A tribute to inspiring doctors: A doctor’s touch

Dear all

Terimakasih banyak atas atensi, doa dan cinta – Hari ini, genap 10 tahun milis sehat.

Saya banyak belajar
Saya banyak memperoleh “harta” selama bergumul di milis ini. Bahagia melihat wajah2 mungil yang protected krn onu ayah mereka sdh bijak.
Bbp mg yl saya membuat draft di bawah ini:

Jakarta 6 Des 2013

Time flies!
Sebentar lagi, milis sehat genap berusia 10 tahun. Alhamdulillaah.

So many things have happened.
So many things have been shared among us.

Selain itu, bbp mg terakhir, ada saja liputan media terkait nakes dan profesionalismenya.
Saya mencoba mencerna dan berharap bisa menarik pelajaran.

However, tonight, I virtually met two great physicians. Dr Robert Gupta and Dr Abraham Verghese.

(Dr Robert Gupta is a neurosurgeon, has a great love for neuroscience. He is also a great violinist (LA philarmonic orchestra). Namun demikian, email kali ini lebih merupakan renungan perihal “sentuhan” dokter.

Dr Abraham V adalah seorang ahli infeksi yang saat ini bekerja menangani HIV AIDS. Beliau juga seorang penulis.
Sebelumnya minta maaf ya kalau dongengnya kepanjangan atau gak penting. Minta maaf juga krn bahasanya campur aduk. Biar saya tetap latihan menulis dlm bahasa inggris (hehehe justifikasi bni yee)

Menurut dr Abraham,
Modern medicine is in danger of losing a powerful, old fashioned tool:
Human touch.

This new world is strange; patients are merely data points.
Let’s return to the traditional one-on-one physical exam.
BEgitu ujar dr abraham V.

In this era of the patient-as-data-point, Abrahan Verghese believes in the old fashioned physical exam, the bedside chat, the power of informed observation.

When we shortcut PE, we are losing the Lopportunity”

Lalu beliau bercerita peihal salah satu guru di dunia kedokteran:

Joseph bell (best teacher) dan muridnya Conan Doyle.

Dr Joseph Bell
Born2 December 1837 was a Scottish lecturer at the medical school of the University of Edinburgh in the 19th century. He is perhaps best known as an inspiration for the literary character Sherlock Holmes.

In his instruction, Bell emphasized the importance of close observation in making a diagnosis.

To illustrate this, he would often pick a stranger and, by observing him, deduce his occupation and recent activities.

These skills caused him to be considered a pioneer in forensic science (forensic pathology in particular) at a time when science was not yet widely used in criminal investigations.

Arthur Conan Doyle met Bell in 1877, and served as his clerk at the Edinburgh Royal Infirmary. Doyle later went on to write a series of popular stories featuring Sherlock Holmes, who Doyle stated was loosely based on Bell and his observant ways.

According to Irving Wallace (in an essay originally in his book The Fabulous Originals but later republished and updated in his collection The Sunday Gentleman) Bell was involved in several police investigations, mostly in Scotland, such as the Ardlamont Mystery of 1893, usually with forensic expert Professor Henry Littlejohn.

Bell studied medicine at the University of Edinburgh Medical School and received an MD in 1859. Bell served as personal surgeon to Queen Victoria whenever she visited Scotland. He also published several medical textbooks. Bell was a Fellow of the Royal College of Surgeons of Edinburgh, a Justice of the Peace, and a Deputy Lieutenant.

Dalam episode berikutnya, dr Abraham bercerita seputar penemuan dua metode pemeriksaan fisik yaitu PERKUSI (diketuk) dan AUSKULTASI (didengar).
Sejarah penemuan perkusi dan auskultasi menurut dr abraham merupakan – The peak of the clinical era

Leopold Ohnburger (kalau gak salah ingat tulisannya) adalah sang penemu percussion.

Apa sih yg bisa ditemukan US tapi tdk bisa ditemukan dg perkusi?
Written: Inventum novum

Sayangnya, semakin sedikit dokter masa kini yg melakukan perkusi. Padahal dengan perkusi kita bisa menemukan adanya: cairan, tumor/massa, atau pembesaran organ.
Saat ini, alih2 melakukan perkusi, tancap langsung: USG or CT dll.

Laennec – developimg the stethoscop.
Silakan googling sejarah beliau menemukan stetoskop. Menarik.

Jadi, menurut dr Abraham:
Kita lupa akan – The power of the human hand.
Our hand that should touch, and make the diagnosis

Dr Abraham juga bercerita perihal seorang perempuan dengan Ca mammae. Ybs browsing dan menemukan the best breast cancer center di USA.

“Aneh”nya, setelah bbp bulan, si pasien kembali ke RS lokal setempat. Dr abraham pun bertanya, mengapa?
Si ibu menjawab:
“They did nt touch my breast”

Mungkin para ahli yg menangani si pasien beranggapan semua sdh jelas dg mri dan ct tetapi, buat pasien, sangat penting bahwa dirinya diperiksa, diteliti, diraba, ditanya, diajak diskusi.

Selanjutnya, dr Abraham bercerita bahwa: That the patient and I are in a “primitive” ritual.

Maksudnya? Ritual yang mencakup:
– chat ( anamnesis)
– pemeriksaan fisik mulai dr observasi (inspeksi) sd auskultasi

Dan kebanyakan pasien lantas bertutur:
“I have never been examined like this before”

Padahal, pasien HiV tsb sudah tahu dan dokternya juga sdh tahu bahwa ia/mereka berada dalam kondisi terminal. Namun, bahwa dokter masih meluangkan waktu utk mendengar, meraba dsb, means a lot to them.

Jadi, menurut dr Abraham:
Rituals are all about TRansformation

Ketika seorang pasien, membuka kancing baju, berbaring untuk diperiksa oleh seorang dokter, maka sebenarnya ritual ini sangat “sakral” karena si pasien tengah melakukan “penyerahan diri”.
It was a submission
It was an offer

Ketika dokter sedang duduk di samping pasien yang dying, sambil memegang tangan si pasien, maka sungguh indah jalinan emosi antara keduanya. (Baca dr peter Saul seorang intensivist; beliau meminta maaf krn dokter sering memakai istilah “life saving” which is not true at all.

Mari kita kembali ke “ritual” tsb, mari kita lakukan observasi dan pemeriksaan fisik yang baik (bukan jumping ke lab atau pem radiologi).

Katakanlah kita tak berhasil menolong, dan merasa “gagal” tetapi … Let us always examine the pt

The ritual is catrrtic for the doctors and necessary for the patient

Maaf jika tidak berkenan

Salam sehat
Selamat milis Sehat, semoga tak lekang oleh waktu

Wati

-patient’s safety first-

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