Cast & Curious

Tag: Orthopedics Practice

  • Emotions while treating a pediatric trauma case

    injured kid..they evoke so much pain from injury largely not of their making

    Of all orthopedic trauma cases I’ve worked on, my heart bleeds the most for pediatric patients. I don’t know but their helplessness and innocence always evoke this feeling of worry. Many pediatric trauma cases are often a result one adult, guardian or parents, gone remiss in guiding or understanding a child growing up. While many adults blame kids for crossing streets alone or unguided (thus running their vehicles over them), they too agree its the kids guardians or parents that really had an oversight. An irony?

    Maybe. But the pediatric trauma patient is almost always a victim. Why? Imagine suffering an injury as a result of a road mishap only adults understands, or being blamed for violating traffic rules even licensed drivers rarely follow? And they wretch in pain for something they rarely know?

    This is exactly why treating pediatric trauma patients entails stretching a surgeon’s patience more than you can offer any adult patient. Why adults busy themselves finger pointing on so many things, the child wretch in pain for an injury he or she rarely knew of. That is something pitiful than any other thing. Don’t you agree?

  • Philippine Orthopedic Association 2011 Mid Year Convention at General Santos City

    POA 2011 Mid Year Convention Flyer

    This year’s Phil. Orthopedic Association (POA) Mid Year Convention will be on May 5-8, 2011 at the KCC Convention Center General Santos City. POA-South Mindanao Chapter, the host for this event, chose the Tuna capital as its venue and has lined up interesting topics (Read this souvenir program) for the participating orthopods.

    This year’s theme,”Habal-Habal sa Gensan”  focuses mostly on orthopedic trauma resulting from motorcycle injuries and its socio-economic impact on Filipinos. Habal- Habal is the local vernacular for a motorcycle used as a passenger transport vehicle common in the countryside. As everyone might have noticed, traumatic injuries from motorcycle accidents tops the list for causes of acute trauma injuries in the Philippines.

    So lets relax a bit off our busy cutting lives and enjoy this year’s mid year convention!

    See you all at the Gen Santos City!

  • When surgeon shopping ends up with just facility shopping…

    “Hello! And again!” I happily greeted this patient sitting on my clinic chair. He smiled back , albeit sheepishly and said  “Sorry doc!” . “Don’t mention it, it is your right by the way”.

    (Photo credits goes to http://blog.drfirst.com/eprescribing/florida-providers-beware-of-doctor-shoppers/)

    I saw this patient about 2 months prior to this consult in one of my other clinic in another institution. He consulted me for a certain orthopedic problem, examined him, ordered the needed diagnostic procedures and appraised him carefully of my treatment recommendations. This including financial considerations and proximity of institutions where we can do the necessary procedures. Then I lost him to follow up.

    Mr. X resurfaced 2 weeks after, in my other clinic,  in another institution thinking he was seeing another surgeon. He was surprised as I am that we met for the second time in another clinic and in another institution.  I don’t know if he was just plainly uninformed or he wasn’t very particular physician names, but I’m pretty sure my name was clearly printed on this clinic door. The guy was surgeon shopping and is surprised that so far, he window shopped the same surgeon in two different institution  – me and myself.

    That aside, I went on with my routine patient consult gave the same treatment recommendations as before. His surgical problems needed the same surgical treatment. Nothing changed. Went he stepped out of my clinic door, I had this inkling I won’t be seeing this patient again. Indeed, I lost him to follow up. Again!

    Until this very moment, when he showed up (again) in one of my other clinic in another institution different from his previous consults with me. I greeted him “Hello, …again!” …He went pale. So the rest of the story goes.

    Just how he ‘window shopped for the same surgeon, three times, without him knowing” is mind boggling. But he obviously wasn’t very particular with names. He was shopping for the “surgeon” who will give him the treatment he liked.  It’s unfortunate he ended up with the same specialist three times, in the process.

    In a small city where “specialists” is as scarce as physician, “surgeon-shopping” may just be actually “healthcare facility shopping’. So patients, pay particular attention to your physicians names…

     

  • Do you charge professional fees for additional procedures done to address complications or morbidity?

    This question was thrown on me recently by a newbie colleague who was agonizing on whether or not to charge patients for an additional procedure he did to address a complication. I instantly went blank thinking what to say.

    when surgery goes wrong…will you charge mr. bean?

    In the field of medicine or at least here in the Philippines, there’s really no hard and fast rules on charging professional fees for services rendered to patients. This service for fee setup of our healthcare system is somewhat messy and often embarrassing to patients and doctors alike. The price haggling is totally unnerving. Sadly, this is what plague the professional practice of most physicians here in the Philippines.

    Such charging “grey” is even more embarrassing in cases where patients entailed additional services outside of their routine or planned operative procedure. While explaining and appraising procedure risks and complications to patients is a requisite of any informed consent, most patients still think that additional procedures,  should be an additional work for the physician and the healthcare providers alone. Patients or their financiers are not obliged to pay the healthcare providers for the services rendered for these additional procedures. Wherever, that notion came from, the stress on the attending physician(aside from that of managing the complication) is enormous, working on a very limited logistics to address complications. Besides, Docs have mouths to feed too.

    This situation is akin to the “heroic” services rendered by physicians to dying patients. Just because the patient dies (despite the doctors valiant efforts to revive the patient), the fees for the physician’s services (resuscitation)  does not “die” with the patient too. Services rendered have to be paid even if the service given did not achieve its original goal (that of reviving the patient). Can this situation be applied to procedures done to address morbidities?

    What do you think??

  • Lesser Surgeons?

    I’m amazed at how surgeons in provinces surpass the seemingly insurmountable odds besetting their practice. I’ve heard of horrifying stories regarding provincial practice during my training, that I sometimes wince at the thought that me too shall join their ranks soon when I get back to my hometown.  Then I got the first hand “feel” of what its to be like a surgeon from the provinces.

    In my first year of practice I remember managing one patient who sustained multiple closed fractures of the ankle and that of the leg. On treatment appraisal I found out the guy can afford an operative procedure for the (bimalleolar) ankle fracture but not that of the leg fracture. I was in a dilemma at that time since current evidence only supports good overall functional results if both fractures will be treated operatively at the same time. Treating the two fractures differently or separately will result to a less than good outcome the review further noted. I racked my brains out for a middle ground solution. I can find none more than speculative statistics. I presented this dilemma to the patient and let him decide based on the ‘literature” and statistics I was explaining. I was dumbfounded with what he told me after my lengthy explanation. “Do what you think is best doc”.

    Not only that.  I  told the patient that because we don’t have intra-op x-rays in that institution, it’s either we risk infection bringing out the patient to the x-ray room during operation to check for fracture reduction or just feel out reduction and accept whatever comes out after surgery. His only answer was “do what you think is best doc”.

    Inside OR, there were so many other things that are less than ideal and often “damning’ to surgeons. I’m pushed to use a manual drill because we don’t have a sterilizer fit for my power drill. No pneumatic torniquets. No reduction clamps nor suitable retractors. And did I say before we don’t have a c-arm or an intra-operative xray machine? None of the nurse assists is comfortable with my orthopedic instruments. If this surgery turned horribly wrong, I wouldn’t be surprised. So I made sure the patient knew exactly what are our risk and he too wouldn’t be surprised if this surgery go bonkers.

    I don’t know how the patient’s surgery went well despite these never ending list of “have nots. He went through the surgery knowing all of these and it went well, save for the surgeons’ anxiety and stress. I couldn’t sleep before and after the surgery knowing the odds we’re getting through. Frankly, I’m scared more than the patient but choice is something limited for us during those times. The need outweighs the risk.

    Nowadays, I stil encounter a few of these have nots in most of my ORs, and I’m just as scared as before. I always talk these oddities to my patients and secure their approval before performing any surgery on them under these situations. This doesn’t lessen my anxiety and stress level though. It just pushes me beyond my comfort zone trying out new things “unorthodox”  that are anchored on a logical framework I’m taught during training. Ultimately, need is such an impetus for innovation.

    So I wonder, does these insurmountable odds make us- the”provincial” cutters, less of a surgeon?