Quality of care...

I had always considered the diagnosis and management of acute appendicitis as a index for an competent ED doctor...careful hx and PE would lead one to the diagnosis...

I had a cousin who is very much older than me… my granny and my mother’s eldest sister got pregnant almost the same period… My cousin was 20+ years older than me, a story regarding of him was shared amount us during our childhood.

We were warned not to do any sport after meals as one would get appendicitis (which is not true…). My eldest cousin had a big vertical scar across his belly. The story goes like this; he had suffered from abdominal pain and later seen at various clinics and he was only sent for ops after generalized peritoneal sign was noted. The ops was a major one as appendix had ruptured….

I had read over the net about this poor Indian chap who suffered from abdominal pain lately…

http://www.freemalaysiatoday.com/category/nation/2012/09/24/ibu-kesal-dengan-layanan-buruk-hospital/
9/5 pt noted with diarrhea, abd pain, vomiting

9/7    9am seen in Klinik kesihatan - discharge

9/7 8pm seen in ED Seremban GH – discharge

9/8 ?   seen in private clinic

9/9 8pm seen in ED Seremban GH admitted to ? medical ward

9/10 9am diagnosed as ? appendicitis

9/10 4pm transferred to ? surgical ward and sent to OR…

It is queer that no doctor had ever mentioned the possibilities of peritoneal sign during the consultation. The Medical officers in Klinik Kesihatan ,ED Seremban GH and the private clinic doctor had discharged the patient despite of noted the pain and symptom for over 2-3 days. The 4^th visit to ED and the medical officer still admitted a patient with peritoneal sign to medical ward is a beyond standard medical care.

Could just shock my head…. Is it because those medical officers did not receive any specialist training making them incompetent or was the patient pain so non-specific.

There is still a lot of improvement for the health care in Malaysian..