What is the diagnosis… (1)?


This is a funny clinical encounter when I did my elective in IJN in Adult Cardiology department.

 Female, 56, complained of tight chest pain, pain in the eye, inability to talk. She has been consulting many specialists of different medical fields (gynecologist, gastroenterologist, neurologist etc). Her previous visit to a physician was chaotic since she demanded answer to what was really wrong with her and ended by her refusing to pay for the consultation fees. Clinical investigations showed no risk factor of any cardiac disease (normal cholesterol level, BP 120/70, no DM, not smoking, not alcoholic). Previous tests were normal (ECG, Echo, CXR, blood tests, OGDS, Stress Test). Other tests also showed no abnormalities in her. The previous physician concluded that she has anxiety disorder and begged the current physican in IJN to refer the lady to psychiatry. When the physician in IJN told her that nothing was physically wrong with her, she kept complaining again and again about her problems.

What is your diagnosis? I think the lady had Somatization Disorder since she complained of multiple organ systems problems with no identifiable underlying physical findings.

Hehe. Talking about IJN, I wanna bring an old news about Dr. Mahathir having a heart operation called Coronary Artery Bypass Graft (CABG @ Cabbage @ Bypass) in IJN. FYI, CABG is the largest number of adult cardiac surgeries (70-80%) and the success rate in IJN is 97%. All the consultant surgeons in IJN have mastered the surgery pretty excellent already, and guess what?

Dr. M flew out a chief cardiac surgeon of one of the best hospitals in US, the Mayo Clinic, Rochester to assist in CABG operation along with the already excellent and best cardiac surgeons in Malaysia to conduct a relatively not-so-complicated operation on him. Being a harsh critic of the US, it’s very ironic that Dr. M trusts Americans with his heart on a personal level.

This reminds me of a very rude post-op VVIP patient who demanded that no medical student (me) should be in his room, only chief of cardiac surgery department operate on him, and demanded too much from the nurses… prepare the milk like I instruct you to, clean me like I instruct you to, do this la, do that la… He is a political secretary of a current Malaysian minister.

 Hmm… guess when those people on higher ground fall, they really feel the pinch, huh? Now, now, instead of importing surgeons or demanding super VVIP services, why not just improve the currently suck healthcare system? Better government hospitals, better pays, better equipments and amenities, better working hours, better training and education for doctors and nurses… With this, even the unluckiest can benefit something out of it.

4 thoughts on “What is the diagnosis… (1)?

  1. huhu..i’m clueless about the diagnosis..waaa..can’t even guess anything..btw about these high status people,they wont realize anything until they get in the same boat as the unfortunate one…

  2. Kamilsifu: don’t worry, you’ll learn more on 5th yr on psychiatry rotation (hope they really teach us about this) else better learn yourself because you dont wanna be damned during housemanship.

    Ompok: yeah she is. medical studnts also are hypochondriac; they learn a new disease and they think they’ve got it. Hopefully that lady wont get worse till Munchausen syndrome

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