DChua's MAR 04-8

Indexing Title: DCHUA’s Medical Anecdotal Report [04-8]

MAR Title: BL-Hind Sight

Date of Medical Observation: October 8, 2004

Narration:

Upon arriving home, my longest patient on record- my own dad complained of eye pain since morning with blurring of vision. He was on maintenance eye drops since loosing his right eyesight to glaucoma ten years ago. Finger pressure examination of his eyeballs confirmed that the disease was now trying to claim his remaining eye. I increased his medications to treatment doses from preventive ones and set to bring him to the nearest hospital the next morning.

The aged ophthalmologist verified the diagnosis (albeit noncommittal on the subtype, hence definitive treatment), told me that the prognosis was not good, changed the medications to newer ones, and told us to follow up after a week. I borrowed his portable eyeball pressure-measuring device for home use and reported back the next day of my dad’s deteriorating condition. I was advised to admit my dad for stronger medications but complied long-distance since I was on duty then.

After a week of admission, enduring multiple needle pricks everyday for an ancient history of diabetes secondary to obesity, loosing an internist due to being a difficult patient with an even more difficult care-giver (my mother), getting various opinions on treatment options and timing, undergoing routine cardiopulmonary evaluation, my dad underwent an operation under local anesthesia. I could not give him straight answers on the percentage chances of loosing his eyesight, and neither could the specialists.

Three weeks later, with a slight improvement of his poor remaining vision, my dad has not resumed watching TV or reading the daily papers- his only pastime since his third stroke confined him to bed eight years ago. If I could turn back time, would I have done things differently and prevented my dad’s sliding deeper into his major depressive disorder?

Insights	Discovery	Stimulus	Reinforcement
Physical	Glaucoma subtypes have differing treatments, including medications, laser types, and surgeries. Ophthalmologists don’t trust Schiotz tonometers or have them handy. Specialists have many enough shortcomings even within their own field of specialty.	Is blindness from glaucoma always preventable when detected early enough? Check itemization of hospital bill. My dad was charged for 2-D echo that was never done. Always use PhilHealth when possible. Keep sample meds sorted.	Digital tonometry is accurate for screening. Physician bias depending on field of training.
Psycho-social	Endorsing a relative-patient to a friend-physician over the phone is wrought with unforseen problems. Most physicians loose their temper with difficult patients.	Have a meticulous foresight to plan for all amenities and possible problems for your dear ones. Value a second opinion. How to change physician without hurting the first.	Dangerous complacency after endorsing patients. Physicians don’t charge their colleagues.
Ethical	No accurate answer can be truthful for prognostication of disease entities without actual data from studies.	Best time to operate on glaucoma failing medical treatment, with attendant risk of worsening condition.	Defensive medicine routine CP clearance is overwhelmingly widespread. Is it proper to assume the role of physician for loved ones?

Insights

Stimulus

Ethical