Dialysis Dilemma
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A patient who is a govt servant for nearly 50 years was just diagnosed to have end stage renal failure (GFR < 5 ml/min). He was told to get a place for dialysis outside since the place in the hospital are limited if he wants hemodialysis (the one with the machine next to you where it channels your blood out, and dialyse it)...
Upon hearing this, he shouted and cursed the medical personnels available saying that why he could not get a place since he is a loyal rakyat and has served the govt for so long... He retorted and claimed that he will create havoc if he is not given a place to dialyze...
Though there is another option where it is called peritoneal dialysis, where he can get it done in the hospital everytime, he wanted a better quality of life and less pain by optioning for hemodialysis...
He kept swearing and cursing until the medical assistants have to hold him down, but he became aggressive and the authorities are called upon to take him down...
I was one of the doctors getting screwed by the patients, and I couldn't say anything at all... Sad......
We wanted to help so bad, but...
What would you do in such a situation? -
oh.. u are a doctor?
hmm in every line, there's bound to be difficult customers..
esp old patient like him ar.. lose patience easily. -
old man scare to die ..... haiz. my neighbor commited suicide leh. husband n wife... both of them.Originally posted by renorenal:A patient who is a govt servant for nearly 50 years was just diagnosed to have end stage renal failure (GFR < 5 ml/min). He was told to get a place for dialysis outside since the place in the hospital are limited if he wants hemodialysis (the one with the machine next to you where it channels your blood out, and dialyse it)...
Upon hearing this, he shouted and cursed the medical personnels available saying that why he could not get a place since he is a loyal rakyat and has served the govt for so long... He retorted and claimed that he will create havoc if he is not given a place to dialyze...
Though there is another option where it is called peritoneal dialysis, where he can get it done in the hospital everytime, he wanted a better quality of life and less pain by optioning for hemodialysis...
He kept swearing and cursing until the medical assistants have to hold him down, but he became aggressive and the authorities are called upon to take him down...
I was one of the doctors getting screwed by the patients, and I couldn't say anything at all... Sad...... We wanted to help so bad, but...
What would you do in such a situation? -
thought malaysia provide free dialysis threatment to its citizens?
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no 1 stopping fr giving him dialysis lah, he's at terminal stage and suddenly dawn on him he wants to live longer.
if he has taken dialysis earlier mebbe still got chance horsepeter will keep a bed for him. then again, they always hv a lack of beds, nothing new. his value of statistical life is low compare to an able bodied person. -
well..if i m not wrong, you are only a trainee doc or newly grad doc rite?
You cant do anything regardless of who you are, what position you are in.
I shld say, in psycholgical pt on view, he might just get agitated because of the amount of time and effort he had put into his career (in govt sector), YET he cant even get a place in a govt hospital for dialysis treatment.
YOU see the link here my friends? So, its emotion that is over him. Its was best that authorities were called in, bring him away from the situation and give him time to calm down. Slowly, they will try and talk things into him, sending rep from maybe NKF to advise him on his options.
SO, its like pp slogging their life in a particular company, and then, after you retired, you wanted to buy something from them but not given discounts...
..you will feel grieved over it..
but of cse, the dialysis treatment as mentioned is more severe lah.
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Too many ppl with chronic renal failure and end stage renal failure... not enough machines to cover all... my goodness, it makes up nearly 10% of the whole of population, if not even more... almost all of those who are having diabetes mellitus now, will get kidney failure soon in about 10-20 years time... Diabetes is almost present up to 20-25% of the whole of population...Originally posted by dragg:thought malaysia provide free dialysis threatment to its citizens? -
did we beat malaysia in this area too?Originally posted by renorenal:Too many ppl with chronic renal failure and end stage renal failure... not enough machines to cover all... my goodness, it makes up nearly 10% of the whole of population, if not even more... almost all of those who are having diabetes mellitus now, will get kidney failure soon in about 10-20 years time... Diabetes is almost present up to 20-25% of the whole of population...
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Originally posted by renorenal:Diabetes is almost present up to 20-25% of the whole of population...
Damn kua zhang man!
1/4 malaysians has kidney failure!? -
How much more painful/inconvenient is this peritoneal dialysis as compared to hemodialysis?? -
I dunno ler.. have to go to NKF Singapore and ask...Originally posted by dragg:did we beat malaysia in this area too? 
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For peritoneal, they stuff a Tenckhoff catheter or a tube into your stomach (POOF) and dig dig dig for the peritoneum and place it there, the peritoneum act as a membrane for the toxins to seep through...Originally posted by DriftingGuy:How much more painful/inconvenient is this peritoneal dialysis as compared to hemodialysis??
HD is less painful, coz it's just pricking your fistula with a needle and then the machine will do the work... PD at one time they have to put in 20L of fluid into your body, channeling in and out.. -
There are 4 stages of kidney failureOriginally posted by DriftingGuy:
Damn kua zhang man!
1/4 malaysians has kidney failure!? Many causes leads to kidney failure, and diabetes is the main one, following closely behind by Systemic Lupus Erythematosus (SLE)...
Others being gout, autoimmunity, post-streptococcal infection, and stones (calculi)... -
So each time go for peritoneal must open up a hole in the stomach and dig??Originally posted by renorenal:For peritoneal, they stuff a Tenckhoff catheter or a tube into your stomach (POOF) and dig dig dig for the peritoneum and place it there, the peritoneum act as a membrane for the toxins to seep through...
HD is less painful, coz it's just pricking your fistula with a needle and then the machine will do the work... PD at one time they have to put in 20L of fluid into your body, channeling in and out..
No wonder he complain la... like that damn jia lat lei
And I tot HD is simply diverting blood from a vein to a machine and back? -
Yeah HD is simpler... Its called a fistula, the vein and artery at the wrist or in front of elbow is fashioned so as to create a tunnel in between them... that will be the site of inserting your needle...Originally posted by DriftingGuy:So each time go for peritoneal must open up a hole in the stomach and dig??
No wonder he complain la... like that damn jia lat lei
And I tot HD is simply diverting blood from a vein to a machine and back?
PD we will put up a permanent catheter once the patient decides to have PD for the rest of his life, so he don't have to puncture everytime he comes in lor... -
Some people dont like foreign objects perm sticking out of from within their bodies I guess... Imagine trying to sleep knowing that theres a tube that leads from the outside to your stomach..Originally posted by renorenal:Yeah HD is simpler... Its called a fistula, the vein and artery at the wrist or in front of elbow is fashioned so as to create a tunnel in between them... that will be the site of inserting your needle...
PD we will put up a permanent catheter once the patient decides to have PD for the rest of his life, so he don't have to puncture everytime he comes in lor...
Anyway heck care lor... as long as he won't die then you did your best liao right? -
I didn't have the last say... but I was screwed with some really hurtful statements... sometimes it does make you wonder the returns that you get after you tried your very best to solve the patient's not only medical problem but also social problem...Originally posted by DriftingGuy:Some people dont like foreign objects perm sticking out of from within their bodies I guess... Imagine trying to sleep knowing that theres a tube that leads from the outside to your stomach..
Anyway heck care lor... as long as he won't die then you did your best liao right? -
You can refer the patients to the social worker for assistance. They will help the patients in this area. As a doctor, you should know that there's KDF which is subsidised by the government.Originally posted by renorenal:I didn't have the last say... but I was screwed with some really hurtful statements... sometimes it does make you wonder the returns that you get after you tried your very best to solve the patient's not only medical problem but also social problem...
The in house dialysis center is for patients admitted in for different illness that happened to have kidney failure. The number of machines there is defintely not enough.
Contrary to what have been said, which ever method u chose, it is a torture.
socially, emotionally, monetary.
HD :
- Compulsory dialysis 3 times a week.
- Each session about 4 hrs. Must go to dialysis center.
- can only make short trips out of Singapore
- On the fistula arm, you are not to carry load of more than 10kg.
- if fistula vein block or not throbbing, high fever, or anything must check into ER immediately
PD :
- Compulsary 3X a day
- Can do it at home yourself. each session approx 3 hrs.
- Stomach will looked bloated. Forget about slim waist and going for a swim.
- you have to stockup cleaning fluid at home to perform the procedure.
- If you want to go overseas, have to bring them along. together with some declaration.
You took too lightly about the needling in HD. It is very painful. The first few sessions you are can take pain killers. After that you have to bear with it and accept it as part & parcel of your treatment.
As a doctor. Besides being medically competent in your profession, you need to have compassion too. Sometimes 'try your best' is not enough.
Cheers. -
Originally posted by Magnus:
Indeed, I have to agree with you on the pain issue, but that is variable amongst patients, as so far most patients that I have talked to told me that the pain is bearable, hence it made me to come to such a conclusion.
You took too lightly about the needling in HD. It is very painful. The first few sessions you are can take pain killers. After that you have to bear with it and accept it as part & parcel of your treatment.
As a doctor. Besides being medically competent in your profession, you need to have compassion too. Sometimes 'try your best' is not enough.
Cheers.
And yes, I do agree with the statement of trying your best is not enough, but the patient indeed left us with no choice, just to imagine you being in our situation, where we have arranged a place for him in the private dialysis unit (btw, I am based in Malaysia) and rush for his applications to get him an urgent location for HD.
Though everything has been set up, he still complained and wanted to get a place in the govt hospital even though the ones in the private clinic (more like social care welfare) offered for free dialysis.
The patient to us, is being unreasonable in this aspect, and not to even mention going to the hospital director and throwing threats at them.
I do understand that the above statement that you have mentioned most of the time involves patients who are cooperative and have a certain amount of denial in the first place, but such a condition I faced that I have just described is totally a difficulty. -
Thanks for the clarification. Suddenly then realised that you are from Malaysia. I'm looking at it from Singapore point of view. Sorry for my outbust.Originally posted by renorenal:Indeed, I have to agree with you on the pain issue, but that is variable amongst patients, as so far most patients that I have talked to told me that the pain is bearable, hence it made me to come to such a conclusion.
And yes, I do agree with the statement of trying your best is not enough, but the patient indeed left us with no choice, just to imagine you being in our situation, where we have arranged a place for him in the private dialysis unit (btw, I am based in Malaysia) and rush for his applications to get him an urgent location for HD.
Though everything has been set up, he still complained and wanted to get a place in the govt hospital even though the ones in the private clinic (more like social care welfare) offered for free dialysis.
The patient to us, is being unreasonable in this aspect, and not to even mention going to the hospital director and throwing threats at them.
I do understand that the above statement that you have mentioned most of the time involves patients who are cooperative and have a certain amount of denial in the first place, but such a condition I faced that I have just described is totally a difficulty.
I have seen a 14 yr old kidney patient while warded pull tantrums at her parents, hurled abuses at the nurses, ridiculed fellow patients.
I do have friends and family members who died, suffer, live from this disease.
In some of the cases, I felt it is negligence of the doctor and ignorance of the patient. The doctor will rush thru the consultation and the patient did not seek 2nd opinion. In the end, what can be control became end-stage. -
what kind of mentality is this?Originally posted by dragg:did we beat malaysia in this area too? -
Sigh... sometimes I am beginning to wonder how the hospital and clinics work in Singapore...Originally posted by Magnus:Thanks for the clarification. Suddenly then realised that you are from Malaysia. I'm looking at it from Singapore point of view. Sorry for my outbust.
I have seen a 14 yr old kidney patient while warded pull tantrums at her parents, hurled abuses at the nurses, ridiculed fellow patients.
I do have friends and family members who died, suffer, live from this disease.
In some of the cases, I felt it is negligence of the doctor and ignorance of the patient. The doctor will rush thru the consultation and the patient did not seek 2nd opinion. In the end, what can be control became end-stage.
Though we Malaysia do have our downs, but somehow negligence cannot be tolerated... -
U do know if you go against the system, you will be cut down right?Originally posted by renorenal:Sigh... sometimes I am beginning to wonder how the hospital and clinics work in Singapore... Though we Malaysia do have our downs, but somehow negligence cannot be tolerated... 
This happens to a few doctors/specialists that I know. They only mean to do good..but the administration dosent look kindly on it. -
Yeah... I know... but what to do? Sometimes you have to go against the system, but nowadays, things are getting better... the administrative personnel understand most of our intentions at the end of the day...Originally posted by alexkusu:U do know if you go against the system, you will be cut down right? This happens to a few doctors/specialists that I know. They only mean to do good..but the administration dosent look kindly on it. -
Originally posted by renorenal:Too many ppl with chronic renal failure and end stage renal failure... not enough machines to cover all... my goodness, it makes up nearly 10% of the whole of population, if not even more... almost all of those who are having diabetes mellitus now, will get kidney failure soon in about 10-20 years time... Diabetes is almost present up to 20-25% of the whole of population...