Wednesday 7 October 2009

Are you listening to me, Doctor??

I remember back in the days when I was in medical school, 'communication skills' were the big thing. How to speak to your patients to get the best information, how to ask open questions so you get answers that are the patients own and not what they think you want to hear... And on and on ad nauseum. Well, I have had cause to visit a fair few medical practitioners since I've stopped working and I have come to realize a few things... It's easy to speak to doctors who are trained like I was. They're the ones looking earnestly at you and saying things like,'...and how did you feel then?' or '...what else happened after that?'. Things changed when we got here to Jakarta. For one, the poor air quality meant kiddo's asthma and allergies and what have you all made a massive comeback. Not to mention the food poisoning etc etc... So forever at the doctors clinics mean wading through a lot of chaff to get to the wheat.

The first thing I noticed was that people in general are very laid back and smiley here. Same for the medical staff. It's not that your problem is unimportant, but that's the way they are. Some more so, some less so. But in general, going to see a doctor here is a little like walking into a spa. They speak in the same soothing voice, same smiley face... I've essentially had to come up with a way of giving them information so that they get the important bits, and not wait for the polite pauses before they ask about the next symptom. I'm always concerned that they will forget something in the time it takes for the consultation to end.

This is what I do... I tell them everything that has happened in sequence, what I've done, whether it's been effective and what's happening now. E.g. I've had a cough for 4 days and a fever for 2. The fever goes away with panadol every 6 hours but for the last day I have had green phlegm and my chest hurts when I breath. 10mins condensed down to 1min. I never tell them what I think the diagnosis is because a) I don't want to influence their thinking b) I'm interested in their diagnostic processes c) there's a reason doctors are advised not to treat themselves or people close to them... I was once so annoyed by hubs complaining about a couple of spots that I missed the fact he actually had shingles!

Another thing I've noticed is that all the competent doctors in Jakarta only practice during office hours. Off hours, it's dicey. I have yet to see a doctor, or hear about someone seeing a doctor off hours that has left me feeling anything other than nervous. On our first trip here, kiddo fell and split her head open. We went to SOS and the doctor on call (she looked younger than my 20 yr old cousin!) had to call someone to ask for advice on whether she should put stitches in. Also consulted ME on whether the skull XRay was ok! Um... anxious mom dealing with freaking out husband and kids here!!! In any case, kiddo left sporting 3 stitches in the back of her, thankfully, unbroken head. Lots of other stories on weird and wonderful diagnoses to cover for the fact that some on call guys really have NO idea what's wrong with you... And obviously can't even make up plausible stories. Others are just forgetful. My husband got a metal splinter and the fellow forgot to ask about tetanus status! I had to ring the practice manager from KL where I was on holiday, and she had to then call the clinic and get it sorted. What a hassle!

Well, I discovered a handful of doctors that I trust. Top of the list is Dr.Ade, a GP at Global Doctors. She's there all week but not weekends. Lovely lady. Very competent though does appear very laid back. Very good diagnostically. The regular GP at SOS was good too though I have to say that I 'bonded' with Dr. Ade much better. For kids, the selection is better. Dr. Isabella and Dr.Lineus at Jakarta Women and Children Clinic are pretty good. Though I have had some raised eyebrow moments. Nothing horrific. Dr.Isabelle (different lady to that at JWCC) at Global is also very sensible and nice.

The one paediatrician I wish was still in the area is Dr.Johannes. He's a paediatric pulmonologist (chest doctor) who used to be at JWCC and is now somewhere in Tangareng. Not much bedside manner to speak of. Very brusque and hurried (unlike his other local colleagues) but he sorted out kiddo's asthma and allergies within 6weeks. Hats off to him, wherever he is...

All in all, medical services in Jakarta are probably not as terrible as made out to be. But how on earth do non-medical people decide which doctors to see?

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