Indexing Title: RJOSON’s Medical Anecdotal Report [04-4]

MAR Title: Difference in Opinion between Former Student and Former Faculty

Date of Medical Observation: July 29, 2004

Narration:

GE was a respected mentor during my surgery residency.  He was influential in my being a scholastic and a practical surgeon.    After my graduation, he would ask me to assist in his private operations as a way of helping me establish my practice.  As years went by, when I was on my own already, he would show his admiration for my surgical skills with his referral of difficult cases.  Whenever he would refer patients to me, I would feel honored.

Several months ago, he referred a 12-year-old boy with a preauricular mass and multiple neck nodes.  The boy had gone through extensive work-up but still with indefinite pretreatment diagnosis and the family’s resources had been drained.  Always a compassionate physician, GE referred the boy to me with specific instruction for parotidectomy to be done in a government hospital for free.  When I evaluated the boy and reviewed his voluminous records, based on pattern recognition and prevalence, a parotid malignancy was very unlikely.  My clinical diagnosis was lymphoma vs tuberculosis.  Thus, I did not do the parotidectomy as suggested.  GE and I had discussions on the boy’s management on several occasions.  He was insisting that a parotidectomy be done and I was trying to convince him that it should not and I would not do it.  The discussion came to a point that out of frustration, the following statement slipped out from his mouth: “When I referred the boy to you, it is not that I cannot do the parotidectomy and that you can do it better than I do.”  These words disturbed me because of the implications that I have become a conceited, disrespectful, and ingrate person.  I re-examined myself as to the validity of my former mentor’s statement.  I also re-evaluated the patient repeatedly trying to convince myself that a parotidectomy was really needed.  I came to the conclusion that what really prompted me not to do the parotidectomy was my firm belief that a parotid malignancy was very remote. I decided to do another neck node biopsy which revealed anaplastic lymphoma.  I felt relieved when I saw this diagnosis.  I immediately, respectfully, and tactfully relayed the diagnosis to my former mentor who fortunately accepted it. 

Three months after, the mother of the child came to me to inform me that the boy had died during chemotherapy in a children’s hospital.  She was thankful that at least her child did not suffer from the pain and disfigurement of a parotidectomy had I did it as instructed by GE.

Several weeks ago, my former mentor called me up to congratulate me on my being chosen the University of the Philippines Alumni Association Professional Award in Medicine.

Insights (Discovery, Stimulus, REINFORCEMENT):

Differences in opinion between a former student and former faculty on patient management in private practice can occur in real life.  What to do?  The first value to keep and uphold is respect for each other person and opinion.  The second value to project is humility when one discovers one has the correct or the wrong diagnosis or opinion.  The third value to preserve is compassion for the patient’s welfare and to use it as a guide in making a decision on patient care, that is, when one is given the authority by the patient. 

Differences in opinion between a surgical resident and a surgical consultant on patient management also happen.  What to do?  Same three advises as mentioned above.  With the consultant being the captain of the ship, though, his decision should be respected and followed by the surgical resident.