Indexing Title: NALUDINOs Medical Anecdotal Report [06-04]

MAR Title: Understanding patient’s beliefs

Date of Medical Observation: May 2006

Narration:

            Late in the evening during our tour of duty, a man in his early twenties arrived at the Emergency Room. Not the best male specimen, I must say. He was clearly in good health. He was a wasted young man. Apparently in distress, with very icteric sclerae. He was eventually triaged to another department. With the deluge of patients at the emergency room, I completely forgot about the sick man. The night dragged on, we went about our business.

            The next morning, as we were preparing to endorse to the next group, an intern approached to refer a patient. As she was presenting the case, it dawned on me that she was presenting the case of the young man I saw that night.   She was now asking us to examine a patient which they diagnosed to have ascending cholangitis.

            The patient was treated for hepatic abscess two years ago at our institution. Apparently feeling well, he was discharged and was lost to follow up. Approximately one year ago, the patient became jaundiced. Despite this, he did not seek consult with any health professional. His condition persisted up to the present.

            Examination revealed a septic, in distress patient. We had to intervene.

            We then explained to the relatives our treatment plan and the risks involved. Upon hearing this, the mother shed a torrent of tears. Apparently, the condition of her patient was not fully explained to her. She thanked us for finally telling her the truth but to our surprise they refused to give consent. She said that they had already accepted the fate of the patient.

            We tried hard to convince them with our treatment plan, but to no avail. When we followed up on the patient, we learned that they decided to bring the patient home.

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

            As the old cliché goes, “the truth shall set you free.” How hard can it be to tell the truth? How hard can it be to finally break the sad news. Are we the harbingers of doom? Not really. We are doctors. We give help to those who need help. There are times when we must be able to keep a straight face and tell the sad news. Yet there are also times when we are the ones who give hope to those who have none.

During our journey in life as physicians we will be able to meet a broad spectrum of people. Some will have a line thinking similar to ours; others will possess a different set of values. Both will demand the same kind of compassion and understanding.

Inspite of all our efforts to understand and to help, there will be those who will go against our medical advice. It is not for us to condemn them but to understand them and provide them with other avenues to explore.