Indexing Title: NALUDINOs Medical Anecdotal Report [05-08]

MAR Title: Doing it  the right way

Date of Medical Observation: September 10, 2005

Narration:

She was just like any other patient. Another one of those brought in by the police for routine issuance of medical certificate prior to detention, the usual suspect. We just went through the motions of examining her and then we issued the medical certificate. The whole time the patient was at the emergency room, she was sobbing and complaining that she was a victim of police brutality. She was eventually discharged and was in now in police custody. Everything was fairly routine after that.

After an hour or so, the patient came back. She was now with persons claiming to be her relatives. Immediately they started shouting and hurled accusations at us. They claimed that when she was brought to the hospital earlier, we conspired with the police in issuing a medical certificate stating that she no injuries. They started asking for the name of those who attended to the patient. No amount amount of explanation could appease them.

And then we remembered about our medical recording. We retrieved the chart and were relieved with what we saw. Indeed, it was written in the history that the patient claimed that she was allegedly beaten up by the police office resulting to injuries.  The final diagnosis showed that she had a hematoma at the parietal area. When they saw the chart, they were no longer in a fighting mood. Suddenly they became apologetic. Apparently when the patient heard that she had "negative" skull x-ray, she thought that she was "negative" for injuries.

The group then asked for another examination, claiming that she was beaten up by the same police officer when they left the hospital. Indeed we saw that she had more injuries and issued another certificate.

The following day, I saw the patient and the police officer on the evening news. I was glad I performed my duties well.

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements):

At the emergency room, the sheer number of patients can overwhelm the unprepared. Most of the patients seen are those brought in by the police for routine issuance of medical certificate prior to their detention. They come in droves and in the wee hours of the morning.

Sometimes the repetitive nature of the situation leads those that are involved into complacency. The temptation to put everything into a "de kahon" medical recording and management is very great but must be avoided.

The situation above certainly illustrates the point. If we did a "routine" history, put a "routine" physical examination instead of doing it properly, everything we did and wrote on the chart would all be suspect. By exercising caution and doing the "proper" procedure we avoided potential medicolegal suite.

Another way of avoiding a potential complaint is to establish good communication with the patient and his relatives.  By not engaging the patient or her relatives in a word war and instead being in a clear state of mind, I was finally able to placate their anger.

It is not enough that a doctor goes on duty and just goes about doing the duties assigned to him. The physician must go on duty and fulfil his responsibility with care and with respect to those that entrust their welfare to him.