Indexing
Title: RJPeralta’s Medical Anecdotal Report 08-09
MAR
Title: Communication is still the key
Date
of Observation: September 2008
During one ER duty, the department of Internal Medicine referred to our department a case of a 65-year-old female because
of the impression of acute appendicitis. Taking her history, I learned that she
went to the hospital with the chief complaint of epigastric pain a day before consult.
There were no associated symptoms. The internal medicine resident was
treating her as a case of Peptic Ulcer Disease. ECG was done and revealed non
st t wave changes. During her ER stay, the epigastric pain shifted to the right
lower quadrant area without any associated complaints like dysuria, anorexia, fever, chest pain. During my physical examination, the pertinent findings were flabby, soft, direct tenderness at the right
lower quadrant area, with involuntary guarding. I referred the case to my senior
as a case of acute appendicitis probably perforative and we decided to have the patient transferred to our service and booked
her for emergency appendectomy. I explained to the daughter the patients’
condition and that of the hospitals’. I told them that from my history
and physical examination, I was thinking of acute appendicitis with probable perforation as the cause of their mothers’
abdominal pain but I’m not 100% sure. Well, unless I see it face to face. I also explained to them that acute appendicitis is an emergency case wherein an immediate
appendectomy is needed. But at the time of their consult, there was no available
bed and if ever she will be admitted, the patient will be “5th in line” for the said procedure and still has to
procure the needed materials. Many problems!
They said they understand and are willing to wait for a vacancy and their turn and are going to buy the said materials. I again reiterated the need for immediate intervention but they were as persistent. I admitted the patient with the hopes of finding a room and having
her ready for operation (Pre meds) while they were completing the needed materials. They were also requesting that I handle
their mother’s case because they appreciate that I’m explaining to them everything.
After a day, they were admitted at Room 308 and on the 3rd hospital day, I was able to operate on her. Intraoperative findings were appendix retrocecally located in its perforative stage
with localized peritonitis. The base was found but wasn’t good looking
so intraperitoneal drain was placed. Immediately post op, I approached the relatives
and told them what I saw, what I did, and what I planned. They said thank you
and are willing to follow whatever I, their doctor would recommend. Everything
went smoothly; they follow instructions to the dot. The drained was removed on
the second post op day, placed on diet as tolerated on the third and was discharged on the fifth. A week after, they followed
up. The surgical site was healing without any signs of infection and the home
medications were taken compliantly. After a few weeks, they again followed
up with the histopathology results.
Insight: (Physical, Ethical, Psychosocial)
(Discovery, Reinforcement,
Stimulus)
Being in a government hospital is a very advantageous thing. Well, training
wise. We have no problem with the number of cases and we got to see different
disease entities, common and rare ones. But if you start to think about it carefully
you can see that we are not just training, skills wise but also the whole process of dealing with patients.
From my 10 months of training in this hospital I came to realize that part of treating a patient is informing them as well as their relatives with what they have and how to deal with it by making them
part of the treatment process makes them more responsible for themselves and their patients.
Communication is still the key. Educate each patient, each relative. Arm them with the knowledge they need because only through this means that we can
achieve our goals of:
• Live patient
• No complications
• Satisfied patient
• No medico-legal suit
Thank you and good morning!
