Friday, January 27, 2017

Back to the basics: start with a standardized case history sheet for plastic surgery missions

One of the observations that I made during my trips to several primary care mission hospitals is the woefully inadequate, or even absence of, proper case histories for seemingly common ailments. As a result, there have been several hiccups in patient management, including some near total disasters in the OR.

Some of us who have a surgical background will probably be aware of the high incidence of post operative complications following appendix removal for suspected appendicitis . The real culprit is often not the appendix, but a perforated duodenal ulcer mimicking appendicitis. This is commonly known as  Valentino's syndrome, named after the actor Rudolf Valentino who died after a missed diagnosis and incorrect operation in 1926 at a New York City hospital.

Missing a diagnosis is most commonly seen after a careless history by doctors, ignorance, or the complete absence of the patient case history. If we were to round up the usual suspects in a morbidity or mortality session, you can be sure it will be one of these suspects.

A surgical procedure may be relatively simple in experienced hands, but unless one cultivates the habit of carefully screening all patients thoroughly before any procedure, mistakes are bound to occur . You might be requested to help a doctor to perform a routine procedure in the OR, only to find out before the operation that the patient has a thyroid storm on the table when anesthesia is given;the history/clinical examination was not done even though the patient's diagnosis was actually staring at you in the face as Grave's(hyperthyroid) disease!

The list goes on and on , and mistakes are often repeated  at such centres where no concrete steps are being taken to check such imbalances.

Better safe than sorry. Make it a habit to carefully screen all medical and surgical patients before any minor or major procedure.

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