Your words reminded me of a popular joke (but a little bit old already) told by the emcees (the MCs or the Masters of Ceremonies) during the wedding receptions.
“After married, husband will become the head the future family, must be respected by the wife and made a ‘GENERAL’ of the family. The wife should be satisfied as the lower ranking ‘MAJOR’ position in the family.
After that if there is any ‘General problems’ it will be the General husband’s duty to decide. But all the ‘Majour decisions’ must be left for the ‘Majour’ wife to decide.”
So I used to treat General patients as a General Practitioner and need to refer all the majour problems and majour diseases to relevant specialists.
But I had learned a lot of lessons in referring the patients to the Specialists in Myanmar and Malaysia.
Just after finishing my house surgeon (HO here) post, I opened my evening clinic at my parents’ house at 30th street Mandalay and opened another clinic in Sar Doe, Myitnge Set Kwe (or Condensed milk Factory corner or bend). On the Rangoon-Mandalay highway, there was a “Broker shop” (or Pwe Yone) from Myingyan.
I was called for a house-visit to a Postpartum (or postnatal) patient having high fever with chills and rigor. As that area was a Malaria endemic area I had done a thorough history taking and physical examination and diagnosed that she was having UTI. Her left kidney was ballotable, tender and Urine FEME was full with pus cells. I took her urine and checked at the minilab at the back of MU3, Prof U Tun Thin’s ward, because there was no private lab in Mandalay back in 1977.
I took my father’s jeep next day and sent to the GP of one of my Lecturer Consultant Specialists. After he checked, he asked me in Burmese, infront of the patient, whether I was sure it was not a Malaria patient with the large spleen. After that he continue to scold me (in front of my patient) for being bold to give the possible diagnosis of Pyelonephritis or Renal Abscess.
But I feel proud as at last after admission to the hospital and after undergoing all available investigations, the patient had to undergo a left sided nephrectomy. (I felt vindicated because I was still a young doctor but I felt sadness for the patient.)
Second patient was a teenage girl from the Talingyi village, far off the main road, about 7 miles away on the side of Myitnge River. The girl was the unmarried girl and the daughter of the landlord of my temporary mobile clinic. As she was suffering from hysterical hyperventilation followed by carpopedal spasm and also complaint of palpitation, insomnia etc., I had explained the parents and had given mildest relax medicine available, Releasin Tablets.
Later when she complaint of massive discharge with SPA pain, I had given some antibiotics without checking the VE and decided to send to one of the consultant OG specialist.
I took my father’s jeep again and sent the patient and her mother to the above OG’s clinic. That “Ma Ma” OG (not Ma Ma Kyu or U Soe Myint) scolded me in front of the patient again (in Burmese) telling that any idiot standing at the road side platform could give those pills and accused me as unethical for treating that kind of patient without specialists training in Psychiatry and Gynaecology.
I was sad and shy but never talk back nor complaint to the pt and relatives. But pts’ mother was a very intelligent person and when I sent them to their relative’s house when they were going to stay overnight, she remarked that she did not like the rude attitude of that OG and threw away her medicines. She thanked me and asked me not to feel bad. Then only she revealed that she decided not to give the presents she brought from her village, big tin of oil, a bag of rice and her firm products and asked me to accept them, in addition to the presents she intend to give to me.
I continued to work there in Myitnge daily and visited their remote village twice a week as a mobile clinic work. The girl’s disease was uneventful till another 5 years. Since then, I never send any patients personally to any specialists but just sent them with a referral letter if really need only. And I learned a lesson; I used the general terms with the vague diagnosis as if I was not sure.
When I arrived Malaysia, I thought the Specialists here are better ethically but I found out that they are acting like their counterparts in my country and some of them had scolded my patients for relying on GPs and not seeing them directly in first place.
Once I referred a child with the ear injury to an ENT Surgeon in a Private Hospital in Ampang, KL. The whole family is my regular patients, the mother told me that while she was digging the ear of her daughter, the younger daughter pushed her and she accidently injured her child’s ear.
It is no need for a GP like me or other doctors to even check the child as her ear was full of blood and the blood was oozing out from the external auditory meatus. As the mother’s employer was a Big International company and used to cover the Medical Benefits at the private hospitals (if the panel doctors like me referred) I sent her to that hospital’s Medical Officer @ A&E.
The STUPID so called specialist later wrote a letter complaining and blaming me that I HAD injured the child’s eardrum. Even if she could not read my handwriting on the referral letter, as a specialist, she should know how to take a proper history. The pt’s mother immediately came to the clinic when I rang up to her about the letter. She apologized me and told me that when she explain in Bahasa Malaysia, that that dr never even listen properly to her but was worried more about the payment mode as she was going to charg about five thousand to do the examination and treatment under anaesthesia.
I complained to the Director of that hospital and tried to call her clinic few times but she tried to avoid me. But I never get any apology from her or from the relevant hospital authorities.
Another unfortunate incident was when my regular pt, a Ph D doctor, businessman, IT/Multimedia specialist had a chest pain. His whole family members are my regular patients and even the eldest son who was studying and now working in US used to visit me if he comes back to KL. Younger son is also studying in an expensive private school. Now he is working as the senior officer in the present PM’s office at the media /press section. I even had published his wife’s picture shaking hands with TDM at my daughter’s wedding.
When he complaint about his Angina Chest pain only on running fast on the treadmill that day, I took his BP, which was normal as usual. And he is the thinnest, fittest in the whole family. (No need to see the records as I knew the whole family medical history very well) ECG was completely normal but I took his blood samples and sent to Pathlab for the Cardiac Infarct. But I had given him Asprin (Casprin 100 mg 3 Caps), GTN, Isoket and also given the referral letter to the private hospital against their unwillingness to admit to hospital or to do any procedures. I strongly advised his wife to cancel her planned trip to USA the next day, although her tickets and all the travel arrangements were already done and confirmed by her son who is working in USA. I even rang up to his business partner because of his wife’s request to help persuade him to see the cardiologist. To make it short the blood results returned in the evening shown the strong possibility of Myocardial Infarct. I rang up to them and had to advise strongly and repeatedly to go to hospital because he was relieved of all the pains and so comfortable after my palliative treatment. In short he was diagnosed as MI and operated.
But he and his wife’s repeated praising of me in front of the Cardiac Surgeon may had irritated him and that Specialist Cardiologist told them that GPs are unreliable (up to now we never know or meet each other as he is practising in Damansara side and I am at the opposite side of the town). The Cardiac Surgeon baselessly alleged that my ECG machine is useless like other GP’s. (May be he became jealous as that keep on telling that although ECG was normal, I had correctly diagnosed, treated him well and ultimate safe his life.) Actually it is his fate and Allah’s will. So all the praises should be directed to Allah only.
After discharged from the hospital, before going back home, MashaAllah, Alhamdulillah, pt dropped at my clinic counter to thank me in front of the all my patients. He and his wife tried to compete telling about how I had saved his life and the bad mouthing of the specialist.
Never mind, I found out later that cardiologist insists on giving anti-hypertensive medication although he never suffered and never high and because of that my pt’s got a hypotension and almost got another MI. I referred back to him and he stopped that medicine.
I wrote this in response to my friend doctor and my pt’s in my FB_
FB comment after sharing this posting_
Naing Wai Win
”A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch a manure, program a computer, cook a tasty meal, fight efficiently, die gallantly.
Specialization is for insects.” Heinlein quote. Thus, i’m proud to be a jack of all trades.
And I believe Sayar Dr. Ko Ko Gyi is a generalist too.
He quit the specialist road after passing MRCOG part 1.
Although the world needs specialists, generalists rule the world. Is that right? Ko Myo Min ?
Yes Ko Naing. The world is the generals’ world. Not those Generals! The mother Earth is for jacks. Thus we have such elective diversities and never get bored in life. It’s enough one Ibrahim Lincoln, but not his dynasty to continuously have son Lincoln, grand son Lincoln and so on. Otherwise, Obama will now be just day dreaming on the bank of Mississippi.I mean, USA have such a jack of all political system and that is what it takes to be what USA is today about.
- Best Doctors’ Announces Physician Selection Service That Matches Members with Expert Specialists (eon.businesswire.com)
- Many doctors order tests rather than do a history and physical (kevinmd.com)