Dr Mohamed Rafick Khan Abdul Rahman was an ex-RAMD medical doctor. Make a search in google, you will discover this person is well known in blogger world. His writting is also appear occasionally in Malaysiakini.
PUSRAWI Medical Report.. did RPK erred?
July 29, 2008
by drrafick @ Dr Mohamed Rafick Khan Abdul Rahman
1. As usual and expected, RPK made another stunning revelation about the so call medical report from PUSRAWI with the far-reaching conclusion that the report suggest that there was no sodomy. I feel very upset when I saw the article that RPK wrote. Let me explain why.
2. First of all, it is not a medical report. It is a doctor Out Patient notes. Going by the letterhead, it could have been PUSRAWI record but I cannot be sure because in the cause of my work I have never had the opportunity of seeing any similar documents from PUSRAWI. On the document, it shows that it was signed and the rubber stamp shows the name of Dr Mohamed Osman Abdul Hamid. He is a medical officer and probably has done some PR examination in his lifetime. Obviously, it would not be as frequent as a gastroenterologist would.
3. I am going to share with you on what was written on that piece of paper and why I feel RPK has stretched his imagination a bit too far. On the paper, it was written that the patient complains of Tenesmus of one-week duration. The word Tenesmus means difficulty or straining when passing motion. Usually patients do not come to clinics and say they have Tenesmus. They will say that they have not been able or having difficulty in passing motion. I wonder why the doctor uses the word Tenesmus. Whatever it is, the note indicates that the problem has been around for one week. The duration is important.
4. Among others it is also written that the patient did not observe any blood whenever passing out stools. I am no expert in handwriting but if one were to see, there are marked differences in the style and quality of writing after the sentence “not noticed any PR bleed”. In my assessment the medical history is badly taken. It keeps repeating the same thing where it says about pain in the anus and not noticing blood in the stools. It was noted that the doctor wrote that the “patient was alleged assaulted by intruding a plastic item in anus” I could not make out what was written in the next line. The person who wrote this notes failed to document the date and time of the allege incident. This is important. In the medical world when doctor writes some thing happens one week ago may not necessary means that it actually happens 7 days ago. The date and time is important as it has an impact on the injury and potential wounds that has taken place.
5. On the following page of the medical notes some scribbles notes can be observed. Among others, that I can make out includes no pallor and no fever (opallor, o febrile). While it might be the style of writings of some doctors but most doctor put the null sign after the word and not before it (e.g. palloro) . This is the first time I saw a doctor writing putting the null sign before the word in my 20 years of being a doctor.
6. In the next paragraph, general examination shows that there was no pallor, he was comfortable and afebrile (no fever) . It was noted that a per rectal examination was done (P/R) and there was no active bleeding, no ulcer or pus seen, No injury seen, No tear seen.
RPK wrote that “The doctor’s report (which can be viewed below) says that there is zero (0) skin tearing, zero (0) active bleeding, zero (0) traces of pus, etc., which basically means he can’t be suffering from a pain in the anus as what he alleges.” With much regret, I am in the opinion that RPK has jump the gun and made a far-reaching conclusion. His conclusions were unfair. It did not take into account the factor of time that has taken place. It has also not look at the issue of the mechanism of injury. I will deal with this in the later paragraph.
9. The doctor made the diagnosis TRO Assault (Sodomise). The short form TRO is a common terminology that is use by doctors, which means “To Rule Out” . What it means here is that, the doctor is in the opinion that the diagnosis of sodomy need to be rule out and not as what RPK has interpreted that it has been rule out. ( RPK says: The doctor’s diagnosis is that he rules out or TRO (to rule out) assault (sodomised)). Again, RPK has jump the gun and made the wrong conclusion. RPK also mention that “In short: Mohd Saiful Bukhari Bin Azlan is not suffering any pain in the anus and neither was he assaulted or sodomised in the anus”. Well RPK, I feel you have put words, which the doctor did not say.
10. Under the heading of “Rawatan”, the person wrote “Advice to go to government hospital” and “(plan to do a police report)” RPK wrote “Saiful then said he would like to make a police report so Dr Mohamed Osman suggested he go for a second medical examination at a government hospital”. I think there is a twist here. The writings did not say that the doctor advice him to go to hospital because he wants to make a police report but merely stating that the patient has indicated that he wants to make a police report.
11. Under the circumstances, it is quite clear that what the good person (doctor) have done is the right thing. He has advice the patient to go to the government hospital for a second opinion. This is a norm. I am sure he made that advice because, no private specialist or doctors wants to be involved with such a headache. This is a norm. Private hospitals tend to push death cases, potential medico legal cases to government hospital. They will not take it. The person action is justified.
12. RPK continues to narrate his writing in his usual fashion. I have a lot of respect for RPK and I know he has a large following. However, I think RPK should not have made such conclusion just to set the mind of the readers. In this case, especially when many readers would have jump to the conclusion on seeing the writings and the PUSRAWI medical notes. This is simply irresponsible. This would make people to lose their trust on you, RPK.
13. Please, allow me to interpret and explain what the person who wrote the notes has written. This is based on the 2-piece document that RPK published.
This is a case of a male by the name of MSB with an IC No 850706015687. He went to see a doctor about one week after being alleged assaulted with a plastic object in his anus.
There was no mention about the plastic object details like its length, width, thickness and hardness. If it was a small and soft plastic object and has been lubricated then, it is expected that a tear did not take place. If it is a big object like a proctoscope and adequately lubricated, there will be no tear. For a tear to take place, the object must have not been lubricated and probably of a decent size. If it is a small object, it must have been sharp and was done against the persons will. If the person is experience with anal sex, his action was voluntarily, then I do not expect any tear.
The patient did not complain that he has seen any blood in the stools. This was confirms by the examination which shows that there was no tear or ulcer.
The examination was very limited in value as it is only a PR and not a proctoscope. It is not even mention about the prostate size, the tension of the anal sphincter or colour of stools, which means that the doctor probably did not put his finger into the patient anus.
In most likelihood, the doctor merely does an external anus examination, which will not show longitudinal mucosal anal tear if it was present. The fact that there was no complains of seeing blood means that there is no vascular tear. There was no infection and as such, there would be no pus.
14. In conclusion, I would like to say that RPK has misinterpreted the facts. He has also exaggerated the interpretation of the doctor writings. I think who ever has been advising him , has not given a fair opinion His writings have come to such a skewed conclusion and now his writings is being politicised. Overall, I think this medical note has not proved or disapprove anything.
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