Date of Medical Observation
November 2007

Narration

A 37-year-old male was admitted due to fracture on his right distal humerus. It was allegedly due to vehicular accident that happened about two weeks ago.

The patient  was personally endorsed to me by one of my junior consultants who happened to be a relative of the third party  involved in the said vehicular accident.

He was about to undergo  Open Reduction Internal Fixation procedure that night during my tour of duty.

I will be the one who will assist on the case.

It was remembered that this patient absconded or went on DAMA a couple of times for unknown reason. This brought a little annoyance to some of my co-residents.

The operation was set. Together with our orthopaedic surgery consultant we conducted  the planned ORIF.

Surprisingly, the operation did not went as smooth and easy as expected.

There was a lot of  callus formations. We had a hard time doing the adhesiolysis.

It took us almost three hours before we were able to clean the articulating surfaces of the elbow joint from fibrosis and adhesions.

“It doesn’t look a two weeks old fracture.. It was a neglected fracture dislocation.”

my consultant commented.

We just fixed the joint with pin and concluded the operation.

Then we informed my junior consultant regarding our intra-operative findings.

He then talked to the patient the following morning. The patient confessed, the fracture was already 2-year-old.

INSIGHT

<!--[if !supportLists]-->n  <!--[endif]-->Physical, Ethical, Psycho-social

<!--[if !supportLists]-->n  <!--[endif]-->Discovery, Stimulus, Re-inforcement

There are some issues brought by this event.

There are so much reminders for us physicians about Doctor-patient relationship.

All those principles of privileged communication and patient’s right to privacy. These were all  instilled in our minds

This was a medico legal case but we played not the medico-legal officer.

How are we going to conduct ourselves in situations like this?     

We just attended to the patient’s medical need and not expected to meddle on legal matters. 

Is it just right to remain silent and not divulge our expert opinion regarding the matter for it would bring harm to our patient?

Afterall, our patient is our client.

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