RAMOSA’S MAR [15-02]:Bridging Discord

MEDICAL ANECDOTAL REPORT
Indexing Title: RAMOSA’S MAR [15-02]
MAR Title: Bridging Discord
Date of Medical Observation: January 30, 2015
Tag: Impact of Family in  a Patient’s Healthcare 
Category:  Professional/Ethical, Reinforcement

NARRATION:

I thought it would be an uneventful ward duty when a patient suddenly went into cardiac arrest. The patient was a 66-year-old male who was admitted as a case of Subacute Subdural Hematoma, Left Cerebral Hemisphere who underwent Burr holing and evacuation of hematoma. The patient has been admitted in the Surgical Intensive Care Unit for a month. Within that period of time, I noticed that there has been a steady decline in the number of visitors and relatives who looked after him; until recently, the patient has had no companion for almost a week. Also, his relatives were not as aggressive in terms of medical management; medications were not given, requested ancillary procedures were not done. To put it simply, the patient’s relatives seemed to have left him alone. So when the patient had cardiac arrest, no relative was present. Cardiopulmonary resuscitation (CPR) was started and while doing so, we were trying to call his sibling but there was no answer. After 30 minutes of continuous CPR, the patient still had not responded and was subsequently pronounced dead. I then repeatedly tried to call his sibling over the phone until finally she answered. I told her what happened and to my dismay she didn’t seem to be affected at all. She just said “Ahh…ok” I then asked her when is she going to claim the body and she replied, “Pwede ba bukas nalang? Gabi na eh.” (Can we get it tomorrow? It’s already late). I told her that she should get it immediately and said that we were talking about her brother not just somebody. After some time, she then agreed to drop by. I couldn’t help but feel sorry for the patient.

INSIGHT: (Physical, Psychosocial, Professional/Ethical), (Discovery, Stimulus, Reinforcement)

“We’re born alone, we live alone, we die alone. Only through our love and friendship can we create the illusion for the moment that we’re not alone.” – Orson Welles

This encounter made me realize the impact of a family member or relative in a patient’s health care. Medical treatment is not a one way process. In order to achieve better outcome, the physician and the patient with his/her relative should cooperate and have a thorough understanding of the patient’s situation. It is often said that in the Filipino healthcare setting, it is not only the patient who is our client as physicians, but their entire family as well. The burden of making decisions relating to healthcare is not only the patient’s alone, but the entire family.  It is because of this culture of ours that I was initially disappointed with the relatives of our patient. Not only did they seem nonchalant about the death of their family member but also were they not in a hurry in the claiming of the body.  Unbeknownst to me at the time, however, that behind this family discordance is a story of neglect wherein the patient left his family for another. It was then I realized that this may have been the reason why the patient’s relatives were how they were. In such cases wherein relatives are not inclined to be a part of the management of the patient, we physicians have to take charge and prioritize the well-being of our patient, despite our strong background that every decision should be a shared decision with the family.

This particular situation has led me to review the values I was honed with as I was being trained to become a holistic physician. I recalled the oath that I took before I pursued my goal of healing others, which states, “The health of my patient will be my first consideration; I will maintain the utmost respect for human life.” We physicians should pursue the welfare of our patients with the goal of restoring his/her maximal capacity the moment that we accept the responsibility of healing them. In situations wherein there is family dispute, our responsibility lies in explaining the circumstance surrounding the patient’s condition and the expectations relating to his case and finally in convincing the relatives in deciding what is best for the patient. All these efforts are done for the goal of providing optimal care to the patient, as this is the message of the oath that started the profession of healing.

ROJoson’s Notes (16dec30):

This is one challenge that physician has to faced – taking care of patients who do not have relatives or guardians.  Best effort with compassion.

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