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By: Haliza Zurah
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| Thursday, 13-Jul-2006 15:44 |
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Esei Perubatan mengenai Sakit Puan
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Gambar hiasan semata-mata
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Doktor wanita
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Berikut merupakan laporan yang saya tulis mengenai isu sosial berkaitan dengan bidang perubatan setelah didatangi seorang pesakit. Melalui esei ini, saya cuba gambarkan cara pemikiran seorang doktor dan halangan dihadapi daripada komuniti. Esei ini ditulis sebagai tugasan kolej pada akhir rotation General Practice (klinik swasta).
A 20 year old Indian lady came to Bayan Baru Clinic with a history of missed period for 2 months where the last menstrual period (LMP) was on 28th April 2006. We asked if she thought she might be pregnant. She admitted on having unprotected sex with her boyfriend. Urine Pregnancy Test (UPT) was done and it turned out to be negative. We asked if she was relieved, she said yes.
We also assumed that she was exposing herself to Sexual Transmitted Illnesses (STI) because we should take the information more broadly to the point that she may have sexual intercourse with more than one man. This is partly why we were ready to start on consultation with the patient. We took the opportunity to ‘chat’ about the contraceptive method available with her. However she refused to listen to our advice about using contraceptives. When asked what she’ll do if she got pregnant, she said she will take care of the child. On further questioning, she also hoped that she will not get pregnant (even without contraceptives).
Part of doctors’ obligation is to make the patients understand the situation they face and giving out options of medical services and products available. However it is not an easy task if the patients do not want to listen or block their minds from understanding. In this case, the patient does not even know what she wants. She also appeared to have no principle and very much confused. The patient may have a self-conflict on wishing to meet the motherly instinct /woman nature on having a child but at the same time feeling unprepared to accept the responsibility. Of note, the elder sister had her first child at very young age and this may be the major contribution to her conflict.
The effect of this behavior among the community is failure to establish knowledgeable patients on self health management. We are not able to get our message across to help them in finding solution of their health problems also advices on long-term health care. This is a real problem faced by medical practice in Malaysia. The patients are not willing to learn about their illnesses. It is rare to find patients who have their own initiatives to study and gain knowledge about their diseases. Community members also not very sensitive about the current issues brought up by the Ministry of Health that meant to educate them about their own health care.
This patient appeared to be not well educated and her family aware of her having sex with her boyfriend. In cultural aspect, the acceptance of family with pre-marital sex shows that the community has changed the perspective about this issue. Recently, sex is becoming less sensitive where Malaysians are more open to discuss about it. No matter how open the community is becoming, there are still part of Malaysians who still find sex as a sensitive issue to be discussed openly. We have to beware of that matter therefore in General Practice, it should be dealt gently. The consultation should be patient-oriented session that focuses on the patients’ needs. Also we have to become more concern about the cultural and religious aspects as we live in a multicultural country. Example, to give advices on contraceptives use, we have to ask which will be the preference instead of giving a long lecture on all six contraceptive methods. Also consider factors such as partner preference, age, religion, culture/ethnicity, family, parity and the need of reliability. This will be a more successful consultation.
Personally, I will not be able to say much to this patient. She had a decision for the meantime but I will reassure her that she can always come to see me to seek any advice on her issue with women’s health. With this action, I will be able to play part as a health promoter, giving advices on health protection and prevention of ill-health.
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