Reporting your observations: Beyond the call?

A senior urologist had taken a patient aged 82 for cystoscopy. The surgeon was in some doubt about why he was doing the cystoscopy, but since the patient had complaints he did not want to miss anything serious. I was about to cannulate a vein for anesthesia on the left forearm which was abducted on a arm board when I noticed a thumb sized vein on the chest wall. I wanted him to see it. As soon as he saw it he know that he had missed something big. He removed his gloves and put his hand on the upper part of the abdomen. He later confirmed that it was a big gastric carcinoma with complete blockage of the vena cava. Needless to say, the scopy was abandoned.
My point is that your should report your observations to the surgeon. I asked my students whether they narrate their observations. Some did not respond, some said that it is not our job. In my opinion one of our duties is to guard the patient’s interest; if you observe anything significant report it since silence could harm the patient. When I taught, I presented my private practice cases to my students as problems, I asked them whether they would proceed with anesthesia, refuse anesthesia, or would they like to know what happened to the patient. I made them think about it and discuss it in the next meeting. In this manner they learned much more than what text books could teach them.