Thursday, 14 April 2011

Should a patient know what's wrong with him? Jury says No!

One of the more annoying things I've noticed that happens constantly and frequently in the hospital, is that patients usually have no idea what's wrong with them. I'e been asked several times by patients' families and the patients themselves the simple question of , "Doc, What's wrong with me and when can I go home?"

Now there ARE several explanations to this dilemma that I'm pretty sure is Egypt specific.

  • Patients don't bother asking the residents when the resident looks at their chart, RIGHT IN FRONT OF THEM. Whenever they ask me, I tell them, "What did the resident tell you?" and they say that they didn't ask. They don't ask because they feel that if they do ask, they'll inconvenience the doctor. Alot of times, the residents will be rushing through the patients when checking their files and charts because they have other places to be. This isn't saying that the patients aren't getting the care they need (they don't but it's not because of the resident usually). It's just that the residents usually have no time. Alot of the times, patients feel that they'll inconvenience the doctor simply by asking. They assign this god like status to the resident and if he's questioned even once, they have a propensity to believe that the resident will just say " Did you just question me? That's it! Fuck you. Fuck your family! Get the Fuck out of my ward."  This isn't true (well , most of the times at least)  To these patients, I tell them to just ask their resident nicely and they will answer nicely.   

  • The asshole patient and/or assholes of a family. Yes I know, it goes against every moral fiber of my being to say that some patients are just genuine assholes but yeah, some of them really are. Now usually, it's mostly the family who are assholes. These people want to know EVERY single step of the process, and once told, they will not shut the fuck up about what to do. They think their patient  is the only person in the entire hospital, and that the entire hospital staff should bend over backwards to save this and only this man's life. The problem with telling them what's wrong with the patient (especially if its a severe illness) is that they'll question your skills as a doctor (because they'd rather not believe you than believe the patient is super sick). This becomes even more of a problem when they decide to want to go to another hospital (because maybe another hospital's going to tell us he's not going to die, because you know... That's how hospitals work. Like raffles) So they put the patient's life in jeopardy by risking and threatening to move him AND/or not give him the medication you prescribed. It becomes a ethical minefield when you think about it. Do you not tell these people the severity of their patient's illness in hopes of just offering treatment because they will lose their shit if you do, or do you tell them and damn your patient to die because they're fucking stupid. I know what you guys are thinking, "How do you know which families are assholes and which aren't" There's a general rule to this. If 7 people are coming in to bring 1 patient and they're screaming at you as you're trying to help,  rest assured they're the people I'm talking about.

  • The patient is kept in the dark because his family has decided he's to weak to sustain the diagnosis for himself.  This, to me, is the worst situation. What happens is , the patient's family come in to your office to ask what's wrong, so you tell them. After you tell them, they beg you not to tell the patient because 'he won't be able to handle the diagnosis' . Obviously this is more prevalent in more serious traumas and conditions. They will literally go down on the floor on their knees begging you not to tell the patient saying that they'll tell them when the time is right. I, personally, fucking hate this. I've had this happen to me a few times and I'd respond by going to the patient and telling him what his family just told me. If he says "Just tell me Doc" I do. Nothing should ever be kept from the patient.  Ever. There's even a worse example of this that happens, and that's when someone dies. Now, when someone dies we usually tell the relative who's waiting outside. So we had a death happen a while back and he had a bunch of relatives waiting outside, but his brother was the one waiting closest. So we went to him and told him. What he told us next was unbelievable. He told us not to tell the family or talk to them because he'd deal with it. So we agreed thinking he'd have his own way of saying it. The guy went outside to his sister and the rest of the family and told them "Guys! He's fine! Let's all just go home and visit him tomorrow." I never understood why he said that until the next day. He showed up again the next day and I asked him  why he did that. He told me it was for the safety of the doctors. Had he told them, they would've gone in and beat the living shit out of every single one of us. Scariest part of it all, was that he was dead serious.
Now these are just a few examples of so called 'breaches' in the doctor patient confidentiality relationship, and it's the kind of stuff you're sure only happens in Egypt. But you know what? Ethics be damned, the way people are here, normal moral ethics don't work. You need to understand the patient's social background and deal accordingly. Otherwise, people will beat the shit out of you. And who wants that?

PS: Seeing as how this wasn't that funny of a post here's an entertaining story relating to what I just talked about that happened to me the other day. There was this guy that needed to change his dressing on his lower back (Dressings are just pieces of cotton wrapped in gauze soaked on wounds that are washed with antiseptics. We change the dressings to prevent infection) So the guy specifically told me he didn't want to be sprayed with the topical antibiotic spray because it burns like a bitch. Now the guy needed to be sprayed. So his wife just whispers to me ," Don't tell him. Just spray." and she proceeds to trick him by showing an empty bottle of spray saying it's all finished.I disagreed.  I told him, "Listen, I know the spray hurts like a bitch. But it's to prevent you from getting infected again and so reduces the time you get to spend here. So the man agreed and I sprayed and it was all over. After I was done, he called his wife an asshole and told me, "Thanks for being up front with me Doc. As for you woman! Don't talk to me for a whole day! "  So she looked at me and said "Thanks for ruining my marriage Doc!"  I did what anyone else in my position would do. I laughed. Does that make me an evil person? 

1 comment:

  1. It doesn't make you an evil person, no. It makes you a good doctor, I guess.