Neonatal jaundice is commonly observed among newborn infants, caused by hyperbilirubinemia. Severe hyperbilirubinemia should be recognized and treated to prevent kernicterus, a condition characterized by irreversible neurological damage. In most cases, hyperbilirubinemia results from a physiological increase in the unconjugated bilirubin concentration, combined with immature mechanisms for conjugation and enhanced enterohepatic circulation. However, certain conditions (e.g. prolonged jaundice, onset in the first 24 hours after birth, rapid rise in serum bilirubin, etc.) should raise the suspicion of an underlying pathologic mechanism. In general, unconjugated hyperbilirubinemia can be caused by (1) an increased, pathologic production of bilirubin, (2) a deficiency of hepatic uptake, (3) an impaired conjugation of bilirubin, (4) an increased enterohepatic circulation of bilirubin, or (5) a combination of the above . In case of pathologic unconjugated hyperbilirubinemia, an increased production of bilirubin due to hemolysis is the most likely cause. Therefore, a common approach in the diagnostic work-up of neonatal unconjugated hyperbilirubinemia is to differentiate between hemolytic and non-hemolytic diseases as a first step .
Cultural differences are known to cause a gap among citizens in general, but also between non-natives and their physicians1. This could affect the quality of healthcare these patients receive.
A premise for any patient-physician relationship is trust. The most important predictors of trust are similar to the predictors of patient satisfaction2. Furthermore, several studies have shown that patients who have more trust in their doctors show better therapy compliance3,4,5. Also, research has shown that patients are more satisfied with female than male physicians6.
- Age: 54
- Gender: Female
- Native country: Ghana
- Medical history: Graves’ disease, smoking and hypertension
- Family history: Cardiovascular diseases
- Initial presentation: Coughing, shortness of breath and no fever.
- Examination: Normal auscultation and normal percusion
Once, I found myself in a potentially dangerous situation with a patient who has a borderline personality disorder. It is very easy and tempting to get dragged into an argument with these kinds of patients. I was aware of my own tiredness that day which made me vulnerable and perhaps somewhat rash. The patient was highly agitated and we got into an argument. I let myself get so caught up in her line of reasoning and became offended by her insinuations. My responses increased her anger and it led to an unsafe situation which I did not realize promptly, even though I knew that she was prone to physically lash out. She had demonstrated that fact only a few weeks before this incident and she was threatening me with similar actions now. I retreated to a safe environment while other colleagues tried and succeeded in their attempt to defuse the situation. The patient’s reaction was disease related so I should have known better. However, my tiredness got the better of me. Normally the patient and I get along just ne so this hit me by surprise.
I have learned a lot from that encounter. Foremost, I will remember and take heed how my own physical and mental state can in uence my work and performance. I will not be tempted to enter into an argument of which you know beforehand will only create unnecessary tension or worse. I will take better care of my own protection and call for help on time.