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Recently, I was called to attend two cases which share the similar problems:

Both cases presented with diabetic related complication which were involving severely infected foot which required urgent operation (amputation).

Case 1: a bad case of septic arthritis, After 3 operations failed to cure and AKA is proposed.

Case 2: a bad case of right ankle ulcer, after  1 operation and BKA is proposed.

Both patients are equally determined to keep their foot and equally to fight till the end regardless the price (unfortunate, death is the price to pay).

Both of the patients sign a discharge at your own risk declaration and seek “alternative treatment” elsewhere and finally came to A &E in severe sepsis and at the verge of death.

Case 1 patient died after intubated at the A&E. Case 2, the patient was intubated and was sent to general ward (instead of ICU care). ICU physician will not accept a “hopeless” case.

Question: Are we, the doctors were doing the right thing?

Why we allow the patient and their family made this obviously irrational decision?

After all, there is a 101% definitely treatment and the treatment is the only option and yet….refused by the patient. Furthermore, patient is “IN” the hospital, which mean their wants treatment and should surrendered their right (treatment choice) to the doctors.

It’s time to be be rational.

After all, we are doctors and who else had the rights to do so.

We choose the best option for the patient.

Patient autonomy is stop here. Period.

I sure the patient will eventually accept the fate  of losing their legs and yet survive to see their children grow up and getting married. I will even accept that I may get scold and get sued by the patient if he wakes up and realize his leg is long gone. It’s definite worth it.

Too bad,  we just don’t push hard enough!!!!!!!!

We just being too nice and it’s unethical to be soft and too chicken!!!!



One of my patient who was referred from surgery, was asked on the prophylaxis of endocartitis in view of patient MR and AR conditions.

I do a search on propylaxis and came to know that NICE had published latest guideline on prophylaxis on IE.

And the latest recommendation:

Prophylaxis against infective endocarditis
1.1.3 Antibiotic prophylaxis against infective endocarditis is not recommended:
• for people undergoing dental procedures
• for people undergoing non-dental procedures at the following sites1:
− upper and lower gastrointestinal tract
− genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth
− upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy.

The recommendation basically altered the view of the need of prophylaxis in any of the surgical procedure.

I was on-call the other days.

My nurse had been blaming me for admitting a morbid obese patient. Well, it’s more difficult to taking care of obese patient as she and 2 of the nurses are pregnant!!

Just acrosss the other ward, 5 nurses are currently pregnant at various POA and well, guess, you can see many many of the staff nurses are pregnant across the hospital!!!!

Have you wonder why?

The reason is the ministry usually sent junior staff nurses (who just graduated, just got married and desperately want to have a happy family) to the 3rd class ward (heavy workload). So, i guess it just a norm….

This is a 30 year-old man who was admitted for sepsis 2nd to sacral sore.

Look carefully at this image.

I am absolutely correct of predicting the reaction to the news of setting TCM in local hospitals.

I myself, strongly against setting up of the traditional medicine department.

Somehow, the health ministry seem so enthusiastic.

I against the practise of chinese medicine are mainly they are not science based.

There is concept of poison, but no mention of bacteria, virus and other causes of illness.

Simply, the understanding of disease/illness is based on concept lay down by the physicians several hundred years ago.

In Chinese medicine, The examination of a patient is only based on palpation of pulse of hand and the general observation of face and skin.

The western medicine had expanded to various imaging technique and devices. And it’s supported by other mode of biochemical investigations.

The understanding of pharmacological effect of medicine is based on traditional medical herbal book.

In western medicine, the understanding of drug effect is at the molecule level.

Many of the traditional medicine contains  substances that can harm human body such as heavy metal. It’s even contains western medicine, especially steroid.

A case report in Singapore that a man had consume large amount of mercury after seeking traditional medicine.

October 2008
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