One difference, though, in my experience as a
medical practitioner now from that when I was still a medical student, is that
there are more variety in patients. When I was a medical student, most of the
patients I saw were the indigent. We help them, and they help us by letting us
learn from their illnesses. We were just focused on the proper medical care
adjusted to their financial capabilities. The art of dealing with different
kinds of people were slowly being forged. Hospital politics were not that much
of a concern.
However, in the ample time I have spent out in the
real world, practicing the art and science of Medicine, I have encountered so
much more patients that I haven’t seen when I was a medical student. And with
this, a lot of the real world rules have to be factored in the medical care. I
have, in my mind, formed several categories for the different patients I saw
everyday:
1.) The Compliant Patient
He feels that there is something wrong with his body. He
is aware that his health is compromised. He knows professional help is needed
and he does seek professional help. He is honest and cooperative with his
physician. He is compliant with his medications and comes for follow-up
consultations. This is the kind of patient that every physician wishes to have
all the time, for how can a physician properly perform his duty if the patient
doesn’t perform his?
2.) The Pasaway
He is stubborn. Very stubborn. He feels that something
is ailing him but doesn’t seek help. Or he may have consulted with doctors in
the past but does not take his prescribed medicines.
Common reasons given for noncompliance with medications
are: a) he feels okay already; b) medicines are expensive (note: but he’d spend
a lot on herbal supplements, whose efficacy and safety are not proven through
scientific studies and are only guaranteed by the attractive encouragements by
print and television commercials and hearsays, and spend some more with
consultations with quacks or anyone who’d promise him an instant cure with the
laying of hands in return for money or "donation").
Or, maybe, he is compliant with the medications, but he is
still ailing because he keeps on doing the very things he was advised to avoid
(e.g., smoking, alcoholic drinks, sugary foods, etc.), thinking he has the
medications to keep him at bay anyway. And then, his health worsens. He comes
to another physician and comments on how his previous doctor wasn’t any good,
doesn’t know his Medicine, etcetera.
I see plenty of this kind of patient in my practice. And
the interesting thing about it is, most of these patients are well-off and
educated. Most are college graduates; some, even postgrads. These are the
people who should have a more mature understanding of their health condition.
But still they are stubborn. These patients can be quite challenging to take
care of. Unless they change their attitude, no doctor, no matter how good he
is, can really help them. These patients will always walk away, unsatisfied,
and go looking for another doctor, who’d tell them the same things, which will
cause them to seek another doctor. And another. Thus, the cycle of doctor
shopping goes on. It will not stop, unless they suddenly come back to their
senses or are already dead from the illnesses which they vehemently refuse to
accept.
3.) The Borderline Hypochondriac
Pardon me if I use this term loosely, but it must be
understood that some patients who belong to this category really do have
psychiatric problems.
This kind of patient has multiple "ailments". He’ll come
to the doctor complaining of many symptoms (abdominal pain is the most common)
and will have low pain threshold compared to the average. Results of physical
examination will be pretty much normal, as well as his laboratory exams. But,
still, he will claim his "symptoms" are worsening. Sometimes, medications
help. Sometimes, medications "worsens" it. Giving placebo (a substance having
no pharmacological effect but given merely to satisfy a patient who supposes it
to be a medicine) does the trick. Perhaps this patient just wanted to call more
attention to himself. Or perhaps it is a psychiatric problem. If it comes to
worst, a help from a psychiatrist would be needed.
4.) The Executive
This patient wants to be treated like the Crown Prince.
When he comes to the clinic or the emergency room, he wants that all attention
should be directed solely to him, regardless of the purpose and time of his
visit. And not rarely, the relatives who came in with the patient demand more
attention. To further illustrate my point, I will recount my experience with a
particular patient during my internship year.
I was the emergency room intern, two years ago, in
a private, tertiary hospital in Mandaluyong. It is not rare that we have toxic
duties at the ER, as most patients who come were the affluent health cardholders
who do not have time to go to the HMO clinics during the day and would come at
the ER after their work for outpatient consultations. Then, add to that the
real emergency cases like vehicular accidents, stroke, and heart attacks. Then,
one night that we were having a lot of opd patients, there came in a real
emergency, a person who complained chest pains and suddenly went unconscious.
My resident and I immediately attended to the newcomer, because he needed our
attention first (for goodness’ sake, the patient just had a heart attack!). The
patient was already cyanotic (his skin is already livid from inadequate oxygen
in his blood) and his blood pressure was fast going down. The other patients
just have to wait until this newcomer has been stabilized or, worse, pronounced
dead. As I was doing chest compressions on the patient, this idiot relative of
an opd patient just came stormed inside the cubicle and asked in a very loud
voice if no doctor is going to attend to his brother. I told him that I already
saw his brother and he is being hydrated and that I’m awaiting the results of
his stool analysis (I said this while I was busy with chest compressions. Just
imagine how awkward that situation was). Why, are there only two doctors in
this hospital? His brother came first and should be attended to first, said the
idiot relative. He then further demanded that his brother be seen by the most
senior doctor in the hospital. This guy really pissed me off and so I told
the staff nurse to please tell the guy to step out of the cubicle because we are
attending to a real emergency. And the guy went out, continually yakking about
how the hospital is incompetent, etcetera.
Some people can really be quite insensitive. From the way
that idiotic guy acted, I can gauge that his intelligence level is way below
standard. Moronic even.
I encounter a lot of patients and patients’ relatives who
are like that idiotic guy. And it can really drain a doctor’s strength during
duties.
5.) The Phone Stalker
This is the kind of patient who likes to have phone or
text consultations. A common text message would be like this: I have cough and
fever. What medicine do I take?
Please, do not be like this patient. It is very
dangerous. Please do understand that Medicine is not as simple as knowing which
medications are for cough, for fever, etcetera. Different illnesses present
with cough and fever. Some headaches are benign; others can be precursor of
something more complicated, like a neurologic pathology. A lot of
considerations are made before making a diagnosis. The doctor needs to see the
patient for himself, unless he is quite familiar with the patient’s medical
history to make a diagnosis. The patient may describe what he is feeling
differently from the way a doctor may describe it. An insect bite, for a
patient, is simply an insect bite. For a doctor, an insect bite is a wheal or a
petechiae or a pustule. It could be many things. It may not even be an insect
bite really, but rather, it is how the patient interprets it. The doctor, who
has trained his clinical eye for many years, needs to see the patient for
himself to make the diagnosis.
These are just some of the categories I have formed. I
may add to it, after few more years in practice, though. I just hope that more
patients would fall under the first category, not for the doctors’ sake, but
also for theirs. If you belong in the other categories, please do take time to
reflect on yourselves after reading this entry. It will be better if you revise
your attitude towards your health and health care givers and be the mature
and intelligent individual that you should be.
