Sunday, May 11, 2008

Patience, Patients

Too many a time, the role of a patient conjures images of a wasted and bent little old lady struggling to take her steps due to the incessant pain of severe osteoarthritis. Patients are humans and humans are mortals capable of much unthinkable and downright mind-boggling train of thoughts.

Patience, Patients

The internet is a blessing for souls like me who are no scholars in etymology.

The term ‘doctor’ originated way back in 1303 and was originally used to refer to religious teachers and advisers to denote a person capable of providing lawful teachings and right the wrongs in society. It wasn’t until almost 40 years later in 1377 when healing men (and women, if there were any back then) were also referred to as ‘doctors’.

As early as 1320, someone who ‘bears or endures without complaint’ is considered to be patient. It is regarded as a virtue, an admirable quality to be quiet in one’s despair. The origin of the term ‘patient’ in reference to someone who is ill and in need of a doctor’s services is less well-defined.

It’s quite an irony then that patients are referred to as patients because if they were really patient, then they would not be complaining about their suffering but endure it in silence. Maybe the term ‘patient’ as a noun was employed to remind doctors seeing ill persons to be patient in their conduct and mannerism and endure their patients’ idiosyncrasies in silence and solitude.

It can be so easy, so effortless and even fun in fact to go on a doctor-bashing spree just as how political analysts and foreign commentators and blog owners appear to be so merciless and unruly in their condemnation of those in the political thrones.

Let’s do something different for a change. Let’s go on a patient-bashing spree. After all, we are all patients at one time or another and will become ill come a certain point of our lives.

The Stupid Patient
A 22-year-old Chinese guy came knocking insanely on the clinic’s door. He created a small commotion at the counter, demanding the clinic nurse for immediate medical attention. I checked out the chaos unfolding within my earshot. He was a chap with fair skin, hardly a pimple scar on his cheeks. His hair took on a golden-blond hue and towards the scalp, revealed the underlying original black hair. His royal yellow Timberland tee shirt had droplets of blood scattered all over. His right elbow was held flexed in place by his left hand. Blood was dripping from his right hand onto the clinic floor, but not without staining his oversized khakis hanging an inch or two below his pelvic bone. There were multiple cuts on his fingers, each wound oozing a constant but small amount of blood.

“Hi Doc. Good evening, how are you?” he bid me in perfect, accented English upon my appearance.

“Obviously better than you,” I replied. If he can be so cheerful and casual with all the blood that was trickling away, he was in no dire emergency or drunk or most probably both.

I said him down to dress his wounds. In the government hospitals, it’s usually a nurse’s job, but when one is doing locum, everything falls into the locum doctor’s purview. I could see that he has had previous injuries before. He had lost all shape and contour of his knuckles over his middle, ring and little fingers of the same hand.

The young man clarified that he celebrated a futsal goal three weeks ago. In his jubilation and ectasy, he had punched the turf with all his might and soul. His right hand had remained swollen and numb ever since then but he was so sure that it would recover he didn’t see a doctor for it. That night when he came rushing into the clinic, he had punched the glass mirror in his bedroom out of sheer frustration over what he though was an underprivileged life. Ah Beng had also taken a few drinks before he decided to vent his anger at his mirror, and I am not referring to Vico but Vodka.

The patient was formerly a law student, sent on a family scholarship to a high end university in the United States. He was happy there, or so he thought – so much so that every hour is a happy hour to booze and get laid. It wasn’t exactly breaking news or the greatest surprise of the century that he failed to make the cut in his annual exams. That, it seemed was why he was furious and mad about life.

I completed the dressing and advised him to get an x-ray done for his futsal injuries, knowing pretty well it might not make a difference. He had fractured metacarpal bones from his joyous celebration over a goal that didn’t change the world. By now, it was too late for any orthopaedic intervention. He just might have lost the use of three of his five fingers forever.

These are patients that I deem really stoopid with a capital S. Stupid because they think they were smart. Stupid because they do dumb things that bring harm to themselves. Stupid because they will never learn and will do it again. Stupid because they are spoiled, ungrateful brats with a mirror as their worldview. Lastly, stupid because they take much pride in doing the things they do and thinking the doctor is actually interested to hear their story and impressed by their fitting rage.

Patients are allowed even expected to be ignorant about their conditions and illnesses. It is exactly a doctor’s job to educate and teach patients about disease prevention and treatment. A doctor can never however, bring change to stoopid patients like the aforementioned Ah Beng.

The Know-It-All Patient
It is commonplace for doctors to ask patients “What’s wrong?” when we see one. It’s certainly better than asking the patient what brought him/her to the hospital to which the right answer would be a car or an ambulance.

When asked “what’s wrong”, most folks would just go on to describe their cough, cold, sore throat, pain and headache. The more cheeky ones would reply that if they knew what was wrong, they wouldn’t have come to see a doctor in the first place. Such replies usually trigger a chuckle or a natural smile unless the doctor is depressed or simply devoid of any sense of humor.

Then there are those who would jump in right into their supposed diagnosis and start demanding some state-of-the-art treatment, even when such modalities are not yet available or proven in clinical trials. These are usually the Engrish-speaking, educated urban folks who just might have a friend or two who happen to be a doctor too.

Such patients are usually the most unrewarding to treat.

They are obstinate and so full of themselves that any additional education is practically impossible. They are convinced that the fungal infection is eczema and proceed to treat themselves to a course of steroids. I applaud them when they turn up with a severe and generalised fungal dermatophytoses. They are certain that their blood pressure is high only because they just walked two metres from their seat into the clinic, although the records say that their blood pressure has been high for almost three years now.

Mr Know-it-all even recruits medical jargon like adenocarcinoma, myocardial infarction and benign nodular hyperplasia of the prostate.

Among all patients, these really stretch a doctor’s patience to its limits.

The Fake Patient
There are times when I feel like giving up on studying and further training out of frustration and a pinch of desperation and settle for general practice. Don’t get me wrong, general practice and family medicine is truly noble and rewarding in its own right. It’s just that not everyone can practice family medicine. Those who dislike gynaecology and paediatrics like me for instance, will never make an effective family physician.

At times when I feel like resigning and opening up my own humble clinic, there will always be some angels sent from heaven in the disguise of patients.

A young man saunters into the clinic and requests medical attention. He wears a Manchester United cap with a matching red jersey. His blue jeans looked neatly pressed, held firmly in place by a Harley Davidson leather belt. The ends of his jeans spread out in a bell-bottom cover over his leather boots.

Hardly the painting of an ill person…

He makes himself comfortable, raising one leg across the other as he rattles off his presenting complaint. His symptoms were vague like lethargy and headache. His story was inconsistent, flip-flopping between duration from two weeks to two days. His descriptions were nonsensical and did not match any specific disease category. He had normal temperature but claims to have a high fever.

The truth emerges when he is asked about his occupation. He is a university student on a Yayasan Sabah scholarship in his final year of accountancy. He has skipped one class too many and is barred from his final examinations. He is a fake patient, just like the cop looking for a medical certificate to avoid tomorrow’s major drug bust or that young executive suffering from a hangover on Monday mornings.

It remains to be seen whether these are angels disguised as patients or the other way around.

Their existence will never cease while their desperate ways of obtaining a doctor’s letter will always evolve. They waste their employers’ money and betray the trust of that state scholarship. They add to the doctor’s coffers and subtract the available consultation time available for other patients.

Fake patients have no respect for themselves or the intellectual value of the medications they are prescribed, most of which end up untouched.

Regardless, fake patients do an excellent task in keeping me determined not to pursue general practice as a long term career. If that’s the only good they do, then they are doing it pretty well.

The Serve-You-Right Patient
The pot-bellied, bespectacled Chinese man moved with a swagger as he slowly marched into the consultation room. His collared t-shirt was tugged neatly into his three-quarter khakis and a piece of folded paper was mounted under his right armpit. He took a seat and explained he wished to enquire about being a hepatitis B carrier.

I was curious. I asked for the report just as he was about to unfold the laboratory results for me.

The father of two and grandfather of three had hepatitis B all right. The only thing is that he was not a mere carrier of the virus but one with the disease and all its possible complications. He also had syphilis which he most probably contracted from the Filipino ‘guest relations officer’ at the karaoke he regularly frequents.

There is one thing peculiar about Kota Kinabalu whenever I think about karaokes, which is not too often, if at all. Entertainment outlets like karaokes and pubs and discos easily outnumber mobile phone outlets. In a land so endowed with the beauty of nature, it’s amazing why anyone would opt for karaokes and clubs for enjoyment.

I explained in detail the possible complication of chronic hepatitis B and syphilis and the need for further tests to exclude other sexually transmitted diseases. He nodded in comprehension but declined further investigation and treatment. He was comfortable with his lifestyle and has no intention of turning over a new leaf.

Patient’s autonomy, right? So be it then.

This Chinaman has chosen to spread his viruses around and one day die from it. The law does not provide doctors with the power to overrule patients’ decisions and choices. He may and may not contract HIV one day, but he’ll die a horrible death nonetheless from complications of hepatitis B.

His family might remember his as a loyal father and a reliable provider, and maybe blame the doctors for failing to save the patriarch of the family.

Someone somewhere, a doctor seated in a clinic knows better.

This is not an article to belittle patients and their rights in modern medicine. Too many a time, the role of a patient conjures images of a wasted and bent little old lady struggling to take her steps due to the incessant pain of severe osteoarthritis. Patients are humans and humans are mortals capable of much unthinkable and downright mind-boggling train of thoughts. There are many more types of patients that really test one’s patience.

To write any more is to test your patience.


rahsia said...

There you are, providing us with another point of view.

zewt said...

right... i shall refrain from letting out what i have read in the net when i see the nephro next week...