Friday, July 31

When helping the needy is NOT an option

I actually wanted to rant about something else, something that has been pissing me off so much at work that it's unhealthy. But I think I have have cooled off; I've lost steam. There is, however, something that I have to let out. This is about family taking advantage of indisposed loved ones. This is the truth about government hospitals and clinics in Malaysia: we actually care about patients, especially Malaysians. With RM 1 (sometimes RM 5, or RM 15, but I won't get technical over here) you can register to be examined by a certified doctor, and you will receive proper care. Sure, queues are horrendously long, and some find the care substandard, but we don't say no. We treat patients first to the best of our capability, and payment comes later, when the patient is discharged alive or deceased. Those who cannot afford the standard payment of RM 500 maximum (for Malaysians no matter how many years they have been incarcerated* in a hospital) may opt to pay in installments. If they cannot afford even that, there are channels opened for social welfare to help. So when is extra money involved? When the patient has to pay for implants not provided by the government, such as titanium bone plates and implants. Pharmaceutical companies provide the government with a set number of implants, and with payment from patients, those implants are replenished so that other patients may benefit from similar surgeries. I'm talking specifically about Neurosurgery here: we do not charge extra for major operations, or ventricular-peritoneal shunt insertions for hydrocephalus (them babies with extra large head -- had their families sought treatment earlier, them heads won't be so big), or prolonged ICU stays. We do have to charge for special programmable VP shunts (around RM 2000), and titanium skull replacement (less than RM 5000) and plate-and-screw implants (around RM 150 per set of 3). Totally optional. There are free alternatives available. We also have to charge for spinal implants, and these are the expensive ones. So it pisses me off to no end seeing headlines about families needing RM 30,000 for treatment of hydrocephalus, or RM 100,000 to get a paralysed patient walking again. Sure, private centers charge about that amount, but government centers provide the same (and at times better) care and management. Students are given free treatment. So are parents and children of civil employees. If those needy families need the money for long-term care of their special needs children, be upfront about it. Don't go saying 'this poor baby needs RM 25,000 for an operation'. That's a load of bull. This brings about the latest cause of my grief (not the one I didn't mention at the beginning of this post). There was this unfortunate lady, unconscious after a massive intracranial bleed, and complicated with multiple problems. Then her husband came, demanding to see a doctor. Since I am in charge of ICU, I stayed back after office hours to talk with the husband (wasn't that long, only a few minutes. I try not to stay in the hospital more than required). So he came into the Sister's room, brown shirt faded and frayed at the hems, a few days' worth of stubble lining his jaw, and eyes bloodshot with layers of bags drooping the lower lids. His voice was gruff, his vocabulary limited. I wanted to help him out, no questions asked. His nephew came along, tall and imposing. His white T-shirt was not in a better state than the old man's. The old man wanted me to write a note to the bank, authorizing him to withdraw his wife's money, to be used during her hospitalization. I wanted to help him no longer, regardless of how dire his family's condition might be. You see, it is much easier for us to just give that goddamn signature. Apparently a doctor's signature carries more weight than gold bullions. Just sign it and get it over with. So simple. But throughout my tenure here in Neurosurgery, I've had patients who complain that while they were unconscious and incapacitated, their families cleared out their bank accounts, sold off their homes and lands, leaving those patients with nothing to live on once they've recovered. They came to me begging to help them regain their lost possessions. Unfortunately I couldn't do anything other than advising those patients to lodge a police report against their inconsiderate families. I told those same patients that if they could procure the documents with their thumbprints authorizing their families to withdraw their bank funds, dated when the patients were unconscious, they should sue their families. Fuck them all. There were also instances when one child of an unconscious patient came and got what he wanted: that goddamn signature of authorization. Another sibling came later, screaming shouting yelling, claiming that the useless brother never took care of their mother. He had no right to do what he did. We couldn't do anything to help. The damage had already been done. I didn't press the other sibling to sue, because the doctor(s) who had their signatures down may get into trouble later on. Yes, it is freaking easy and expedient to just sign and get done with it. No risk of getting stopped and be beaten to a pulp later. No risk of being yelled obscenities. No risk of an early stroke from all that stress. But we're here to help people, and help is not limited to giving medical care. So please, I implore my colleagues out there: please do not sign off power of attorney or authorization to withdraw money/transfer assets of unconscious patients. It is unethical, and damaging to ourselves as well as to the affected patients. Oh. The uncle I was talking about. With his limited vocabulary, he sprouted obscenities. He said that I am not a good doctor, and I do not care that his family is hard-pressed. His nephew said that if they did not withdraw the money, the bank would return the amount given by SOCSO. I told the husband that I refuse to help because I was also thinking about the patient lying unconscious on the ICU bed. I told the nephew to ask the bank to write a formal letter of affirmation to what he claimed. I would help then, to write a letter to the bank stating the patient's current condition. As I said, a hassle. But is not about me. Patients come first (not all the time, but hey, I'm not perfect). *question not my choice of word. Try staying in a hospital more than 2 days; you'll feel imprisoned too.