Sunday, January 15, 2012

Family ties

The other day, the mother of my patient was frantically texting and calling me concerning the illness of her niece. Apparently, her 14 year old niece was being seen in one of the big hospitals here and was diagnosed to have Dengue. Her niece was never under my care at any point in her life. I do not know any of the relatives at all. And she wanted my opinion on whether what the doctors at that hospital were doing was right or wrong.

I understand how it is when it comes to family ties, most especially in the Philippines. I hate saying it, but I will. The Filipino will take family relationships to the extreme. It takes a Filipino to rub it in you that they are relatives with so on and so forth, even to the nth degree of consanguinity. It takes a Filipino to rub it in you that the father of the mother of the sister of the brother of your third cousin's cousin 's in-law is "closely" related to you. Even being godparents alone for the Filipino is taken to the extreme. I cannot imagine how anyone can have 24 godparents for their baptism - but believe me when I say - only the Filipino can! As my partner would say - OA!

And here's the rub. As a physician, I am aghast whenever I see patients with gazillion relatives at the bedside of my patients when I make rounds. It's like the whole "barangay" of relatives happen to be there and I need to defend my dissertation in front of them. After I explain the illness of my patient to the "crowd" and go through the academic exercise of explaining at my findings, my work-ups, the medications to be given, and of course the prognosis or outcome, it's question and answer time. Parang Miss Universe beauty pageant!!! Santissima madre de Dios!!

Most of the questions come from the kibitzers. Yes. The kibitzers! These are the relatives (many of whom are probably not related directly) of the patient. While I don't mind questions being asked for clarification purposes, I take a direct hatred (with seething eyes) on the kibitzers that come up with comments like "YOU KNOW MY SON HAD THAT DISEASE ALSO BUT HIS DOCTOR GAVE SO AND SO MEDICATIONS TO HIM. WHY AREN'T YOU GIVING THE SAME?" And I ask "SO WHO ARE YOU?". And you get the reply, "OH I'M THE 3RD COUSIN OF THE MOM OF YOUR PATIENT." And then I want to slap somebody in the room.

In short, while I am open to questions, especially when it comes to the illness of the patient and that I believe that the doctor should clarify all things with the patient and that the patient (or his/her legal guardian - usually the parents) should be made fully aware of the situation and that all consent are INFORMED CONSENTS, I have this place in my heart that loathes kibitzers and their uncalled for comments.

And so I told the mom of my patient that:

1. Your niece is not your daughter.
2. You do not have the right to decide for your niece. Her parents are there and you are a kibitzer. All you need to do is listen. If you have a question, you can ask the doctor of your niece. You can clarify things with him.
3. You should not ask me to approve or disapprove the management of another physician on a patient that is not mine, that is not your responsibility, and that I have never seen in my life.
4. It is not ethical to ask for an opinion only because you want to show off to other people that you may have some "knowledge" in the illness and then brag about the little knowledge you have. This is not the part wherein you "Phone a Friend" in order to get haphazard opinions on patients we have never ever seen in our lives.
5. When something goes really bad or really wrong with the patient, remember, all decisions - right or wrong - are the responsibility of the parents. If something terrible happens because you were interfering in the management, that your opinion compromised the outcome - you should be blamed for interfering with the management.
6. To stop texting me regarding the condition of her niece! She's like a resident updating me the platelet count day in and day out! Susmaryosep!

As for other doctors reading this blog, let me remind you that it is NEVER GOOD TO PROVIDE YOUR OPINION UNLESS YOU HAVE SEEN THE PATIENT. Always give the reply - NO COMMENT!

We have no right "auditing" our colleagues behind their backs unless your professional opinion is sought for by the primary party concerned and not by the kibitzers!

Confusion is brought about by entertaining strangers at the bedside of our patients.

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