Bedside manners: do we care?

Teaching bedside manner might prove to be one of the most challenging tasks in medical education as it is not easy to structure or formalise such training. Besides, the rigorous training process for acquiring clinical and technical skills often overshadows the humanistic aspect of medical care. The aim of this study was to assess the perception of final year medical students as well as the faculty regarding the teaching and practice of bedside manner including a brief evaluation of students' bedside manner. A cross-sectional study was conducted involving final year medical students from five medical colleges [n=193] and faculty from a single institution [n=29]. Sample was selected using systematic random or convenient sampling techniques. Data was collected using self administered, anonymous, structured questionnaire. Data were analysed using SPSS-17. While evaluating students' bedside manner, 85% of the students reported they always take consent while interacting with a patient whereas, only 17% of the faculty members agreed with this. Only 3% of the faculty members reported that students take care of privacy of patients and none of them thought that students reassure a patient during an encounter whereas the percentages among students were 76% and 48%, respectively. Though students thought they need to improve, majority [56%] of them was confident of their bedside manner. On the other hand, 83% of the faculty members rated students' bedside manner from fair to poor. A large proportion [69%] of the faculty members were not satisfied with the quality of teaching regarding bedside manner, reporting lack of focus on this particular aspect of medical care as the most important cause. Majority of the students [87%] believed doctors have a better bedside manner in private as compared to public hospitals. Students have an inflated evaluation of their bedside manner but majority felt a need to improve. A sharp contrast exists between students' and faculty's opinion regarding the practice of bedside manner by students. An outright lack of focus on bedside manner was reported as the most important cause for inadequate emphasis on teaching this particular aspect of medical care

Comparative study of management of common bile duct stone, our experience of 20 patients at sir Ganga Ram hospital Lahore

To compare different methods of management of CBD stones at Sir Ganga Ram Hospital Lahore i.e ERCP with pappilotomy, Sphinterotomy or removal through Dormia's Basket and Open Cholecystectomy with choledochotomy. It was observational comparative Study. The adult patients having CBD stones. One years i.e. from 15[th] June 2008 to 15[th] June 2009. The mode of management of these patients for common bile duct stones was absorved. The out come and complications of both techniques were compared. Total 20 patients were included in the study. Out of them 12 were managed by open cholecystectomy and choledochotomy and the remaing 8 were treated by doing endoscopic retrograde cholangiopancreaticogram [ERCP]. The out come of both techniques were than compared. In our Hospital the majority of the patients of CBD stones are being managed by open technique i.e. open cholecystectomy and choledochotomy along with T-tube insertion, which is contrary to the approach of developed countries i.e. endoscopic and laproscopic approach

Presentation and management of hepatic trauma at Mayo Hospital, Lahore, Pakistan

Hepatic injury is one of the most challenging problems for trauma surgeon. We collected data of all hepatic trauma patients received at one of the unit of Mayo Hospital for two years. The purpose of the study was to know different modes of presentation, time interval between the time of injury and hospital report, different management options available, morbidity and mortality. We found that young males living in cities are maximally prone to this type of injury. The patients presented late and most of them in hypovolemic shock. We treated 10.5% conservatively. The more extensive the procedure attempted, the higher was the mortality. We curtailed our mortality to 18% despite inadequate facilities. However we recommend a more conservative approach as we had encouraging results with it

Penile fractures experience at Mayo Hospital, Lahore

With prompt diagnosis and expedient surgical management, Outcomes remain excellent and complications are minimal. In our setup general surgeons deal with the penile fractures. This Study presents a total number of thirteen cases presented to our emergency in last two years [from June 2004 To June 2006]. We managed to pass Foley catheter in all. Circumscribing degloving incision was made in all and corpora were repaired. Four had co existing urethral injuries which were repaired primarily

Liver trauma management: an experience and future directions

Trauma is the leading cause of death in young adults. In Pakistan gunshot injuries, penetrating assault injuries and blunt trauma from road traffic accident are amongst the leading causes compared to UK where blunt trauma from road traffic accident and assault predominate. The liver is the largest solid abdominal organ with a relatively fixed position, which makes it prone to injury being the second most commonly injured organ in blunt or penetrating abdominal trauma. Damage to liver range from sub capsular haematoma to complete avulsion of vascular pedicle. A prospective review of 69 patients who presented between 2002- 2005 in three surgical units. There were 57 [82%] males and 12[18%] females, age ranging from 15-65years were included in this review. There were 33 patients with gunshot wounds, 14 with penetrating wounds, and 18 with blunt trauma. 25 patients had isolated liver injuries and 44 had associated other visceral injuries. The majority of patients were treated with hepatoraphy / debridement except 9 patients who required peri-hepatic packing. Nine patients died. Six patients who were haemodynamically stable were treated conservatively. We advocate use of Ultrasound and CT scan in assessment and non operative management of solid organ injuries in selective patients