doctors.....

I had this call from one of the head nurse 2 days ago. It was 9+am and I was reading the newspaper in the house( I work 12-12). The head nurse asked me if I knew my patient JL's  son is a opthamologist(80 or maybe 90% of Taiwan doctors are specialist...). I gave her a negative answer. She then told me that his son had called and asked us if blood transfusion was being done... I told her that no - his Hgb was 8.9 mg% and it was gold enough for a bed-ridden old-aged male. The head nurse told me that she had given the same answer and the son had complied with a unsatisfied tone. The son further claimed that he had bought EPO and injected JL from time to time. I asked the head nurse if she had told the son that he was admitted because he had fever and urinary tract infection. The head nurse said yes and she told me that the son had her  that they had been controlling urinary tract infection with cranberry juice and requesed for a discharge stat if no blood transfusion is to be done . But the patient had fever .......

Well, I had met good and all-rounded doctors in Taiwan. But many of them are only good at their sub-specialty. I recalled that when I was doing my housemanship in my hometown. I had a called from a psychiatrist  asking a patient condition. She had asked a few "sharp" question and at the end told me to care the patient properly - she reminded me that she had done medical posting before....  well, this true for a malaysian medical officer - they rotated through those major posting... well, the taiwan trainning defer : doctor dipped themself into subspecialty too early.  There is this hospital F which is not far away from our hospital which practice a different kind of rules

   1.UGI bleeding would be transferred if the Gastroenterologist is not on call that night
   2.Pnuemonia would not be admitted if the Chest physician is not on call that night
   3.Patient with pneumothorax would be transferred as they had no chest surgeon
   4. Peadiatric referral to ED would be suggested to see OPD of OPD is available

   Reason of 1 and 2 : the GI man does not want to care pneumonia patient and the Chest physician does not want to care UGI bleeding.
  My comment : they seems to forget gastroenterologist and chest physician hold a general medical specialist diplomate...

Reason  for 3 : the ED physicians( an "s" mean all of the ED doctors...) do not want to insert a chest tube ( should the board of EP retract their diplomate ???!!!!) ...

Reason for 4: The ED physician would need a paeds consult before any child is admitted and most of the time - the pediatrician would transfer the case out....

Well, anyone do something about it ... I am still waiting,.......