Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

The unhappy patient my perspectives--dr uday kumar

495 views

Published on

  • Be the first to comment

  • Be the first to like this

The unhappy patient my perspectives--dr uday kumar

  1. 1. BOSCON 2013 ORATIONTHE UNHAPPY PATIENT MY PERSPECTIVES DR UDAY KUMAR MS(ORTH),DNB(ORTH) 31ST March 2013
  2. 2. HAPPY PATIENTS--ARE LOYAL--WILL REFER OTHER PATIENTS TOYOU--THEY GIVE YOU PROFESSIONALSATISFACTION--IF YOUR PATIENTS ARE HAPPY, YOUWILL BE HAPPY TOO
  3. 3. PLENTY OF HAPPY PATIENTS BUTSOME ARE UNHAPPY 5% TO 15%
  4. 4. A happy patient will tell two of his friendsAn unhappy patient will tell the whole PLANETthrough word of mouth/internet
  5. 5. WHAT DO THEY DO
  6. 6. WHAT COULD THEY DOThey could go to ---police --media -tv -press -internet --consumer forum
  7. 7. INTERNET BLOGS-just avoid Dr X at this hospitalas he is incompetent-Dr Y is fooling patients with false degrees— ?Mch(orth)USA -please avoid Y hospital—WORST EXPERIENCE —20 year old equipment -uncaring nurses etc
  8. 8. UNHAPPY means-----sad, unlucky, depressed (webster dictionary) first used in 14th centuryPatients do not care how much you knowThey ONLY want to know how much you care.
  9. 9. Why is the patient unhappy?-communication gap in doctor-patient relationship-mismatch between expectations and reality
  10. 10. “You are as strong as your weakest link”Unhappy with -- hospital/clinic -- doctor -- nursing care -- surgical result —good/bad --cost -- re-surgery/rehab
  11. 11. HOSPITAL--APPROACH ROADS POOR--DIFFICULT TO PARK--TOO FAR--WOULD LIKE HOSPITALS NEARHOME
  12. 12. --INEFFICIENT RECEPTION--INSURANCE SECTION-- PILLAR TOPOST-POOR AMBIENCE-LONG WAITING TIME
  13. 13. Times of India
  14. 14. doctor-DOCTOR HAS -- NO TIME TO LISTEN TO ME -- NOT EXAMINED ME IN DETAIL --NOT EVEN TOUCHED ME --NOT EXPLAINED MY PROBLEM OR THE SURGERY PROPERLY --LACK OF TRANSPARENCY ABOUT COSTS
  15. 15. NURSING CARE POORFOOD VERY BLAND—NOT TASTYAMBIENCE---BED NOT CLEAN ----BED BUGS ---AC NOT WORKING ---TOILET NOT CLEAN ---ETC ETC
  16. 16. UNHAPPY FOLLOWING SURGERYSURGERY—UNINDICATED --INADEQUATE/IMPROPER --ON WRONG SIDE/SITE—CATASTROPHIC --POOR/GOOD RESULT --POOR PHYSIOTHERAPY --NEEDS RESURGERY FOR VARIOUS COMPLICATIONS
  17. 17. EXAMPLESUNHAPPY PATIENT AFTER A BAD RESULTUNHAPPY PATIENT AFTER A GOOD RESULT
  18. 18. UNHAPPY PATIENT AFTER POOR SURGICAL TECHNIQUE OH MY GOD ! XRAYSDisclaimer: No ill will meant to any orthopaedic surgeon
  19. 19. IATROGENIC DISTAL HUMERUS # FOLL I/L NAILING.
  20. 20. PROXIMAL PART NAIL OUTSIDE BONE SCREWS OUTSIDE NAIL
  21. 21. ORIF
  22. 22. I/L NAILING
  23. 23. VOLAR BARTON’S #
  24. 24. ORIF
  25. 25. PFN
  26. 26. PFN RESULT
  27. 27. UNDISPLACED MEDIAL MALLEOLAR #
  28. 28. FOLLOWING ORIF
  29. 29. THR
  30. 30. ACL RECON
  31. 31. BILATERAL HIP FRACTURES
  32. 32. HEAD INJURY---I/L NAILING—NO PROXIMAL LOCKING
  33. 33. 4 weeks later
  34. 34. LONG PFN
  35. 35. PFN
  36. 36. TBW ???
  37. 37. BIMALLEOLAR #--ORIF
  38. 38. LOST SCREW
  39. 39. ORIF HUMERUS
  40. 40. CASE DISCUSSIONSUNHAPPY PATIENT AFTER A BAD RESULTRESURGERYHAPPIER
  41. 41. CASE 1• 40 yr old male• # shaft L femur mid third• Underwent open K nailing & cerclage wiring elsewhere• After 1 and half yrs --
  42. 42. AP LAT
  43. 43. 1st Exchange nailing closed—I/Lnail (9mm) – 3 & 6 months later
  44. 44. -2nd exchangenailing (10 mm)-BG-6 months laterBG absorbednail broken
  45. 45. 3rd exchange nailing---broken nail and screwsVery unhappy---multiple surgeries—poor result
  46. 46. r
  47. 47. Nail removal --Orif with LCP--Bone graft
  48. 48. 6 MONTHS LATERFINALLY UNITED
  49. 49. Happy patient
  50. 50. CASE 2• 60 year Female, Domestic helper• Pain Both hips few months• Walks with walker• Medically fit
  51. 51. AMP LEFT HIP
  52. 52. SCREW & WIRE FIXATION RIGHT HIP
  53. 53. NO PAIN RELIEF LEFT HIP-------AMP TO THR
  54. 54. THR DISLOCATED
  55. 55. CR LEFT HIPNO PAIN RELIEF RIGHT HIP-----SCREW/WIRES REMOVED--BIPOLAR
  56. 56. PATIENT PRESENTED LIKE THISBILATERAL LOOSER’S ZONES AFTER MANY SURGERIES- NO PAIN RELIEF-VERY UNHAPPY BILATERAL ADDUCTOR TENDINITIS – PAIN RELIEVED WITH SIMPLE LOCAL INJ & OSTEO-MALACIA TREATMENT ---HAPPY
  57. 57. CASE 3• Male 55Years• RTA 2 years ago . Gr III B comminuted fracture Right Leg• debridement-• minimal Internal fixation+ Ex-fix, Vascularised free flap.
  58. 58. X-RayNON-UNIONPAINFULUNABLE TO WEIGHTBEARVERY UNHAPPY
  59. 59. OR+ Locked Nail+ BG+ Fibulectomy
  60. 60. HAPPY PATIENT
  61. 61. Case 4•19 YEAR OLD MALE•AC COMPRESSOR BLAST•SUPERFICIAL BURNS OF BODY•COMPOUND # BOTH BONES UPPER I/3RD RIGHT LEG•TREATED ELSEWHERE –DEBRIDEMENT -UNILATERAL EXT FIX -SSG
  62. 62. ONE MONTH POST OP
  63. 63. UNHAPPY
  64. 64. AP LAT
  65. 65. ILIZAROV BONE TRANSPORT1 MONTH POST DISTRACTION
  66. 66. HAPPY
  67. 67. CASE 545 YEAR OLD MALEUNDERWENT CEMENTLESS THR FOR OA HIP4 YEARS AGO
  68. 68. He dislocated his THR 3 times within 6months---treated by CR 3 times—patientvery unhappy
  69. 69. Open reduction and insertion of a head with a longer neck Now patient is happy
  70. 70. CASE 6—Neglected trauma- 25 YEAR OLD MALE- ROAD TRAFFIC ACCIDENT- CLOSED INJURY TO RIGHT ANKLE- TREATED BY A NATIVE BONE SETTER FOR 4 ½ MONTHS WITH BANDAGES- NO NEURO-VASCULAR DEFICIT
  71. 71. XRAY ANKLE—AP /LAT---4 ½ MONTHS POST INJURY
  72. 72. CT
  73. 73. 3D CTANTERIOR MEDIAL LATERAL
  74. 74. 4 ½ MONTH OLD NEGLECTED TALAR #DISLOCATIONPAINFUL DEFORMITYDIFFICULTY IN WALKINGUnhappy
  75. 75. LATERAL APPROACHOPEN REDUCTIONTRIPLE FUSION
  76. 76. POST OP ---1 YEAR
  77. 77. POST OP ---1 YEARSo far happy
  78. 78. UNHAPPY PATIENT INSPITE OF GOOD RESULT
  79. 79. 75 yr old lady -3 wk old displaced osteoporotic # neck humerus. AP LAT
  80. 80. ORIF with osteoporosis treated
  81. 81. 1 year POST OP----FRACTURE UNITED---FULL ROM INSPITE OF WHICH PATIENT IS UNHAPPY--??
  82. 82. CASE 263 YEAR OLD LADYDM/HTN/COPDOA LEFT KNEEHTO (L) KNEE—2004STAPLE REMOVAL JULY 2012
  83. 83. POST HTO
  84. 84. TKR NOV 2012
  85. 85. PATIENT IS VERY COMFORTABLE WITH LEFT TKRBUT IS GENERALLY UNHAPPY FOLLOWINGSURGERY DUE TO PSYCHO-SOCIAL PROBLEMS
  86. 86. MANAGEMENT
  87. 87. General Guidelines• Give the very best medical care possible• Respect the patient’s dignity• Listen to the patient’s and family’s concerns• Always be compassionate and caring
  88. 88. Don’t hide from unhappy patients
  89. 89. HOW TO MANAGE UNHAPPY PATIENTS-Listen to the patients and they will tell you what is wrong. Lawson Smith-Welcome the complaints. “If you’re happy with the way we treat you, tell yourfriends. If you’re unhappy with the way we treat you, tell us.”
  90. 90. Do not run away from unhappypatients. -see patient repeatedly -make house calls -refer patient to your friends for second opinion (you may have missed out something) -take patent’s permission - discuss his problem on internet eg. Indiaorth
  91. 91. Inform patients about -- limitations of surgeryEg “If you had a hip replacement, you are not going to run amarathon next day”. -- inform that, despite our best efforts, no treatment is without risk or carries a 100% guarantee of success
  92. 92. PREOPERATIVE STAGE--- Discuss entire procedure in detail withpatient Informed consent-Talk in numbers and give percentages eg, ’Twenty percent of patients may needan adjustment with this procedure.’--- Stress the time required to heal.
  93. 93. POSTOPERATIVE STAGE-- never disagree with what a patient sees is wrong-- Remind the patient that healing takes time eg: from 6 months to a year.-- See the patient with increased frequency - show that you care - Don’t send the patient away for a month andhope that they will cool down.
  94. 94. DEALING WITH ANOTHER SURGEON’S UNHAPPYPATIENT--Never say anything bad about another surgeon. “If you see a little fire, put a little water on it, not a little gasoline.”-- Make a friendly call to the other surgeon who did the originalsurgery. Let him know you have seen the patient. Mention that you supported his original work.
  95. 95. CONCLUSIONS---FOR UNHAPPY PATIENTS-WHEN IN TROUBLE--STAY CALM-LISTEN TO THE PATIENT- RE-ESTABLISH RAPPORT-KNOW YOUR LIMITS-DON’T COMMENT ON ANOTHER DOCTOR
  96. 96. -WHEN IN DOUBT, REFER AND TAKE HELP-EXPLAIN LIMITATIONS OF SURGERY-PROVIDE OPTIONS-TREAT THE unhappy PATIENT LIKE A VIP

×