Feedback on Management of a Surgical Patient Process by OMMC Surgery Residents – February, 2012

Feedback on Management of a Surgical Patient Process by OMMC Surgery Residents

(after reading the manuscripts in:

https://sites.google.com/site/patientmanagementprocess/home

https://sites.google.com/site/patientmanagementprocess/management-of-a-surgical-patient-process)

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The patient management process provides a guide for surgeons in the diagnosis and management of a surgical patient. It provides a systematic way of arriving on a diagnosis, you must be able to measure the level of certainty and give options or additional work-up to increase certainty. In the medical school, we were introduced with the ruling in and ruling out of diagnosis, but the patient management process provided a more organized way of thinking.
This process best applies in the government situation where equipments and funds are lacking. Since most of the patients are in low economic status, we are providing them the most practical way possible yet is still rational. Although we are given this method, we must accept that there is a limitation to what we know and what we can do so we must still know how to refer patient.
Thank you Dr. Rey Joson for providing us with this method, this will surely help not only the residents but also the patients that we see everyday in the hospital. But it is still difficult for me to assess the level of certainty, It probably involves the mastery and experience of a surgeon. Regarding number 2.2 that if the treament of differential diagnosis is the same as the primary, paraclinical diagnostic procedure may not be done. Can this still be accepted on a private setting where all procedures are provided?

Glenn Villanueva

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Sir, Good Afternoon. I’ve read the Self-Instruction Module on the Management of a Surgical Patient, as well as the powerpoint presentation. After reading, I took the Summative Evaluation. I had a mistake on choosing the modality of treatment for 1 scenario, that is no. 8.2. As for me, I have understood the module but I still have questions on the Paraclinical Diagnostic part. Are there  cut-off values for the accuracy and yield that would help you determine which paraclinical diagnostic to choose or does it mainly rest on you to decide which among the diagnostics are more cost effective?Meanwhile, in the Intraoperative Management part, there was a mention about drains. An additional information which may be noted in this part is when to place a drain. Thank You Sir for this module which will be helpful in managing our patients properly.
Sheena Siapno
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Sir,
After reading your email on study of management of a surgical patient process, what struck me most is the line, “every move has a reason”. As health care providers, when we treat/manage a certain disease or illness, we can not do things that are unnecessary because it might cause harm than help the patient’s condition. Everything must have a reason and should be based on what is warranted by a patient’s clinical picture. It is especially vital during a surgical procedure to avoid complications or iatrogenic complications specifically. Knowing the “BRCA” is of great help in determining paraclinical diagnostics and treatment options. I will always remember all these and apply it even after residency training.Thank you sir. I will share this with PLM medical students with your permission.
Princess Co
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Good day sir! Foremost sir I am very thankful that you allowed us to read your presentation on Study of Management of a Surgical Patient Process. This was really of great help particularly on our part as resident and clinician wherein this will scientifically guide us to come up with a rational diagnosis, rational use of paraclinical diagnostics and rational treatment for our patient. I am thankful that I was able to answer your formative/summative evaluation correctly. Thank you sir for reminding me that in medicine there is no absolute according to the basic maxims. I recommend that this should also be presented to other physicians and clinicians as well who are practicing especially in the provinces wherein not all equipments, laboratories and procedures are available at all times. I also recommend that this will be part of the lectures presented among our medical clerks, interns and newly registered physician for them to be guided accordingly in managing patient whether surgical or non-surgical.
Oni O’ Connor

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Sir, thank you. I also agree that the management process in surgical patients will help us a lot in coming up with a diagnosis, having proper differentials, choosing the right imaging procedures ,and treating patient whether surgical or non surgical. It would be beneficial both for the patients and the doctor, time wise and financial wise. As residents who are just starting a specialty this would help us a lot in dealing with surgical patient being our guide especially that we still have a lot of things to learn. If we ever master this, I think we will be more competent in dealing with our patient.  Even though I failed to answer all the questions correctly, I’m still happy because I think now i can treat our patients more effectively.
Miong Abad
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Sir, I would like to express my gratitude for your never ending desire and patience to educate us on the essential knowledge and know-how on the safe practice of surgery.
This patient management process that you have shared us is very important in our pursuit of excellence in this profession. In my review of it, I noticed that it made my thought process in decision making in management of a disorder relatively easier. It is a great help to us, esp. to alma and myself. The two of us only have a year to master it before we apply it on our private patients.
We hope you wont get tired in sharing us your wisdom.
Thank you very much sir!
John Lloyd
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Thank you sir. After a review on the study of management of a surgical patient process I  agree  mastery of the patient management process is a must for all of us. Its maxims, rules, and guides could be applied to all kind of patients and help us to be a good physician. I am happy that I was able to answer correctly all the questions on the summative evaluation at the end of the self instructional program.
Alma Jawali
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Good morning sir. The guide you created in the management of a surgical patient has greatly showed me the many options on how to approach different cases from a variety of patients. From the initial setting of establishing good rapport with the patient to arriving at a diagnosis which fits the clinical history and physical examination we obtain in a systematic and step by step fashion, your write-up gave me more ideas on how to conduct myself when dealing and treating our patients. Each step was very precise and had enough evidence to support itself such as if a paraclinical diagnostic procedure is needed, especially if we are not that certain with our clinical impression and need an examination to increase our degree of certainty. The study also reminded me that when performing surgical procedures, each action must have a purpose and the less unnecessary movements we commit, the more sound our operation would be.
With all the information I obtained in reading your letter, I can only hope and do my best that I may retain most of it and be able to practice each guideline you made as I do my duty in treating the ill and give them quality service that they deserve. Thank you sir.
Marco Sanico
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Thank you for sharing this to us. It has been a challenge for doctors, especially for those who are young in the procession to come up with a sound and appropriate diagnosis when managing a patient. Indeed it is an arduous task that need to be mastered as we go on with our career. When we were in medical school we were taught to diagnose a patient with a different approach base on the different signs and symptoms we gather from our history, which i honestly had a hard time doing.


The good thing about this guide is its practicality and ease in arriving with a proper diagnosis of a certain patient, which is the starting in managing a patient. And it has been my practice for the past years to incorporate this patient management process in discussing with the patient their own disease. From my experience, our process has offered a better perspective on the part of the patient when comes to their diagnosis, paraclinical diagnostic procedures as well as treatment options..

I greatly appreciate sir you unmatched effort for continuously guiding us, young doctors, in preparation for our future career. Good day sir. 
Ariel Celzo
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Thank you sir. It’s like making surgery residency training easy. it’s systematic, and will not get us lost whenever we see patients.This process is not being taught in med school. It’s such a big help especially to us young doctors. We still need to have a lot studying to do to supplement this process. And we need to practice this in every patient that we see. Thank you again sir.
Jessie Oracion
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Good morning sir. Thank you for sharing your program for management of a surgical patient. The program was concise, well designed, and organized. The learning objectives were truly fulfilled for I have answered the questions in the formative evaluation/summative evaluation correctly.  I strongly suggest that we share this to other colleagues. The program should be read/ reviewed from time to time to reinforce us on how to manage a patient, and also, this can be a guide in our Case Presentations for the benefit of fellow residents. Thank you very much sir.
Voltaire de la Cruz
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Thank you sir for providing us with this materials. Patient management process will greatly benefit not only the physicians but also the patients. It provides a systemic guide for us in arriving with a sound diagnosis and manage the surgical/nonsurgical patient correctly. Mastery of this process will surely make us competent physicians. We should apply this to every patient we encounter. Thank you very much sir.
Rembo Aguda
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Good am sir! Thank you for sending us this format on how to manage surgical patient. It is a good program for us learners to become effective, efficient and humane health professional in dealing with different kinds of patients. Thank you for giving us a blow by blow and a systematic  pattern on dealing with surgical patients. This outlined formed could help us surgical residents to avoid unnecessary movements during surgery and gave us ideas on how to manage patients using pattern recognition and prevalence.
Glenn Gervacio
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Good morning sir. The information has provided us with a detailed and scientific approach into managment of the patient’s we will encounter. It is notable that early on in our still young careers, we are taught right through years of study and experience. i want to convey that it will stand with me as i deal in coming with a diagnosis and providing the best management possible to our paitents. Thank you sir.

Lucas Bersamin

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Dear Sir,

Thank you for sharing this module to us. This will serve as an important aid to guide us in managing a surgical patient.
Jen de Castro
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Thank you sir for this information. It is a complete package. Personally I have adapted this kind of approach with different patients whom I have seen. It is very helpful in every aspect. And the fun part is I was able to answer every question. Thank you again sir.
Angel Montessa
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