11 May 2008

Malaysian hospital series 0004

Series 0004: Code of ethics for radiographers

Hari ini temani dia ke klinik. Sakit pada tapak kaki katanya.
Doktor minta lakukan x-ray, jadi temani dia jalani foot x-ray.

Kemudian kami menunggu untuk dipanggil kembali berjumpa doktor selepas radiograph siap diproses.

Selepas beberapa ketika, radiographer tersebut hendak menyerahkan radiograph (x-ray film) kepada doktor, tetapi kebetulan melalui kami. Apabila terpandang dia, radiographer tersebut terus menyapa dia.

"Tengok ni, ada benda tajam kat kaki." Katanya. "Sebab tulah rasa sakit...bla bla bla.." Dan dia masih meneruskan kata-kata.

Saya yang sedang ralit membaca terus teringatkan sesuatu patologi yang pernah dipelajari di kelas. 'Calcaneal Spur!'
Dan serentak itu saya mengangkat kepala melihat film tersebut.

'Betullah calcaneal spur. Tak sangka..' Hati saya berbicara lagi.

Setelah radiographer itu berlalu pergi, dia bertanya beberapa perkara kepada saya berikutan kata-kata radiographer tersebut. Saya menjelaskan serba sedikit sahaja.

Calcaneal spur ataupun flower horn (ini panggilan oleh para doktor), lebih kurang boleh dikatakan cangkuk yang terbentuk daripada tulang (read: hook of bone). Biasanya terbentuk di tulang tumit (read: calcaneus).

[note: I have to continue in English, it's hard to explain in Malay..]

This kind of heel spur is not the primary caused of the pain. It is due to the irritation to the soft tissues (read: fascia) when the spur pressed on them. Thus, the pain occured when the patient is in prolonged standing or walking. This condition also get worsen every morning after sleep, when they tried to have the first step on the day.

If you wanted to know why and further infos, you can always google them, aite?

Back to the main topic, the radiographer is actually not following the code of ethics even though he has a good intention (read: ni'at baik).

In Malaysia, the KKM (read: Ministry of Health Msia) has set up a list of ethics for radiographers (read: grade U41 and below, above than that, I am not sure). One of them is the radiographer could not deliver any information or suggestion, diagnosed from the film to the patients. The word suggestion here is in the term of bahasa isyarat dan yang sama waktu maghrib dengannya. Heh, I'm just kidding.

In other countries, those radiographers have the right to do the report for each film, being at the same level as radiologists (read: Radiologist is a medical practitioner who makes a speciality in radiology). It is only in Malaysia where radiographer could not say anything. It is going to be hard if the patients are our family members.

Thus, I do think the KKM should revise back on this issue for the U41 radiographers (read: Ni level degree holder). Because they have the knowledge on the pathology, and tell you what, in Msia, most of the radiographers are better than doctors in analyzing a radiograph. This is what happened in real life.

Why did I say that? Before giving evidence, I would like to give a logical reasoning on this matter. Radiographers saw various films every day, reaching hundreds every week (read: for GH etc usually in the range of 800 every week). They really could differentiate between a normal and abnormal anatomy shown on the radiograph as they have diagnosed many of them every day. Practise makes better, isn’t it?

A case for example; a patient complained on having pain and being x-rayed. The doctor looked up on the film and said everything is normal. Luckily, her brother who accompany her is a radiographer and found a fracture on the film. He quickly went back to the doctor, and show up the fracture. And the doctor admit that she missed it.

The patient might be going home and suffer if the fracture was not found. And the doctor is actually almost giving harm to her. This is where the importance of team work. I mean, the doctor can easily ask for other doctors’ opinions to avoid this, just for reassurance that everything is alright.

I am not understood why the KKM has set up the limit. Looking at the condition in Malaysian hospitals, many radiographers who have talents and knowledge were not treated so just because they are not radiologists. For example, ultrasound scanning could only be performed by radiologist, even though radiographers also have the specific skills on the machine. Hey, we know how to handle the probe. =P

For this issue, it is like an ‘adat’ (read: tradition) for this to happen. Radiographers’ knowledge, skills and status is lower than radiologist, one tradition. Ultrasound is only to be performed by radiologists, one tradition. Means, we do learn and practise on this in our university, but the knowledge is nowhere to be applied in working place as they won’t allow us to. Thus, takyah ar susah2 blaja kalo da memang hanya jadi hak radiologists ;p (read: takpe, additional knowledge)
Hey you, the future health practitioner to be will change this environment, inshaAllah.

We have once being practise in a condition where we do scanning for our cousin who admitted to A&E due to trauma (read: accident). The film showed a bleeding inside the brain. The real challenge began after the scanning where the family members asked us what is the condition. Sedangkan kod etika cakap kami takleh bitau pape.

The lecturer being as the family member, and ask us one by one. Really, buntu fikir the best answer. Nak bitau hal sebenar, langgar etika. Nak cakap tatau, takkanlah tatau. One more thing, our lecturer akan bidas balik our answer as a view from a family member. So, when I were asked what will I do, I said,

"Sir, I wont do the scanning, I will pass the job to Najwa." Pointing to a friend besides me.

"So, you are escaping, huh? Means that, in the future you have to be in the same hospital with her." He said.

Heh, dah kena balik. The easiest solution is, work at the place where you have no relatives there. Hehe.

note: Bila sampai turn najwa untuk jawab soklan sir, she said,
"If it were my relatives, then, I will pass the job to Hasanah!" Hoho, macam tu eh. :)

For this issue, remember, ni'at tidak menghalalkan cara. Tapi pandai-pandai jelah. Bila da masuk bab ni, susah jugak, tapi pasti ada cara. Just avoid where you can, and deal secara saksama where you cannot avoid. Applicable for all issues in life. InshaAllah.



Faisal Admar said...

Saya baru tahu pasal calcaneal spur nih. Terima kasih kerana kongsi info ni. Maybe saya kena bawa umi saya check/scan di klinik. Boleh la mention pasal benda ni nanti dekat doctor.


NMZ said...

Betul gak, die biasanya jadi kat middle age person.
And in fact, kite takka sedar pun sebab jas rasa mca masalah skin..so boleh gak gi check