Of black sheeps and wolves

Doctor(DR): Good morning, what brings you here today?
Patient (Pt): Hi. I am having a headache. Went drinking last night.

DR : Oh… so how’s your headache now? Did you sustain any fall and maybe hit your head or sustained some other injuries?
Pt : (looking like he was trying not to smile) No lah. Maybe just hangover.

DR : So how are you feeling now?
Pt : I am better lah, but I don’t think I am well enough to work. Can you give me an MC for today?

DR : But didn’t you say you are feeling better? And today is only half-day for you….
Pt : But so “sian”, I am the only one rostered to work. The rest don’t need to come today.

DR : I don’t think that is a very good reason to ask for an MC.
Pt : (Can be seen thinking, brows furrowed) Actually, doctor, I also have diarrhoea this morning.

DR : Ok…. So how many times did you have diarrhoea, and when did it start?
Pt : It started this morning. Must be the seafood I had last night…

DR : So apart from drinking, you had seafood too?
Pt :Yes… beer and seafood mah… I also cannot remember how many times I vomited…

DR :Thought you said you had diarrhoea?
Pt : …I meant to say diarrhoea…

DR :Ok. So was there any blood in your faeces…was it black in colour?
Pt : I did not notice.

DR : Any other problems, like abdominal pain, vomiting?
Pt : No, only diarrhoea.

DR : In that case I will need to examine you, both externally and internally. Which means I need to examine your abdomen and also inside your rectum. I will put a finger into your rectum to check your stools.
Pt : Is that necessary? The internal examination?

DR : Well, you cannot remember whether there was blood in your faeces. Sometimes, in some infections, you can have bloody diarrhoea.
Pt : (mumbled something) ok..

DR : Can you please get onto this examination table?

( ….abdomen soft and non-tender. Bowel sounds present, not hyperactive. PR done. Hard brown stools. No melena noted….)

DR : Thought you said you had diarrhoea?

(This entry shall end here)

There have been quite a few letters to the newspaper forums lately and discussions made on some internet forums that army doctors are not “caring” or “professional” enough. It has been implied that they treat everyone as though they are faking their symptoms etc. Well, all the doctors do worry about missing something serious as it could mean their livelihood at stake if they were found negligent. No one likes to be disciplined, reprimanded or having to be hauled up to stand in front of a committee of enquiries.

And even if there were such uncaring doctors around, it is only a very, very small percentage of them. Like I said before, there are blacks sheeps in every strata of society. It is important to know that obviously, some patients have the intent to take the doctors for a ride. We do not consciously doubt them. We do take each and every patient seriously, but we must also be aware that such possibilities do exist. Boys do cry wolves at times, and in the army, there are many boys.