ICE ICE Baby

For those who are old enough to remember when Vanilla Ice dominated the airwaves, I apologise for reimplanting that tune inside your brain. You will now be playing it in your head for the next few days. But the topic I wish to blog on today is not white rappers, but something related to the clinical encounter.

Back in the days of Community, Occupational, and Family Medince (COFM, aka cough-medicine) in med school, we were told that being a doctor involved more than diagnosing and treating diseases. There was also this other inconvenience called the patient we had to deal with.

We were told that every patient had his ICE - Ideas, Concerns, and Expectations. Now let's see how much I can remember of what dear old Prof Goh has taught...

Ideas
By which we usually mean erroneous ideas, exemplified by the new mother who comes to your clinic stinking because she hasn’t taken a shower in a month for fear of ‘wind’ getting into her bones.

Concerns
By which we usually mean irrational concerns, exemplified by the woman who refuses to go for a Pap smear because she’s worried about the cost of treatment for cervical cancer if she is found to have it. Well, I suppose a funeral is expensive too but that’s one expense we all can’t avoid anyway.

Expectations
By which we usually mean unrealistic expectations, exemplified by the guy who thinks he needs 2 days MC because he’s got an itch on his arm.

The underlying message from COFM seemed to be that a good physician will take into account and explore these ICE, and deal with them effectively to ensure a good clinical episode. The other implication is of course that if you fail to take the ICE into account, you are a bad doctor.

In other words, ICE is the reason why patients are sometimes bastards.

Well, what they forget is, sometime, on the ICE planet, the doctors strike back…

The truth is, my dear patients, we too have our own ICE – doctors' Indicators, Clinical Guidelines, and Ethics!

(Aspiring medical students, if you read this in a textbook someday, remember you saw it here first.)

Indicators
By which I mean performace indicators. Doctors in the public sector are already audited, and Ministry of Health plans to audit all those in the private sector too, down to GPs. This means that our performance bonus or continuation of license will depend on how well we meet the target numbers.

So if your blood pressure is consistently above 140/90mmHg, or your HbA1c is consistently above 7, and you refuse to step up your treatment, GO SEE ANOTHER DOCTOR! I don't care if you have a valid reason for not being able to live up to the Ministry's standards like you have no money for the medicines or if you are blind, live alone, and have no one to administer your insulin - it's totally unfair for me to suffer for your predicament. Go sabo someone else!

Clinical Guidelines
In case you haven’t realised, doctors don’t suka-suka treat their patients. There are studies involving tens of thousands of human guinea pigs conducted by big drug comapnies who tell us that's how they prove their medicine is the best one for you. If we deviate from these guidelines, we might get into trouble with the Medical Council when something goes wrong. The fact that the drug company sponsored my last conference-trip to Hawaii has nothing to do with this, of course.

So if you don’t want to follow the treatment I recommend, GO SEE ANOTHER DOCTOR! Again, don't expect me to risk losing my license just so you can be treated according to something you read on the internet, newspapers, or your religious text. If you just happen to be one of those people for whom standard treatment doesn't work, please get out of the gene pool and my patient pool.

Ethics
Last and definitely the least. There is a code of conduct which governs the things a doctor should and may not do. Doing something that is considered ‘unbecoming to the profession’ is punishable by the Medical Council too and very malu when your classmates find out.

So if you want to get your kicks from cough syrup, sleeping pills, or give or receive sexual favours from me, I will tell you: "GO SEE ANOTHER DOCTOR!". Go make your request somewhere else... like the Bubble Tea stall which happens to be co-located on my premises...


I guess my point is, at the end of the day we are all human beings with our own wants and constraints. I don't believe any of us (patient or doctor) wakes up in the morning and decides to go to a clinic just to piss someone off. Doctors know patients have their reasons for encounter (another COFM term), but patients must also understand doctors have limits and standards placed upon them.

It's professional, not personal.

Bonus Quote from House MD

Dr. Eric Foreman: I thought treating patients is why we became doctors?

Dr. Gregory House: No, treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable