MESANICO’S MAR [15-07]:A Patient Reluctant To Undergo an Operation

Indexing Title: MESANICO’S MAR [15-07]
MAR Title: A Patient Reluctant To Undergo an Operation
Date of Medical Observation: July 2015
Tag: Not all patients our open to have an operation done
Category: Professional / Ethical – Reinforcement
I received a text message from a patient I was preparing to undergo surgery one morning. The patient was a 39-year-old female with an ulcerating mass on her left supraclavicular area, biopsy revealed it to be a dermatofibroma protuberans. After referring the patient to our service consultant and completing all the needed diagnostic examinations, I was able to schedule the patient for surgery. However that morning, which was approximately one week prior to the said schedule, she informed me of her plan to postpone the said operation. Her reason was that she was scared of undergoing the procedure, which I explained would involve excising the mass on her left shoulder and closing the succeeding defect. I also explained that she would be under anesthesia and that she would not feel any discomfort. Even after thorough explanation though, and after reiterating the need to undergo the operation especially with the diagnosis of her said disease, she still insisted to delay the procedure. Three days later, she again texted me to tell me that she had decided to defer the procedure entirely. I had not heard from her ever since.
INSIGHT: (Physical, Psychosocial, Professional / Ethical)
 (Discovery, Stimulus, Reinforcement)
Our training in this institution constitutes of a cycle of us seeing to patients who seek consult at the Out Patient Department, Emergency Room, or even those being brought to us by our consultants, assessing them properly and completely and if there is a need for surgery, prepare and schedule them for the said procedure. Usually the entire sequence takes 2-3 weeks to complete, even with a longer span of time if the patient has the need to undergo clearance from different departments. Once cleared and scheduled the patient may then be operated on and discharged a few days later. Most patients awaiting our scheduling are usually enthused once they receive our call.  However, the patient I encountered in my narration was a peculiar one. Despite having all the preparations done such as her clearance, her diagnostic examinations completed, and her schedule set, she still opted to defer the procedure. Time unavailability was not much of a concern, as compared to her fear of the said operation. After explaining to her how we would conduct her operation, she was still committed to not undergo the excision of her mass. This experience reinforced in me the idea that not all patients will be prepared to undergo operations, especially if they involve certain procedures, such as excising a said mass on a very exposed area. The least we, the surgeon can do, is explain it to them in a more acceptable way, such as telling the patient how comfortable the patient would be once the anesthesia would be given; or how the need of the operation is very much needed, especially with her present diagnosis, which could be a disease very close to a malignant one. With proper explanation, the whole complication of the patient not having the operation done may be avoided.
ROJoson’s Notes (17feb2):
No matter how clear and adequate and exhaustive a surgeon’s explanation is, there will always be a subset of patients who will be afraid to undergo an operation and therefore postpone and even forego.   Surgeons can only do so much.
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