MEDICAL ANECDOTAL REPORT
Indexing Title: SSSFELICIANO’S MAR [15-10]
MAR Title: Balance of Positive and Negative Thoughts
Date of Medical Observation: October 2015
Tag: A good balance between positive and negative outlook for proper judgment on patient management
Since I started residency, I was always anxious. I always have negative thoughts regarding myself. I always question myself if what I did on my patients was right. Did I miss anything? Will my patient be ok? Agitated as I am, I was pre-duty and our Outpatient Department (OPD) duties were done but my heart couldn’t skip a second. I went back and forth my patient’s room and the conference room. It was my 39-year-old male patient’s 3rd post-op day where I did exploratory laparotomy and nephrorrhaphy for a kidney injury and pancreatic injury secondary to stab wound. He had episodes of bilous vomiting and a sudden onset of abdominal distention. I immediately requested for electrolytes and plain film of the abdomen(PFA). Electrolytes were normal but it took hours for the patient to be radiographed since X-rays had to be done outside. It was already late that night that I came to see the PFA which had non-dilated bowels, with presence of pre-sacral gas and with no air-fluid levels. In short, PFA was normal and didn’t show any signs of obstruction. I went back to my patient and noticed that there was no distention anymore, no episodes of vomiting and very minimal nasogastric output. His abdomen was soft and non-tender. I was relieved. I was already preparing myself to open up the patient for a re-exploration. It was a good call to wait before doing further management on him. The patient was discharged a few days after.
(Physical, Psychosocial, Professional/Ethical) (Discovery, Stimulus, Reinforcement)
Being a surgeon is not about always saying “Let’s open up the patient”. Not all patients that come to you is surgical. Not everyone needs to be operated on. To be able to do your job, therefore, as a surgeon, calls for a good and balanced clinical judgment, and a compatible diagnostics correlation.
Having a patient brings excitement to me. I always wanted to discover what’s happening inside. I always have the hype to explore. However, the other side of me brings butterflies to my stomach. After operation and the operation didn’t went well, I start to question, what else can I do for this patient? What have I done wrong after I explore? Was it me, or was it the patient? No one likes morbidities or mortalities. Not you, neither the patient. But what if it comes? In my four years stay of residency, I have come to realize that I have to teach myself always to calm down-to sit, gather my thoughts, understand the process, and get the catch. I’ve always been negative about my skills and my judgment. When something happens, I have no one to blame but myself, and to get rid of the guilt, I always wanted to take the challenge again. This story, now, teaches me to get a good balance of my positive and negative thoughts. We are able to properly manage our patients by not being too passive, but not being too aggressive, as well. What matters in every patient management is not the label of us having a failure, but the life of the patient. Our judgment is not dictated by what we feel, but by how the patient presents to us. To sum it all, a good balance of the negative and positive sides brings proper patient management.
ROJoson’s Notes (17jan20):
Medicine is problem-solving and decision-making. It is also balancing the positive and negative sides of things; balancing benefits and risks; balancing the pros and cons; etc. Choose the one that has more benefits, less risks, affordable and available.