Medical Leave and Antibiotics 2
Yup, this is a 2 episode(r). It's so bad, but, what I had previously deduced had come true, I told her that she would see me again when she refused to heed my advice, my professional advice and true enough she came to see me yesterday. See here for a better perspective of what has actually transpired on the first part. She came yesterday asking for sick leave and as usual, advice. This time its persistent cough, breathlessness and pain in the throat as well as hoarseness of voice. She claims that she hasn't recovered till today (I would be really surprised if it did).
Frankly I was mildly bemused and happy to be proven right, but in retrospect I reckon if she would had listened to me initially, she would jolly well be doing her yogic postures by now. I did the neccesary checkup and concluded that she is currently having bronchitis with mild inflammation and swelling of her voicebox (Larynx).
What should I do? I think the problem is not no longer straight forward and easily rectified. She needs all sorts of medication if she want to really recover. I advised her accordingly, again, but suffice to say that she is stubborn as a bull. Ah well, I reckon I don't want to argue and I gave her an abridged version of what I think and feel. I gave her my thoughts about the situation and told her that she needs medication and not merely rest with appropriate amount of fluids. I told her at this present condition, no amount of antibiotics can help her, and what I can do is to give her some cough mixture and that's about it. I told her to seek alternative viewpoints especially from a chest physician if need be. I am washing my hands clean with this one.
No doubt I am dumbfounded that people especially lay people have a preconceived misconception regarding taking medications. It's amazing that antibiotics are widely used in Malaysia but not so in western countries like Australia, but it would seem that cases of resistance Downunder is very much higher than here. Why is that so? I know that they aren't using antibiotics until the very last stage and there is no question of overprescribing and abuse, but is it neccesarily having less resistance? I doubt it. Perhaps infections especially bacterial has been left to fester longer and with this it is given time to develop resistance as well? All this are mere speculation on my part. But there are numerous "superbugs" in Australia that it's difficult to eradicate and treat. I am not condoning giving antibiotics and I feel that there is a need to regulate prescription of it, but not heeding any professional advice due to a misconception is taking it a bit far. I reckon with and only with proper education would people learn.
Frankly I was mildly bemused and happy to be proven right, but in retrospect I reckon if she would had listened to me initially, she would jolly well be doing her yogic postures by now. I did the neccesary checkup and concluded that she is currently having bronchitis with mild inflammation and swelling of her voicebox (Larynx).
What should I do? I think the problem is not no longer straight forward and easily rectified. She needs all sorts of medication if she want to really recover. I advised her accordingly, again, but suffice to say that she is stubborn as a bull. Ah well, I reckon I don't want to argue and I gave her an abridged version of what I think and feel. I gave her my thoughts about the situation and told her that she needs medication and not merely rest with appropriate amount of fluids. I told her at this present condition, no amount of antibiotics can help her, and what I can do is to give her some cough mixture and that's about it. I told her to seek alternative viewpoints especially from a chest physician if need be. I am washing my hands clean with this one.
No doubt I am dumbfounded that people especially lay people have a preconceived misconception regarding taking medications. It's amazing that antibiotics are widely used in Malaysia but not so in western countries like Australia, but it would seem that cases of resistance Downunder is very much higher than here. Why is that so? I know that they aren't using antibiotics until the very last stage and there is no question of overprescribing and abuse, but is it neccesarily having less resistance? I doubt it. Perhaps infections especially bacterial has been left to fester longer and with this it is given time to develop resistance as well? All this are mere speculation on my part. But there are numerous "superbugs" in Australia that it's difficult to eradicate and treat. I am not condoning giving antibiotics and I feel that there is a need to regulate prescription of it, but not heeding any professional advice due to a misconception is taking it a bit far. I reckon with and only with proper education would people learn.
posted by mercuri2000 at
4:45 PM
8 Comments:
Hmm..actually, i like antibiotics la. duno y but, probably i feel that it's an extra guard that'll shield me from infecting the same virus again...
But some docs just wouldnt give .
& it'll makes me feel like " Cheh, whats the diff of me seeing you & just get panadol by myself to cure the ilness if i dont get that extra shield? "
:p
By
Winn, at December 14, 2005 10:36 AM
Basically its ignorance and 'a quick fix' mentality and a failure to take responsibility for one's own health. The doctor can't do everything for you after you had messed up your health.
But there is always a time and place for everything I believe; and antibiotics have a role to play at times. I find it rather startling that winn actually like antibiotics! Didnt read your post huh? duh!
By
Francis Ho, at December 14, 2005 5:42 PM
Seriously, I do confess that antibiotics are sometimes used a bit too often. (and the problem of resistance...)
In fact, we have patients who say the doctor is being stingy if they are not given antibiotics, even for common flu.
The perfection is in moderation!
How about treating the patient but no MC?
By
Robin CHAN, at December 14, 2005 5:54 PM
Robin:-
MCs are the panacea for everything in Malaysia, I don't know abt Singapore.:P
But yes I do agree to a certain extend about the abuse of Antibiotics. Problem with Malaysian healthcare system is that doctors dispense our own medications and with this naturally comes the tendency to overprescribe as it's now business related. Maxim is the more varieties of med we prescribe the more we can charge. I think this is wrong.
I will only prescribe antibiotics if and when I feel that the patient needs it. So the trick in this case is to identify a doctor that u can trust and stick to one.
winn:-
actually antibiotics as such is a dangerous medication if used inappropriately. It would be best to leave this to the experts! kekekeke :)
fh2o :-
well said. patient information is upmost importance. Problem remains that with the advent of freely available information over the net, it's prudent to know which to and not to trust.:P
By
mercuri2000, at December 14, 2005 6:37 PM
I totally understand the issue on MC.
In fact, I am one of those guilty one, since I cannot write my own MC.
When I see my good old GP, we talked about everything else(except when I have a sore throat) and he always end with, "You have your medicine right? Is two days enough? Take a good rest and don't work too hard!"
I have been seeing him for 30 years now.
By
Robin CHAN, at December 14, 2005 6:50 PM
Robin:-
Take this scenario for example, assuming if there is a patient, a paying customer, that visits u and wants medications and MCs, would u in my position refuse them? It would mean that they will never come back if u deny them MCs. Then how?
It's a hopeless cause, fact remains that we need to be able to "please" the patient. So unless some insurance or national heath scheme is implemented, abuse of medications as well as MCs will be rampant.:(
By
mercuri2000, at December 14, 2005 7:07 PM
Yes mercuri, I can understand your position, especially if you are running your own business.
Let me illustrate a familiar case:
Paracetamol poisoning is a serious problem in Singapore, especially in Children.
Mothers are highly excitable, even more than their crying baby and can go to 3 doctors in 1 week, if the child's fever does not come down.
As Family Physician, the most important role is to determine if this is the case and provide necessary "mother" counselling.
I remember one of my friend told his patient: "If the fever doesn't come down, don't panic, come back and I will give you stronger medicine. Even if you don't come back to me, please bring all your medicines to show the next doctor."
This is what I call responsible counselling.
If a patient come to ask for MC and antibiotics, when the medical condition does not call for them, I would not dispense and also pray that such patient will not come back to my clinic anymore.
What if a drug addict come and ask for repeat order of cough mixtures?
By
Robin CHAN, at December 16, 2005 3:16 PM
There is something that I am against doing, which is indescriminate prescribing of antibiotics as well as psychotrophics as well as cough medications.
Eventhough I am practising on my own I am never going to compromise my professional intergrity, case in point, if I do sell psychotrophic and cough mixture to addicts freely, would u imagine the amt of "undesirables" that is congregating in my clinic? THAT itself would be the biggest deterrent for genuine patients and hence on the long run destroy my potential. The Potential growth on my practice. I would choose to earn a honest living anyday.
By
mercuri2000, at December 19, 2005 9:04 PM
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