and the disease progrssing( can be fatal).

And I just can't understand why the MO in ER refuse to admit a patient which the hospital's specialist referred for admission.

Unfortunately, these incidents keep on recurring in most GH.

I know GH's ER can be like a pasar malam on a bad day. But the have 2-3 doctors on call per shift, right?

The attitudes of those manning the ER should improve. From the Ma, the nurses, the attendants and the doctors too.
They can give the profession a bad name( as if I care),heck, but the patients lives or wellbeing is on the line here.

Cases like a heart attack or an active stroke needs fast and proper management. Every minutes count. Any delay of a proper treatment will amke the complication worse or lives at stake. No, we can't afford to have that. We can't afford to let people die for our poor attitude and for not doing/giving our best treatment/effort to try and save them.

I do hope the MOH is aware of these incidents, and I do hope media will report( if it is true that is, not just sensationalizing a complaint), hoping the ER lot will improve. They need t improve.

TQ for updating us about Adrian.My regards to him.

Nightwing said...

Hi Daphne,

I am sure your grand dad is proud of u and is in a better place.

I think it is the same world wide. Just that in Western countries...at least the rudeness(sorry for wrong spelling)is at the minimum.

For our country, not sure if it is the pay or the system..that lead to this kind of thing. Empathy is not there.

Waited for so long, all they did was give panadol...is not a good thing. They should explain to people why the need to wait/observe so long...

Time is critical.

zorro said...

Yes Daph, it is dismally sad the way our GHs are run. Even if the doctor is as abrasive as "House" they are impeccably knowledgeable. It is sad when people joke about sending people to our GH to die.

If you are suffering from hypertension never go to University Hospital....you may get a blood clot just PARKING your car in the car park. The architect was definitely high on drugs when he designed the Trauma Centre car park.

Kerp (Ph.D) said...

it is amazing. altho he's not fully recovered but he's so much on the right track.

anyway, interesting take from tokasid and as usual, uncle bernard never fails to tickle my rib, funny but sad at the same time...hihi..

winniethepooh said...

Thanks for asking Daphne, forgot to mention, that incident happen some time back. She is hopping and running about now hehe

ah, its u who is cold ar..sorri sorri, must hv misread it :) I didnt notice that 'cut off' just wanted to ask how is Adrian (which u hv later updated on your blog!) so glad to know he's well :)

hv a great day Daphne!

Daphne Ling said...

Hi Tokasid,

Ah...This explains a little how come observation in the GH is such a popular trend...Thanks!

But this whole Observation Unit thingy seems to have backfired, cos now people who should be admitted also are not admitted!

Look at Adrian! I shudder to think what would have happened if his father didn't transfer him to a private hospital...

And look at my friend S...What if she had had an aneurysm (which could lead to a stroke!) later in the night because of the bp? I mean, you send her home and let her walk all around!

What about my Ah Kong? He is so old...Anything could happened while you let him sleep it off while supposedly under observation!

Daphne Ling said...

Hi Nightwing,

Thank you, and I am sure my Ah Kong is in a better place too...He was a great man, with a huge heart...

Panadol seems to have become standard treatment for everything, which is scary...I don't know how an MO can prescribe Panadol for high bloog pressure! And one which is so high, at that!

S's mother took her straight to another hospital where they did the necessary...And thank God S's doctor now is a very concerned lady, who takes care of S very well...

Daphne Ling said...

Hi Uncle Zorro,

Haha...I've seen the UH Trauma area, and I agree with you...Don't talk about parking wei, just getting into UH is enough to kill people!

As for House, oh God! He is sooo cool, and hot! Haha...If we had doctors like House, we'll be cured in a day! Or, a few days, the latest...

I would not mind his bedside manners...He cures! It helps he's got the best eyes! Hehe...

Daphne Ling said...

Hi Kerp,

Yes, it is amazing his recovery! I am just sooo glad for him and his family...

As for Uncle Bernard, trust that he'll come up with something funny (like his boo-boys and boo-girls thingy last time!)...

As for Tokasid, he's the best person to share! Doctor ma...

Daphne Ling said...

Hi Winnie,

Good to know your sister is doing well...

And thanks for coming back to clarify =)

You have a great week too!

*Hugs*

kl_gal said...

Here pun sama lah. They call them County hospitals here ( govt hosps) and the patients are mostly the poor and uninsured.This cab driver I know had really high blood sugar levels ( he'd had diabetes for a long time and didnt know it-no insurance, therefore no doctors visits). He was going blind and almost semi comatose. Went to a County hospital and was put on a gurney in the waiting area ( no tests, no iv) for 12 hours because of shortage of beds!! When he was finallly admitted, the doctor was surprised that he was still alive.
Privately insured patients fare a little better but most ER's here also take on trauma patients ( gunshots, accidents, etc), so if you visit on ER during a bad trauma day/night..figure on waiting for a long time

Pi Bani said...

Ahh, waiting at the ER... so common isn't it? But like Tokasid, I can't understand why the MO wouldn't admit a patient who was referred by a GH specialist! Lawan taukeh betul...

Nightwing said...

Hi Daphne,

Good to hear ur friend S is doing fine. When u r free, please check this site out.

http://transcripts.cnn.com/TRANSCRIPTS/0709/26/lkl.01.html

Cheers.

Daphne Ling said...

Hi KL_Gal,

Hmm...You're not in Malaysia huh? I guess these are universal problems we all face then...

I wonder whose fault it is when the doctor is surprised the patient is still alive...After all, who is in charge of admitting the patients into the ER according to priority?

And wasn't hospitals supposed to save lives first and foremost before anything else? What happened to 'do no harm'?

Daphne Ling said...

Hi Kak Pi,

Because my friend S said she didn't feel anything...

But then again, isn't hypertension known as the silent killer?

Like the specialist told S when she refused to go to the ER on the grounds she was feeling fine: "S, by the time you feel something, it is too late!"

I guess the lesson we all learn here is: IF they ask you how you are feeling, say BAD...

Daphne Ling said...

Hi Nightwing,

Thank you for checking back on S...I will be sure to let her know! =)

Thanks for the website...Such a touching story, what parents would do for the kids...Special children are indeed born to special parents, huh?

Mat Salo said...

Aiyo,

I pray to God that if something happens to me (emergency situation laa) that a top class private hospital will be nearby. Like Dr. Tok Acid said, the GH is good but it's like a pasar malam. This problem at Gov't hospitals everywhere I think, even in the US. Yes, intervention and 'active' management is critical. I wonder how many patients in Gomen hospitals have 'expired' this way... from being 'neglected'...

Daphne Ling said...

Hi Abang Mat,

Tulah...I was telling Mott (see above ye?) that there's a chance private hospitals might send a patient to the GH in the case of an accident...

1) Either so serious, they cannot handle, or 2) The patient can't pay!

So, while the hospitals and/or staff contemplate their interests, what is to become of the patient?

DareDevil8 said...

if the guverment is by the people and for the people and the resources are utilised and managed to the max for the rakyat,u expect lotta those problems???

lisa said...

Sorry to hear about the sad case and so called 'incompetency'.. however, since I'm not really a doctor however knows that government hospital has limited beds, the reason could be that there are certain guidelines to admit patients. In the case of heart patient, I'd read something about a doctor who'd developed a chart or something that the physician could use together with the ECG to determine if the patient is to be send home, admit or put under observation. There is a possibility that some doctors might be in doubt as to wat todo, yet burdened with the workload, aren't able to work through the whole case.. so observation bay become their 'put on hold' folder ....

In any case, thank God Adrian is doing great. Thanks for the update, Daphne!

Kerp (Ph.D) said...

yes D, i've tagged ya. hihi...check it out.

http://letswheel.blogspot.com/2007/10/meme-tips-on-blogging.html

thanks!

Anonymous said...

Your friend, S, might has symptom of hyperthyroidism, ask her to go for a blood check.

Anonymous said...

Yes... Its very frustratin to deal with the people in the hospital! They dun seem to give a damn! Can we do something?? I even wrote a complaint in thestar.. too bad i think its filtered and never posted!!! Arghhh GH suppose to save life.. not a slack place for them to goyang kaki!!! ANGRYYY

kl_gal said...

No Daphne,I'm not in Malaysia..I'm in LA. Dont know if the private hospitals are much better though..I have a problem with Pantai hospital..my dad had an abdominal aneuryism ( not sure of spelling) 10 years ago at New Years time..went to Pantai..guess what..it took them 24 hours to give him a bl**dy MRI..after which they waited because all the doctors who could have performed his surgery were on vacation.He passed away one day later. So I think we get screw*d either way..take your pick..a free scre*ing or one yang kena bayar

Daphne Ling said...

Dear everyone,

Sorry for the late replies...

Hi DareDevil8,

No, I don't expect these problems if that is the case...

But to be fair, I know of many, many competent and dedicated doctors in GH...It is just the ER which is very problematic!

Daphne Ling said...

Hi Lisa,

I really don't know the how's, what's etc when it comes to the heart and ECG's...

But my guess is that an old man with abnormal ECG and breathing problems warrants admission!

Likewise, a young girl with funny ECG, with BP that high and a letter stamped URGENT by a specialist too warrants admission!

But then again, that is just my opinion =)

Daphne Ling said...

Hey Kerp,

You wait till I get my hands on you...;)


Hey Anon 11.13 am,

S has been checked for Hyperthyroidism (nope, not it) and a whole host of other problems...But thanks for leaving a note nonetheless =)

Daphne Ling said...

Hey Anon 3.40 pm,

I am sure The Star filters things...After all, I am sure they get tons of letters every day...

What to do? You know, I find that in the clinics, it is the nurses and receptionists etc which are more 'problematic'...

They bark at the patients, people who accompany patients, and even people who come asking for info!

Overworked? But that's not an excuse to be rude at 8.30 am in the morning no?

Daphne Ling said...

Hi KL_Gal,

Oh dear...Oh dear...

I am so sorry to hear about your dad, may he rest in peace...I know it has been 10 years, but please accept my condolences...*Hugs*

My friend was complaining about Pantai (Penang) the other day too...She said 'Die also I won't go there'...

My family sees a physician (family doctor) in Pantai Ipoh, and Dr Kathleen Yeap is such a sweetie...Old people especially love her because she will listen to them grumbling for hours on end!

In fact, my family and late grandfather have seen quite a few doctors in Pantai Ipoh, and they have all been up to mark...The nurses too are very friendly...

My mum's theory is that Pantai Ipoh is relatively new compared to the other Pantai's...

kl_gal said...

Daphne,
Thanks for the condolences, sayang. I guess its the luck of the draw..when you get ill is as important as where you get ill ( at least in KL)

Anonymous said...

dear daphne,
i m glad to heard that both of your frens, S and Adrian is fine now. :)
actully i am here to ask for your help, hope that with your knowledge can offer me some advice.

these few weeks i very fan2, i really don't noe whether i should go to neurology center of HKL or not.
i have migraine for many years since i was in secondary 2, till now is almost 7 years already.
migraine really affect me a lot in my life as i can't have activity with my friends.
last month i accompany my fren go to HKL to see doc coz she have lymph node swelling, i sun4 bien4 register to see doc for my migraine (outpatient). i told the doc my condition, she asked me to go to check my BP(130/75), my eyes and blood. after she see my results, she said she'll prescribe me ponstan and she refer me to neurologist for further check up, she explain to me that she scare i might have brain tumor. by the time she said this, i don really scare as i had use to the pain, it's just like a part of my life and it's been so many years already, but i am still alive, i don really believe i might have brain tumor. i scare my family will worry so i just said i won't go for the specialist as my mum don't believe any government hospital, but i don't seek for any private specialist's help.
many of friends, family and doctors said it's because of tension but i don't think so.
this is because many condition can cause migraine, even when i go out play with my frens, sing karaok, shopping or having camping. it's really torture to me coz i'll vomit and it's so painful that i have to walk lightly and slowly, i can't have any face expression, i have to talk slowly and lightly as every action i do will worsen my headache.everytime when i sneeze, i feel that my head is going to burst,because i have nose allergy, so i'll sneeze continuously for many times.Besides, i have no appetite to eat anything, can only lie down on my bed till my headache fade away. usually my migraine will last for about 3 days or more. the pain is consistent and gradually increase in intensity.
i din seek for any help from specialists yet but i do seek for help from clinics when the pain is so terrible that i can't stand, but everytime docs will only prescribe me some panadol or ponstan. they din help with my migraine at all. after that, i know seek for docs help will only waste money and time as i noe migraine can't be cure.
however, i did try for chinese physician in singapore, the docs is very nice and patient with all my complaints, everytime when i go follow up she'll prescribe me with different zhong yao according to my condition, i din do accupuncture. after almost 6 months of treatment for my migraine(accompany with anemia, flatulence everyday, and nose allergy), i think i am really healthy already as most of the symptoms had disappear, yet migraine also decrease in frequency and intensity. so, i decided to stop further follow up because i really feel bad to let my mum accompany me to go singapore all the time and also the fee is high for my family, one week's medicine cost $42. though my mum said money is not important as long as doc can cure my migraine but i still don bear to see my parents' hard earn money spend for me like that.
after i stop the medication for about half year, my migraine come back again, and it's just like a time bomb to me, affect my daily life.
i also found that i can't be excited as i play with fren, what i mean is my mood can't have a big change, i think it's also a cause to my migraine.
i'll also sensitive to light(no matter i wear spec or not, i'll feel my eyes are not comfortable when i see things) and sound.
hash... it really affect my study especially during exam, lots of things wait for me to memorise yet i can't memorise anything everytime migraine,i can do nothing but admit defeat. see all my housemate and coursemate study hard to fight my exam, i feel so helpless and hopeless, so many time i have the urge to give up study , pack my things and go back home, but i can't bring myself to do this, everytime when i think of my family, they must be disappointed if i really give up study, i can only hang on.
before exam i migraine when i memorising ( i am an biomedical science students ), during exam i'll also migraine when i have to answer lots of MCQs and essays.
i don noe who to talk to, so when i accidentally enter your blog, read your blogs make me feel that u're a really nice person with magnanimous and gold heart.
coincidentally i read this blog, so i decided to send you this message hope you can give me some suggestion, i don noe whether i should go to see the specialist, it's on 7 march( friday ).
i not sure whether will u read my message, just hope if u did read this, please give me some suggestion.
thanks ya, :)

p/s : i am sorry with all the spelling mistake and any grammar mistake as my english is weak. :)