It is raining now, no outdoor activities, and i am still waiting for my girl friend and her housemate going out for dinner, so hungry!!! Not knowing of the reason, i am staring at this monitor and started to write something quite special that i met today.
I went to 5th Paediatric Ward earlier on. As tomorrow will be a ward round with Dr. Shanti, thus we have to cover all the patients available in the ward as she might want to know all the patients there. To my surprise, all the patients at the beds allocated to me were old cases, which meant i need not to clerk new history today, as i have already known them as they admitted. After seeing the progression of the patients from the case notes, it was still quite early. Then i decided to go to talk to the mother of a sick child which i think was quite an interesting case.
The patient was a 11 years old Chinese girl newly diagnosed with systemic lupus erythemathous 4 months ago. This is an autoimmune disorder that might affect many other organs in our body by the antibodies of self-produced. She had few episodes of fits before the admission and then referred here. On the day 1 and 2 of the admission, she looked so tired that she could not speak or moving her body, as the fits attack was quite frequent. After started her on anti-epileptic, her conditions improved and she seems cheerful and able to talk, but slurred. She was diagnosed to have cerebral lupus with brain atrophy after a brain MRI.
The mother was the person that i talked to during their first few hours in the ward. Initially she was not keen to be interviewed by anybody but after my explanation, she agreed and i took the history and did some simple physical examination. She has been staying in the ward since the first day taking care of her daughter and in fact, she has lots of thoughts and opinions of the care given by the doctors, and she started to share them with me.
The patients expectation, is what often we worked as health care providers might neglect. As the time is so restricted and lots of studies and other patients to be taken care of, we tend not to focus much on the psychosocial part of the patients. Whenever there is new admission, we (or other medical students or others...) tend to see what case is it and if it attracts attention, he or she might immediately go to the patients and ask for permission to interview the patient, and what happens next? The medical students get rejected from the patients. Honestly i have faced this scenario so many times that sometimes i might feel phobia of approaching patients and yet i still do not know what i should do to fix this. (Do i need to have a thicker face?? So that i won't be so embarrassed whenever rejected by patients. Actually i know this is a stupid thought, but i would rather consider the conditions and approach the patients when i have more than 70% of not rejected by the patients, maybe by luck or by chance, of course i did fail sometimes.) From the discussion suddenly i realized that actually almost all the patients are really willing to share their story no matter how sad they are with their illness, of course the patients must be fit enough to think and talk. The reason why they reject to be interviewed is mostly that they are still new to the environment and need to settle down their swinging mood after admission. Then the 2nd reason is that too many staffs interviewed them before and they become frustrated to be interviewed repeatedly. Thus, before we approach a patient, always observe for a suitable situation that favours the interview, and to ease the patients for the new environment. And also if possible, come back frequently to review the patients so that they can gain trust in us.
Also, to treat all the patients equally and never priorities one patient in front of another patient, unless in an emergency situation. Because of the time, again, we might rush the job of seeing patients according to the schedule, and the consequences are, we cannot assess the patient fully, not able to build up rapport with the patient, and the patient might feel they are of no importance. Therefore, always find a time to sit back and talk to the patients to understand their expectations and needs, as what always taught by primary care medicine.
Thanks to the patient's mother, now i can know how to do with my patients, and i enjoyed the feedback she given. I would say this was a share of thinking rather than a teaching, because we know it someway actually, it's just that, do we usually practise them as the time is so restricted and we are so busy?? I must say i will try, because this will render me to be a good and better doctor, as i always wish for.
