Who is the one to decide? The patient or the doctor

This is a topic which always come to discussion in between surgeons. Recently in the breast cancer clinic we were explaining to the patient about the treatment options she has. She was a young lady, recently married, mother to an infant. She was detected with breast cancer one month after she stopped lactation. That too, with multiple liver metastasis. She had a lumpectomy in a private hospital. The Fine Needle Aspiration report before lumpectomy was not suggestive of any malignant lesion. But the report of the lumpectomy specimen came out as breast cancer with positive margins. Then she was worked up and found to have metastatic lesions.

            She came to our clinic even without removing the drain tubes of previous lumpectomy surgery. She and her family had lost their faith in the previous treated hospital, once they came to know that the lump turned out to be a cancer. We planned her for further treatment and explained to her the options. Once she was left we had a discussion on what to do, when patients say “Doctor we are ready to undergo whatever treatment you decide”. This is a common reply we receive in our clinics. Most of the patients are illiterate who cannot digest about the various treatment options we offer. But it is not just about illiteracy, educated people too put on the responsibility of taking decision over the doctor.

            Things might be little easier for the physician here. Because most of the time the treatment is not going to do any harm if at all no benefit was received. But with the surgeons it is not like that. Any procedure considered trivial or minor with a calculated low risk can result in an unexpected outcome like death or chronic painful complications. Our junior consultant was of the opinion that if the patient is going to leave the decision to us, it shows their faith in us and it will make our part easy. But according to our senior consultants, they will not embark on a surgical procedure unless and until they hear from the mouth of the patient the choice they made.

            It too early for me to decide. But I always like to follow my dear professors. Experience is something that matters more than brain in surgery!

My cup is empty and ready to be filled

           
             Two and half years of residency has passed, six months left for the exam. The responsibility of ward work is left for juniors except for supervision and 'expert opinions'. Not many night shifts, Thesis on the way of completion. A bit of free time to think, self assess and organize. Where do I stand now.

            Sadly, I stand pretty much close to where I started, if assessed in an optimistic way, but far behind than the starting point if assessed in a criticising view. When I joined, I had a high volume of theoretical knowledge and some clinical experience. Now I have more of clinical experience and minimal knowledge from books. Things which are not practised, names which are not used are forgotten.

           Today was the first grand rounds after the joining of new residents. Our dear professor asked some questions to the resident who has competed one and half year and come back from specialty posting. He was mumbling half chewed answers. Then the professor made this comment to the new bees : " Don't think your seniors are dumb fellows, they were good, even better than you when they joined. Now this is what you are going to be after three years of residency. So think twice whether you want to continue in this unit." The enthusiastic newcomer said "Yes, Sir, I want to be!"

           This is how usually the residency works for most of us. Our Professor recalls his friend saying, "Sir, don't ask me questions, But name a competitive exam and give me six months. I will crack it." That is what we are experts in! Now all of my upper storey feels empty. The same time I also feel that fresh energy and thrill, of embarking on a 'Mission Exam'!. 

           But don't misinterpret me. The years of residency is what make a surgeon. With the knowledge gained from clinical practice, I can find new meaning, understand and actually feel the material that has been described in text book. Now it is totally different in a refreshing way when I read the same surgical text book, I read during my Undergraduate period.