AALVEZ’S MAR [15-04]:For the Patients

Indexing Title: AALVEZ’S MAR [15-04]
MAR Title: For the Patients
Date of Medical Observation: April 2015
Tag: I learn to disregard differences between residents for the benefit of patient
Category: Professional/Ethical – Reinforcement


It was 11AM. An emergency referral was relayed to me by one of our rotating interns for an emergency insertion of internal jugular catheter insertion from the Internal Medicine Department.

I quickly went to assess the patient. I then asked the IM resident if the patient had all the materials for the procedure. The material for the procedure were still not secured. The Operating Room was available during that time. I reminded the IM resident to quickly secure what was needed so that we can do it immediately. I went back to my post.

Three hours had passed. The IM resident went back to me demanding me if we could immediately insert the catheter. The operating rooms were in use at that time. I told them we could not do it immediately due to unavailability of the rooms. The resident raised her voice telling me the patient suddenly showed uremic signs and symptoms and access was immediately needed to be placed. She demanded me they needed to have an access immediately for dialysis. If not done immediately, they would raise the matter to their chief resident.

I did not like how she told me about it. I was first angered by what she told me. However, cooler heads should prevail in this situation. I did not react to her statements. I just thought patient should be our main priority in this situation. I referred the case immediately to my senior at that time. We went immediately to the patient and we saw the patient. He had one seizure episode. He was dyspneic and restless. He was also needed to be restrained. We then decided to immediately insert the catheter in the emergency room.

I assisted the insertion. After 15 minutes, the catheter was inserted. The patient underwent hemodialysis immediately. The resident then asked for forgiveness for her behavior and thanked us for immediately responding to their referral. I told her it was okay. We may also have fault and it was all for the patient.

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

In our residency training in Ospital ng Maynila Medical Center, we received referrals from the different departments. They seek our help through our technical knowledge and skills as surgeons. These referrals can be classified as urgent, emergent and non-emergent.

In my second year of residency training, often these referrals may become the source of miscommunication and disagreements between our fellow residents from other departments. We often hear different opinions and view on the case referred. A referring department may also disagree by our recommendations which may be seen as disrespectful to them.

However, we should not let our misunderstanding get in the way of seeing our patients. It is best to immediately assess the referrals of our fellow residents to avoid the misunderstanding. After seeing the patient, we should refer it to our seniors. We, then, should talk with our fellow residents regarding it to let them know of our side and to have a fruitful discussion of the referred patient. Lastly, we should agree collectively on what we should do to the patient. After all, all we are doing are all for the patients.

ROJoson’s Notes (17jan14):

Differences of opinions exist among physicians.

They just have to present their opinions with respect and humility.

In the end, they should agree collegially what is best for the patients.

This entry was posted in AALVEZ’S MARs, Difference of Opinions Among Physicians. Bookmark the permalink.

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