Curhat Akademik

Sometimes I don’t put on a DD because I think I have effin’ screened every diagnosis that is possible (yes, I quick read the PPDGJ III from F0 until F9 to make sure I don’t miss anything), and I’ve had them ruled out. If there’s a fourth or fifth digit, I try to use it as well. Then someone would go, “How if we put [insert diagnosis here] as a DD?” and mentally I’m gonna be like, “Yes, I thought of that, and I’ve ruled it out. Didn’t you listen to the history?” then I explain how it was ruled out (which actually was already stated in the history). Then another people would go like, “When did the [insert chief complaint here] start?” and I will mention a time, then another question like “What happened after that?” come up, and mentally I’m gonna go like, “It was CHRONOLOGICALLY DOCUMENTED IN THE HISTORY DIDN’T YOU HEEEEAAAAARRRR?” then I give a summary about what happened that leads to the decision to go with the proposed diagnosis. Then someone would say again, “Okay, just fill up some DDs, will you? Because in University [insert university name here] we need to make 7 DDs” and mentally I’m gonna go, “I made those 7 DDs and I have ruled out the other six. Why do I have to keep all those ‘baggage’ merely to keep the space filled up? Can’t I just go with this one and move along?” Then someone would go, “Okay then, if there’s no further question then let’s move along to the next case.” Then I go thank the God almighty for His mercy to let me move along before I lose my sanity.

At other times, when symptoms aren’t quite typical and causation is not immediately established, I make some DDs after again, flipping PPDGJ III from F0 to F9. Sometimes I checked out Medscape too. Then I checked the recommended medication and a bit of psychological intervention. Then I reported the case for getting myself some advice. Then it turns out that all my DDs are wrong and what happens in this case is caused by a definite condition that is just right in front of my eyes that I grossly miss, so no further work-up is required. Then I try to explain why I think it’s something different, then I get the “It’s it, and this is how we treat this one” and period. And I’m gonna be like, “whaaaaaaattttttt????” because to my knowledge, for a multifactorial condition, it can be freakin’ hard to establish causation, even after a long term longitudinal study with huge sample size; which explains why most variables are more of association than causation. If it was indeed THAT easy to establish a causation, this frikkin’ field of science would only have one textbook of less than 200 pages and I wouldn’t be in this field in the first place because it would be damn boring. I’d rather sing in an audition to replace Jessica’s place in GG. Well. Whatever. *head bang

There’s also this saying that I hear kind of often that goes like this, “Cobak aku jadi Inke, ilmiah banget, bikin tugas apa-apa tu gampang.” Then I just smile. Then on some occasions when it’s appropriate, I try to get those people who said it to experience being me or somehow doing things the way I do (e.g. being detailed, staying longer on something when necessary), then they go, “Ah nggak ah, aku kaya biasanya aja. Aneh nanti kalau kaya gitu. Capek juga.” Then I was like, asemik jebul dho PHP mung manis di bibir memutar kata malah kau tuduh akulah segala penyebabnya. And I was left in the state of being dazzled plus annoyed plus irritated plus (occasionally) hungry plus jomblo. Life can be so unfair sometimes.

There’s also this talk (it’s one of many, btw) between me and dedek-dedek gemes (DG) that went like this:

DG: (taking a peek to the written record) Pasiennya ASD ya Dok?

Me: (nodding while continuing writing) Ada yang mau ditanyakan?

DG: Kalau ASD itu gimana Dok?

Me: (leering at PPDGJ III in his hand, thinking “ning njero cekelanmu kui po yo ra ono pembahasane to yo?) Dilihat PPDGJ-nya. Ada? Kaya gimana di situ keterangannya?

DG: (flipping then reading monotonously)

Me: (nodding) Jadi ada apa aja ciri-cirinya?

DG: (re-reading randomly)

Me: Udah Pediatri?

DG: (nodding doubtfully)

Me: Ngecek Denver kan ya di sana? (nod) Kalau di Denver biasanya domain apa ya yang delay-nya signifikan kalau pada ASD?

DG: (giving a big grin) Ngg…. Apa ya…

Me: Domainnya Denver ada apa aja?

DG: (still grinning)

Me: (continuing writing while –I thought- I was letting him think. But still no answer after a long pause, so I ask again) Hlah? Apa aja domainnya?

DG: Lupa, Dok..

Me: (gazing in amazement) Trus kalau lupa, kamu diam aja gitu?

DG: (still no answer)

Me: Bawa HP? Cari di google. Ada nggak kira-kira?

DG: (taking his phone, start googling. Still no answer after I have finished writing five lines or so, but finally he said..) Nggak ada sinyal, Dok..

Me: (exhaled deeply while telling myself, “sabar.. sabar”. Took my phone, did a search, found the result in 15 seconds, handed the finding to him) Kelihatan nggak gambarnya?

DG: Kelihatan, Dok.

Me: Apa aja domainnya?

DG: (reading the four domains of Denver test)

Me: Jadi yang mana yang paling signifikan terganggu?

DG: Personal-sosial, Dok.

Me: Iya, personal sosial. Kalau yang terganggu di domain Bahasa, biasanya gangguannya jadi apa ya nantinya?

DG: (grin)

Me: (realizing that I might have asked too random question) Ya kalau di Bahasa, mungkin nanti kalau usia sekolah bisa jadi learning disability, disleksia, atau kalau masih prasekolah biasanya jadi speech delay.

DG: (nodding repeatedly)

Me: Sudah neuro?

DG: (nodding a bit doubtfully)

Me: Kalau gangguan berbahasa pada orang dewasa, biasanya pasca stroke gitu, namanya apa ya?

DG: (grin)

Me: Punya Medscape?

DG: (showing an expression that seemed closest to the sentence “what the hell is Medscape?”)

Me: Aplikasi referensi di HPnya ada apa aja? Yang biasanya dibaca-baca buat belajar gitu

DG: Ada D*rl*nd sama *n*t*mi … itu aja sih Dok

Me: (nodding repeatedly) Sekarang ini kamu proses belajarnya lagi di tahap preklinik apa klinik?

DG: Ng…. klinik

Me: Terus kalau D*rl*nd sama *n*t*mi tu kira-kira lebih banyak dibahas di pendidikan klinik apa preklinik?

DG: Ng… preklinik…

Me: Terus berarti kamu nggak punya aplikasi yang bisa dipake referensi untuk pembelajaran preklinik? (shake head) Terus kamu nggak merasa ada yang kurang terus nyari gitu?

DG: (grin) Enggak…

Me: (big exhale, and then I did the almighty gesture of face-palm. With both hands, of course)

So my conclusion is, “Mungkin dedek2 gemes itu dikirim untuk membantu saya mendekatkan diri pada Tuhan.” #tolongInkeYaAllah



P.S: Yes, on talks when I'm fully attentive*) and the talks somehow makes sense, I remember my and your speech and expression with about 70-80% accuracy. That's the part of the training. Sometimes I also know when you mean what you say and those times when you don't; observing that swing from one state to another is just fascinating especially when somehow you seem to believe that I fully believe what you say because I'm nice and naive.
Okay I start to sound like that guy with antisocial personality disorder. I should stop. Bye!

*) I'm rarely attentive, don't worry. I forget a lot