One of the lessons I've learnt in clinicals is that as doctors we are not gods, so all the more having been through only 6 weeks of internship I've no right to judge humanity. Nevertheless through my observation of a variety of patients I need to express some thoughts over these folks.
What makes an ideal patient? We don't have the right to say for the duty of all doctors is to treat all patients. We have to understand that ill people and their relatives can be emotional about the situation. But the best working relationship occurs when the patient allows us to do our work. Questions are welcome, but not to the point where they doubt or belittle us. There is no need for presents or even a thank you actually, just no mean treatment.
However, these 6 weeks, despite the majority of my patients being very likeable folks, there are some whose actions, I believe, do not contribute to a constructive doctor-patient relationship:
1) Doctor, I don't want to be treated
There was a man who had a history of AOR discharges (At Own Risk/Against Our Recommendation ie getting out of hospital against the doctor's advice) who was admitted to our team after he fainted. He berated the team for having lost his handphone, although we repeatedly reassured him that it was with his wife. While in the ward he rejected insulin treatment and hypocount measurements for his diabetes. We gave in to his desire to be AOR discharged again.
Nevertheless I've learnt to be detached about AORs. We don't have the right to keep people against their own will, and some people have their reasons for AOR discharge, like the single mother who wanted to go home to take care of her young daughter, who would be alone. In the beginning though, I found it frustrating when our recommended treatment regimes were rejected
2) Doctor, I want to be treated for a disease which I don't have
I suspect that some patients are admitted purely for social reasons, namely because their family members cannot find them a place to stay. There was an old lady admitted to our team and was sitting out of bed looking very healthy, however she started coughing whenever a healthcare worker walked near. The nurses witnessed it, and I personally tested out this hypothesis and it worked.
Being meticulous, my consultant discussed with us the possible things that could have happened to the patient IF she had a real pathology. She then discussed at length with the patient the possible treatment of her "cough", which was simply lozenges. The whole encounter took 20 mins, and I did notice some of her family members giving a sneaky grin although I could be overly suspicious. I just thought the whole encounter was not a good use of healthcare resources, after all you did not need a US-trained specialist to prescribe lozenges.
3) The doctor is my enemy
No doubt, relatives of patients are under a great deal of stress, but it is not a solution if they don't see the doctor as being on their side. The house officer I was working under called the daughter of a patient, but he was curtly told by the husband that she was not available as she wanted to have her lunch in peace. I never knew that we were here to intrude into and mess up the lives of people but that's how some see it.
4) Doctor, I am an Emeritus Professor
I've had, with a bad feeling inside, showed a patient's X-ray to his moody daughter, who was concerned that his age and comorbidities made him unsuitable for surgery. She was quite convinced that it was a small fracture although in retrospect, I should have made it clear that it was a complete fracture of the neck of femur (Garden's II). Nevertheless, I walked away learning that if patients and their relatives are attempting to show their intelligence, you'd either be smarter or refer them to a higher authority. Given our junior rank, the latter option is more feasible.
Also, there was another incident where the daughter of this other patient called the nurse, not wanting to speak to the junior doctor but a doctor "well versed in medical terms". I should have told her that my House Officer actually passed his MBBS.
5) Doctor, I am the all powerful Minister of Health
Luckily, this did not happen to me. Rather, my relative was narrating the events surrounding my great grandma's hospital stay. Out of frustration she yelled at the doctors and she recounted this incident with pride, saying that it made her feel good inside. Undoubtedly, her ego trip must have wounded some House Officer or Medical Officer.
Another relative told me with gusto that if the hospital was understaffed, the senior doctors should help out with the mundane labour eg. taking bloods, setting plugs. "Tell them to come down at night to do the job la" I recalled her saying. While I acknowledge that some people have many opinions, I think they need to differentiate between what sounds good and what works. I can't imagine telling Bill Gates to help the junior programmers with writing some scripts, could I?
So much for the jadedness. Looking back, I've also identified two groups of patients/relatives which are a challenge to handle, but I've declined to lump them in the former category for the simple reason that their actions are reasonable and understandable. Doctors earn their respect and wages by learning to handle them:
1) Pseudo-malingerers
I cannot emphasise "pseudo" enough. If they are not picked up, both patient and doctor are in some trouble. There was a frail old man under my care who complained of what seemed to be musculoskeletal chest pain (ie not a heart attack or serious lung condition) and we investigated him without finding anything significant. This led me to conclude that he had a low threshold for discomfort.
A couple of days later, he complained of nausea which I decided to dismiss. I thought that staying in the hospital for a prolonged period makes many people uncomfortable anyway. The next day, my House Officer was called to see him because he skipped breakfast and lunch. I was genuinely ashamed because of this incident, after all skipped meals may lead to electrolyte imbalances, which can have profound effects on health.
There was another time, during a night call, I spent twenty minutes clerking and examining this young man who was complaining of a mild burning sensation in his limbs after a potassium infusion. Actually, these sensations are normal after potassium is given and there really wasn't anything wrong with the man. I grumbled about this man to my friend, for which I got a telling off. After all, laymen don't know about side effects of treatment and can be afraid of them. It is the doctor's job to manage expectations. Ok friend I'll learn.
Although I have the secret wish that patients complain only when something significant has happened, I know it is absurd for a doctor to request to treat only healthy people, unless he wants to do Derm or Plastics.
2) Doctor let me help you...
... A little too much. But really, it's ok. I've had relatives who showed me the patient's medication on their iPhone, asking if I need to copy them down. And the same people could go up to the computer, look at it, and ask a long list of questions. But then again, we have to empathise with these anxious relatives.
The textbooks taught me to deal with disease but scarcely taught me about humanity. It is humanity that stops Medicine from being a mechanical clockwork like profession. I admit that half of you would end up jaded about humanity and the other half more empathetic towards it, but both are steps you take while growing up anyway.
You? To anyone reading this, hopefully you'd share about the doctors you like and the ones you don't. Stay healthy and happy all
0 comments:
Post a Comment