11 June, 2007

Unclear On The Concept

Some patients can be so unbelievably clueless. Some examples :

  • Man walks in, sits down, says HI and then asks, "Doc, what's my BP today?" Wait, I haven't checked!
  • Woman, told that she's just been diagnosed to have diabetes mellitus from her blood test, exclaims incredulously, "You didn't even check my urine! How do you know for sure?" (Can I propose that the misnomer kencing manis be banned?)
  • Man, told that he has renal impairment, asks, "Which one? The left or right kidney?"
  • Woman, a hypertensive on treatment, pleased that her blood pressure has returned to normal, asks hopefully, "So am I cured? Can I stop my medications?"

A former consultant of mine was of the conviction that no one should ever be admitted for hypoglycemia. If ever, he was adamant that it was the medical practitioner's fault. I remember an exchange during a grand ward round when we were house officers in the medical ward.

Consultant : Why is this lady here?

HO : Hypoglycemia.

Consultant : You are not answering my question. Why is this lady here?

We were dumbstruck, but really, his point was that no patient would develop hypoglycemia if we took the trouble to educate our patients.

HO : We have counselled her on multiple occasions, but she just doesn't understand.

Consultant : You don't need a high IQ to comprehend these instructions, just common sense. And she can't be so stupid.

(Turned to patient) Makcik, apa itu Proton Saga?

Patient : Tak tahu lah!

This has now been immortalised in our memories as the "Proton Saga Story". The point is, patient education is extremely important, but on many occasions, all your advice and instructions fall on deaf ears or get deflected by a thick cranium.

Well, we do try anyway.

13 comments:

yltan said...

Hmm i sometimes why some of the consultants would behave in such a manner. Wouldnt it be simply more gentle if the consultant were to say : Hello, apa khabar makcik? Makcik kena hypoglycaemia..makcik tahu ke apa tu? Kalau tak tau...nanti doctor ni ajar ok? Lepas tu makcik tak perlu lah selalu masuk hospital..... (then consultant turns to the HO or MO) well we have gotta educate makcik before she goes and ensure she gets some info leaflets as well as inform her family members. By the way how low is her sugar levels and how bad is her control? Right then...shall we move on.... (and hence the consultant and team moves on to the next patient)... Selamat pagi aunty....yada yada yada

Now doesnt that feel more like a proper ward round? In a way...less intimidating. We have spend 5 years in medical schools and sometimes even more ... and yet...when we see our colleagues or even patients...we treat them nevertheless in the most inappropriate way sometimes....

My two cents...

Anonymous said...

Clueless patients anger me. Worse, I have zero tolerance for clueless and carefree patients. They might as well see a bomoh.

M K said...

Don't get unset about clueless patient. I got patient testing on my management. For example, doctor ,can you get my BP. After i tell them BP normal today 120/80. He will answer me actually i reduce the dose you giving to half today then start lecturing to you that he don't need so many medication.How about that?
What i called a amateur driver try to teach Alonso to drive car!

fibrate said...

YLTan : I'm sure you know which consultant I was writing about...but I do miss his grand wards immensely.

Nocturnale : Cluelessness is like surrendering your right to health. I'm all for patient empowerment!

Fang : Ha,ha, good analogy! :D

eve said...

I get the "now that my BP is normal , I can stop my medicine oredi" patients all the time..sometimes really got no patience for them....No matter how much you try to educate them , they just wont listen..Just when you think you are about to have breakthrough , the next month TCA will the same problem again...Sigh..

dieselfire said...

Lol! Never knew there's so much anecdotes in a doctor's life! *arrgh* What would my doctors be talking about me pulak ?

fibrate said...

Eve : Like I said, thick cranium :)

Dieselfire : Now you know how "petty" we are, sitting around talking about our patients!

Cytusm said...

I got very irritated when patients see you and start complaining too many pills they have to swallow. Before they leave, they ask, "Doctor, can you please give me Vitamin C and B Complex, also don't forget to add Panadol and cough syrup, the black one".

Worse still, in some of my patients, when I told them their BP was alright, they replied that " Oh great, I have stopped taking it (medicine)". Be their own doctor. I would be happy to say, "Oh well, I can discharge you then".

Anonymous said...

Sorry ar, but I'm a bit clueless too...

What's wrong with asking "left or right" for renal impairment? Is it because it affects both?

yltan said...

fibrate: yes...i do know who you mean.

i just feel that many of our patients are not so well educated and informed. Nevertheless the more they are literate, the more litigation and complaints coming our way. Feel fortunate to be treated still as the high and mighty doctor...in years to come...i dont think so we will be treating patients the way we are treating them now...

fibrate said...

Cytusm : Typical. Want to stay in specialist clinic but don't want to listen to doc!

Anastasia : Actually, there's good reason to ask right or left. Generally, the patients I see are those with renal impairment of a medical nature, such as that resulting from diabetes, hypertension, abuse/overuse of certain medications etc so the damage is usually bilateral. Of course, there are cases where the renal failure is caused by disease affecting only one kidney, such as renal stones, or abscess. My unfair generalisation, that one. :)

YLTan : Can't we have well-balanced patients who are educated and empowered yet courteous and appreciative? That would be a great doc-patient relationship. Too much to ask for?

Palmdoc said...

Real story...
When taking medical students in Klang Hospital and teaching examination of higher mental functions

Lecturer: Siapa Perdana Menteri Malaysia?
Elderly indian lady: Samy Vellu!!

fibrate said...

Palmdoc : LOL...

Going OT now, but I've got a similar Samy story. This happened during a Star Quiz Quest semifinal many years ago. It was my rival team's turn to answer.

Q : Where does the Thaipusam procession begin every year in KL?

A : (after an awkward silence)Err...Samy Vellu Temple?

Maybe he is bigger than the PM.