PCORACION’S MAR [15-01]: Absence of a Patient’s Parent Causing a Dilemma in Patient Care

Medical Anecdotal Report
Indexing Title: PCORACION’S MAR [15-01]
Title: Absence of a Patient’s Parent Causing a Dilemma in Patient Care
Date of Observation: January 2015
Tag: Understanding a patient’s personal background can improve patient care
Category: Professional/Ethical – Reinforcement

NARRATION:

I operated on a 14-year-old male with an acute surgical abdomen secondary to blunt abdominal trauma. He was alone at the time so my co-residents and I had to give the consent and provide for the lacking materials. He had a splenic injury which I was able to repair. I waited for someone to come and inquire of his condition but no one did. From the time he was being observed in the emergency room to the patient’s recovery in the ward, his father was absent. A middle-aged woman came once to visit the child but was never seen again after she accomplished the classification for the admitting papers. When asked where his father is, he simply looks away and says “Hindi ko po alam.” (I do not know.) No one was there to take care of his needs. He needed blood transfusion so I took care of it. He was doing well and two days post-operatively, I was able to come across a petite 18-year-old girl sitting at his bedside. She was his sister. She was an out-of-school-youth living with her older out-of-school youth boyfriend vending various items in Luneta to get-by. I asked her to fetch their father so I can talk to him. She reluctantly said yes. I waited but no one came nor did she return that day. Again no one was by the child’s side. Her sister would come and go. It felt as though she was avoiding me. The social service had been tapped but the father never showed.

The day came when he was ready for discharge but no one was there to fetch him. I decided to talk again to the sister and insisted that their father come and talk to me so that the patient may be discharged properly and the issues with the billing be cleared. Later that day, the girl returned with their father. Talking to him, I could not help but give him a lecture for not being responsible for his son’s welfare. He reasoned that he was working as a parking attendant in front of the national museum. I did not accept it. To my surprise, he admitted that he had another family. He has a new wife and they had kids of their own. I told him to buy the medicines for the child. I let him go in disgust. I turned to the sister. She said that their mother left them too a long time ago. His brother was staying with her mothers’ sister but she will take him to live with her and her boyfriend now.

Understanding dawned on me. They only had each other and no one else. I talked to her. In totality, I told her to rise above it all and never to lose hope. I also talked to my patient. I bargained with him to change his ways and help her sister. He just smiled. He came back the following week. His wounds had healed and were visibly better. I reminded him once again of our deal before he left. I pray that he does.

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

Consultations are interviews. We gather data in order to assess an individual. It is coupled with physical examination to help us arrive at a working diagnosis and plan for the best management for the patient.. In this data collection, some are not meticulous about the personal and social history. It has become routine to only ask about alcoholic intake, smoking habits and drug abuse. We seldom include more personal information on a patient’s background because we assume that it is not necessary for the planned treatment.      Work, family set-up, environment of the residence and educational background are all important not only in helping diagnose lifestyle related diseases but also in establishing the treatment plan most suited for the patient. If pre-operatively one can discern that a pediatric patient came from a broken family with no adult support group then the approach in establishing a physician-patient relationship can be crafted to suit the level of a child that feels abandoned and neglected. If done correctly, one can allay fear and anxiety and command cooperation without struggle. Most importantly, proper authorities can be brought earlier in the course of management. Ancillary treatment can be added to the management to address these special issues. Dilemmas arising from an absent parent or guardian will not only include problems with obtaining consent for procedures but will encompass the sustainability of the post-operative care of the patient.

This is what I overlooked from the start. I had difficulty establishing rapport with the patient because I stereotyped him as a delinquent whose parents will come anytime, making the greater burden of his welfare lifted from me and transferred to them instead. I was lax to assume that he had a family who can take care of him and it took time for me to act upon it.  We must be keen to pick up on this. Investigate it if its not apparent. We are taught to be holistic surgeons and this aspect of patient care should be addressed as best as we can.

ROJoson’s Notes (17jan4):

Holistic, professional and compassionate surgeon in action!

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