By: Rudy Dewantara MD
A 30 year old man came to ER after having his second, third and fourth phalanx of the left hand chopped by a saw machine. He had to had his three fingers amputated, leaving only the proximal phalanx. And now a month after the surgery, while the pain has subsided, he still have to deal with a frustating problem related to the function of his left hand. It is obvious that the patient isn’t merely dealing with severe pain, risk of infection or even shock, due to his chopped hand [now that it has been overcome]. The most devastating problem for the patient is related to the effort of regaining the normal function of his left hand, which is definitely way more difficult to deal with. An orthopaedic surgeon, who’s not only provided with art and science but also a humanistic attitude towards patients [compassion, understanding, warmth, kindness, empathy, etc], will also have to cope with this, together with other specialist.
The philosophy of total care of the patients as well as continuing care for them refers to rehabilitation. The broad aim, or goal, of rehabilitation is to correct, insofar as is possible, the patient’s problem [whether it be physical, mental or social] and in addition to continue to help him or her by treatment, training, education and encouragement to cope with residual uncorrectable portion of the problem and his or her attitude toward it, in order that his or her life may be changed from one of dependency to one of independence, from one that is empty to one that is full. In a sense, rehabilitation is ‘going the second mile’ and often farther with patients, and it is applicable to the disabling problems of all fields of medicine and surgery. [Salter, 1999]
The definition of rehabilitation renders a great obligation for orthopaedic surgeons. In above case for example. After treating the patient’s original problem, by doing a surgery on his fingers, it does not necessarily mean that everything is settled. There is still a more important problem to deal with, namely regaining the normal function of patient’s left hand, now that he is only 30 years old and there are still so much he can do. If the patients were older, say 70 or 80 years of age, the problem that he would have had might not be as devastating as were he younger. Or, it can be even more frustating if it were happening to a 10 years old boy. This is true as for the words “a given disorder may present a different problem for one individual than it does for another, not only in relation to age, sex, occupation and any coexistent disease but also in relation to his or her personality and his or her psychological reaction to the problem.”
What makes it a “burden” ?
An orthopaedic surgeon will have to cooperate with other specialist such as nurse, physical therapist, occupational therapist, prosthetist, psychologist, and others, in order to perform the process of rehabilitation. It is therefore, takes a lot of time. Not only to regain the normal function but also to give a psychological support, because patients have to face their problems for quite a long time. The process being a complicated one, is not easy. It takes a considerable care, awareness, and responsibility of doctors. They’d even have to spend more time in the process of rehabilitation than the surgery itself. Although this is a team work, orthopaedic surgeons as the “primary doctor” has the obligation to communicate of all available chances and options, which is one again, takes extra time. And again, this is not easy. This can be a problem if doctors do not aware of the philosophy of rehabilitation, hence take it for granted, which is definitely a great loss for patients.
In my opinion, this is the beauty of medicine. In particular, this is the art of being an orthopaedic surgeons, which is one again true as for the words “our function as practitioners is to cure sometimes, to relieve often and to comfort always”.