到底该怪谁呢？

@res

The surgeon described how he dutifully did an ultrasound-guided fine needle aspiration of the small nodule.
The results? Adenocarcinoma. Breast cancer.
Here’s where things get interesting. Apparently, this woman is a die-hard altie. And I do mean “die hard,” as she will quite likely die very hard for her beliefs. She absolutely refused any surgery or treatment for her cancer. It was explained to her that a less than 1 cm tumor with no evidence of spread to the lymph nodes carried a highly favorable prognosis, with upwards of 93% long term survival with proper surgery and adjuvant chemotherapy and/or hormonal therapy.
This woman would have none of it. She wanted to pursue “alternative” medicine. And pursue it she did, with a vengeance. For three years, she disappeared off the radar screen.
A few weeks ago, she reappeared in this surgeon’s office. In the interim, she had tried Essiac tea, homeopathy, the Hoxsey therapy, the Gerson treatment, and Reiki therapy, among others, all the while visiting various “healers.” The results? If you’ve been reading here, you can guess the result.
Her tumor had progressed.
Not only had the tumor progressed, but it had progressed a lot. When the surgeon saw her again, now more than three years after her diagnosis, her tumor had grown to 5-6 cm in size. It was now stuck to the chest wall, distorting her nipple, and ulcerating through the skin in a five centimeter area of bleeding, disgusting goo.



Let me tell you of a similar tale in our shores. The patient is a relative of a colleague of mine, an ENT surgeon. He found out about her having breast cancer. She was afraid of surgery and instead landed in the clutches of a doctor who practiced Ozone therapy.

Advanced_Breast_Cancer
(advanced breast cancer : picture from emedicine.com)

Ozone therapy was administered on a daily basis, each session costing RM400 or thereabouts. Apparently through out the course, the patient was not assessed for response in anyway by the doctor concerned. Eventually another relative of the patient (a nurse I believe) confronted this practitioner who hastily referred her away to a surgeon. By that time the tumour had progressed and the patient now has lymph node and liver metastases.
Breast cancer is generally quite slow growing and patients can live with advanced disease and metastases for quite some time, sometimes even for years. This gives ample opportunity for Quacks to ply their trade. The sad part is these women are being sentenced to Death by Alternative Medicine. So what can we do about it? Who’s to blame?
Do we blame the patient for making the decision? Do we as doctors blame ourselves for not trying hard to convince the patient to do so otherwise (often we can advise patients till we are blue in the face but they ultimately will make up their own minds). What about rogue physicians who undertake unorthodox practices like Ozone therapy for breast cancer? Shouldn’t they be blamed and even punished? We mentioned a high profile case in Holland where Doctors were suspended for use of Complementary medicine in a celebrity with Breast cancer. I have yet to see similar cases in Malaysia involving doctors who use unorthodox methods in cancer patients. These doctors are causing harm by denying patients a chance for proper care with proven methods. By administering ineffective unorthodox treatment, the cancer will progress to incurable stages. So should we blame the system for failing to discipline these doctors? The system here demands that patients complain about these doctors to the Malaysian Medical Council. I am waiting for the day that happens.
摘自《http://new.medicine.com.my/2012/10/death-by-alternative-medicine/》

看了这篇文章，到最后，应该怪谁呢？怪医生没尽责解释清楚吗？怪这些卖保健产品/alternative medicine practitioner吗？还是怪病人没有research清楚吗？
最近我的病房最近也来了一个病人，进了两次医院，都是说肚子痛，痛了很久，第一次和第二次都照了CT，都证明是肠胃破洞了，一定要动手术了，第一次他不要动手术，签字discharge，第二次，他还是拒绝动手术。specialist和consultant都尽力去说服他动手术了，可是他还是不肯，还差点吵架那种。过了1-2天，一直发烧，肚子一直痛了，还是不肯动手术。时间拖越久，对他的outcome越不好。最后，趁night rounds做完了，离放工还有一点时间，我就坐下来，慢慢和他谈，说了10-20分钟，他还是不听，到最后，他的叔叔来了，我就趁机找他叔叔谈，告诉他叔叔状况，最后他终于答应了。我就立刻帮他准备血，准备动手术的东西，第二天早上就立刻动手术。她很幸运，还来得及，没什么complications，手术后康复得也很快。之后，这病人就很听我的话了，叫他做运动，他也跟着做，应该在这两天discharge回家了。看到这样，其实自己也替她高兴，这也是我们做医生所得到的满足感。
在医院也曾看过一些类似的病人，认为可以值得一试其他治疗法，觉得反正试了，也没副作用。可是很多也不知道，其实这些产品/草药带来的不只是副作用，可能不只对病情没什么帮助，反而延迟了治疗，导致原本可以很小事的，变成了大手术或无法挽回的地步。

moot

黑心点来说，没什么不好的。 如果恶化一下子死掉了， 反而省心。
怕他们恶化死不掉慢慢耗而已。那就是大问题了。

@res

moot 发表于 17-2-2014 10:27 AM
黑心点来说，没什么不好的。 如果恶化一下子死掉了， 反而省心。
怕他们恶化死不掉慢慢耗而已。那就是大问 ...

是啊，只是觉得可惜。结局可以比较好的。

moot

@res 发表于 17-2-2014 10:40 AM
是啊，只是觉得可惜。结局可以比较好的。

正当的做法， 不相信第一个诊断， 也应该去不同的医院做检查咨询。

不过马来西亚没那个普篇知识， 加上就算买医药保险也可能不涵盖二次三次的检查。许多人就去拿自己做药品实验。 都希望自己侥幸的误打误撞能好（其实机会比买彩票还低）。 有些“自然”的保健药品里头也有毒，不少人就连内脏也毒坏掉了。

至于某某神药保健药品能“治好病”的"听说“ 故事我听过很多，可是就没一个能拿出医药报告证据出来。

@res

moot 发表于 17-2-2014 11:15 AM
正当的做法， 不相信第一个诊断， 也应该去不同的医院做检查咨询。

不过马来西亚没那个普篇知识， 加 ...

很可惜。如果你问这里的人，普遍上都会相信草药是没有副作用的

@res

I have read a lot of comments, regarding the state of our country's healthcare.

Many stinging criticisms has been put forward by many, on a lot of issues related to healthcare; the overcrowding hospital wards, long waiting time in accident and emergency, incompetence, unprofessional and insensitive medical staffs and so on.

I must admit that there are a lot of weaknesses in our system.

Much have been said about the doctors. Doctors' quality, medical errors, attitude problems and so on.

As a doctor myself, I have to say that we are a big part of the system and of course we should be rightfully blamed when the system fails.

Honestly, it is getting increasingly difficult to do a good job as a doctor.

Not about the time of work.

Not about the seemingly low pay in comparison with what other professionals are getting with the time and effort spent.

Not about the stress at work actually.

To me, it is more about the patient factor.

I once met Mrs A, a 55-year-old lady, who takes up 2 jobs as helper in hawker stall.

I spent so long talking to her way past my lunch hour, and that of my clinic nurse, to get her to change her diabetic insulin jabs, only to get her telling me, with full conviction in her eyes, that she has some friends taking herbal medications from China and they are all cured of diabetes.

"Western medications are good, but herbal medications has no side effects," reasoned Mrs A.

There was then a Mr B, a 60-year-old retired civil servant, who refused a medication called Perindopril after I said that we need to check the bloods after two weeks in case the medication causes the kidney function to worsen.

"Why are you starting me on such medication that can hurt my kidneys? Where you graduated from? I want to see your specialist."

Those words are hurtful, Mr B.

Then there was also a Mr C, who was so unhappy after waiting for hours in the clinic. "I paid taxes you know," said Mr C.

I am not from the Inland Revenue Mr C, and I don't care a slightest bit, whether you have paid your taxes or you are getting a BR1M.

I always find patients' attitude and beliefs towards our "Government Service", very mystifying, to the extent that I think solving this might save more lives than finding a new vaccine, getting more specialists or building more
hospitals.

People can wait for same duration to pay an expensive fee, to see a private doctor, but can't seem to do the same in a free, government clinic.

They thanked their private practitioner who referred them to public hospital with a fee, but gets very agitated in public hospitals when the nurses over the counter give an appointment to see specialists later.

"It is cancer you know! How can you see in TWO weeks!"

"I want to talk to your specialist now!"

No wonder it is always very difficult to keep specialists in government settings.

It is not about the pay. It is not about the burden of the workload.

It is the patients' general attitudes towards a free (oh well, there is
a fee), cheaper service.

There are so many who smoke a few pack of cigarettes a day, eat nasi kandar at midnight, but expect to have a life without disease while at the same time refuse medications.

"My friends all okay and no problem. Doctor, you got check properly or not?"

"My uncle smokes 2 packs a day, he is still up and well at age of 79. Doctor, I know what I am doing".

Sometimes it is very difficult. And I always think to myself, what kind of patients would make my job a bit happier and easier?

Is it the highly educated ones, who thoroughly google their diseases' pathophysiology and the gold standard management; and demand the best medications that even I am not authorised to give my own mother. We have never given away substandard medications, just not the most expensive ones.

Or is it the not-so-well-educated ones, who don't bother to know their diseases and only keen to seek opinion from the bomoh and listen to their friends in the kampung, changing doses of medications on their own according to their "feelings".

The answer is, I dont know. Patients are always patients, with their unique expectations and beliefs. Some of these beliefs and expectations are really making doctors' life difficult.

Having said all that, there are always some patients who make us smile.

Those who appreciate, thankful, and listen to what you have said and comply with the medications and advices. It is an absolute beauty and satisfaction to see them get better, at least the numbers, as they might not feel the difference between a blood pressure of 170/90mmHg or 120/70mmHg.

But sometimes we can't do a good enough job for certain patients, because of the number of patients in our setting. There are times when we want to monitor them more closely, but if doing that would mean operating the clinic way past 2 pm. I do sometimes feel a bit worried for some of these patients.

There are simply too many patients who we can't refer to the local polyclinic because, apparently, the waiting time there is too long for them.

There is one thing for sure, and there is one thing that I think we all should spend some money on: patient's education.

Patients have to be responsible for their own health.

It is actually to me, the most difficult part in being a good doctor; to educate your patients about their diseases. We must strive to educate the public. We have to rethink our strategies to educate, to strengthen our public health efforts.

It might seem impossible to have the makciks and pakciks in kampung to be able to adhere to the diabetic diet, but we must try harder

Preventative, health talks might seem less glamourous and less effective than the minimally invasive coronary artery bypass surgery, but it will save more lives than the latter. – April 6, 2014.

另一篇文章

jj_86

@res 发表于 7-4-2014 10:16 PM
另一篇文章

哈哈，这篇是我的朋友写的。。很佩服他表达能力和细微的分析..

@res

jj_86 发表于 8-4-2014 10:23 AM
哈哈，这篇是我的朋友写的。。很佩服他表达能力和细微的分析..

我觉得写得很好，所出了我们的心声
因为我国的patient education真的太差了，看看这里的帖子里面的回复你就会明白我说什么了

jj_86

@res 发表于 9-4-2014 07:36 AM
我觉得写得很好，所出了我们的心声
因为我国的patient education真的太差了，看看这里的帖子里面的回复你 ...

我其实之前也想热心的尽量想要帮忙解决网友的问题，可是他们的回复让和对TDM的信任度让我很灰心，现在多数都潜水着

@res

jj_86 发表于 9-4-2014 02:12 PM
我其实之前也想热心的尽量想要帮忙解决网友的问题，可是他们的回复让和对TDM的信任度让我很灰心，现在多数 ...

我很认同
看到自己读了那么多年的书，行了多少年的医，到最后，病人还是宁愿相信短短2-3分钟的产品广告，却是会让人心灰意冷的

jj_86

@res 发表于 9-4-2014 02:16 PM
我很认同
看到自己读了那么多年的书，行了多少年的医，到最后，病人还是宁愿相信短短2-3分钟的产品广告， ...

现在仔细想一想，其实西医的存在只是提供多一个治疗方式，让病人有多一份选择的空间，我们也像个推销员推销着健康，最后决定权在于病人手中，到底买不买我们的产品。。

@res

jj_86 发表于 9-4-2014 02:22 PM
现在仔细想一想，其实西医的存在只是提供多一个治疗方式，让病人有多一份选择的空间，我们也像个推销员推 ...

你也可以这样说的，再说白一点，我们也只是一种服务型行业

chiropractor

很多患者心態是要：1) 快好，2) 便宜， 3) 省事省時間。所以寧願相信講的天花亂墜的產品廣告

@res

chiropractor 发表于 10-4-2014 10:57 AM
很多患者心態是要：1) 快好，2) 便宜， 3) 省事省時間。所以寧願相信講的天花亂墜的產品廣告

很可惜，到最后花的钱更多，复原时间也变得更久