Indexing Title: ROJOSON’s Medical Anecdotal Report [06-04] 

MAR Title: Physicians and nurses as potential instigators of patients’ complaints 

Date of Observation: September 2005 to April, 2006  

Narration: 

A 50-year-old Filipino female was scheduled for elective cholecystectomy.  During induction, the anesthesiologist noted plenty of oropharyngeal secretions and signs of impending laryngeal spasm.  He decided to abort the induction of anesthesia. The cholecystectomy was thus deferred.  The patient went home alive but disappointed. After the operation, she registered a written complaint against practically all the members of the medical and nursing staff who attended to her for poor quality medical and nursing care.    

This medical anecdotal report will limit itself to only one of the many complaints of the patient, that is, the non-performance of cardiopulmonary clearance by the attending surgeon (yours truly).  Despite repeated explanation, the patient insisted that cardiopulmonary clearance should have been done as she considered this a routine preoperative procedure and if done, could have avoided the laryngeal spasm and cancellation of her operation.  She cited that one physician and a nurse in the hospital telling her that a preoperative cardiopulmonary clearance should have been done.  The issue was settled when the medical director and the chairman of the department of surgery declared that preoperative cardiopulmonary clearance is not routine.

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

Beware of our colleagues in the health profession.  They are potential instigators of complaints of dissatisfied patients against their physicians.   

Among physicians: 

The Hippocratic Oath that all physicians pledge to abide, strictly speaking, should be able to prevent physicians from making comments that will put their colleagues in a bad light.  However, in the real world of medical practice, taking the oath upon licensure is no guarantee of protection for physicians against instigation by colleagues.  First, there is a subset of the physician population who would disregard the oath in an attempt to destroy their physician-colleagues because of jealousy and animosity.  Second, there is a subset of the physician population who would disregard the oath in an attempt to protect the unknowing patients and the community at large from harms being perpetuated by incompetent and unscrupulous physicians.  Another subset, the biggest subset, consist of physicians who forget the oath because of a habit to express differing opinion or worse, make negative comment on the actual management done by another physician, thinking such an expression will not do harm to their colleagues.  There is no problem to give differing opinions in patients seeking a second opinion before a management is done.  After an actual management is done by another physician, a colleague should be careful to the point of inhibiting himself from making comments, particularly negative ones.   

With medicine being an inexact science, with the absence of a standardized way of learning and teaching medicine, with so many “controversies” in medicine, and with the physicians’ management approach being influenced largely by their philosophies and idiosyncrasies, there is no one or uniform way of managing a patient.  Such a situation contributes to confusion on the part of the patients when they look at how physicians manage a patient.  Physicians should be aware of such a situation and should not elevate patient’s confusion to a dissatisfaction level against a managing physician-colleague.   

For nurses: 

I am not aware of nurses also having the Hippocratic Oath or any oath along the line of pledging that they will respect the decision of the physicians.  As nurses, they should respect the decision of the physicians. If there is a question, they can either discuss this with the attending physician or consult a higher office in the hospital. They should not openly comment or discuss their differing views with the patients. 

In the absence of a documented clinical practice guidelines and pathways in the hospital, nurses tend to consider the usual practice of physicians in the hospital as the standards.  Physicians who “deviate from the standards” are at the mercy of these nurses.  I don’t practice routine cardiopulmonary clearance.  Oftentimes, I get a night telephone call from the nurses asking or reminding me of the cardiopulmonary clearance for my patients for operation the next day.  Now, I got a complaint in my hand because of a comment of a nurse. 

Personal resolution: 

After explaining the probable clinical diagnosis and the benefit and risk of each option in the paraclinical diagnostic procedure and treatment plan on a piece of paper, I have the informed consent or informed refusal signed by patient and relatives to save me from the hassle of misunderstanding and instigation from whatever source.