Pride? Ego?

I just knew i felt real angry and irritated during the encounter, but i couldn't tell why till i thought hard about it after my clinic ended

I have been seeing this lady with OA knees for the past 4 months, a total of 3 encounters. As usual, i started her on meds and physio, hoping she could get away without an operation. However, she came today and complained that the pain was not getting anyway ideal. I asked her if she would mind doing a knee replacement..... Then it happened.

Her daughter whipped out a piece of paper and said meekly:" one of my relatives told me to find this surgeon in another hospital.. Can you help me write a letter so that we can see him?"

It was quite common for patients to want to go elsewhere for operation, so i gave my usual warnings that they will be charged private rates etc. And we went on to compare a bit of the price if an operation were to take place there vs here. She persuaded me again and again for the referral saying that it will be an earlier appointment if i wrote the letter though i told her again and again it will be the same since she will be a private patient there. I gave in after my clinic assistant pushed me a little.

I carried on again to tell her we will stop the appointments here since she will already be going elsewhere. But the daughter went on to say:" oh can we keep the appt? because if we go there then if it will the same treatment but if too expensive then we can come back here right?"
I almost exploded (but i didn't know why then) to top it off my clinic assistant said:"they just want a second opinion la.. give them a date lor..)

I gave whatever she wanted and was glad that she was out of the clinic in what felt like eternity. Fortunately that was my second last patient.. i was in a super foul mood and i had real difficulty forcing smiles on my face when i saw the next patient.

I thought about my anger again an again after the day ended. I would usually just laugh off things that anger me during work.. like demanding patients or unreasonable nurses, but this time.. it was different, it hit me real deep.. I finally realised why.

1) I had to write a letter to another orthopaedic clinic for this patient who wanted a second opinion, meaning they are thinking my treatment was crap. And i even have to provide 'after service' for them to give them another appointment!!

2) So if this big name surgeon happily did a TKR and the patient happily walked without pain afterwhich. This daughter will happily say:"wa this surgeon so good! see him once then operate then good liao! not like this other doctor in this other clinic! See him so many months also no use!"

3) The daughter was obviously not listening to me when i tried to explain we were trying conservative first then operative if it was not successful

4) The clinic assistant was not helping me at all!!! Why wasn't she like most others who would feel the same way and played by ear with me?? Doesn't help that the hospital they want to go to was the one she was from previously and she had a good impression of it.

I don't know if it was my pride or ego that was hurt, making me feel this bad. But i will definitely feel injusticed if the op was done elsewhere and the daughter were to complain about bad treatment from me or the clinic i was working in..

Persuasion

Completed Vampire Bloodlines not long ago and Guoping had been telling me all this while: Wa!! Eh you need to increase persuasion to almost max to win the game man...

Persuasion does not seem to only apply to Bloodlines.. A doctor needs a lot of it also.. Wonder what level i am now.. Enough to complete the game? haha

Ethics is hard to understand. "patients should be able to make choices for their own treatment" Yeah, but if i tell some one: hey you need this operation really.. Otherwise sure 99% cannot survive one.. How many patients still got a 'choice' to make?

i find that patient's decisions are usually swayed by their doctors. My head of department once admitted:"i haven't done much joint fusion before, so naturally i will paint a picture to a young patient who supposedly needs one according to textbooks' recommendation that he will benefit from a arthroplasty instead"

Persuasion: we always unknowingly use it so that patients tend to decide according to our point of view, but again isn't that the reason why people need to consult a doctor?
whenever an elderly with multiple comorbidities come into the hospital with a fracture, we will most of the time say "oh, she has very high risk for operation, unlikely to tolerate analgesia blah blah.. high chance of dying on table blah blah.. but of course if you still decide for op we will try our best" Er... which relative will take the risk and send the patient to what supposedly is hell's door as painted by us? So this patient will definitely decrease her chance of walking in future but supposedly increase her chance of living longer.

Then there are those who initially die die don't want operation/amputation, then we will stalk them every morning round, telling them all the scary things that will happen if the operation did not take place. Then try to downplay the operative risk or the possible chance that post operatively the situation will still be the same or even worse.

It sounds crudely like a game, but i'm glad some of the persuasion led to patient's becoming well and discharged. Though probably there are a few others the family will give you the "i thought you say can become well after op one??!!" kind of look. But what to do, we're not god but like it or not we have to play it. Who can deny this? Medicine is not 100%, unless we can look into the patient's future, we can only state probabilities and advise for the treatment that will most probably lead to the best outcome.

Felt.... Like Death

I never felt this previously, despite the many encounters i had as a HO.
I stepped within the drawn curtains and then i felt it... Death... Total stillness.
She just became a matter just like the neighbouring bed/resus trolley..... Lifeless.
No nurses with me, no other colleagues around. Just me and the patient i had been seeing for the past 2 months. It was hard to describe, it wasn't the sight.. It was truly a feeling.
I haven't even looked at the ECG strip, haven't done the Doll's and pupils reflexes. What i had to do next was just routine.

I had been asked may times before: whether i felt sad when one of my patients passed away. I usually say "not really". This time, it was somehow different. First time i felt like crying, and also first time i had to certify a death.

I remembered how awake she was... how we first tried so hard to save her leg... and ended up trying hard to save her life... without avail. She wasn't the most motivated of patients, but she was one of those that appreciates you when you spend more time talking her into a treatment. She also had a super dedicated husband who comes everyday without fail to see her, buy her food, keep her company.

I guess i felt real sad that everything went in vain, and her husband despite his relentless efforts had to face the inevitable. This is probably the first case i had tried to fight for a patient's survival. Also the first time i had so much contact with the patient before she went into her pre-death coma.

I wonder if i would feel this again....