Medical Anecdotal Report
Indexing Title: OPLIZASO’S MAR [15-6]
MAR Title: Obedience – An Important Piece of Learning
Date of Medical Observation: June 2015
Tag: The significance of accepting the purpose of a command can lead to a better patient care
Category: Professional/Ethical – Reinforcement
The day that we admitted our consultant’s patient (pay-patient) was really unforgettable for me. She was a 25 year-old female with an assessment of bleeding Mixed Hemorrhoids. She underwent emergency hemorrhoidectomy. The procedure went well and the patient was able to tolerate it with minimal post-operative complications. However, on the 1st post-operative day, her surgical wounds suddenly bled profusely which was immediately packed. Important laboratory tests such as complete blood count with platelet count, prothrombin time and partial thrombo-plastin time were done which revealed decreased hemoglobin and thrombocytopenia. The patient was given a loading dose of IV tranexamic acid and was monitored every hour. I was on my from-duty status when my senior requested me to personally monitor the patient until the next day. Initially, I was having second thoughts about accepting the request because I was already exhausted from my tour of duty at the ER – I might not be as efficient as I was when I was still on my first few hours of duty, and might commit mistakes which could be of harm to the patient. But as a junior, I followed my senior’s command and monitored the patient until the next day. After countless calls from my senior, I could not help but entertain a question in my mind: “Am I really doing this for my patient’s sake or am I only doing this because I was told to?” Fortunately, dawn came soon enough, and the patient was able to survive the night without any bleeding episodes. I then finally came to answer that question-nothing is more important in this job than the patient’s welfare. It is not about my patient being private, not about my senior scolding me when I am not able to do my job, but it is all about my passion to help a patient and let him live a good life.
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
“Every great person has first learned how to obey, whom to obey, and when to obey”. This situation has given me a tricky dilemma. I’ve been a resident for some time and this was the first time I have ever contemplated this predicament as a junior resident. After many exhausting and sleepless months, there are new learnings that went by that made me realize that we doctors must always obey those that are more experienced than us because this was our way of learning how to be a good doctor. They say that studying and learning will never stop for us doctors. Albeit we become great consultants and expert practitioners on our own. A “perfect and ultimate doctor”, as we all know does not exist. There will always be a senior or somebody far better skilled and more knowledgeable than us. We should take them as a gift for us that we should always respect and obey. Afterall, medicine is a dynamic profession. It is ever-changing and indefinite. We need our dear colleagues, regardless whether they are juniors or seniors, to be able to manage our patients. I have realized and acknowledged that in our practice and in whatever we do, patient’s safety should be our primary concern. We should always keep in mind that our patients trusted us with their lives and in return, we must manage them very well.
ROJoson’s Notes (16jan20):
A surgical resident has obligations to both his team mates and to the team’s patients. He obeys “commands” from his team leader and he also obeys “commands” of his patient’s needs.