AALVEZ’S MAR [15-07]:Realization of a Patient

MEDICAL ANECDOTAL REPORT
Indexing Title: AALVEZ’S MAR [15-07]
MAR Title: Realization of a Patient
Date of Medical Observation: August 2015
Tag: Helping and Explaining the Consequences of a Patient’s Action
Category: Professional/Ethical – Reinforcement

NARRATION:

One Sunday rainy evening, a patient accompanied by his wife caught our attention as he slowly approached one of our junior interns. Their clothes were soaked wet, and they held four small bags with clothes and pillow. The man’s face showed fear, resentment and pain while he was squeezing his right hand on his abdomen. On the other hand, the wife’s face exhibited firmness and a little bit irritated as she helped him sat on one of the benches.

One of the junior interns approached them and asked, “Ano pong ipapakonsulta nyo sir?” (What would be the reason of your consult?) Patient was about to answer but his wife cut him and instead said “Masakit po ang tiyan ng mister ko doc” (My husband has abdominal pain). We immediately assisted the patient to one of the beds for abdominal examination. Patient has direct tenderness in epigastric area, while normal abdominal exam in the rest of the quadrants. I was about to explain the possible causes of his abdominal pain, when he grasped my hand, and he stuttered, “Doc mamamatay na po ba ako?” (Doctor, am I going to die now?). I noticed the wife’s face changed from firmness to disappointment. She took a deep breath and said, “Pagsalitain mo muna si dok” (Let the doctor speak to you first).

Given the chance, I explained to him the possible causes of epigastric pain and what we will do for the observation and management while he was in the ER. I said that most likely, it is an acid peptic disease and usually it can be acquired by chronic smoking, eating sour, and spicy foods, and skipping meals. I also said that that kind of abdominal pain is chronic, and that he should sought consult earlier so as to prevent complications. However, the patient continued to be agitated, and he seemed not listening to what I am saying. He uttered, “Doc, hindi na ko maninigarilyo talaga at magpapalipas ng gutom. Buhayin nyo lang po ako. Bata pa po ang mga anak ko, at ung panganay ko magdedebut na sa isang linggo. Please doc!” (Doc, I will not smoke anymore nor skip my meals. Just do what it takes for me to live. I still have children, and my eldest will celebrate her 18th birthday next week. Please doctor).             

His wife then said, “Dati pa kasi kita pinapatigil, ayaw pa. Saka sabi ko na dati magpatingin tayo ng maaga para hindi na lumala” (I already asked you to stop, but you did not listen. And I also told you that we should go to the hospital so that it will not worsen). Patient then held the hand of his wife and said sorry. He was given his pain medications, and was observed. Eventually he was sent home.

 INSIGHT:

(Physical, Professional/Ethical, Psychosocial)

(Discovery, Stimulus, Reinforcement)

Prevention is better than cure. We often hear this statement from different media. The best way to manage a disease is to prevent it. Preventing a disease is done first by determining the possible etiologic factors, and early manifestations of the disease. Coupled with the basic knowledge of the disease, patient also should have a good health-seeking behavior.  These are the recipes that will help prevention of the disease.

Aside from early diagnosis of the disease, benefits of good health-seeking behavior save time, energy, and money. It also lessens the probability of complications.

As a doctor, we should be meticulous enough to explain the disease of the patients, from etiologic factors to management, so that they will know how to prevent re-occurrence of the disease earlier if possible. Patient education go as far as what we try to explain to our patient.

ROJoson’s Notes (17jan20):

Physicians should educate patients on ways to restoring and maintaining health. Physicians should motivate them and teach them the value of perseverance especially in health matters.

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