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Sunday, February 19, 2012

Abusing Emergency Department

After being in the department for almost 2 months, I have seen literally thousands of patients and about a small portion of the patients seen in the department does not warrant an admission to the emergency department.

Few of these patients will present with insignificant body injury and then, prior to being discharged from emergency department, they will ask for medical certificate for 2-3 days. This is usually seen at the end of long weekend / public holiday.

A small number of patients who has been under followup of specialist clinic presented for a variety of complaints. Upon further questioning, their motive is to seek earlier clinic appointment or to seek earlier date for surgical operation. Truth be told, the waiting list for operation in the government hospital is very long and it is extremely difficult to get earlier date for operation unless the patient him/herself has suffered an emergency complications of the organ itself. Otherwise, I personally recommend them to go to the private hospital for an earlier date for operation. In term of clinic appointment, it is quite difficult to get earlier date unless your medical condition has deteriorated significantly over the past few months

There is quite a big group of patient who came to emergency department for insignificant minor trauma. For example, they had been involved in an accident and then suffered a small abrasion wound about 0.5x0.5 cm. Apart from that, they are quite well. Although emergency department is reserved for all type of trauma cases, I don't think this group of patients should come to A&E. At least they should go to GP first to seek the appropriate treatment. Most of the time, this minor trauma will resolved by itself without any intervention.

Emergency department is for emergency cases. If the community keeps on abusing the department for non life threatening condition, I don't think the department can cope with the large number of patient and give the best treatment for all patients.

4 comments:

Nurul.Liyana said...

since i'm in paeds, sorts of patient admitted just for fever...further clarification, they just came to ED to get antipyretic...but need to be admitted because came after 12mn. the admission in paeds ward is quite a lot after office hour because that is the time the parents home and realised their child is sick. thus brought the child to hospital. parents anxious is another factor for the admission in paeds ward. fever just one day, not even given syp at home, want admission. how to make our community more knowledgeable & educated in health issue???

nhhas said...

Assalamualaikum...

waahh.. lama tak menjenguk ke sini.
posting mana Doc?

btw, sorry sekadar komen/ luahan perasaan daripada "orang awam" macam saya...

Hmmm i guess you guys para2 doktor yang budiman perlu "work much much much more harder" to educate people.
above are keluhan para doktor. tapi cuba letak diri kalian ditempat pesakit tersebut. Kalau dah dia sakit, sure lah dia rasa itu penting untuk dirawat dan ditangani. Manalah dia nak g kaji pulak "health parameter" sama ada dia patut g OPD or ER or sekadar duduk rumah telan panadol yang dibeli di 7e(hehehe).

Ramai juga, kenalan family yang meninggal kat depan kaunter ER, kerana lambat treatment. Perlu ke tunggu sampai ke tahap itu baru dikatakan PENTING dan EMERGENCY?
Apa justifikasi penting dan emergency mengikut piawaian local n international? Mungkin boleh kongsi.

Apapun MOH memang betul2 kena kaji dan baiki kelemahan ne semua. kena akui. memang health service kita masih banyak ruang untuk dibaiki (i tak kata lah tak bagus) cuma MASIH ADA BANYAK RUANG for improvement. Sorry to say MOH paling tak mencapai KPI. Kes denggi makin banyak. Padahal kat umah tu, ya ampun. Setiap minggu kena sembur. Tah hapa lah yang disembur nya... Yang pasti kanak-kanak seronok pulak g main asap forging tu. Ne pun nak kena educate juga ne...

Hmmm ne tak masuk lagi kalau klinik kesihatan kat putrajaya yang kena tunggu 4 jam just to see the doctor for 5 minutes??? wah.... melampau tahu...
pastu balik office kena marah sebab spend masa lama kat hospital.
time slip sudah tidak laku di office.
maka memang layak patient mintak MC.
huhuhuhu.....

sorry sekadar pandangan orang awam. Yang sungguh kecewa dengan servis hospital2 kerajaan. Bagi yang berduit ne, memang lah akan ke private yang kos nya (sabar jerlah).
Tapi timbul isu lain pulak. Kalau yang berduit ne g private, apa benefit kami sebagai penjawat awam?

Hafiz said...

@nurul liyana.
For paediatric patient, parent's anxiety factors plays a major role in deciding for ward admission. This is commonly seen in parent with their first child. If the parents are anxious and unable to look after the child, it is better for the child to be observed in the ward.
The threshold for ward admission in paeds is certainly lower than the adult and thus, unfortunately, there will be lots of ward admission after 12 midnight.
In term of educating the parents, there is still a long way to go to educate the parent and the community overall.

@ huda.
Waalaikumsalam. Sebenarnya saya pun dah lama tak update blog dan lawat blog orang lain pun :)

Memang diakui banyak kelemahan dalam sistem kesihatan di Malaysia ni. Tahap pengetahuan mengenai penyakit berjangkit dan yang berbahaya pun masih ramai yang tak tahu lagi. Begitu juga dengan penggunaan Jabatan Kecemasan di kalangan masyarakat.

Nanti kalau ada masa, akan cuba cari mengenai kategori kes kecemasan yer.

Kebiasaannya, pesakit yang akan meninggal dunia jika tidak dirawat dengan segera akan dimasukkan ke Jabatan Kecemasan dahulu dan pesakit yang stabil, akan dirawat kemudian. Semua pesakit yang datang akan ditapis dan diberi kategori tertentu sebelum berjumpa dengan doktor.

Kebiasaannya, pesakit yang stabil akan tunggu agak lama dan ini lah yang biasanya akan jadi punca aduan di kalangan orang ramai.
Namun, masalah ini sukar nak diatasi kerana setiap jabatan kecemasan hanya ada jumlah katil dan staff yang terhad sahaja pada sesuatu masa untuk merawat pesakit yang setiap hari makin ramai.
Sepatutnya, hospital kerajaan bagi khidmat untuk semua rakyat Malaysia, namun begitu, semua tempat ada had maksimum untuk melihat pesakit pada setiap masa. Maka, terpaksalah orang ramai menunggu lama

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