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Don’t blame us for not detecting dengue in patients earlier, say docs

Published: 1 Feb 2015

PETALING JAYA: General practitioners (GPs) have objected to the view that they usually missed dengue detection on patients’ early visits, saying that the dengue rapid test should be carried out only when symptoms were suspicious.

“Even when we confirm dengue on day one, if blood pressure, platelet level and everything else is normal and we send the patient to a government hospital, they will turn away the patient,” Medical Practitioners Coalition Association of Malaysia president Dr Jim Loi said.

GPs, he said, would normally do the test on patients’ second visit.

Based on past incidents, he said patients referred to government hospitals after they were diagnosed for dengue on the second visit had been turned away when their vital readings were normal.

On Wednesday, Health Minister Datuk Seri Dr S. Subramaniam urged GPs to stock up on dengue rapid test kits as 99% of them missed the diagnosis on the first visits.

However, Dr Loi noted that cost was also a deterrent factor for many patients.

The normal rapid test cost RM30 to RM40 (NS1 antigen test) while the combo rapid test kit (IgG and IgM) cost RM80, not including consultation and medicine, he said.

“If symptoms persist after two days, we would advise them either to return to us to check for dengue or go straight to the hospital.”

He said early detection had no bearing on patient mortality as it would depend on how patients were managed as the disease progresses.

Malaysian Medical Association president Dr Krishna Kumar also said patients were not screened during early visits because it was not economically viable to do so.

“Currently, we don’t think it is necessary to do the test on the first day of fever but we tell the patients to return after two days if fever persists,” he said.

He noted that patients could miss the diagnosis if they hopped from one doctor to another.

The Federation of Private Medical Practitioners’ Associations president Dr Steven Chow said commercially available test kits could not confirm the diagnosis of dengue in the early stages of the disease.

“What is most important is a high index of suspicion for all cases and the proper use of the test at the appropriate time,” he said.

He said the decision was best left to the attending doctor to advise on adequate fluid consumption, monitor the patient regularly for danger signs and to refer problematic cases with potential complications to hospitals for further management.

“This has been the standard operating procedure recommended by the Health Ministry,” he said.

Originally published in thestar.com.my
http://www.thestar.com.my/News/Nation/2015/02/01/GPs-Test-done-on-second-visit-Dont-blame-us-for-not-detecting-dengue-in-patients-earlier-say-docs/

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