Ethical Issue

Today was a very extremely disappointing day. The story begins this way....

Last Thursday I was at the PD clinic following our IMU lecturer in the outpatient clinic. I was supposed to take a history from a couple of patients and present them to the lecturer as usual. I remember vividly that the staff nurse practically forced me to go out and clerk this new case even though I wanted to listen and observe Dr. S's teaching and counselling. It was a blessing in disguise. I talked to the patient. And she had prolonged and heavy menses and she had a mass in her abdomen. She was referred from the Klinik Kesihatan.

Anyway, after Dr. S examined her, we could not come to a conclusion. Not even after examining and not after ultrasound. The mass was so big it covered her entire abdomen and patient was of course worried.

After that, Dr. S wanted to refer her immediately to HTJ and she knew that they won't admit her without a CT scan. A CT scan appointment in PD would take months to get. Hence she had decided to call the Head of Department in HTJ to make sure the patient gets an admission on that day itself and hopefully a CT scan straight away. This was all done as the situation was really urgent.

What had disappointed me was, when the patient was admitted, she was in the hospital for 3 days, blood was transfused, no CT scan was done. Patient know nothing about her condition.

She was again admitted on the following Thursday. Only the next morning she would have her CT done. At that time, the mass had doubled in size. CT scan showed that the mass has spread to the lungs. Again the patient was not told what had happened. Then my lecturer came about and questioned the doctors in the hospital on what they were doing and I am under the impression that she would be operated on immediately and probably chemo for her metastasis. That day after all the doctors discussed in front of the patient without even acknowledging her, the patient called me and ask me what was happening. I explained to her that I may not be the best person to tell her but she insisted, so i told her that it doesn't look good and the cancer has spread to the lungs. she was calm, she said she'll fight it, and operate and she is willing to try. I was amazed by her optimism and hoped that evening the doctors would quickly devise a good management for her.

The next morning, to my horror, the patient was not there anymore. Apparently she was discharged and would be seen the next week in the outpatient clinic. And no doctors went to tell the patient what was going on. And she is being pushed to the other department. Even though a management plan has been suggested.

I understand that the specialist in charge was being squashed by two big heads. I am disappointed that because of the squabbling between this 2 big heads, decision cannot be properly made and the patient was being pushed to another department.

This is how sad things can be.