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Showing posts with label cold. Show all posts
Showing posts with label cold. Show all posts

Tuesday, June 15, 2010

A Family Doctor's Tale - MY COMMUNITY OF PATIENTS

MY COMMUNITY OF PATIENTS

Patients consulting me at the clinic were mostly from the housing estate in which the clinic was situated.

There were 8 clinics all together in the whole housing estate plus 2 Chinese traditional medicines shops with sinsehs (Chinese traditional doctors). 
Competition was pretty tough. 
However my clinic work was more of a community work for me so I do not mind the competitions as long as I have a reasonable income from the clinic.

Fifty per cent of my patients were of the low income and low middle income group of the population situated in the housing estate and nearby rundown shacks of Holland Village. 
A few were from the landed properties near Holland Village.

At that time Holland Village was not the glamorous Holland Village which you will see now with its many eateries and niche shops. 
At that time it was more like an arts and craft type of village with cheap goods.

The remaining fifty per cent of my patients comes from various parts of Singapore. 
There a group of Hainanese dialect Chinese patients from Sembawang recommended by their relatives. They were a close knit community. 

There was another group of Teochew patients from the Hougang area. 

There was a diverse group of patients from a kampong (rural village) on a small island called Pulau Brani who has relocated to Telok Blangah and Queenstown who were recommended by one of their friend who was cured of his asthma by me.

There were also groups of Malays staying in Queestown, Chua Chu Kang, Bedok and Jurong who were recommended by a friend who was treated for her osteoarthritis with great improvement. 

Some patients came from Johore which was in Malaysia and Tanjong Pelanping in Indonesia. The standard of medicine in their countries were not as good as in Singapore. 

Such was the power of word of mouth in spreading my reputation as a good doctor.

 Early in those days I was seeing babies treating them for jaundice, infection of the navel, and of course colds, coughs and diarrhea.
I used to give away pamphlets on breastfeeding which was still the recommended method of feeding. 
For those who were already on milk powder, there were samples of free milk powder given by milk companies  to promote their brand of milk and an accompanying mother's book on how to use the milk, taking care of the postnatal problems, and taking care of the baby.

I also gave childhood vaccinations to the children such as the Triple antigen of tetanus, diphtheria and poliomyelitis until the 1985 when all the children slowly migrate to the care of their own pediatricians (children doctor). We had to throw away a lot of those expired vaccines and stopped  the vaccinations.

I also did prenatal examinations for all pregnant women who wished to be under my care giving prenatal monthly checkups and vitamins until the fifth month of pregnancy when they were referred to Obstetricians in private or public hospitals.

There was a Malay woman from one of the islands of Singapore who was married to an older Malay Man.
She was under my care for her first pregnancy. She was a naive and trusting woman and refused to go to Hospital until she was due to deliver. I advised her on the need to check on any pain or bleeding. Everything went well until the day when her water bag burst. I check on her , confirmed that the head of the baby was inside her pelvis and sent her to hospital.She even asked me when she would deliver. I told her "about six hours". True enough she did deliver 6 hours later. It was her belief in her doctor that made her deliver exactly at that time.

Nowadays all the pregnant women would see their own obstetricians and preferably female obstetrician.

Up to today I have families up to 4 generations who still come to see me though they have moved away from the estate. 
Of course they would consult their nearby doctor first but if they did not improve, it was back to their old family doctor (me) for treatment.

Many of my old patients have passed away during my 36 years of family practice but their families still come to see me or buy my cough mixtures, skin creams or my combination of drugs for rheumatism, cold, cough or diarrhea.

If your treatment is good , there will always be patients who will follow you. Even if they cannot come themselves, they will send their families or children to buy the medicines that worked for them.

Wednesday, June 2, 2010

A Family Doctor's Tale - THE RUNDOWN FAMILY CLINIC

THE RUNDOWN FAMILY CLINIC

It was a rundown family clinic in a nearby old satellite town with mainly people staying in public housing. 
There were a few factories around the town where people from the town can find jobs. 
There were also a large area of landed property surrounding the town which houses mostly the middle class population. 
There was a primary school in the town for the children staying in public housing. 

It was also the only family clinic in the town.
It was started by an Indian doctor who has been there for almost 15 years. Because it was run down and small , there were very few doctors willing to work at the clinic especially on a commission basis. Most prefer work down the business district with a fixed salary.

For me it was a challenge to my medical ability to run a small rundown type of clinic. Besides I like informal dressing and this clinic was very informal. There was no need to wear ties and most importantly there was no night duty so I have more time to spend with my wife and daughter.

My first 2 days were spent with the old family doctor going over the medicines, the drug companies that I can order from, the factory contracts that he has and how to charge for them, finally recording all the income and expenses in his account book. He also left his phone and address in India for me to contact him if necessary before he left for India.

The mornings begin with a trickling of patients with the usual cold (A Simple Guide to Common Cold), cough ( A Simple Guide to Coughing) and diarrhea (A Simple Guide to Gastroenteritis). Most of the patients were from the nearby public housing apartments. There were some contract patients from the nearby factories.There were also a few middle class patients from the nearby landed properties who as usual like to ask a lot of questions.

Whether rich or poor I treated all my patients with respect and as equals. Soon I developed a following of patients due to my friendly attitude.

Most of the afternoons were fairly quiet so I spent some time getting to know the medicines available in the clinic. I tried mixing some mixtures and combination of medicines to see whether they have better effect on the treatment of the patient. I also called up a few drug companies to send their sale men to see me in the afternoon and promote their medicines.

I also manage to get their price lists of medicines to familarise myself withe wide range of medicines in the private medical practice. Some sale men will leave samples for me to try their product in order of getting orders from me.  I also tried out the samples to see which are effective and which are not.

In the meantime I was also learning from the the elderly Clinic Assistant who treated me like a son. She was 50, in the pink of health and very healthful in her advice on the use of certain medicines. She also did stock taking and advised me to order medicines whenever stocks were low. I was very lucky to learn from her experience.

Besides the usual cold , cough and diarrhea cases I have also seen skin allergies( A Simple Guide to Allergies). skin infections, muscle sprains, arthritis( A Simple Guide to Osteoarthritis), hypertension( A Simple Guide to Hypertension), diabetes( A Simple Guide to Diabetes mellitus) and giddy spells( A Simple Guide to Dizziness).

There were of course the ENT cases of fish bone stuck in the throat or foreign body in the nose and ears which I easily removed due to my ENT training.

On Saturdays morning my wife will bring my daughter to the clinic to explore the area and also play in the playground provide by the satellite town.

It was a fairly easy life compared to my hospital postings.Very soon the 3 months had passed . My patients had increased 150% from the beginning and I was getting a salary of average $1,800 (from the 70% profits) which was above the $1,500 most of my locum doctor friends were getting.

Before the end of the 3rd month, the old Indian Family doctor asked whether I could stayed another 2 more months as he was held back from returning to Singapore. I was happy to continue as some of the patients were sad to see me go.

In the meantime I have learned a lot about a family clinic work.
1.How to write in the drugs for every patients in the Medical dispensary book
2.How to order medicines
3.How to write vaccination certificates
4. Hoe to issue death certificate in a heart attack case where I had to make a house call
5.How to keep an income and expense account which was important for income tax purposes.
6. How to deal with malingerers giving them the benefit of the doubt the first time and warning them that I will not be so pleasant the next time.


By the time the old Indian Doctor returned I have mastered every thing I need to know about running a solo clinic.
The old Doctor was surprised that I did so well. 

In fact my wife and I like the clinic so much that we made an offer to buy it from the old Indian doctor. However he was not willing to sell.

Thus ended my experience in the Small Run Down Clinic.

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