Friday, July 13, 2012

Nocebo Effect at Brent Hospital Zamboanga City

Nocebo effect, not placebo effect: Induced illness studied

After reading the article above from I remember my son's experience at the hands of a doctor at Brent Hospital on April of this year (2012). 

It was a terribly busy afternoon preparing for the Mindanao Islamic Education Conference 2012 when I received a frantic call from my mother telling me to come home immediately. I couldn't understand what she was saying and I kept asking her to repeat again and again. After a while my father took the phone away from her told me to come home as soon as possible because:

 "your son Khalid cut his middle finger half of its diameter"

And so I came home and brought him immediately to the nearest hospital - the Brent Hospital. At this time the bleeding has already stopped, this brought to me comfort knowing that none of his arteries were damaged.

Soon enough we were in the Emergency Room and Khalid's middle finger was examined by the Emergency doctor who couldn't decide what to do with my son because "his finger is small". A decision was made to call a specialist surgeon, whose name we will not mention, to examine my son. After some time the doctor arrived, saw and examined my son and said:

 "He needs general anesthesia because of the terrible pain of injecting anesthesia to the finger and he has to be admitted".

Ready to do everything possible and halal for my son, I almost accepted his advice except that general knowledge informs us that general anesthesia should not be used unless really necessary. At this juncture, I sought the advice of my mother who was in the waiting room. She and I were thinking the same. It is also worth noting that at this critical time of decision making and informing consent, we were not informed about the cost of the whole process - anesthesiologist, surgeon, hospital admission and medicine. Alhamdulillah, coming from the health profession I inquired about the cost and it was between twenty to thirty thousand pesos.

Even at that time I was still ready to shoulder the cost for the sake of my son. But a little voice in my head was telling me not to because of the risk and side effects of general anesthesia to my son's health. Besides he already had a general anesthesia few years back when he was circumsized.

Going back to the treatment room, cold and dry ambiance, Khalid was lying on the plinth with a bright light shining at him. A nurse was there and of course, the doctor was there. My son was terrified upon hearing the ordeal he is about to face. That excruciating pain that the doctor was telling me in front of my son again and again brought him to shiver. He was almost crying when he heard what the doctor said.

The doctor was very insistent to do the general anesthesia emphasizing the terrible pain my son would experience. I can understand at that time what the doctor was trying to do. Patient and family education is necessary for inform consent . But the way he was doing it was to me at that time 'dubious' and at this time 'uninformed'.

Imagine yourself, a young person of twelve, being indirectly told that you will suffer the most painful experience of your life repeatedly again and again while you are lying helplessly on a treatment room with a bright light shining on you? Even now, I still feel the terror he was experiencing. At that time, my son was even refusing for them to touch his hand, what more of injection and suturing it.

I made a decision not to give general anesthesia despite the doctor's 'advice'. The nurse was ordered to 'prep' understandably for infection control. My son's eyes flooded with tears. I turned his head to me and told me to look me in the eye. The nurse damp the wound with Betadine and it was at this time Khalid was really in pain. I was almost on the brink of regret why I decided against general anesthesia.

But magically after a while the pain subsided. Then local anesthesia was given and the suturing began. At this time Khalid was calm and I was even making jokes that made him smile while the doctor was suturing his finger.

After the whole thing, I was surprised to hear what Khalid, my dear son said:

"The most painful part was administering Betadine"!

 "The injection was not that painful and I didn't feel anything during suturing".

Alhamdulillah we went home. I was driving silently. Khalid was with my mom at the back of the car. My father was at the front seat. Everyone was relaxed.

At that time, I wasn't aware of the nocebo effect. Because of the doctor's over emphasized 'education' of the possible 'excruciating' experience, my son needlessly suffered.

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