Friday, September 30, 2005

COAMS #3 - Doctors make guesses?

(September 30, 2005 at 06:57 AM)

The more I study medicine, the more I don’t trust doctors… I realized that doctors are taking risks everyday. Every diagnosis made is merely just a guess. You get clues from personal history, family history, medical history, social history… perform physical examination and order investigations (eg. X-rays, CT scans) for further clues… then, with all these hints, you come up with a diagnosis… decide on the best available treatment, and the rest is up to God….
In case you are still not convinced, let me share a personal experience with you:

It was past midnight. I was admitted to Hospital Kuala Lumpur after blood donation. I had seafood fried rice for dinner (but it was like only 3 small tiny prawns)… nevertheless, I supposed I had too much sensitized mast cells (a blood component which causes allergy) that I had a hypersensitivity type one reaction (in other words-allergy in it’s severe form).. to cut short, I had asthma and my left had was frozen-unmovable. The medical staff there said I lack carbon dioxide, and his guess was right. He made me breathe in a bag, fixed my problem, and discharged me. Little did he know, I spent the WHOLE night throwing up and felt terrible the next day.
So, what did I do? I went to the clinic the next day, with my very last energy explained the whole situation to him and what did he respond? He said my problem is fever and dismissed me with paracetamol(penadol)!! OH MY GOD!! I should learn to treat myself!!

p/s: if you happen to live in KL, NEVER go to KLINIK REDDY (this advice is genuine-be thankful that I’m risking my neck to save your life!)

Again, past midnight. This time, my course mate had severe abdominal pain and we rushed to Klinik Reddy (apparently, the nearest 24-hour-clinic). The doctor palpated my friend on seated position and simply scribbled – SUSPECT ACUTE APPENDICITIS – and referred us to Hospital Kuala Lumpur. This was quite shocking as from what I understand, appendicitis is SO PAIN that a patient would practically jumped up when you press Mc Burney’s point – which my friend obviously didn’t and even hesitated to tell whether that part hurts. Either he’s got extremely poor guessing skills or he wanted to go back to sleep. Nevertheless, I lost hope on that doc!

So, we went to HKL, waited for an hour or so. The doctor, fresh graduate from India I suppose, was rather excited when he learnt that we were medical students. He laughed at the KlinikReddy Doc’s silliness, as appendicitis is a rather an unlikely diagnosis. And so, he examined my friend, explained to us that she had epigastrium pain and not at Mc Burney’s point. His guess? UTI –Urinary Tract Infection, which was quite puzzling as well as what does epigastrium pain have to do with UTI? (p/s: epigastrium = upper middle abdominal part) He scribble down a note and dismissed us to take our medicine. On the way out, I couldn’t help but to ask him the question on my mind. He thought for a moment, re-examine my friend,.. then he said ‘hmm… probably gastritis…’… and GUESS WHAT? He did NOT change the diagnosis or treatment. Instead, he added a few more drugs to the list and pity my friend,.. she had like 4 IV injection plus oral treatment and a bunch of drugs….

Thanks to the doctor ‘guesses’….


  1. I could say nothing more to agree with you. doctors had so much burden making olife and choices everyday, or if the way u put it, guesses. But with so many diseases now a days, it probably too hard to diagnose the disease, more so when it comes to tracing the disease etiology.

    Still the medical world had made much technological breakthroughs in the past century that, if doctors could not find out through physical palpation, checks etc...there's still lots of machinary out there^^ lucky for us to be in the 21t century.

    Its really too bad you were misdiagnosed. haha blame it all on bad luck~

    you know i do have one question here since you're the only logical person right now to ask this haha. at one point of time a friend of mine suffered Asthma, and it was really TERUK i think. well, usually (as all first aiders weere trained^^) we would have place her in a sitting position, then encouraging her to if have breath on her nebulizer and stuff. But the fact is she doesnt have one. the attack was kinda acute you see. I think she went into somekind of a muscle paralysis (was it due to hypoxia? guess not, no cyanosis) but erm, she was rigid and when we tried to move her, she COULDNT move her muscle. Well in such cases...(of course the best way is to send her to a local clinic) but if help was delayed, is there anything we could do? I don't know, i wasn't an experienced FA.

    And oh, ^^ congratulate me i juz recovered from a nasty urticaria. yikes~

    doctors today are getting more and more intolerant and rude. Some even unethicle, i mean, don't you guyz have accountabilities? When i was visiting the doctor for my skin eruption, he was kinda rude when diagnosing this (plus my flu) and when i asked him if my side pain was probably an adverse drug reaction, he didnt EVEN CHECK ME. the end of the day he wanted to prescribe me drugs. I said i have some drugs in my house and asked if i could take them.
    he simply replied "i don't know what that drug was" (even though it was from his clinic, obviously he was a businessman trying to sell his drugs more than a doctor) and when i asked him another type of drug for running nose, he said the drugs were ineffective (though it was again, from his clinic)

    How was that even possible?

    The Big Stomach

  2. dear Mr Spynchter (aka big stomach),

    sorry to hear about your misfortune.. i guess the problem is, when you are a doctor at a health clinic who have to see fifty over patients each day, with limited time for each patients, you get kind of grumpy.. again, there are just too little doctors..

    i guess you were have some form of allegies - which the skin rash (urticaria) and running nose - both signs of type one hypersentivity.. (but of course, that is just my guess, as i havent seen you for a full examination, etc).. adverse drug reaction is probably unlikely, as drug reaction like steven johnson's syndrome usually present much much worse, with swollen body parts and mucosa bleed.. so i guess, the doctor gave you some symptomatic relief for your symptoms, perhaps some anti-histamines (which works for both the skin rash and running nose).. erm.. i guess it would be sufficient if you take the drugs that the doctor prescript.. you should have brought the drugs to show the doctor, if you want to know whether you can take it or not... again, you need to check the expiry dates, and we wouldn't want you overdosing on the same group of drugs, do we? and the efficacy of drugs, i think it differs from patients to patients.. as everyone's body is different.. so the doctor would usually prescript a common drug first, if it does not work, then the dr would change the drug...

    so, bottom line, i would agree with what the dr did.. which tells you not to simply self-take over the counter drugs which you are not sure of... but i am sorry that the doctor did not spend some time to explain all this to you.. perhaps leaving you puzzled and all...

    and about your friend who had asthma, i think she had an episode of hyperventilation at that time, which causes her to have carpal pedal spasm, some form of muscle paralysis especially in the hands and feets.. this is because she was anxious.. the reason for this because she had too little carbon dioxide (co2) as she is expelling co2 to quickly... and the solution is simple, get her to breath in a paper bag! and since your friend has a history of asthma, i would advice her to see a doctor, to take a full history and access her severity and control of asthma.. being asthmatic, she needs to have an inhaler.. and if she has persistent asthma, steroids inhalers would be helpful to help her live a symptom-free life! so, DO SEE A DOCTOR!

    p/s: about this post which i have written 5 years ago, i would like to apologized for what i blogged, me being super naive 5 years back. i finally understood why the doctor treated my friend that way.. it was because my friend was having UTI and gastritis.. she had the triad of UTI : dysuria, suprapubic pain and frequency... and on top of that, she had gastritis.. therefore, the doctor was giving her symptomatic relief, and started her on antibiotic treatment.. but if i were him, i would have at least done a urine dipstik, which he didnt, oh well..

    p/ss: you are a first aider / medical professional?

  3. Hello, thx for da explanation, that at least makes the doctor forgivable. I am not medical professional, i am but a first aider, joined the Red cresent society 1 year ago, love first aid, love the medical field...haha,
    you could put it in another way, my aspiration is to be a doc someday..if that was ever possible

    Erm, actually i went to two doctors and the "better" one (forgive me if i put it this way) prescribe me three combinations of anti histamines, namely, Chrolophemine (or sumthing like dat i cant remember well), Ketotifen fumerate, and ah, what's the other one? i dun remember.

    Well i never self-prescribe myself medicine (not without a pharmacist or doctor approving me of it), hehe but usually i take carinox for flue and erm mefenamic acid for pyrexia...still the Klinik doctor did told me once that taking paracetamol was far more effective than ponstan...hmmm, but that was what other doctors prescribe...what do u think i should take best?

    hyperventilation, but seems most unlikely, i mean, the typical symptons were missing, she wasnt like gasping for air or something, there were no signs or increased breathing rates...but well it might juz be wud u said, carpal pedal spasm.

    So i went through some of ur bloggies and noticed that you have problems with mandarin eh? Well for the first time in my life then i was proud to be a chinese school educated student. But before that i had always regret to have to sit for chinese in SPM. My chinese is weak haha and i always lament that i still had to take chinese as a sub. Chinese is so hard to score A you see...well 1 year till SPM i have less than 356 days to prepare @.@

    Anyway it was nice chatting with you, do you think you would leave me a hotmail add so that we could discus further? ^^

    haha, would love to be ur friend.


    (Mr.Spynchter was just a name for the big stomach blog me and my other buddy set up to well u noe, start making big bucks, hahaha)

  4. dear Zerga,

    i'm glad to hear young hearts aspiring to be doctors.. all the best, you can do it if you want!!

    you mean chlorpheniramine (piriton)? be careful when you take this, because it is sedative... so you should only take before bed.. not when driving/exams/etc..

    i am not sure what's ketotifen fumarate though.. are you sure it's an anti-histamine?

    paracetamol is generally known to be better for fever than mefenamic acid (ponstan) .. then again, it works differently for different people.. i personally prefer paracetamol because it can be taken on an empty stomach.. ponstan on the other hand can cause gastric pain...

    clorinox is a non-sedative antihistamine, for running nose..

    i hope i have been helpful to you, concerning drugs... again, i'll like to stress that you should consult your doctor or pharmacist before taking any drugs... :)

    btw, do you realised how lucky you were to be able to read and write in chinese.. how i wished i knew chinese too,.. sigh....

    lastly, all the best in your spm! :)

  5. Hello Hello^^

    yes piriton....yeah its sedative the doctor did warned me bout that tho.

    yeah ketotifen fumerate or zaditen i think is an antihistamine..i checked the net on dat one. then again i checked the net on everything.

    ^^ of thx for da infomation. I think i'll stick to Ponstan, its been my antipyretic drug for god knows how many long years.

    and yes you've been most helpful, i dun usually have much people to ask to (in more detail) dat is other than the net itself. Wikipedia had been a good company though there are at some point of times the languages gets "medic-gibberish" and i don't understand a word the languager you doctors communicated in each day, haha! But i am grateful that I have got myself the Merck Manual Home edtion. IT IS A LOVELY, LOVELY book. Its for all concerned patients/consumers/whatever like me hahaha and hey, its in everyday english language^^ muakz, love it.

    So i hope i am not bothering you all these perhaps irrititating questions hehe.

    If it was not too much of a trouble....what do you think of taking NSAIDs and COX-2 inhibitors? I mean generally for pain killers. you see, when at first my mom complained of knee pain, we went to see a orthopaedist. He made a general diagnosis, nothing specific though, couldnt name the disease either but he gave my mom arcoxia for two weeks.

    Well an inquisitive person like me is sure to find the drug info on da net before anything^^ But what i discovered shocked me. Is it true that patients weere said to face adverse drugs reaction of heart failure/cardiac arrest using COX-2?

    i duno that was what i recalled. Then what about Nsaids? Arent Cyclooygenase 2 suppose to be the new replacement for NSAIDs? supposedly better becoz it wouldnt cause gastric pain or sumthing like dat.

    Hehe, perhaps i myself have thought too much. I don't know but hey, its our body we are talking bout.

    Well if you were to study in a chinese school, your english wouldn't get to be as great as in an english school. And also, Chiense stands above all others. You get the world when u win something in chinese, debate etc. But when u win in English some competition outside school. What you get is NOTHING except the cert a word of congratulation. The fact is our school never do take english seriously enough. The whole graduation book was chinese, english essays were limited. So you see how depressing it is sometimes. But then I am at least grateful i could read and write, though it had since long been a burden to my marks, cause the weightage in the exams is so much, always dragging my exam percentage and stuff down ==

    Very nice and infomative chatting with you.

    Lastly, don't forget to follow the big stomach campaigns to follow in the Nov holidayz.

    We have :
    1) big Stomach Go Green Week (a little sumting to comfort poor mothernature)
    2) The world, in your stomach (travelling round the world in 7 dayz)
    3)The battle of the gastric family (me and my friend here r gona tag)

    Been blablerring nuff i guess^^



  6. dear Zerga,

    not bothering at all... in fact, i am glad to see your interest towards your health and various drugs.. it's really good to have patients who are interested in what they are taking... it makes it easier for doctors to take a full drug history from patients...

    yes, you are right, ketotifen fumerate or zaditen is an antihistamine H1.. Zerga, do you have asthma? my what i understood, this drug is usually used as an add-on medication for prevention of chronic asthma. it can also be used as an antiallergic drug. but of course, when it comes to drugs, the best person to consult is a pharmacist... you can try to ask hanping84 (you can find his blog link at my blogroll list)... perhaps he could clarify things better for you.. he's a pharmacist.. =)

    about COX2 inhibitors, well, no drug is without it's side effects.. the more reason why one should never self treat themselves... as some drugs are only suitable for certain group of people.. not to forget about drug-drug-interactions and all.... the more reasons why the public should consult a doctor/pharmacist!

    in my opinion, if you are comfortable with ponstan, you can stick to it.. it should be safe for you if you do not have gastric ulcers or kidney disease... but make sure you do not take it on an empty stomach... and ponstan also has it's side effects... but it's a generally acceptable drugs.. really, there are no drugs in this world without side effects...

    hey, you get to read/write in chinese, and i am so envious of that!! well, i never see winning an English competition as 'just a cert or a word of congratulations'.. okay, perhaps i haven't won any debates or such, as the other students in my school were much better than i am, in terms of language.. i did participated in a few essay writings competition though.. and yeah, it's not 'just a cerd or word of congratulations'.. i guess, the experience is very enriching.. and to see your work published, i think there's nothing in the world which satisfy a writer even more... the hard work, is all worth it, really... i could not comment much about chinese competition though, but i suppose that the experience would be enriching as well..

    big stomach campaigns? how nice.. traveling around the world in 7 days sounds interesting.. perhaps you could mention more about it in your blog or send me the link.. you must be very busy, juggling between your campaigns and spm.. anyways, all the best!

    good day! =)

  7. Oh nonon no worries my friend, SPM is one whole year ahead. I'm just a form 4 student (though tomorrow is me ad math exam grrr)

    Erm, I never had asthma. None at all, not even a slight attack. So why was it given to me?^^ the doctor has his reasons i guess.

    oh thx for the pharmacist's link^^ i'll see that i make myself there when i do have questions like this, for now all my little question marks in my head is cleared (for the time being)

    yeah i guess "its not juz a cert and congratulation" but you know, you just don't get to expand that much in the english community of a chinese school. The fact is, take for example:

    Chinese debate (1 year, practise like 100 and 100 of times) preparing themselves for a whole lto of competitions

    English debates (NEVER PRACTISE)
    after u r in da debate team ur practise is ur real match^^

    and nobody gives a damn if u win or not, haha but of coz there is always self pride when u won something.

    I dunno how to describe the feel, its like so UNFAIR sumtimes that well the school doesnt cares. And oh did i mentioned to you that English is just weighted 5 in the average calculation in school while chinese is 7? argh....

    Well exam is coming my head is gona explode again soon i guess.

    Ah yes the campaign, ok^^ but it'll be after our examz, hahahaha, we'll start campaigning later, but ltos to do, will be sure to send u a link, hehe


  8. dear Zerga,

    you have exam tomorrow, and today still onlining?? hehe... should be studying,.. then again, maths not much to study... just practice.. all the best ya!

    were you in your school English debate team / Chinese debate team?? i sort of can feel the emotional attachment when you talk about the unfairness... oh well, don't worry too much about that..

    lastly, all the best in your exams! you can do it! =)


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