Week 4 - Patient Compliance

Until now, I have never realized how large an issue patient compliance can be for physicians. Sometimes, how reliable a patient is can even alter the treatment course that at medical doctor chooses to follow. For example, I went to a conference on Monday morning with all of the plastic surgery residents and fellows. The main topic of discussion was emergency wound care but I was surprised to learn that the course of action can be extremely different depending on the perceived dependability of the patient which can lead to vastly different results (all methods provide reliable outcomes but the amount of scarring or degree of functionality after a major wound can be different depending on the treatment protocol). It was interesting to hear the students discuss treatment plans for patients and realize that although every patient will receive adequate care, some patients don’t receive the “best” care because they are unlikely to follow the necessary steps or return to the hospital for further action.

As I mentioned in last week’s blog, I saw a 61 year old woman present with an extremely large tumor. I truly don’t understand how she could have waited so long to see a physician about her problem-after all the breast reduction cases I’ve seen I am sure that she was having back pain in addition to all the other side effects from the tumor. Since the doctors were worried about her returning to the hospital, they scheduled surgery to occur as quickly as possible and I saw the tumor resection occur on Monday. The tumor weighed a total of 2.8 kg (~6.2 lbs) and was removed as one mass (the woman weighed just over 100 lbs so the tumor was over 5% of her body weight!). The surgery was quite intense because they had to tie off so many large blood vessels while holding the huge mass in place so that it didn’t tear away from her body and cause her to lose a lot blood. Once the tumor was removed, Dr. Grant closed the wound as best as possible with the remaining skin by undermining the margins. He used a skin graft from her leg to close the remaining wound and then applied a wound vac to help the area heal. Although she could have gone home after two days in the hospital, her physicians decided to keep her there for an extra day so that they could ensure she got the care she needed in case she decided not to return for her checkup.

Another interesting case (which doesn’t necessarily have to do with compliance as much as it has to do with unwise choices) involved a woman who presented with back pain after going to an unlicensed Columbian doctor in New Jersey. To give her a nicer buttocks region, she had free silicone injected into the area (apparently this is a popular procedure in the local Hispanic population). Unfortunately, after only a few months, the silicone began to migrate all through her back and cause her pain. Because it is free silicone, Dr. Grant explained that it is impossible to completely remove all of it and the microscopic particles are likely to be causing her pain. She explained that just a week earlier, the silicone had coalesced into a large tumor-like lump but had dissipated again. Dr. Grant said that he will do his best to remove any silicone that happens to coalesce again but cannot presently do anything for her.

I cannot wait to see what surprises next week brings!