PCOracion’s MAR [15-05]:The Dilemma with Patient Disclosure

Medical Anecdotal Report
Indexing Title: PCOracion’s MAR [15-05]
Title: The Dilemma with Patient Disclosure
Date of Observation:  July 2015
Tag: Disclosure in patients that have been managed by another physician
Category: Professional/Ethical – Reinforcement

NARRATION:

A 68-year-old female sought consult at the out-patient department for an anal mass. She noticed it a month prior to consult. It was occasionally painful and was constantly present. She claims to have undergone staple hemorrhoidectomy 3 years ago. She showed me a histopathologic report stating hemorrhoidal piles and squamous cell cancer. She asked what it meant. I didn’t answer right away. I inquired if her previous doctor had talked to her about it. She was told that she only had hemorrhoids and all of it was removed. I asked if I could examine her and she obliged. There were 2 distinct hard tender sessile masses each approximately 1 cm in size at the anal verge. The sphincter was intact with no mass in the anal canal. The patient said that when she went back to her doctor she was told to get the mass removed. She was reluctant for she didn’t want to spend as much as she did before. I tried to carefully place my words. I said that the mass I saw were unlikely to be hemorrhoids and I am suspicious that it could be malignant. She adamantly opposed it, saying that her doctor said she only had hemorrhoids and nothing else. I let her rant. I told her that she should talk to her doctor about it. She didn’t want to. I relayed this to my colleague and the patient was eventually referred to our surgical oncology service consultant. She was advised to undergo chemotherapy.

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

We can encounter patients that have been managed by another physician and want to transfer for completion/change/revision of management due mainly to financial constraints. The management becomes tricky because the case is already complicated. In a few instances, the issue lies in the incomplete disclosure of information to the patient regarding his condition. The dilemma to the new physician is whether he should or should not fully disclose what he has deduced from his own history taking and physical examination.

A physician-patient relationship is founded on trust and mutual respect. It denotes two-way communication, patient cooperation and empowered decision-making. Without complete disclosure this cannot be fully achieved. Though it is with cost for a physician to commit to full disclosure, it is incumbent for him to relay important information and details that can or will affect a patient’s disease condition, his perception of his current state and his decision in the course of his management. It is never good to withhold information.

It is ethical to call the attention of the previous physician that a patient of his has transferred to your care and discuss the patient’s disease. In our setting this does not happen. It is however expected that physicians caring for patients that have been managed by another where complications or adverse events occurred, to disclose his findings to the patient in a manner that is truthful but not derogatory to the previous physician. There is a risk that the previous physician can be implicated for neglect or malpractice but committing non-disclosure in these complicated cases will further add harm to the patient’s well-being.

As young surgeons, we must learn proper patient care. It must be ingrained in us that proper patient care encompasses the moment we first meet the patient, during pre-operative preparation, intra-operative management, post-operative care and even up to follow-up after discharge. We must be truthful always in every step of the way. If we are knowledgeable, we can handle the possible outcomes and adjust the treatment. We can educate the patient about it without losing rapport. We cannot render good patient care, avoid complaints and promote customer delight if we do not abide by this.

ROJoson’s Notes (17feb13):

The physicians should be truthful in their explanations and advices. Timing and how to communicate are what the physicians should consider when they do explain and advice.

 

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