Being Listeners

Doing medicine is not just about giving the best advice or the best drug. Myself at times tends to get hasty when the workload gets too hectic, and starts jumping to conclusions before the patient could even finish his/her sentences. At the end of the day, what the patient needs most may not be the advice you give, or the blood tests or x-rays you’ve ordered, or even the medication you’ll be giving. They just want some of your time, to have you listen to their troubles and that, easily be the best medicine you could ever give.

Come to think of it, I’ve talked about this before in one of my previous post. I can be a little cheong hei (long-winded). In person, I don’t really like to talk much and I’m not really a people person but when it comes to talking to patients, I can talk non-stop. The irony.

A couple of days ago, I saw an elderly gentleman who was in his late 60-s, complained of body aches. He had multiple issues like an excised kidney for renal cell carcinoma, underlying gastric reflux, osteoarthritis and all the yadda-yadda stuff. Funny part was I didn’t dwell much on his presenting complaint. After asking a few quick questions, he then started sharing about him having the initial thought of dying as soon as possible since he had so many medical problems at hand. However, since the coming of his new born grandson (which he described him as sooooo cute), he decided to live a little longer until at least he’s in school. And he asked, “Can right?”. Speechless moment with an awkward pause, which I replied with a smile. And of course he carried on sharing about his life stories for a while. In the end, he thanked me and left the room happily without having me to examine him (Fine. I admit I had totally forgotten about it). Somehow, after the conversation, it kinda brightened up my day, especially when you’re being bombarded relentlessly with tons of patients to see each day.

Just thought of sharing it with you guys as listening, is both therapeutic not only for the patients but for the receiving party as well.

Are you a good listener?

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Good Doctors – Dr. Ng Kwee Boon (Obstetrician and Gynaecologist)

Dr. NgDr. Ng, a very soft spoken and humble man. He takes time to explain the details and loves to chat. He believes that the best way to treat if through knowing the patient as a person rather than treating the disease itself. He never rushes through a consult. You’ll notice funny little antiques between him and his trusty nurse who urges him to see at a faster rate as there are so many other patients waiting in line to see him. Speaks in a variety of dialects including Hokkien and Cantonese, although he communicates best in English.

Specializes in scopes, which includes laparoscopic and hysteroscopic surgeries, which most patients prefer these days as these surgeries leave smaller scars and have a faster healing time. If you’re wondering what is laparoscopy, click HERE.

He runs a clinic in Tung Shin Hospital. You can get more HERE.

Rumor has it that he will be retiring soon. But when, no one knows. However, if you’re looking for a good O&G specialist around Klang Valley area, you may want to consider seeing him.

Family Medicine Specialization in Malaysia

You may ask, why do I need to specialize in Family Medicine? Fortunately (or unfortunately), you do not require any specialization to be a general practitioner (GP) in Malaysia as anyone with just an MBBS or an MD can be one, as long as they finish their service with the government. In other countries, a GP is a specialist, and you have to pass exams before you’re allowed to practice independently.

However, if you do plan to improve yourself, take this as a challenge, be it for self-improvement or for the betterment of the patients that you’re treating.

There are 2 pathways that you may take.

If you’re in the government sector, you can always try to get yourself into the Master Program. Total number of years for completion would take 4 years. However, there will be no guarantee of when you’ll be enrolled into the program. Just gotta keep trying until you get it. Bear in mind that you’ll be bound by the government upon completion. Failing the exam will cost you money, and yet, you will still be bonded.

For those who’s not keen on waiting, the alternative path is to take post graduate training offered by the Academy of Family Physician of Malaysia (AFPM). Duration of the program will be 4 years too. However, if you’re working as a general practitioner long enough (10 years or more), you can be enrolled into a cram course called DFM-S which takes only a year instead of two, then to continue on with the Advance Training Program (ATP). Only after ATP, you’ll be eligible to sit for the FRACGP exams. Thing is, you’ll be financially tighter as compared to taking the Master Program as you would have to fork out about RM40,000 during these 4 years, which is quite a considerable sum.

Choice is yours.

To X-ray or Not to X-ray

That is the question. Of course we’re no Prince Hamlet but we do have to make a wise decision on whether we should request an x-ray for a patient who has recently injured/sprained his foot, ankle or knee.

For feet or ankle joints. Quite simple. By Ottawa rules, as long as there is pain over these 4 areas when pressure is applied, do an x-ray.

  • Posterior part of lateral maleolus.
  • Posterior part of medial maleolus.
  • Base of 5th metatarsal bone.
  • Navicular bone.

If patient is unable to bear weight on the affected ankle joint, do an x-ray.

For knee joints. Only do an x-ray when:

  • Patient is above 55 years of age.
  • Tenderness over the patella and nothing else.
  • Tenderness over head of fibula.
  • Patient is unable to flex his knees to 90 degrees.
  • Patient is unable to bear weight despite limping.

Then again, rules are rules. And rules are meant to be broken, when your life is at stake. Things don’t usually go the way you want it to be.

Patient: Hi Doc, morning. I want an x-ray.

Me: Morning. Er. Huh? What’s the x-ray for?

Patient: It’s for my knees. Can I get it done today?

Me: Wait wait wait. What’s wrong with your knees?

Patient: I have this pain in my knees.

Me: And how long has the pain been? Months? Any falls or injuries?

Patient: Just yesterday. Had a twitching pain in the right knee for a couple of secs. No fall what-so-ever. Thought might as well I get both x-ray’d since I’m here.

Me: …

Me: I doubt you need an x-ray for that sort of ..

Patient: Why not? I personally took leave today so that I could come to have an x-ray done and you’re not giving it to me?! Are you going to be held responsible if anything happens to my knees?!

Just one of those daily nonsense I get during the usual jam-packed clinic sessions. Life ain’t as easy as you think it would be.

Work Place

Ever curious as to how a polyclinic in Singapore looks like? Here’s a shot for ya.

PC

Although I hate to admit it, it’s considered one of the more comfy clinics that I’ve worked in so far.

Nowadays, surviving as a general practitioner in Malaysia is gonna be tough, and it’s gonna get tougher by the end I get my stuff settled here. Has plans (more like thoughts) to get one going but seeing GPs back home can go bankrupt, I shudder at the thought starting one myself. The initiating cost itself will definitely be a very damaging start. And to start anew in a place with hundreds of other GPs competing with one another, it’s a race out there. Building rapport with patients, and to have them like you, will take time. And time, is of essence. Income will fluctuate, and may very well end up in the losing end. Despite that, I still have dreams of having a clinic of my own. It’s considered a joy, at least for me, to see some form of continuity in care of patients with chronic illness that improves through proper management. However, you don’t really see it (the continuity) in the government polyclinics as the load of patients are shared among different doctors. Seeing a patient and having a plan does not guarantee that the patient will see you again the next, and most likely the plans will change when another doctor sees him/her.

Have you got yours planned out yet?

Why Singapore?

Every now and then, friends and colleagues ask me, “Why are you here in Singapore?”. I’m not actually surprised since not many go through the same route that I’m taking.

And the next statement which follows would be, “You’re from UM or UKM?”. Since it’s the 2 only universities that are recognized in Singapore. Understandable. And when I say no to both, they’ll be stunned for a few seconds, just like how you stun them in DOTA.

Anyway, the very reason why I’m in a Singapore polyclinic is to be eligible to take the final paper of  Diploma in Family Medicine in Malaysia, which is a 2-years course and I’m already close to the end. I travel back each time there’s lectures. Hopefully it pans out well to proceed on to the next path. RACGP, anyone? Then why not just practice in Malaysia instead since I’ve already attained full registration?

Well, you see. Our Klinik Kesihatans (KK) aren’t really a conducive place for on-going learning. Workload is crazy and there’s a huge number of patients to be seen, that is if you’re posted to a densely populated area in the city. In districts, it may not be as busy but most likely you”ll have to turn your “self-survival” mode on. Not to say that Singapore’s polyclinics workload is not crazy. We see approximately 50-70 patients per day per doctor depending on which cluster we’re in. However, the situation is more ideal for learning, with bosses monitoring your management and give you a big spanking if something is not done right. KK do have Family Physicians too but correct me if I’m wrong that most of them  don’t actually bother with your “progress” as long the work gets done by the end of the day. Can’t blame them either, with the current glut of doctors in Malaysia, so many medical officers get thrown to the KKs with so few family physicians, how possibly can they monitor each and everyone’s progress?

Besides, with the same amount of work you’re doing in KK, why not Singapore with a better pay too? At least there will be a standardized care. And with that extra income, you can expand your portfolio by investing in properties, trust funds and insurance to secure a better future. I don’t believe in focusing solely on medicine for your basic necessities. In this new age, you need back ups.

I was in the private practice world for a year, but then I realized it’s heading no where. Working with a company was fine and all, good life, good pay, fixed working hours but there’s not much of a prospect and it kinda went against my principle to put sales at the top of my priorities. And when patients were referred as customers, I knew something was way wrong. As I was planning to leave, Singapore opened its door for me so I just took the opportunity.

Then why not be a general practitioner (GP)? To be honest, GP these days are struggling too. Ain’t gonna join in the fun. Working hours ain’t fantastic either. You’ll have to dedicate more than half a day at work to earn a decent living. With other headaches such as monthly rentals, staff payments, stock checks, licensing and management stuff, absolutely not worth the trouble. At least for now, for where I am. Just gotta set some standards for myself too before I venture out. Skills and knowledge are a must to being a good GP. Once I’m able stand on my both feet planted firmly on the ground then only I’ll think about it.

What’s your plan for the future? Thought about it yet?

Laughter is the best medicine. And listening too.

As cliche as it sounds, it has its truth. This applies in the practice of medicine too.

Of course I don’t just laugh my ass out when I treat my patients, that would be totally inappropriate. Did it once when I was a freshie, totally got backfired. The patient whom I saw told me that I should be serious with my profession, and that statement itself, has etched at the very back of my mind until today. So there’s a limit as to how much you should express yourself too.

I have health colleagues who asked me, “Why do you always smile?”. And my response, “Why shouldn’t I?”.

Do you know that patients find at ease, the most, when they are greeted with a smile when they enter a doctor’s room? The matter a fact, no one would want to meet a sulking looking fella, especially when you’re meeting someone for the first time.  Would you not find it pleasant, when you attend a job interview, the interviewee greets you with a smile? Giving you an unpleasant look would definitely knock your circuits off.

Even when you’re in a difficult situation, be it an angry patient (who’s getting angry for no apparent reason, or at least a logical one) or sad, depressed one, a smile would help to soothe issues out.

However, at times, we need to just remind ourselves not to rush in seeing a patient too. Seeing a patient in a hurry not only causes you to miss stuff, makes you a less empathetic person too. At the end of the day, what the patient needs the most is not the medication you’ve prescribed, just a pair of good ears. If you do take time to listen, each and every patient has a story that they would want to share with you. Of course it’s not plausible to entertain each and everyone of them, but at least be selective to those who really needs it. And when you do, you’ll find yourself given the best medicine that they’ve ever needed. Your time and patience.

Anyway, just sharing my thoughts out loud. August’s my favorite month. Gonna take my time to enjoy it. Remember, to smile and listen.