MBVELEZ’S MAR [15-06]:An Important Role of Patients

Medical Anecdotal Report
Indexing Title: MBVELEZ’S MAR [15-06]
MAR Title: An Important Role of Patients
Date of Medical Observation:
Tag: Explaining to patients their own roles in our management for them
Category: Professional/Ethical – Reinforcement
 
NARRATION:
 
Another duty-day has passed by and our team was already finishing up our pending works and already preparing to go home. Suddenly, I saw my phone ringing, with one of my junior residents calling me. She told me that there was a patient in the emergency room who I managed before. He was a 53-year-old male who previously had a dry gangrene of the second and third digit of his left foot, to which I did a ray amputation of the affected digits. He had several follow-ups then until his wound completely healed. No further follow-up was done until that afternoon when he came back with another complaint of a non-healing wound on the first digit of his right foot. When I saw him in that condition, I felt a bit pity over him but at same time, a bit angry. Angry in a sense that I have made sure before that I would be able to manage his condition even after being discharged, with an obvious positive result for his previous wound, and yet, there came another one. He said that he went to his province to have a few months of rest, but had an accident of having stepped on a sharp object, and did not notice that he was already having a non-healing wound from that incident. Having known that I did not lack from giving pieces of advice and instructions before, I scolded him that what happened was already beyond my extension of help. Suddenly I realized that I have to provide a continuity of care to him as his previous physician, and decided to manage his condition again. After properly referring him to our service consultant, I prepared him for ray amputation of his affected digit. An unremarkable surgery then went on smoothly, and he was discharged after a few days with no significant complications. Repeatedly, I explained to him the importance of taking care of his own body after being sent home, and really emphasized that the same incident should never ever happen again.
 
INSIGHT:

(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
 
We as surgeons know so well that our care does not only involve pre-operative and peri-operative treatment to our patients. More importantly, it should well-encompass our post-operative management over them. Moreover, it does not usually end after the patients are discharged, but should include follow-ups of their conditions until full recovery or even thereafter.
However, just like in any other kind of relationship, a physician-patient relationship should have both parties working out on their parts to attain a considerable outcome. We as their doctors would not be possibly visible all the time for them to watch over them and take care of them. Our patients should be able to learn how to handle themselves after being sent home, but they should be well-educated regarding their conditions, as to how to properly care for their post-operative wounds, what to avoid, and how to mind out their general well-being.
We often encounter patients who do not really comply properly with what we instruct them to do. There are times that they fear to do the things we teach them when they get home that are very important for their disorder. They sometimes worry to clean up their wounds with soap and running water that are very essential in avoiding complications such as surgical site infections. At times, they do not even follow how to properly take their medications or even to come back to us for follow-up. There are even those who do not believe us even after the attention we provided, and just follow what their elders tell them to do. Nonetheless I believe, these situations may be avoided and surmounted once we are able to build a genuine relationship with our patients, and when we make them feel that we truly care for them. They should be able to believe that what we really aim is for them to get better from their illnesses or injuries. As we talk to our patients, we should learn to project ourselves with composure, with enough knowledge, but not being over-confident, so that what we explain to them and what we instruct them to do would have a serious impact in them. Proper explanation that comes from their physicians, who they know are well-equipped with skills and knowledge, and who act as real professional friends who they can rely on to, would leave them no reason not to comply with, as they manage their own well-being even after being sent home.
ROJoson’s Notes (16jan20):
The best scenario is a post-operative physician-patient partnership with continuous communication and collaboration.  The physician can only try his best to achieve such kind of partnership.  Factors, such as cultural, mindset, financial, etc. are potential hindrances.
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