GPVILLANUEVA’S MAR [15-04]:To Speak or Not to Speak

MEDICAL ANECDOTAL REPORT
Indexing Title: GPVILLANUEVA’S MAR [15-04]
MAR Title: To Speak or Not to Speak
Date of Medical Observation: May 2015
Tag: Learning Republic Act 7610, a trigger by the offending mother
Category: Professional/ Ethical – Reinforcement
 
NARRATION:
As I was seeing the patients in the emergency room (ER), my eyes were caught on a man on his early 50’s, carrying a 6-year-old boy rushing to get near us. The boy had multiple abrasions in the face and extremities, looking exhausted and quite drowsy. We immediately started resuscitation after our primary survey while simultaneously interviewing the man who brought the patient. We learned that the boy was a victim of a vehicular accident and the man was the driver of the vehicle that hit the patient. Besides the driver, there was no one else accompanying the patient, so I informed the hospital security to trace and contact the parents or relatives. Although complaining that the patient was the one to blame for the occurrence of the accident, according to him, the boy suddenly ran to cross the street. I then reiterated that it is still his responsibility to bring the patient in the nearest medical facility and to provide complete medical care and the investigations regarding the accident will follow through. Due to the limitations of our institution, I explained to him that some medications will be bought outside and the imaging procedure required would be done on a private diagnostic center. This added stress to the offender and continued to comment on who is to be blamed. Upon re-evaluation of the patient, he was already coherent and we noted no limitations on extremities but we still pushed through with the imaging procedures, basic radiographs and computed tomography scan (CT-Scan) of the head. I was already in the operating room when the boy’s mother came to the scene. I didn’t see the reaction of the mother upon seeing the patient. We let the patient stay in the ER to be observed and sent the pictures of plates to our neurosurgery consultant. No lesions were noted on radiographs. After a while of observation, my junior resident in the ER called to inform me that the patient was unremarkable and was ready to be discharged guided by our neurosurgery consultant. On our pre duty status in the out-patient department, I saw the boy well and awake and very different compared to when I first saw him. I approached the table and immediately introduced myself to the mother which was now with him this time. I then said, “Kahit papaano, magpasalamat po tayo na walang nangyaring malala sa anak ninyo. Bakit naman po siya naglalaro sa kalye? Alam nyo po bang pwede kayong ireklamo sa bantay bata sa nangyaring yan. (We must be thankful that nothing terrible happened to your son. Why is he playing in the streets? Did you know that you can be reported to “Bantay Bata”?) I saw how the mother changed the mood on her face saying that her son is so disobedient that’s why it happened to him. I then advised them that the boy is already cleared and no follow-up is necessary. As I thought that we were already finished with the conversation. The mother approached me again and said “Kahit kailan, hindi po ako naging pabayang ina” (I have never been a neglectful mother.) and left.
 
INSIGHT
(Physical, Psychosocial, Professional/ Ethical)
(Discovery, Stimulus, Reinforcement)
 
“Bantay Bata 163” is a social welfare program of the ABS-CBN Foundation launched in 1997. It aims to protect disadvantaged and at-risk children through a nationwide network of social services. The “Child Protection Program” is an agenda under the Department of Justice charged with monitoring and implementation of Republic Act No. 7610, “The Special Protection For a Child Against Abuse, Exploitation, and Discrimination Act”. The above are examples of programs that were instituted for the protection of children. This recognizes the vulnerability of children and the incapability to protect themselves thus requiring an adult to supervise. Child Abuse from R.A. 7610 was defined as maltreatment, habitual or not, of the child which includes psychological and physical abuse, neglect, cruelty, sexual abuse, and emotional maltreatment.  I did a shallow reading on the acts that would qualify a parent or guardian to be accused of child abuse based on the republic act. Neglect was the nearest term related to my narration. Neglect was defined by failure of a parent or legal guardian to provide, for reasons other than poverty, adequate food, clothing, shelter, basic education or medical care so as to seriously endanger the physical, mental, social and emotional growth and development of the child. Physical neglect includes refusal of or delay in seeking health care, abandonment, inadequate supervision and expulsion from home or refusing to allow a runaway to return home. This clearly succeeds the parent to be accused of child abuse but then our culture does not tend to follow and we become lenient to cases like these oftentimes we let it pass. That last statement by the mother made me think twice and do this anecdote. Have I done something wrong? Are my words justifiable? Is there any way to tell the guardian of their negligence by not offending them? But then again, it is our responsibility to tell them since we know better. It is our duty to fill their ignorance so that it will never happen again and words can be spread for the benefit of the children. After all, I have no intentions to offend her and the purpose was just to remind her of the responsibilities that the law requires her once she has a child, we all have our own bouts of flaws that we need to accept. We see many children being victims of fall every day in the ER, and we must advocate ourselves to inform the parents of their negligence to the law and take that responsibility seriously.
ROJoson’s Notes (17feb8):
As physicians, we should educate people on legal requirements related to health.  Just do it in a professional and compassionate way.   Different people will react differently to the good intentions of the physicians.  If it is welcome, then good.  If not, just accept the fact that one cannot please everybody.
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