Wednesday, July 12, 2006

Triage Tales 21

Disclaimer: The following story is a work of fiction. All similarities to people, places, things and events are coincidental by nature.

Sometimes a training program will have outside rotations. And technically if you are in an outside rotation, there are different skill sets and competencies expected of you.

A resident in an outside rotation "hangs out" at the ER, it technically being his place of assignment in the outside rotation.

The Triage Officer asks him to assist a 60-odd male in his problem, before going and assisting in a more urgent case. On further inquiry, the gentleman only needs a refill of the prescription given to his wife, being seen at the Out-Patient Department.

Now according to Kaplan's review material for the USMLE Step 1 Behavioral Science component, you are required to at least see the actual patient you are giving the prescription to. But, since the Triage Officer in her seniority has asked for the request, the resident in an outside rotation is obliged to perform the service.

Here is the discussion:
"Tay, anong problema?" (What is the problem? Can I help you?)

"Ay doc, magpapareseta lang sana ako ng gamot." (I just want to have a prescription.)

"Ah ganun ba. Ikaw ba ang pasyente? Saan kayo nagpapatingin dati?" (Is that so? Are you the patient? Where have you been consulting for your illness before?)

"Hindi ako doc, yung asawa ko po. Sa Faura kami nagpapatingin. Hindi lang kami nakapagpa-followup agad kaya naubos yung reseta namin." (I'm not the patient, doc. My wife is. We go to the Out-Patient Department at Faura. We just haven't made our follow-up schedule so our prescription ran out.)

He then whips out a drug store receipt, of all things, as a basis for my prescription. Not even an old prescription or a clinical abstract for a semblance of legality. Resident in an outside rotation is aghast.

"Alam ninyo Tay, dapat hindi ako ang nagrereseta nito. Ni hindi ko nga nakikita ang pasyente. Paano pala kung magkaroon siya ng reaksyon sa gamot, na ikamatay pa niya, dahil ibang gamot na pala ang kailangan niya." (I should not be the one making this prescription, especially since I haven't actually seen the patient. Anything can happen to that patient... maybe she already needs a different drug. I might kill your patient if I'm not careful.)

Resident in an outside rotation thinks about the "favor" for the senior resident.

"Sige, bibigyan ko kayo ng reseta for 3 days lang. Pero ang gusto kong mangyari eh bumalik kayo sa OPD kasama ang pasyente bukas na bukas din. Masyadong mahirap iyang ginagawa ninyo."(Ok, I'll make a prescription good for 3 days only. What I want you to do is to go back to the OPD first thing tomorrow. You're taking a very big risk here.)

After that debacle (and effectively putting his medical licence on the line), resident in an outside rotation has a relatively benign duty and was able to sleep at the callroom. He stayed away from the front lines precisely because he did not want to have a repeat performance of what just happened.

As he was looking for an intern, the same senior approaches him and says:
"Sarap ng tulog mo kagabi ah. Sana tinulungan mo naman kami kahit paano." (You slept well last night. I had hoped you could have helped us.)
"Mukhang kayang kaya ninyo naman eh," resident in an outside rotation replies. (Looked like you could handle it.)
"Hindi iyan yung point. Delicadeza lang sana." (That's not the point. You should have some delicadeza.)

Hmmm. Delicadeza. From Spanish:
1. - delicacy
2. (discreción) - tactfulness, discretion
3. (debilidad) - weakness, frailty
tener la delicadeza de - to be thoughtful enough to

I leave it to the reader if the discretion exercised by the resident in an outside rotation was proper. If it was me, I'd side with the resident in an outside rotation.

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