Today is Tuesday, date of 11.1.11. As usual, grand round that I have to do in the morning. All my specialists were around. They have informed me earlier that the ward was full. I went to the GICU first to see 2 of my patients who were ventilated. One baby with intracranial bleed was recovering, extubated and ready to be transferred back to the ward. However, I have no idea how bad is the outcome of the bleeding to the neurological development of this baby. No matter how much we give public education on the use of cradle either in the newspapers, magazines, health articles, forum and etc..etc , still people don't really learn. I hope the baby will recover completely without any neurological deficit. My other patient was not doing very well. The lungs were so bad. He was in HFOV and all the lung medications that he required. He still developed multiple episodes of severe bronchospasms that required resuscitation. The bronchodilators didn't seem to work even though maximised. A real headache. We were using all generic drugs without proper QC. Sometimes it work and sometimes it doesn't. I wonder, how could we rely on medications with no proper QC to be used in the treatment of life threatening situation. No doubt that we are looking for cheaper drugs and I am not saying that generic drugs are all not good but we have to be more selective for the acute life threatening situations like my patient suffered of. I guess the government should look into this matter. We make complaints but no action taken. Sometimes I feel that we are not being fair to the patient. Just changing combivent generic to the berodua original product, the child has less severe bronchospasms. We managed to bring down the dose of intravenous ventolin that make the child tachycardic. In my experience, Astalin, the generic for ventolin is never work mostly for my severe asthmatic patients. I have to ask my MO to go and buy ventolin ori from the pharmacy in Kajang because we have no more stock in the hospital. the hospital is getting the generic astalin from pharmaniaga. Probably astalin can be used in milder cases but not in severe cases and life threatening situation like this. Well, this limitation make us feel so frustrated as a doctor who really want our patient to get better and out from the danger. When you talk to the parents, your heart will just go......don't know what to say. There are many other instances that related to the use of generic drugs. For example, drugs for sedation. You need to give a very high dose to sedate the patients. Sometimes, despite that high dose, the patient failed to be sedated. Sometimes, with the correct dose, they took few days to wake up. Many radiological appointments such as MRI or CT need to be cancelled as the child failed sedation. Or if they do get sedated, the effect of the drug only apparent after a few hours post injection of the drugs. Basically, rescheduling of appointments are very common and my MOs are quite used to it but it is not cost effective because for any procedures, the parents have to take leave and many other arrangements have to be made. Frustration, anger, .......for how long? Malaysia boleh!!!