Wednesday, July 09, 2008

Must It be Private Hospital?

My emotion is quite affected by one incident today.
A man brought in by ambulance, 40 year-old Chinese, alleged MVA (motor-vehicle accident) - car vs lorry, sustained a bleeding forehead wound. GCS on arrival was 8, with unequal pupils, showing that head injury with intracranial bleeding is likely. We stabilized him, then I called up surgical team and spoke to radiologist to arrange for an urgent CT brain.

Everything was quick and smooth. He was ready for a scan then an emergency op if needed. But then suddenly the family came and said, "No need for the scan! We are bringing him to Hosp X (a private hosp in Penang). My friend told me there's a very good neurosurgeon there."
Penang? We explained to them that this would cause unnecessary delay in management, which is highly unwanted in such case. And surgeons, we also have plenty here.

"Nonono! We are bringing him there. I called there already..they said they can send their ambulance to here now."
" But how long is it gonna take?"
"They said around 30 min will do."

Rounds of explanation were given by us and the surgical team on the possible risks and complications of such decision, but in the end they insisted and signed the "At own risk" discharge. By hospital's policy, this is something like you're refusing hosp's treatment despite advice, and of course, you're fully responsible for your action.

Everything was settled at around 11am. Patient was electively intubated to protect the airway, I guess this is the last thing that we could do good for him.

30min passed.
1 hour.
2 hours. (At this time the family was calling the ambulance, they said on the way..)

And guess what, the ambulance finally arrived, at 2pm!!
3 freaking hours.
If every second is a golden second for a head injury patient, please do the calculation that how much time was wasted and how much that we could have done for him, if only they allowed us to, which they didn't.
Invariably, the outcome and prognosis is gonna be less favorable.

Is private always a better place? What made them so sure? That they could risk their closest family's life just because they thought so?
They thought they have made a good decision for him. They thought.

Tell me why.


J2Kfm said...

did he survive?
yeah, some ppl and their misjudgement of civil servants. it's the norm I guess.

Darren said...

He was still alive when he got up the "private" ambulance.
I hav no idea what happened after that. Probably they take another 3 hours to reach Penang..who knows.

s i n g said...


Just like our life.
Sometimes we stubbornly think that A is the only choice for us, and end up neglecting B which might be a better option for us. In the end, we lose both A and B.

pilocarpine said...

life's a bitch, darren.
critical times, only shallow thoughts will flood the mind.

same ciplak items, you sell one at RM 3, I sell at RM 300, people will have a misconception that mine is the better goods as the price is higher, and for some, they don't mind forking out more to get something 'good'. or, so they think.

similarly, lots of people have a misconception about private hospital. they think that private hospital is always better. please take note: always, which is a total b'sh't. the only thing that i can assure that is 100%, if not 101% better is the private's PR (not per rectal).

but of course, saying that, one must also compare the expertise and Intensive care back up of this private hospital to your hospy.

other than that, a nick in time saves life. 3 hours is just too long...

as long we had done our best to counsel them and given them the most appropriate advice, we had done our duty.

it is against human right to force them into op. it is every right for obese to have high cholesterol diet, the COPD sufferer to continue smoking, the renal failure patient to take bottles and bottles of water or the liver disease patients to continue binge alcohol drinking. if people choose to commit chronic suicide, it's their choice, really. Just like the people who voted for BN. (last line is a joke. or is it?)

pilocarpine said...

one more thing, next time if such a delay happens again.

3 hours instead of 30 mins.

tell them they have every right to sue the hospital. this is an obvious negligence.

Cytusm said...

May be the family members have had bad experiences with your hospital before. Or, may be what Palmdoc said was true. There possibly be no neurosurgeon in your hospital. Am I right? Anyway, I have had a bad experience referring a head injury patient with GCS 4, intubated, from a district hospital to the referring hospital in one of the northern states before. The surgical MO refused to accept my patient because he predicted the patient would die. I was half way arguing with him when the patient's family said, "Never mind doc, we will bring him to Penang". I have always respected the family's decision to bring the patient to private hospital, as long as not to 'bomoh'.

joan said...

there is no neurosurgeon in the hospital darren working in, but as far as his story goes, op is possible to evacuate the blood clot ( i assume) n simple craniotomy is always done in that hospital w/ good prognosis if done early. everything was set ready to go n the family suddenly decided to bring pt to penang. i think it's a waste for the pt. may the pt survive, but who knows in what state will he be in if he managed to survive? :(

Darren said...

sing: Ya..maybe like what pilocarpine said, in critical times, only shallow thoughts will flood the mind.

Darren said...

Pilocarpine & cytusm: First of all, it's my pleasure to have both of you visiting my blog=)

Hmm i dun think the patient (or his family) was admitted to hosp taiping before, as they are from Terengganu. As for the specialty, like jo an said, we dun have neurosurgeon here but we have 5 general surgeons and one consultant surgeon. We do manage EDH here. For SDH and other complicated head injury, we'll refer to neurosurgical unit hosp Ipoh. By our ambulance, it usually takes 30 to 45 min.

fibrate said...

Hey Darren, you did your best. In the end our job as doctors only entails providing the correct information to our patients in order for them to make informed decisions. Ultimately it's up to them to choose to receive treatment or otherwise. I used to get frustrated when good intentions were rejected, but at the end of the day, autonomy remains a patient's right. Oh, the public's perception of government hospitals gets to me everytime, but there're also people who appreciate the kind of work that we do, and that alone is enough for me.

Darren said...

Hi fibrate, thnx for dropping by.
Ya what you said is very true, after all, we have to respect patient's autonomy.
I guess similar frustrations will always be there as long as we're practising. But I think i'm like you, if a single pt is appreciative for what we've done, that's enough for my day!=)

Mei said...

But isn't it your "duty of care" to keep him in hospital?
Cause the family wouldn't have signed paperwork that they're his power of attorney or whatever?
I thought if the patient's compromised and are not "competent" to make that decision, then technically, he can't discharge himself...

But what were they thinking?? To Penang??? **you're working in KL I'm assuming?**

Darren said...

Hi's you=) How's life?
Hmm. The decision was made my his closest family members. I mean, we can't force patient into operation against their autonomy, right?

I'm in hosp Taiping now. About an hour distance from Penang=)

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