Povestiri triste din medicina – Lipsa respectului fata de pacienti

Acum 2 luni a fost foarte populara in fluxurile de stiri mondiale o poveste a unui american din Virginia careia i-au fost acordate de un tribunal american daune in valoare de 500.000$ pentru ca un medic anestezist (si alt personal medical) l-a jignit in mod repeteta in timp ce era sedat pentru o colonoscopie.

Americanul isi lasase telefonul pornit pe “inregistrare” inainte de colonoscopie, “pentru a fi sigur ca tine minte ce instructiuni i s-au dat post-procedura”.

Inregistrarea se poate asculta in articolul asta WaPo, spicuiesc: “este nebun”, “unul dintre lucrurile bune in a fi anestezist este ca pot face oamenii sa taca din gura”, “dupa cateva minute de discutie cu tine in preop, vroiam sa te lovesc in fata”, referindu-se la iritatia pacientului din zona genitala “nu atinge, nu vrei sa iei sifilis pe mana sau ceva”, “este probabil TBC in penis, deci o sa fii ok”, “este ebola la penis”, referindu-se la faptul ca isi avertiza ingrijitorii ca intotdeauna lesina cand i se monteaza o branula “atunci de ce te uiti, retardatule?” si lista poate continua.
In jurnalul american respectat Annals of Internal Medicine, al Colegiului American al Medicilor apare un articol in care se povestesc doua intamplari in care niste doctori-educatori s-au comportat lipsit de respect fata de pacientii lor sedati, de fata cu studentii lor, viitori doctori la randul lor.

Prima poveste este despre o histerectomie. Un doctor curata si aseptiza cu betadina labiile si zona inghinala a unei paciente si apoi se intoarce la student si ii face cu ochiul, spunandu-i “fac pariu ca ii place”

I was scrubbed into a vaginal hysterectomy. The patient was under general anesthesia. My attending was prepping the patient’s vagina. He picked up a clamp holding sterile cotton balls and dipped them into Betadine. While he was cleansing and scrubbing her labia and inner thighs, he looked at me and said, ‘I bet she’s enjoying this.’ My attending winked at me and laughed.

masaj uterin

A doua este despre o nastere complicata (a unei mame de origine hispanica). Doctorul ii salveaza viata pacientei facand o procedura de ultima instanta, in care se maseaza INTERN postpartum uterul mamei pentru a opri o sangerare. Ei bine, in timp ce e cu mana adanc in interiorul femeii, doctorul se apuca sa danseze si sa dea din mana libera, fredonand ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.’

Canby then performs an internal bimanual uterine massage. He places his left hand inside her vagina, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That’s what I like. A nice, tight uterus.’ And the bleeding stops. The guy saved her life. I was blown away. But then something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.’ It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ And we stop.

Cel mai trist mi se pare faptul ca cei 2 studenti au ras/participat la momentul nepotrivit, desi stiau in sinea lor ca nu e corect sa o faca. Ma rog, editorialul care insoteste articolul initial mentioneaza ca ei publica aceste povesti in speranta ca va genera discutii constructive despre tratamentul pacientilor si de ce unii doctori aleg sa se poarte nepotrivit.

Asta mi-a adus aminte de un post de pe Respectful Insolence, un blog al unui chirurg oncolog american (David Gorski, managing editor la Science Based Medicine.org). In acest post, Orac era pe buna dreptate scarbit si ingrozit de felul in care era prezentat un moment de “educatie medicala”, povestit pe un alt site cu teme medicale (KevinMD.com – una dintre cele mai citite pagini de acest gen din SUA).

Se referea la un repost a unei postari aparute initial pe un blog (sters intre timp) al unei doctorite chirurg din SUA. Povestea cum profesorul ei, in timpul unei operatii de reparare a unui anevrism aortic, observand ca este “prea” atenta in jurul venei cave inferioare (IVC), o sectioneaza voit ca sa “o pregateasca pentru viata de chirurg” si sa vada cum va repara aceasta urgenta.

anevrism aortic

Adica i-a pus voit viata in pericol unui pacient care-si incredintase viata unor profesionisti…

So here I was, handling the plane (the layer, or space) around the IVC with care to avoid ripping it.  It seemed like the intelligent thing to do.  My attending asked, why are you being so dainty with your dissection there?  I answered that I wanted to avoid ripping the cava because they’re so much harder to fix.
I take it he interpreted my comment as fear, and decided upon a teaching moment.  He took his scissors and incredibly, before my eyes, and with no warning or preparation of any kind, cut a one inch hole in the cava… As I tried to process what I just saw, incredulous that he would actually intentionally make a hole in the cava, and as dark blood poured out of the hole, the tide rising steadily in the abdomen, he remarked, “well, are you just going to stand there or are you going to fix that?”…
So on that day, when the vascular attending cut that hole in the cava, he was preparing me, both for the oral exam, and for life as a surgeon.  He wanted to see if I could handle it.



Sper din tot sufletul sa nu ajung intr-o situatie de genul asta, pentru ca n-as vrea sa regret toata viata apoi faptul ca prin actiunea sau inactiunea mea am fost de acord cu un asemenea comportament…


1 Comment

  1. Din septembrie incep asistenta medicala generala, 3 ani… Cine stie de ce specimene o sa dau si eu prin spitalele noastre…


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