discharge please

"Tak boleh discaj ke doktor? Doktor saja je kan nak tahan anak saya lama2 kat wad ni,"
"Cucuk sana cucuk sini. Doktor nak buat anak saya bahan ujikaji/eksperimen ke?"

These are comments that my colleagues and I are quite familiar with receiving.
My short and immediate response?

"Tak."

Honestly, as a paediatrician working in a busy government hospital, I definitely do NOT want my ward to be full with patients. I prefer to have zero admissions. If patients do need to be admitted, I will try my best to make sure that they don't have to stay more than they have to. In paediatrics, patients are babies, infants, toddlers, children. So lagi la orang kata "Kasihaaann. Budak kecik."
So yes, the less veins we need to prick, the less pain we need to inflict, the better.
Believe me, even though pricking patients for blood or IV cannulation will help junior doctors to master this skill, no house or medical officer ever groans at me when I tell them "no need to take blood" or "no need to insert IV line". Lagi diorang happy adala.
For us, the less work the better.

So why do we still admit patients to the ward? Why do we keep some of them longer in the ward compared to others? Why do we send multiple investigations, not just blood, but also, urine, stools, sputum and even the often "feared" spinal fluid sometimes?

Well, why are the children brought to the clinic/hospital in the first place?

Children don't bring themselves to the clinic/hospital.
I do not go to your house or look around town for ill children to take with me to hospital.
YOU bring them, you the parents and caregivers.
Because you are worried that something is not right with them. They may be sick. Ill. Unwell. Not their usual self. Have a toy stuck up their nose. Breathing funny. Whatever.
If they are okay, we reassure you and send you home. If they are unwell, but we think you can just treat them at home, we send you home. But if we think otherwise, we ask to admit the child.

Various reasons.
The child is too ill.
We don't know what's going on so we need to investigate.
We think we know a little bit but we need to make sure.
We do know what's going on, but the treatment needs to be given in the ward/hospital, not at home.

Why do we keep them long in the ward?
Various reasons as well.
The child is too ill.
The treatment needs to be given a long time.
The treatment is not working. We need to try another way/treatment.
We still do not know what's going on.

Definitely NOT because we like or saja-saja.
We may "try" different treatments, especially if one is not working, but we're definitely NOT doing "experiments" or treating your child as a lab rat. We may not have all the answers but we can't and won't just give up that easily.

In the end, we want the same things as you. For your child to get better, so we can discharge you.
Less patients in the ward/clinic, means less work for us.
We do like having less work.
Don't take it personally.
We assume when there is less work for us, there are also less sick children out there. And that's always good.

Ah. But there are people that say to me "But that's how you make money whaaat."

Again, I reiterate, I work in a government hospital.
Ada patient ka, tak ada patient ka, gaji aku sama whaaaaat.