Medical Anecdotal Report
Indexing Title: LBBERSAMIN’S MAR [15-02]
MAR Title: Through This Simple Change
Date of Medical Observation: February 2015
Tag: Changing the approach of doctors in patient presentation and acknowledgement
Category: Professiona/Ethical– Reinforcement
It was at around 5 o’clock in the afternoon when I received a text message from a co-resident, of us being called for the daily afternoon rounds. It starts off with a resident presenting the case of the patient, including the planned management or procedure done, and the current treatment the patient will be in. It is through this process that we do our daily endorsements for each team’s patients, and give notice to the duty team matters of concern to focus on. Going through six rooms and on to our 14th patient, we encountered in our rounds a 38-year-old male who underwent an appendectomy due to an acute perforated appendicitis with generalized peritonitis. He was one of our patients and was on his 2nd post-operative day of recovery. He was seated on his bed and conversing with his wife when we entered the room. The patient was operated on by one of my junior residents and was originally planned to be sent home the following day. We came up to his bed, a good number of us along with the medical interns and the clerks and discussed his case. While we were doing so, I noticed that none of us had initially greeted the patient, even though the patient had arranged himself at our arrival. Our junior resident then started with his endorsement: “Patient is a 38-year-old male diagnosed with acute perforated appendicitis with localized peritonitis, and on his 2nd post-operative day”. The endorsing resident then informed the body of the other plans of the team for the patient. Seeing the patient give us a subdued look, I can only wonder on how the patient felt then. I can only see him get lost in question, wondering how we can discuss something about him as if he was not there. As we had finished discussing his case, I greeted him by his name and asked: “Kamusta po kayo? Uuwi na po kayo bukas.” (How are you sir? You can go home tomorrow!) I only did it to break the ice. He replied: “Ok naman po ako doc, uuwi na daw po ako bukas. Salamat po sa inyo! (I am ok doc, I am going home tomorrow. Thank you!) I then reminded him of being able to take a bath and clean his wound daily. Before the endorsement rounds went on I said goodbye and told him “Bawal mong kainin ang di masasarap na pagkain” (You are not allowed to eat food that is tasteless). He then broke out into a laugh along with his wife.
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
Every afternoon we go about our daily endorsement rounds, checking on our patients, and updating our co-residents regarding the cases we handled. These endorsement rounds are very helpful in pointing out the necessary things to remember in our patients. It is through this process that we maintain a continued means of treatment for our patients when we are not in the hospital. But at times, what we completely attain in great communication, we may lack in the genuine attitude towards our patients. The objectives we so relentlessly conquer just to see our patients get well, may lead us to miss out on the human factors of our management. Going through this moment where we had missed out on the simple greeting of a “Good afternoon sir, how are you feeling today”, prior to starting the bedside endorsement of our patients. We miss out on addressing him/her to our colleagues through their names and lack the social relationship we have with our patients. Even though our indigent patients either forgive us on missing on their names or greeting them, more often they just do forget about it because we are their doctors. Yes, sometimes as doctors we tend to get slip past these unfortunate mistakes as if we were reading from our endorsements from a piece of paper or medical journal. Sometimes looking in, putting myself in that hospital bed as the patient, I cannot help myself but feel for them. Having a group of people peer through an imaginary mirror, with sound appearing to have been deflected, but know too well people are talking about you. As their doctors, we should know more than this. We should be able to know how we should address them in the presence of other people. We should know how to present their case respectfully to others and avoid discounting their emotional well-being. No matter how small, or simple this act of remembering our patients name and being able to greet them in and out of the hospital, gives them our commitment to them as our patients. We act in respect of our patients as an individual and give them the importance deemed for each. If we set this example, practice it and carry it every single day, we get to improve ourselves for the better. Through this conscious act and attitudinal change, we even set ourselves as a modern, educated, and civilized government doctor. We employ respect to our patients and discipline amongst ourselves; through this simple change.
ROJoson’s Notes (17feb8):
When physicians make rounds as a team, either for teaching or endorsement or both, they should not forget to greet and be mindful of the patients’ presence. They should also cautious in what they are saying in front of the patients. There are things that should not be heard by the patients such as those that will cause undue anxiety.