Doctors Refused To Treat (Comment by Dr JB Lim)

The blogger wishes to thank Dr JB Lim for sharing his most compassionate comments on a recent newspaper report that “a five-day-old baby girl died at a government-run hospital at Jalandhar (India) after her father was unable to pay Rs200 (RM11) for treatment” and offering his professional advice on ways to rescue life under such circumstances.

Tuesday, 31 July, 2012 9:24 PM

From: lim juboo
.

Look at this: http://thestar.com.my/news/story.asp?file=/2012/7/30/nation/11755473&sec=nation

How can they ever do this? What has become of this, supposed to be a life saving profession? It has now become a life-destroyer business.

Maybe it was not the doctor or nurse who did this, but the hospital because doctors are just employees in hospitals normally run by businessman.

Doctors working in hospitals, especially the private ones are powerless against hospital policy, management and their administration.

However, many years ago, a few doctors undergoing a course in Trauma Life Support together with me at Selayang Hospital, and later at University Hospital Kebangsaan Malaysia told me how some doctors working in their own private clinics refused to attend to emergency cases. He cited a case of a child who was unconscious, not breathing, and was rushed into a private clinic somewhere in KL.

My colleague told me the doctor refused to attend to the child because the child had vomitus in his mouth, and the doctor refused to apply mouth-to-mouth respiration on the child because he was afraid of getting his mouth dirty and smelly with the child’s vomitus.

He asked the parents to take the child to the hospital instead.

Of course the child naturally died within minutes because the brain cannot stand without oxygen for more than 3 minutes.

Actually this should not be a problem. The doctor could have used a special face mask over the patient’s mouth, and blow into the ventilating tube provided. Alternatively, he could also use a suitable size Ambu bag to ventilate the child.

Yet another alternative method is to use an oxygen mask or a Bag-valve mask attached to an oxygen cylinder with a demand valve.

The important thing is to ensure the airways are not obstructed in an unconscious patient. This can easily be done by merely tilting the head and lifting the chin (head tilt-chin lift procedure), and then blow into the lung twice if not breathing (look, listen and feel) followed by cardiac compression if no circulation or (carotid) pulse felt. Apply ABC (Airways, Breathing, and Circulation) protocol.

This immediate simple procedure could have saved the child’s life with or without the vomitus present. Any fluid, blood or vomitus in the trachea can easily be sucked out under vacuum with nasopharyngeal tube.

Even a small private clinic should be equipped with at least an Ambu bag, and some form of airways management devices such as B.V.M used with mask, tracheal tube, and other airway adjunct. Even without them, just head tilt chin lift, pinch the nose tight, seal mouth of rescuer and mouth of child or any casualty, can do the job well with two puffs of expired air from the rescuer, and apply chest compression with 2 fingers at rate of 100 times per minute for a child.

The doctor or rescuer should then get someone to activate the EMS (Emergency Medical Service) for an ambulance such as St John Ambulance Malaysia or MRCS.

Unfortunately most doctors in private clinics do not want to attend to emergency cases. They also do not want any ambulance to go to their clinic because this is bad for business for them. We all know about this.

Moreover, most doctors are also not well trained in emergency medicine unless they work in an emergency department of a large hospital.

Worse still, almost all of them do not know first-aid or pre-hospital care. In first-aid they are supposed to use only their eyes, ears and bare hands for immediate resuscitation, but unfortunately doctors must have needles, syringes, tubes and drugs. Without them they are helpless and cannot manage.

There is just no time to ask a casualty to go, or be sent to a hospital. It is the first hour – dubbed “The Golden Hour” especially in trauma case or in acute myocardial infarction (heart attack) before the casualty can reach a hospital that counts. Time is exceeding crucial for the survival of a patient.

Almost all doctors do not know first-aid. A trained and qualified paramedic can do the job far, far better.

The other problem is, a private hospital wants your credit card or cash deposit first even in an emergency, else they ask you to go to a government hospital.

All this is very unfortunate.

Lim ju boo

BSc (Physiol) MSc Postgrad Dip Nutr MSc MD PhD (Med) FRSPH FRSM

Advanced Cardiac Life Support

Regional Staff Officer for Training

St. John Ambulance Malaysia

Feedback from the blogger’s Facebook friend Alex Wongkeeway on Wednesday, 1 August, 2012 4.26pm:

"Dr Lim is quite right about his sigh at the beginning of the essay, 人在江湖. Quote "do not want any ambulance to go to their clinic because this is bad for business for them" that's business reality. The conclusion is so true, cold and pathetic, credit card or cash deposit, your picture is most appropriate, No Money No Talk! Thanks, my e-Taiko, I gained once more, by reading."