The patients who undergo operative treatment are seen by many doctors before the operation. They are examined by the House Officer and Registrar. This examination is comprehensive, including general, systemic and gynecologic examination. They are seen by a gynecologic consultant, who checks gynecologic aspects. They are seen by anesthesiologists thrice - once in anesthesiology outpatient clinic, then preoperatively in the ward on the day prior to the operation, and finally prior to induction of anesthesia for the operation. If there is any doubt about clinical findings of any particular system, they are seen by senior consultants and specialists of the respective illnesses.
All operated patients are examined by the House Officer and Registrar in the gynecology ward postoperatively. They are seen by a consultant the morning after the operation. I was examining such operated patients once. I had not seen them preoperatively, and someone else had operated on them. They were all OK, I had been told by the resident doctors. When I put my stethoscope on the chest of one of them, I had a sudden sinking feeling in my heart. She had the classical murmur of mitral stenosis. She had been given a spinal anesthesia and a vaginal hysterectomy had been performed. No one had known that she had a mitral stenosis - neither the gynecologists nor the anesthesiologists. Luckily she seemed to have a well compensated heart and the breath sounds were OK too. I advised the residents to get a cardiologist to see her. The very next patient gave me the sinking feeling again. She had the classical murmur of a ventricular septal defect. She had undergone a vaginal hysterectomy under spinal anesthesia, and no one had known about her cardiac condition until I saw her. Luckily her cardiac function was well compensated too. I asked the residents to get a cardiologist to see her too. I told the senior anesthesiologist to sort out the problem of the juniors missing the diagnosis. I decided to give my resident doctors my software to learn cardiac auscultation. If the diagnosis had been made, the two patients would have been seen by a cardiologist and all sorts of preparations would have been made which were not made for patients with normal hearts. The following day I saw the two patients again. They were OK.
"What did the cardiology resident doctor say about this patient?" I asked, pointing at the patient with mitral stenosis.
"He said she had a pansystolic murmur. He has advised 2D echo for her" the Registrar told me.
I was aghast. That was the last straw. A cardiologist in training had mistaken a middiastolic rough murmur for a pansystolic murmur. Perhaps the time had come for throwing away stethoscopes and embracing 2D echo technology for daily work.
All operated patients are examined by the House Officer and Registrar in the gynecology ward postoperatively. They are seen by a consultant the morning after the operation. I was examining such operated patients once. I had not seen them preoperatively, and someone else had operated on them. They were all OK, I had been told by the resident doctors. When I put my stethoscope on the chest of one of them, I had a sudden sinking feeling in my heart. She had the classical murmur of mitral stenosis. She had been given a spinal anesthesia and a vaginal hysterectomy had been performed. No one had known that she had a mitral stenosis - neither the gynecologists nor the anesthesiologists. Luckily she seemed to have a well compensated heart and the breath sounds were OK too. I advised the residents to get a cardiologist to see her. The very next patient gave me the sinking feeling again. She had the classical murmur of a ventricular septal defect. She had undergone a vaginal hysterectomy under spinal anesthesia, and no one had known about her cardiac condition until I saw her. Luckily her cardiac function was well compensated too. I asked the residents to get a cardiologist to see her too. I told the senior anesthesiologist to sort out the problem of the juniors missing the diagnosis. I decided to give my resident doctors my software to learn cardiac auscultation. If the diagnosis had been made, the two patients would have been seen by a cardiologist and all sorts of preparations would have been made which were not made for patients with normal hearts. The following day I saw the two patients again. They were OK.
"What did the cardiology resident doctor say about this patient?" I asked, pointing at the patient with mitral stenosis.
"He said she had a pansystolic murmur. He has advised 2D echo for her" the Registrar told me.
I was aghast. That was the last straw. A cardiologist in training had mistaken a middiastolic rough murmur for a pansystolic murmur. Perhaps the time had come for throwing away stethoscopes and embracing 2D echo technology for daily work.
