Syamila: Assalamualaikum Dr.I clerk this pt.initially she was electively admitted for tahbso due to bilateral ovarian cyst.however, this morning dr decided to do hysteroscopy and dd&c instead of tahbso in order to rule out any endometrial pathology. so, my questions:
1)how i want to write my chief complaint? is it still EA for tahbso...or...??
2)why dr suddenly change the operation?
Abd Halim: Sbb dalam hx die latest pipelle sampling showed benign endometrial hyperplasia instead of initial findings which were more malignant in nature.
Dr Shaiful Ehsan: Waalaikumsalam syamila...
That is why in Chief complaint i will advice u guys not to mentioned specific procedure or diagnosis in exam.....becoz it will usually changed after our preop rounds on monday & wednesday afternoon with consultants...
U can write ur CC eg like this:
38 yr old, teacher, para 3, electively admitted for further MANAGEMENT of her underlying abdominal mass for the past 1 year associated with dysmenorrhea...
She was apparently well till...bla bla2..
Dr Shaiful Ehsan: Q2: why suddenly...
Becoz usually the plan for operation is made by 1 specialist while we see this case at gynae clinic...with or without consulting the consultant (usually Dr alik / Dato Rozihan)...
During this time, patient might agree for the above operation....
However, we usually benefit our pre-op rounds....in which we will explore further patient understanding and social background profile.....in which some operation need to be change to meet patient's need...
Dr Shaiful Ehsan: Eg, if this patient is postmenopause & alreday completed family....there is NO WRONG of doing tabhso...
However, if this patient is young, you need to explain to patient that with tabhso...she will get PREMATURE menopause....in which she need to take HRT for at least her age till 50....
And she should understand her risk to develop osteoporosis and Cardiovasvular event is higher compared to those without prem menopause....
Dr Shaiful Ehsan: These are among issues we will discuss back with patients at pre op rounds...in which I DO BELIEVE SHOULD BE DISCUSSED EARLIER....
Other reason possible if the workout so far is still not clear enough....i which the mass could not arising from ovary....but actually benign from uterus.....
In which JUMP into TABHSO is totally not appropriate but hysteroscopy and biopsy is more accurate and justifiable before further surgical options can be discussed...
Thank u very much...
Oh ya...other benefits of not mentioning diagnosis and procedure in chief complaint is that:
U can have diffirential doagnosis in discussion
U can have better provisional diagnosis talley with ur patient presentation
You can vomit out ur fantastic principle of management.....rather than being rigid....tq
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