Index: OLEYSON’s Medical Anecdotal Report [05-05]

Title: Proper advised

Period of Medical observation: June 2005

Narration:

One evening during my tour of duty, a 24-year-old male came in with deep laceration on the left zygomatic area secondary to vehicular accident.

The Triage-Officer who received the patient did a quick interview. Primary survey showed a conscious coherent, not in cardio respiratory distress ambulatory patient.

He was a case of a “hit and run” who was found half unconscious in the pavement. He was accompanied by good Samaritans who extended a helping hand and brought him in our emergency room. The man who accompanied the patient flashed his ID stating that he was a Red-cross volunteer and that he meant that we should attend to his patient at once.

He reiterated on top of his voice that patient’s who are in need should be admitted and be taken care of immediately. The smell of alcohol from that man’s breathing stenches into the ER when they came in.

The emergency room triage officer immediately referred the patient to the ENT since their initial assessment was only a laceration on the zygomatic area.

The ENT clerks attended to the patient at once. Soon after their initial survey, the patient was referred to the resident on duty who prescribed sutures and anesthetics for the patient.

Sad truth about the emergency room was that too many patients came in for consult but with limited resources. That is why when resources run out, our poor patients have to procure whether they like it or not. Unfortunately, the supposedly good Samaritans honestly admitted that they don’t have enough money to buy the sutures.

They further explained that they have no money left, so they have to leave the patient since he was already in the emergency room.

The ENT resident refused to treat the patient if the materials will not be available and if his alleged “bantay” would leave him.

The good man who accompanied the patient cannot believe that a doctor of Ospital ng Maynila refuses to treat a patient because he cannot provide the materials needed for the patient. We were really surprised by the fact that this particular patient was not even referred to the Department of Surgery.

I was just observing the scenario but the Triage-Officer insisted that it should be given to the ENT service.  The situation of delaying treatment of indigent patients who cannot afford to secure the necessary materials seems to be common in the ER setting. I hesitated to give my idea for he was a senior resident from other department and I don’t want to make an unsolicited advised

I remember the study done by my senior resident on putting a butterfly tape on lacerations on the face and wouldn’t make much difference on the outcome of the wound. This procedure offers the same quality in terms of wound healing and would cost less on the part of the patient, especially those who really cannot afford to buy materials. After a much heated argument, it ended up the patient absconded and before he exit thru the door he uttered “ Magrereklamo ako kay Mayor”.

Insights (Reinforcements, Stimulus, Discovery)( Ethical, Phsychosocial, Physical)

It has always been the mission of our hospital to provide the highest quality medical service to all Manilan’s regardless of the social status race and creed made free to all indigent patient at the lowest possible cost (Mission Vision OMMC 1963).

As medical doctors, we took our oath that we will be of service to our countrymen, in the best of our abilities and within the bounds of our duties and responsibilities. But the sad truth was that emergency room supply really runs out of medicines and the patient must procure the materials for the sake of treatment.

So we have to ask our poor indigent patients to procure some materials for the operation. Many times our indigent patients cannot even buy a single syringe for blood extractions that puts our main objective behind.  As emergency room physicians we must be armed with the proper patient management process and follow hospital protocols which makes our decision making more easier needless to say “less stressful”.

I could have given the ENT resident the advice but I was taken aback by what happened.  Furthermore, proper rapport to patient and the so called “bantay” would have enlightened the patient and prevented complaints and even medico-legal suits.