Case senario:

51 years old malay housewife presented with progressive painless left breast lump over 9 months duration associated with constitutional symptoms. It was an incidental finding when she went to OPD Hosp Pekan 3 months ago due to the productive cough. Despite noted the lump, she was not interested to go to the hospital  due to the fact that the lump was not painful. She was given a referral letter to HTAA and had only came last week. Currently, she is diagnosed with left breast carcinoma stage IV.

Things to think about…

Question 1: Did u agree with the management of the patient?

Question 2: If you were the Dr attended the patient in Hosp Pekan, what should you do?

Based on the history, we know already that the patient is not interested to go to the hospital. So, if we let the patient go, there is high possibility that the patient won’t come back or come later, like this patient who went to HTAA after 3 month of the referral. So, there is no point in taken the biopsy or diagnosed the disease when there is we loss the patient to treat. So, the 1st principle is to ADMIT the patient and then, refer the patient immediatley to the tertiary centre. After we hold the patient, then we can ensure that we can treat her after the diagnosis is established.

It is a shame for us to have the patient coming at us with such advanced stage of disease. Despite all kind of the mode of transportations and health facilities that are available in our country, it shouldn’t happen. It should be detected and treated earlier.

So, what should we do to change this? Think about it…