Medical Malpractice in Malaysia's General Clinic

Few weeks ago, I suffer from one sided headache in which I can't tell if it's exactly a headache or migraine. It's not the usual headache that affect most of the part in my head, I can only describe it as slight uncomfortable around the area of my left eyes. And it's so happen that I got inflammation around my gum (later, I found out that it was caused by tooth infection) and I wasn't able to work on that day as I need rest.

Later that day in the evening, I visited the clinic when I felt better. And that's turn out to be a strong trigger for me to write this subject.

It's nothing new for me to be greeted with unfriendly and moody receptionist. I'm used to it and I can live with it as usual.

When I met the doctor, I told her what's wrong with me and describe my condition for the inflamed gum and headache. For my surprise, the first question she ask me was: "Why now only you come?". I was stunned for sometime as I did not expect this type of question. At some point, I don't even see the purpose of asking this type of question. So my usual response made me asking "Excuse me?" to clarify the purpose of her question. Which creep me out when she turn her head staring into my eyes and raise her tone repeating the question "WHY NOW ONLY YOU COME?".

I got chill down my spine with such reaction which took me quite awhile trying to figure out some very basic thing. What other thing I can do visiting a clinic? Looking for set meal? I try to clear my mind to figure out the less sarcastic answer to tell her that I got inflamed in my gum and headache. Naturally, I also told her that I need MC on this which is one of the unavoidable reasons why I have to visit the clinic. If it's not because of my company policy, I would rather staying at home to rest.

The doctor also ask me about my job's working hour that made me more confuse. Eventually, she told me that I should visit the clinic during working hour and not that I can come whenever I like, because that is what listed according to law.

I can get it if she's saying that I should visit the clinic when I'm not at the right condition so that they can get a better look into my condition, but I never heard anything like we are suppose to visit the clinic during office hour. I visited so many clinics in my life after working hour and I don't have any issue so far. If this is a new law or just the rules in their clinic, I can live with it.

I asked several friends after this about the matter where the doctor claim that we are suppose to visit clinic during office hour, and all of them bulled on that idea as they also visit clinic after working hour and has no issue on that.

And then she proceed to ask me to open my mouth to check on my gum. In the middle of the checking, she impatiently ask me to open wider as she can't see properly. I think, it's nothing hard to ask politely instead of asking impatiently, I can let this slip thou. And the entire checking doesn't take long, I'm unsure what type of thing she could diagnose with a less than 15 seconds eyes ball checking on my gum.

After the checking, she turn her head on the computer without a words. Left me clueless. And I have to ask her what's wrong with my gum, and she utter the word "don't know". And that is all she said. I ask her again on what is wrong with my headache, and as expected she just repeat the sentence "don't know".

I told the doctor that I took painkiller the night before due to the gum pain caused by inflammation. She ask me what is the name of the painkiller. I said I don't remember. And the she got more impatient and repeat the same question which left me no choice but repeat the same answer to say that I don't remember the painkiller name. I don't even think it's logical that anyone can remember every single scientific medicine name before they consume it even if it's the short name. I told her I don't need more painkiller because I still have plenty with me. i found it challenging to convince her on this but eventually she let it off. She just provide me antibiotics and mouthwash, and that's it.

The last thing before I go is to ask for the MC, despite knowing that she didn't diagnose anything and don't get to know what's wrong with me. She hesitate to give at first, but claim that she will give it this time but not for the next time if I go after office hour.

In another case, I have a friend who experience an obvious food poisoning symptoms and went for a checkup. As a result, the doctor provided basic checkup and conclude that she has nothing wrong, while she is experiencing extreme discomfort in her stomach. She went for another clinic afterwards, and the doctor from the other clinic pointed out that this is obviously food poisoning.

Before that, I also heard that one of my colleagues experience discomfort in her stomach but couldn't tell what's wrong. She went to the hospital for a detail checkup. The doctor carried out checkup which including x-rays and others. As a result, the doctor couldn't identify what's wrong but she was charged RM700 for those checkups. All these malpractice and ignorance occur during patient visits to the clinic is nothing new in many clinics out there. It's not the first time that I left the clinic feeling deeply disappointed about the lack of diagnose and treatment from the doctor. What worse, it's the same as the case that I mention above, the doctor didn't even provide any appropriate diagnosis. Naturally, the doctor think that the patient has nothing wrong just because they failed to carry out any basic checking.

Medical Malpractice & Negligence is Too Common, Too Dangerous

In medical field, one of the bigger issue is medical negligence. According to Journal of the American Medical Association (JAMA) as stated in Forbes, medical negligence is the third leading cause of death in US.

While medical negligence often related to more serious example that doctor failed to identify the patient condition which lead to unwanted prolong suffering and injuries, many patients did not get informed of the underlying illness when doctors failed to identified them, didn't get the right type of treatment earlier and eventually, the illnesses advance into a later stage which might turn out to be deadly.

According to The Guardian, medical negligence contributed to almost half of the population who suffer cancer at the British area wasn't realize that they have cancer until the last stage. And the alarming thing is, the rate has been increasing every year, result in increasing number of people facing the tragic fate of cancer being untreated and the consequences of dying.

Need more convincing facts on medical negligence? Read these stories about medical negligence.

While the concept of medical negligence in cancer sounds too serious compare to the medical malpractice of failing to carry out basic diagnose and care in the clinic issue as I mentioned earlier, I'm afraid that these two are based on the same concept and might eventually result in the same impact.

In the case where my colleague visited the hospital to check on what's wrong with her stomach and the doctor couldn't find anything, in case it turns out to be something really serious and life threatening (touchwood!), this is a matter of life and death. The carelessness and small mistake of a doctor would result in illness not being discovered and treated earlier, and waiting for it to become worse.

And it's not that our country is lacking of the necessary medical knowledge and facilities. Obviously, the medical knowledge in our country is great and sufficient to save people life, but that is only if the people in the medical positions are doing their job properly.

Slight Difference of Malpractice and Negligence

Despite creating this post, I'm not saying that all patients who are unfortunate to not having their illness discovered earlier are definitely the doctor to be blamed. Despite the advancement of medical facilities worldwide, it's not perfect. Nothing can guarantee all illnesses and diseases to be discovered earlier and everyone can definitely receive treatment at the right time.

This is where I need to draw a line between Malpractice and Negligence.

We talk about negligence when it involve many other factors when a patient is not receiving the right treatment and care from clinic or hospital, other than doctor is not doing their job properly to carry out the right checkup and treatment.

Factors such as machine or equipment faulty and inaccuracy, and inadequate advancement of technology to treat certain illness are part of the reasons we need to consider when comes to negligence. This is something that people got to blame on the medical industry despite the advancement of technologies. But I wouldn't say it's completely reasonable to blame on the medical industry. We had great advancement in terms of medical technology to detect and treat many diseases around the world. It's just not perfect enough that it can cure and treat anything.

But in this post, I focus merely on doctor not carrying out their job properly, which relate mainly to the terms "malpractice". Medical malpractice is when a doctor suppose to carry out his/her responsibility accordingly but he/she failed to do so. While negligence could be caused by external factor, medical malpractice is mainly caused by the doctors themselves.

The Possible Causes of Medical Malpractice

The factors that cause medical malpractice vary according to different doctors and scenario. Definitely, there are times when we can't completely assume that the doctors not carrying out their job means they must be lacking of the specific requirement and knowledge as a doctor, so they should not become a doctor at all.

Before writing this post, I created a thread in a forum regarding this issue. There are mixed responses and ideas among the discussions. While many agree that the doctor failed to perform their duty and it's always been a common issue that everyone used to it. Apparently, people are used to visiting the clinic or hospital but can only bet on luck if the doctor would diagnose and treat them properly even though they definitely have to pay for it.

Many people prefer to visit the same doctor who had treated them before and had good experience with the doctor. But sometimes this also depends on luck. Medical malpractice from the doctor might not happen all the time. It might be depending on different time and situation. It's the same when you recommend a good doctor that you met before to other people, but when that person visits the doctor, he or she might get different treatment.

There are people in the forum who suggested that doctors are also human, they may make mistake or unable to carry out their duty on certain days due to particular reasons, it doesn't always means that the doctor is not suitable for their job.

I could agree partially on this. Doctors, no matter how great it may sounds or how difficult it is to get into this position, in the end of the day it's just a job with better pay compare with many jobs out there. We can't always assume that people who got into the position of doctor are 100% passionate about everything related to being a doctor, and we can safely assume that many people became doctors because of the elder generation trying to make us think that becoming a doctor is much more better in "almost everything" comparing to other jobs.

I'm not saying that this is wrong. We are always brought up this way where we are asked to enroll our life into something because it's good for the future. And I can say that this trend will continue on and on for unpredictable number of years and generations. This is an issue only when we do what others want us to do but we are not aware of what we are doing.

The exact root cause of medical malpractice is unknown, we can only have our own assumptions. Based on the current situations, I can only suggest a few possible assumptions for the cause of medical malpractice:

1. Lack of interest and passion as a doctor
   
   Like what I mentioned earlier, not all doctors chose their path because they are 100% willing to become a great doctor and know what it's all about. There are many people who chose to become doctors, lawyers, or running their own business because these are what the world trying to convince us that's where the future lies. As a part of the negative impact, many people don't really understand what they suppose to do so they are unable to contribute all their effort into that.
   
   
2. Inadequate studies on medical fields
   
   This can be caused by three issues:
   • The current medical studies and knowledge that we have in our world is not perfect, that are limited amount of information we can study and learn that can tell us everything we need to fulfill for the role of doctors.
     
   • The current education system don't focus mainly on making sure that people who became doctors are capable of executing their own tasks and responsibility in a perfect manner. One of the giant loopholes in our modern education systems is to ensuring that people can pass on their examination and get into their relevant job position so that it's good for the economy. This issue causes many graduates passed their education with the preset education requirement, but doesn't completely fulfill the exact requirement according to the real world needs.
     
   • Simply put, the person who undertake the medical course is not hardworking enough in studies.
   
   
3. The doctor is unfit for work
   
   I guess the title is self-explained. Doctors are also human. Even if they know what type of medicine they need in certain time, they may experience sickness and unwell.
   
   
4. In short, the doctor just refuse to treat people properly.
   
   Feeling lazy, something about their personal life bothering them, the type of patient they are dealing with, the prejudice of thinking that a patient is here just because he or she just want MC to skip work, and many other reasons you can think of that causes them refuse to diagnose and treat a patient properly despite they are completely fine and capable of treating a patient properly.
   
   

In the end of the day, the position of doctor can't get away with the relation of being just a job. It requires great amount of time and effort, and it doesn't depends on luck to become a doctor. But there are always a limit amount of professionalism that we can put into any kind of job in this world. The limited amount of professionalism is just common, although this causes many problems and when it comes to the main topic that we are talking about, the issues in medical field cause great impact compare to other job because it involve health, and it has direct relation with people's life and well being.

So, How Serious is Medical Malpractice?

Perhaps so far I only got to mention the most serious issue about medical malpractice is failure to detect the actual illness or disease of a patient, and might eventually lead to illness or disease being untreated and advance into the terminal stage. Which is the most worrying thing since ordinary people like us can only depending on doctor to watch out for our health and tell us when something is going on in our body.

Most of the times, we can only notice something is wrong in our body when something unusual is happening to our body and we can feel that we are not the usual self. But unfortunately, many of the illnesses out there such as cancer doesn't shows you any sign until it's too late. This is why, we have to depend on technology and doctor's help to let us know as soon as something is not right in our body.

If we look into the reality, the issue of medical malpractice that lead to serious and terminal illness or disease due to doctors not diagnosing and providing the right treatment before it's too late is not something that we heard of it all the time. Many people wouldn't realize of the impact because we usually don't have any serious issue in our body.

It just that, when such situation happen, this is beyond devastated for a person's life. And it's not like this is totally depending on luck, as if it's just pure misfortune that it happen to a person, because there were possible detection and cure before it's too late, if only medical malpractice doesn't take place and we are informed earlier.

The impact of medical malpractice doesn't always relate to terminal illnesses. Sometimes the health issue that a person dealt with is not critical and causes death, but it could be a chronic issue that follows a person for life if no one inform us and we did not receive the right diagnose and treatment at all.

Although chronic illnesses might not cause death, but it cause certain level of discomfort and inconvenience to people life, and this can affect their well being and living experience very much. If people with chronic illnesses can receive the right treatments at the right time, even though they might not get complete cure from that, at least they are well aware of the condition and able to take precautions so that the illness doesn't get worst and they know the dos and don'ts to live their life properly, compare to not knowing anything at all and accidentally trigger the condition because they are not aware of it.

So, What I'm Expecting Doctors to Do?

First of all, learn to throw away all the personal issues, prejudice and whatever that could impact the quality of a doctor's way of listening, analyzing and treating patient when they are on the job. I don't know how difficult it is, but I bet it's not apply only to the position of doctor, it's the same for all kind of jobs. While I talked about the limited professionalism that could happen sometimes, this does not mean it's alright to let the mistake go on and not doing anything about it because we are, in nature, living being that frequently make mistake.

For the position of doctor, the needs of ensuring the quality and professionalism is extremely crucial due to the serious impact. Unlike many other jobs, lacking of professionalism in other job might not cause the issue of life and death. This is why being a doctor means far more than just checking out on patient condition and giving them medication.

Not all people understand that the general practitioner (GP) in clinic has major differences comparing with specialist, and being doctors doesn't mean all of them capable of the same thing. Most GP focus on general or common conditions and apart of giving out medication to patients who have common flu and fever, GP plays an important role as the first doctor that patient need to meet and understand if their condition require specialist's attention.

In the scenario when a patient's condition require the attention of a specialist, I don't think the patient would know that he/she need to meet a specialist if the GP did not provide the correct analysis and recommendation.

In most cases of what I heard about people's experience of visiting the clinic, the doctors usually start by listening the detail of the patient's condition, and at most, provide suggestion or idea before giving out certain medication that related or "could help" the patient's condition.

But patient's condition is based on self experience on what they experience within their five sense. A patient might experience little discomfort on the stomach which turn out to be heartburn. During the visit in the clinic, the patient's condition might sounds like an ordinary food-related stomach ache issue. When the doctor assume the condition as stomach ache, that's how medical malpractice happen and cause the suffering of another patient.

While I can't tell exactly what is the correct practice of doctor when a patient visit, I would consider that a GP, should at least listen to the patient's condition thoroughly and discuss a little more of any other symptoms that might relate to certain illnesses or diseases.

For common sickness such as fever and flu, many people probably experience it many times and do not need precise diagnosis to know the condition. But such common sickness might be one part of the symptoms of serious illnesses such as dengue. I think the doctor can discuss a little more with the patient to understand their condition such as how long the sickness have occurred and how serious it is to rule out and identify the possibility of a much serious sickness.

My Conclusion on This

There are great amount of issues about medical malpractice that I wanted to talk about. But if I'm going to include everything into this subject, this article will be endless. In short, I wanted to point out that we are human being that need to put health as main priority. By luck or by gen, I guess I can say that everyone's body definitely has at least a few conditions to deal with, especially when we got older.

We definitely have to spend great amount of expenses into medicine and treatments to cure and maintain the conditions. The question is, are we getting the right treatment? The spending amount for medical treatments is one huge sum, not everyone can afford those money and the bigger problem is, if people spend this money and not getting the right treatment, what's the difference between money contributed to medical field and tax money enforced by meaningless politic needs? It would be a major problem when doctors that hold a position that were meant to save life and contribute better well being for the popularity are not capable of providing the right treatment that people need.