Misuse

 

I had this medical certificate request placed on my desk 2 weeks ago. I reviewed the medical chart grumbled a little while I figured how to write down the diagnosis.

There medical certificate here is something different than the Bolehland. During my service with the MOH, medical certificate a.k.a MC served as a permission for sick leave. It was very crucial for those people especially the laborer group. There were tons of reasons asking for one. It could allow them to take a day off either for rest or run some errant. The issuance of such MC had truly test the wisdom of the relevant MOs.

The medical certificate however was something more like a medical summary with a column for diagnosis and another column for comment. I had always been cautious to write down the diagnosis as it is an official document with possibility of landing into a medico-legal swamp.

The case of a bed-ridden patient who was brought into ED by ambulance for generalized weakness. I attended the patient 10 mins before the end of my shift. I reviewed the chart and found that the patient was seen in our ED the day before for head injury due to fall cause by weakness and poor intake.

The patient was alert on arrival with no sign of cerebral injury. I did not repeat the CT scan but order some blood test before I passed it to my colleague.

The patient was later discharged after 10+ hours of retaining in ED by the day shift physician. A diagnosis of R53.1 (Weakness ) was placed as diagnosis by the physician who discharged him.

The blood test came back normal and the reason of weakness was poor intake….

I was reluctant to issue the MC upon request but had to do so as my named was put under the attending physician column.

Few days later as young lady came and asked for my explanation about the diagnosis and content of the certificate. She identified herself as the daughter of the patient. Judging from her outlook, she appeared to live in urban area.

She had queried about the decision of discharging the patient. The conversation was not a comfortable one as she had a misconception regarding patient discharge. From her point of view which was based on common sense -> all patients discharge should be able to walk out from the hospital without aid. She had questioned our decision of letting a bed-ridden patient to leave the hospital.

She had expected a very detailed medical summary on the MC and asked us why we didn’t write any plan nor detailed instruction of discharge. She had barked on me claiming that she as scolded by my colleague who had discharged her father on that day.

I had asked around later and found out that an unpleasant conversation had occurred between the lady and my colleague. The daughter had requested an admission and was turned down; the reason of admission was that she was busy and she had wanted the hospital to act as an interim care node for temporary settlement. She was offended by the conversation and later she had come to us requesting medical certificate. After obtaining the certificate, she had utilized the diagnosis and the simple notation on the paper to query our decision; stupid but effective one.

The beat up and no retaliate strategy had worked out though and the daughter was in no ground to proceed as I had avoided the provocation by the relative.

The feeling was a strange one, I felt like a ghost being hit by a truck; no scratch over the body. However part of my soul was engulfed by something which I cannot describe.

It was difference from emptiness resulting from a successful striking back. Frankly said, I don’t like both of the feeling; but I need to make a choice…