Saturday, January 29, 2011

Depression and Medical Certificate

Assalamualaikum,


I am a medical doctor. One of the first things that I was taught when I first started doing my housemanship (doktor pelatih) back in 2002 was how to fill a medical certificate (MC), its indication, the rules and regulation, the responsibilities a prescribing doctor carries with it as well as the medical ethics behind it. It is not as easy as A,B and C.


Back then, a houseman was still allowed to write an MC. Nowadays, they have lost the privilege. You need to complete your 2-year housemanship and become a medical officer to enable you to write an MC. A doctor needs to be ensure that the patient is really sick (and not pretending to be sick) and the sickness prohibits him from working because it affects his performance, he needs time to recover and the disease is contagious.


The duration of MC depends on the illness and the most likely duration needed for the patient to gets better or the illness to heal. For example, upper respiratory tract infection (cold/flu) may take up to 2-3 days to get getter, a laceration wound may take a week, a fracture bone can take up to 3 months...so it varies. The doctor's judgment must be based on his knowledge and experience and according to the medical ethics.


I was surprised to read the paper today exposing the duration of MC given to husband of PAS candidate for DUN Tenang, Maarof Abdul Mutalib. This information was first mentioned in marahku.blogspot.com. The blog also shows the certificates if your want to view them. The total MC were 21 days. The first MC was given by a private clinic (Pusat Perubatan Keluarga) in Labis (6-7 January 2011). The rest of the MCs were produced by Klinik Kesihatan bandar Putra, Segamat (10-23, and 24-28 January 2011).


Now, let us look at these figures. The 28th of January is today (Friday), tomorrow is Saturday, which is already a public holiday and the election day is on Sunday (30/01/2011). Hmmm....really, something fishy is going on here. According to the statement given by the PAS candidate herself (Puan Normala Sudirman) the MC was given because the husband suffered from Depression (Kemurungan). She said anybody who questions the MC should see and ask the doctor who had given out the MC himself.


I think the Ministry of Health should investigate this matter further by taking statements from the doctors who wrote the MC. It is not difficult to trace because every doctor has to write down their full name, IC number as well as their registration number on the MC. We know that a private clinic can only give a maximum of 2-day MC, but for the government hospitals and clinics, the doctors can give more.

Questions:
1. Why the MC has to be 3 weeks (21 days)? Why until today?  Just before the election?

2. Who is the doctor who given out the MC? Does he/she has the same political view as the candicate's husband party and hence want to help the party indirectly by giving the MC (in other words, not being honest and not following a doctor's oath and ethics)?

3. What criteria the doctor uses to diagnose depression? There are a number of criteria needed to fulfill the diagnosis of depression based on DSM IV (which is used by Psychiatrists all over the world) . I list them here from a website (in lay people's terms)



According to DSM-IV, the diagnostic manual from American Psychiatric Association, criteria used by mental health professionals, you have Major Depressive Disorder if:
 
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You have had an episode of depression lasting at least two weeks with at least five of the following symptoms:

(1) You are depressed, sad, blue, tearful.
(2) You have lost interest or pleasure in things you previously liked to do.
(3) Your appetite is much less or much greater than usual and you have lost or gained weight.
(4) You have a lot of trouble sleeping or sleep too much.
(5) You are so agitated, restless, or slowed down that others have begun to notice.
(6) You are tired and have no energy.
(7) You feel worthless or excessively guilty about things you have done or not done.
(8) You have trouble concentrating, thinking clearly, or making decisions.
(9) You feel you would be better off dead or have thoughts about killing yourself.

bullet
These symptoms are severe enough to upset your daily routine, or to seriously impair your work, or to interfere with your relationships.
bullet
The depression does not have a specific cause like alcohol, drugs, medication side effect, or physical illness.
bullet
Your depression is not just a normal reaction to the death of a loved one.

You see... you need at least 5 of the above criteria PLUS an episode of depression lasting for 2 weeks. I don't think he suffers from this illness if we based on the above criteria. He was really happy, smiling and up and about from what I can see on the Buletin Awani news at 7pm today. However, I might be wrong because I don't see him myself, take a thorough history and full examination.



4. He is a teacher at SMK Tenang Stesen. How can he is on MC and then go out, campaigning with his wife all over the DUN Tenang area? Is this a right thing to do? 



5. If he really suffered from a depression, shouldn't he be on anti-depressive medication? If he needs 3 weeks of MC, would he be better to be admitted to hospital for treatment? Psychiatric ward maybe?


6. Was he ever seen by a psychiatrist (pakar sakit jiwa)? He needs proper treatment if he really suffers from depression.  


I think  the Ministry of Health needs to investigate this matter further and interrogate the medical doctors involved. I really think something fishy is going on here...If he really is sick, he needs treatment and proper attention from a qualified psychiatrist. I he does not, then the doctors had done something terribly wrong, sinful and misuse his position as a doctor, do something against his oath, medical ethics and code of conducts and actions should be taken.


PAS, PAS....I really don't expect this from PAS people (who are supposed to be religious, honest (amanah), responsible towards themselves/other people (if you are sick, please seek treatment, take appropriate medication and then, rest at home - not campaigning. If you are not, then, you should go to school and teaches your students, that is your amanah and responsibility). 


I gave PAS credit in my previous post. This time, sorry PAS. I am so frustrated with you.



Enough said. 

7 comments:

  1. lawak plak baca pasal ni..maybe depression dia bertambah kalo duduk diam kat rumah kot :P

    tak tau pulak MC pun ada syarat2 camtu. Yah selamba ja bagi MC kat patient hari tu. Siap tanya lagi dia nak berapa hari. Isk2. Thank you for this entry. Belajar benda baru =)

    ReplyDelete
  2. baiknye yah, nk mc please. kya depress sgt sbb pressure keje wiwiwiwiwi

    abg din, that is really embarrassing. kalau betul doktor tu misuse jawatan die sbg doktor, smoga tuhan balas. insyaAllah tak berkat keje dia sbg doktor. (tak tau la kalau bagi die bg MC dikira sbg perjuangan menegakkan islam)

    ReplyDelete
  3. "I gave PAS credit in my previous post. This time, sorry PAS. I am so frustrated with you."

    aik? agak2 la, dr. Dr. frust dgn sapa? PAS the party, calon PAS or suami calon PAS?

    what if i give bad credit to all Malaysian doctors because of the bad few? and yes I do know quite a number. would that be fair? you, on the other hand, are not being fair. if the allegations were true, should the action of the candidate's husband be attributed to PAS? or was it his own shortcoming?

    berblog memang seronok. bagi pendapat lagi la seronok but beware dengan perangkap blog. jangan ingat kita boleh cakap ikut suka. cara dr. ni mcm nak berkempen je.

    of coz, Dr. bebas bagi pendapat, tapi tolong jangan sewenang-wenang nak kaitkan sikap SUAMI calon PAS tu dengan PAS.

    ini masalah orang kita, suka generalizekan orang lain dengan pandangannya. pada masa yang sama, marah sgt kalau dia sendiri digeneralizedkan.

    Dr. semua memang makhluk yang heartless <-- generalization jugak ni, boleh terima?

    yg benar,
    bukan ahli PAS pun

    ReplyDelete
  4. Dear 'bukan ahli PAS pun',

    Thank you very much for your comment. I really appreciate it.

    Of course, being a blogger, we have to be open for criticism. For every point, there will be people who will agree and disagree with you. I take full responsibility for what I wrote.


    Those who do good things towards other people deserve to be given credit, either BN, PR or Bebas. If PAS does good things, then we should support the effort. The same goes to other parties too.


    Yes, it does look like as if I am campaigning, isn't it?. In this post, I only outline the DSM criteria for depression, the ethics of giving MC and the points related to it (these are all facts). The rest, we can judge by ourselves.


    If the allegation is true, it is not PAS's fault of course, it is his own shortcoming (sorry for not being clear enough on this).


    PAS carries Islamic image under its name, for all we know, in its constitution, one of the agendas is to establish an Islamic state. PAS members portray the image of the party. Taking long MC, and then campaigning during the MC period will only give points for BN to attack PAS. And yes, I am frustrated, because his action gives bad image to PAS. (and indirectly to Islam as well because PAS is fighting for Islam).


    Yes, our people like to make generalisation (maybe you're an exception). We label the whole community for the action of a few. For example, Malays are lazy people, Malaysian like to throw rubbish out of their cars, Chinese are hardworking, Malays are not punctual etc.


    If you want to make generalization about doctors, then go ahead, it's your call. And yes, many doctors (not all) are heartless, I can accept this statement.

    Dr. Mahyuddin

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