At the time of writing this post, Malaysia is having a Year End Sale. It's near Christmas holiday and now is school holiday. Every shops in town is throwing crazy deals to attract customers. I had to admit, Malaysians love shopping! If you go to any of the big shopping complexes now, you will face with huge crowd. Even parking your car also is becoming a problem. These kind of shopping promotes growth of economy, and help Malaysia building a stronger nation, but I am going to discuss about a kind of 'shopping' phenomena that will affect the nation. It is called 'Doctor Shopping'.
Basically, 'doctor shopping' does not mean doctors going out to shop. No. It means you and I, people that goes from one doctor to another doctor to get treatment. I will tell you how it cause negative consequences on you. Before that, I want to share a case:
I had a young patient about 4 months old, that came in with shortness of breath and fever for 1 week duration, which is worsening until she cannot feed. So naturally, the anxious mother brought her to the emergency department and the baby was then admitted. Upon history taking,I found out that prior to this, the mother had brought her daughter to a general practitioner, lets say Dr Ay, on day 2 of fever. Dr Ay had prescribed her some medications includes antibiotics type P and paracetamol. So the baby was on this set of medications for 3 days. The symptoms of fever and shortness of breath was not improving, but all the way worsen. The anxious mother became more anxious. Naturally, she thinks Dr Ay sucks, and the medication was not effective, thus losing faith in him. Since she had 'discharged' Dr Ay, and then seek for another Dr, let say, Dr Bee. Dr Bee, without having any knowledge that she already went to Dr Ay and received some medications there, manage this poor child with another set of medications that include antibiotic type Q and also some paracetamol. The mother gladly stopped the antibiotic P and starts taking antibiotic Q. 3 days down the line, the fever and shortness of breath not only worsen, now the baby can't even feed at all and had to be admitted to the ward.
This is what usually happens in Malaysia and I have to emphasis that it is not right! First of all, medicine starts with trial and errors. Even the best specialist also based on this concept, albeit with better percision and less hit-and-miss. No one knows a diagnosis of certain illness, we can only make our best guess aided with some examinations and investigations. However, if the first arrow miss the mark, we have to change the diagnosis. This will only happen if the patient have follow up and came back to us for progression. That is how things goes. In above example, the mother should bring he baby back to Dr Ay for follow up because Dr Ay knows her progress of illness and what to give subsequently. Instead, the mother brought the baby to Dr Bee, who had started the trial and error cycle again. Worse still, there were no knowledge of the child being partially treated with the medications.
Subsequently, it will lead to what we called as multidrug resistant strains. This is what happens: when one person is having an infection and was on antibiotic A, the antibiotic will react to kill the bacteria. However, antibiotic requires few days to reach its maximal actions, usually 5 to 7 days. Less than that, it will only partially kill the bugs. If we stop the antibiotic before its maximal activity, the bugs will react by creating new genes that is able to withstand the antibiotic, subsequently leads to failure of the antibiotics. Once it had fight through several types of antibiotic, a big problem starts. Currently, we have few antibiotics left to fight these 'superbugs' and there are more and more 'superbugs' emerging due to inadequacy of treating the infection. Once the bug is resistant to all antibiotic, there is no way to fight the infection.
Back to the baby, she had developed pneumonia. Since she is partially treated with antibiotic, so we have to hit with a stronger antibiotic, to prevent the emergent of the resistant strains. This leads to longer hospital stay, increased medical cost and disruption of family dynamics. 'Doctor Shopping' is a bad habit of Malaysians that requires change, for a better health care tomorrow.
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