The Other “SIADH”
Physicians are familiar with the term “SIADH” (Syndrome of inappropriate secretion of ADH”) where ectopic foci such as tumours secrete ADH without the body needing to conserve water. The result is water retention, volume expansion, low plasma osmolality, dilutional anaemia, hyponatraemia, hypokalaemia and the consequences thereof.
Another kind of SIADH (Syndrome of Inappropriate Attitude of Doctors in Hospital) has emerged in an age of changing values, inadequacy of healthcare personnel resource and declining respect for the profession. Whilst the majority of doctors are probably professional, efficient and caring, it is undeniable that there is a minority who are rude, overbearing, uncaring and money-oriented. Social media is full of anecdotes which demonstrate this other SIADH; some authentic, some biased against doctors. Worse still are cases where such attitudes cause harm to patients. The first principle of good clinical practice is “Primum non nocere” (First do no harm).
It seems that members of the “noble profession” are unprofessional (The easiest definition of “professionalism” is “the contract between the profession and the community it serves”). A quick look at the Hippocratic Oath reveals that these undesirable attitudes amount to breach of contract. We have talked in jest about the “Hypocritic Oath” for a long time, but in recent years, it has become too real for comfort.
The attitudes and practices most often complained about by patients are:
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- Unpunctuality – not keeping to appointed times.
You cannot really blame the specialists because most private hospitals do not have in- house specialists who have to serve many hospitals, necessitating travelling in heavy traffic. Patients are also partly to blame, insisting on being treated by certain specialists who end up seeing hundreds a day.
- Hurried consultation- patients get just a few minutes of consultation after waiting for hours (often unearthly) way beyond their appointed times.
This is inevitable when specialists have to see hundreds of patients a day. Until the 20- minutes or 30-minutes per patient rule can be enforced (which again depends on producing more specialists), this issue will not be resolved. - “Rude behavior”
There is really no excuse for this attitude. Granted, the doctors are overworked, but we owe it to our patients to treat them with respect. - Inadequate information given to patients.
Medical schools have a responsibility to train graduates in giving adequate and effective communication. This area had not been fully addressed until the last two decades. - Patients excluded in planning management of their illness.
This concept is almost unheard of in our country. Doctors have been reported to discourage patients discussing their case with them with a haughty “Are you the doctor or am I”? - Over- investigation (many doctors get commission on investigations ordered)
A long time ago, Prof. Daw Nan Oo recounted a story of how a pregnancy diagnosis test was done on her 7-months pregnant patient. My husband went for a consultation for “feeling cold” and they just ticked off the investigations , including PSA although he had had his prostate removed. - Not accepting second opinions.
Patients tell stories of how specialists would get angry if they went to another doctor. This demonstrates narrow-mindedness on the part of our doctors. - Long hospital stay- having to stay on just for follow-up.
When my daughter had her son, he was diagnosed with G-6 PD deficiency. We were told he would be discharged early the next morning, after the specialist saw him at 7:30. I waited there all day. She came in at 4:30, just glanced at me (no greeting, although I had taught their batch), and scolded the MOs for two minutes and left. For that, we had to pay for the room for an extra day.The “service charges” were for taking temperature, body weight, blood pressure. Should these not be included in the hospital admission?
- Hidden costs for hospitalization e.g. “service charges”, charge for bedding, charge for taking out garbage etc
The “service charges” were for taking temperature, body weight, blood pressure. Should these not be included in the hospital admission?
Doctors should self-evaluate the quality of their services. This is the least we can do to uphold the status of the profession and preserve our self-respect.
Kind regards,
Dr. Hla Yee Yee
Author Information
Hla Yee Yee
MB,BS (Rgn); M.Sc(Mdy); PhD(Lond); FRCP(Edin)(Hon); Cert.in Leadership for Physician
Educators ( Harvard Business School).
Honorary Professor, University of Medicine 1, Yangon
