Thursday, 24 February 2011

Failure of the surgical department

It gets tricky when you are in a district hospital , some departments with specialists and some without. It gets even more tricky when there are old MO's there who think they are specialists or moral guardians.. or both.

Typically the paediatric department handles all cases under 12 years old, as long as no surgery is required. If surgery is required then the surgical team is called in to handle the case. In a hospital such as mine, the surgical team is typically a 'referring out' team. They do not have a specialist and of the 3 MO's only one MO can safely perform an operation. They have recently obtained a surgeon who is on leave the minute he arrived. But that's fine. He needs to settle logistics. So take note, note, now the surgical team is a surgical team with a practicing and experienced surgeon.

Now when a child comes with any problem at all, the medical assistant will call the pediatric doctor. Even if the child has spiking temperature with voluntary guarding , all sinister signs pointing out to possible peritonitis.This is called the knee jerk reflex of the lower level staff. They can't see the disease,they can only see the age. But that's fine. They don't have an MBBS or MD.

I promptly saw the case and urged my surgical counterpart to have a look to rule out appendicitis, possibly a ruptured one.

The surgical MO saw the case but refused to clerk the case. He instead wrote in the casualty card that the paediatric department should take the case and to rule out a urinary tract infection. At the same time, he can't rule out acute appendicitis either, so please could the paediatric team not start any antibiotics yet lest it masks the signs of acute appendicitis. Oh and by the way, we are not the primary team ok? The paediatric team is,ok?

Okay.. you want the pediatric team to take the case as you think it is more of a bacterial infection of the urinary tract but you don't want us to start antibiotics? So the primary team must listen to the secondary team? Hmmm..

So now the paediatric team is the primary team in an acute abdomen case? Great no problem. I should have just managed the case by myself without the so called 'surgical team' that cannot do any surgery even if my patient's life depended on it. I made sure i reviewed the patient again and called the surgical MO at 1 am to please reassess. If the medical officer is not sure then he should send the patient out to a tertiary centre with a specialist.

Sigh.. so this MO, did his best with what he had but was just short of having the balls to pick up the phone

When the senior 50+ MO came the next morning, he diagnosed the case as a perforated appendix and promptly shifted the blame on the poor paediatric MO aka me (who had to among other things manage proper medical paediatric cases throughout the night), for not referring the case out. I'm sorry i tried my best to alert your team but i guess they were just too blind.

Anyway i was the one who accompanied the child via ambulance to the tertiary centre as the surgical team just could not care less.

If they claim to be so concerned for the patient shouldn't they have made sure the child was stable before and during transport?

These things happen.And don't think the private practitioners are better ok. It is doctor dependent. I have met some of the most passionate and intelligent doctors in the government setting and i hope to be like them.

Is it any wonder i want to do pathology even though i'm trained in pediatrics? There is just too much politics and too many deficiencies that burns my eyes seeing them.Not so much in the paediatric unit, i must clarify but somewhere else.

I hope to be surrounded by academics (pathologists) who can give precise and life saving assessments instead of seeing doctors who need to wait for the patients to go into full blown sepsis before they can make a diagnosis.

Thankfully the boy reached the tertiary centre safely and is pending operation.


bride2wife said...

Good one babe!.. 'they' should read this!!!!

shinchee said...

dat's y working in a hospital with departments often faced such situations... guess i'll b tasting it very soon...


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