February 15, 2017 – a day after Valentine’s and the fourth block examinations of the SLCM, a surgical case presentation was done at the Angelo King auditorium by intern Darwin dela Cruz and clerk Shara Pajarillaga, under the guidance of Dr. Andrei Cesar Abella. It was a case of a 55 year old male with severe generalized pain associated with hematochezia and scybalous stool; other symptoms include recurrent UTI, dysuria, transient hematuria, and fecaluria. After ruling out common differential diagnoses, the working impression was that of acute abdomen secondary to a ruptured viscous probably secondary to perforated diverticulitis, to rule out malignancy. Ancillary tests were done, and histopathology revealed malignancy, specifically colorectal cancer. Final diagnosis was a colonic adenocarcinoma Stage IIIC (T4BN2AM0) with colovesicular fistula.
The interesting case sparked questions from the audience. Dr. Genevieve Padilla-Evangelista asked how the fecaluria was elicited, which clerk Parajillaga answered was through patient interview. She then asked is a rectal examination was done, which was not due to the patient complaining of pain. Dr. Padilla-Evangelista stressed the importance of doing a rectal examination regardless, advising the students to ask help from residents, because “… not doing an rectal exam in a patient with abdominal pain is a no-no.”.
Dr. Irving Tan asked why the patient did not present with fever. Intern dela Cruz explained that the patient was already in the sixth day of ciprofloxacin treatment at the time of admission. Sepsis could also present with hypothermia, Dr. Tan noted.
Dr. Joanne de Ramos, the SLCM Associate Dean for Academic Affairs, then asked the presenters to expound on why a screening test for colorectal cancer is recommended even in nonsymptomatic patients. Intern dela Cruz explained that screening is recommended starting at age 50 years, with fecal occult blood test done annually, while a CT colonoscopy every five years. Dr. Abella added that screening is important due to the fact that a high percentage of colorectal cancers are sporadic even without the presence of risk factors, and that patients with advanced stage sometimes also do not present with symptoms.
Dr. Romarico Azores Jr. , reactor for the presentation, noted that the patient’s history of recurrent UTI and blood in the stool means a poor prognosis for the patient; massive blood transfusions and prolonged operative times, also contribute a negative impact on the patient. He emphasized that this was a case of late colorectal cancer detection, and hence delayed diagnosis and surgical intervention.
Dr. Malaya Santos, SLCM college secretary, commented that the prevalence of medical illnesses that can be screened early, like colorectal cancer, is an important public health concern, and that government-supported screening programs may contribute a positive impact on such
After the surgical case presentation, Dr. Padilla-Evangelista, the head of the Out-Patient Services and Medical Social Service Department of the St. Luke’s Medical Center, took to the stage to tackle on a standardized way of communicating with patients. Her proposal, HAIDET Now!, aims for effective patient-doctor communication in the hospital.
HAIDET is an acronym which also follows the basic structure for patient encounters. HAIDET stands for Hand hygiene, Acknowledge, Introduce, Duration, Explanation, and Thank you.
Hand hygiene is an essential as it lessens contact spread of infectious agents, and also signifies cleanliness within the hospital. Acknowledge concerns with greeting the patients and creating a good first impression. Introduce involves describing the exact procedures to be expected, enabling the establishment of expertise. Duration is about informing the patient on wait times, admission length, routine monitoring times, and the like. Explanation is on explaining to the patient about ancillary procedures and therapy options with follow-up care. Lastly, Thank you emphasizes on creating a positive lasting impression on the patient.
Dr. Brigido Carandang Jr., SLCM college dean, as a closing remark, commented that aside from HAIDET Now!, a culture on punctuality may also project professionalism among patients. Currently the school has been encouraging its students to be punctual, by documenting the attendance during classes.