Journals 
Present Issue 
Past Issues 
 

SMA Editorial Board 

Letters to the Editor 

 

I always believe that doctors in the public and private sectors should complement each other. Our top priority is the welfare of our patients. We should not carve a division between ourselves and deliberately find faults with our colleagues to exert supremacy and superiority in patient management.

I was very upset by two incidents which happened recently to my patients. Both cases illustrated the great insensitivity of institution doctors and their contempt and disdain for general practitioners. Many of my colleagues face the same disparaging treatment from hospital doctors.

In the first case, I referred my patient to a restructured hospital with complaints of chest pain and breathlessness. After four hours of waiting, he was seen by the highly agitated casualty doctor who asked my patient bluntly what was wrong with him.

“It’s written in the letter,” my apprehensive patient replied.

The young casualty doctor had a cursory look at my referral letter and told my patient, rather sarcastically, that he could not make out what the hell I had written.

My patient was shocked by what he heard. “Do you expect me to read what you could not read?” my patient asked rather angrily.

The doctor reluctantly gave my patient a quick check-up and sent him for an electrocardiogram. After certifying that my patient was clinically well, he was sent home.

“Tell your doctor you do not have a heart attack!” the casualty officer told my patient. “You can go home now. You do not need any medicines.”

A visibly upset patient returned to me and told me of the unhappy encounter with the hospital doctor. He was flabbergasted. I was greatly perturbed by the arrogant and indiscreet attitude of the young doctor.

The second case involved a patient on long-term Atenolol and Allupurinol for hypertension and gout. He was also on Lopid for his high cholesterol. He has been on these medication for the past twenty years. He was admitted to the restructured hospital because of chest pain, palpitation and breathlessness.

The good hospital doctor told my patient that Atenolol should never be given in the first place. He stopped the medication because he believed that my patient has no hypertension at all. His blood pressure recorded on admission was 130/90 mmHg.

The good hospital doctor also told my anxious and credulous patient that Atenolol also contributed to his palpitation and ischaemic heart! That remark made my patient want to kill and lynch me. He believed explicitly what the good hospital doctor had told him.

He felt cheated and he lost complete faith in me. He wanted to settle his score with me upon his discharge.

He was admitted for three days and discharged without any anti-hypertensive therapy. He did not take any medication for three days as instructed. On the third day, he felt breathless and his heart was pounding away with a splitting headache. He rushed to my clinic in the evening with a blood pressure of 180/110 mmHg.

He told me the story and I confessed to him that it was very unethical and improper for the hospital doctor to say all those unpleasant things. I did not say anything. He pleaded with me to start him on medications but he did not want any Atenolol. He has lost complete faith in his doctor of twenty years!

I did not want to aggravate the problem and I persuaded him to return to the hospital for further treatment and follow-up. I hope he did not suffer a myocardial infarction or a stroke.

The second case is a classic example of how a hospital doctor can cause irreparable damage to a general practitioner by making an insensitive and callous remark. Insulated within the great portals of the hospital, the institution doctor can make comments with complete disregard for the referring doctor. Some comments are blatantly made to cast aspersions on the general practitioners and in the extreme cases, to put the blame on them.

Such remarks should never be made in front of patients and their relatives. As doctors, we are not perfect and we are not infallible. We should not pretend to be omnipotent. We should be very careful in making disparaging remarks on our colleagues. We might be wrong in our own judgement.

Many years ago, a colleague of mine was threatened with death when a hospital doctor inadvertently told the parents of a child with Steven Johnson Syndrome that the general practitioner had prescribed the ‘wrong’ medicine. The child was given Bactrim Suspension.

Such a remark is uncalled for. If hospital doctor does not exercise tact and sensitivity, especially in cases of adverse drug reactions, the damage to the general practitioner is enormous. It is very painful and difficult for the doctor to confront very hostile patients and their irrational relatives.

Rightly or wrongly, they believe that the hospital doctor being the superior doctor is always right.

I can still remember how a colleague of mine was harassed and threatened by furious relatives. All this started because the hospital doctor told the wife of the deceased that her husband’s sudden death might be attributed to the injection given by the family doctor. It was a remark which triggered off a painful chain of events.

My colleague had to ask for police escort every night when he closed his clinic. He feared so much for his safety that he finally abandoned his clinic and reallocated somewhere else.

A seemingly innocuous remark by a hospital staff can cause great harm to the referring general practitioner. It is always better to communicate with the referring doctor personally before making any comments on the treatment regime. I am sure general practitioners greatly appreciate feedback from hospital staff.

I hope this article will serve as a reminder to all doctors to exercise extreme caution when passing judgement on their colleagues. Whether they are in public or private sector, they must always be discreet and judicious in making statements.