Friday, May 12, 2017

The Things That Medical School Won't Teach You (4) - Sometimes, you'll end up hating your patients!

Everyone gets a little tired of their job sometimes, it's about as natural a process as it comes. If someone is enjoying their job 100% of the time, they are probably as rare a commodity as a unicorn. I believe job satisfaction probably lies somewhere between maximizing the "ups" and minimizing the "downs" of your typical work routine.

As a medical practitioner, I can attest that medical school, TV shows and even forerunners and mentors at least gave me the impression that the medical field would be hard. The hours are tedious, the life is downright difficult, and your colleagues and their respective idiosyncrasies will prove to be a challenge. But then, no one ever prepares you for how challenging your patients will actually be; I'm not talking about your patients' illnesses because between your training and your superiors you'll have that covered. I'm talking about those little unexpected moments when your patients (and their relatives) set you up for failure.

Scenario 1: No situation rings truer than the one I so optimally used to introduce this post. If you've managed to go through your internship without your patient turning on you during the ward round, you are one lucky person. Tragically, even very recently as a medical officer, I had taken an extensive patient history that lasted about half an hour in preparation for the major ward round. As soon as the consultant shows up to listen to the history, the patient starts to poke so many holes in my retelling of the history such that even I am left in doubt as to whether I clerked that very patient. However, the embarrassment doesn't stop there; if you have a consultant like mine, you will be berated in front of your colleagues, accused of 'confabulating' (aka LYING) and dismissively asked to return to take a proper history. Lord knows I am not a spiteful human being, but whenever I have been privy to such treatment, I usually give such a patient a wide berth.

Scenario 2: There are probably fewer less comfortable conditions than morbidity. Being stuck in a strange bed, having nurses (and nurses aides) interrupting your rest on a regular basis to take care of you, and last, but not least, having to endure the ward rounds. Granted though, patients will put up with this because they understand that we're trying to get them better. I remember once having a patient in the ward who looked so sickly, like he was on his way out of this world; on the cusp of kidney failure, yellowed eyes and just a generally poor disposition. First time I talked to his family, I basically HAD to reassure them that he would get better. Eventually, we basically discover that he's only suffering from an acute infection, and we're sure that he'll recover full kidney function.

Once the relatives discover he's out of the woods, their true colours come out: complaints and demands galore. Suddenly, it's as if my medical knowledge counted for nothing, and they're the ones who were in charge. Mind you, this happened during the healthcare workers' strike, and it was beyond irritating to have a basically stable patient demand more attention than the less stable sicker patients. Can't lie: I thanked God when we discharged that patient!

Scenario 3:

Speaking of demanding, few things will irk you more than the patient who shows up at the most inopportune moments. As a rule of thumb, kind of like Murphy's Law, a patient is likely to show up needing your help when it's time for you to clock out and head home. Even worse, though, is the scenario where someone shows up at the Casualty (A&E) Department at the oddest hour of the night with an easily treatable malady. If you've been unlucky enough to work the late night shift, you'd understand that you're usually working with a skeleton crew, basically the bare minimum. As if that wasn't enough, the late night clientele can sometimes resemble the idiosyncratic late night Walmart shopper: CRAZY!

I understand that you may have your issues, but it does help if you're considerate about the tasks that we juggle in those circumstances. We operate in triage mode in the Casualty Department, meaning that regardless of the time you set foot in the department, I am going to address the needs of the most severe patient first. I pre-assessed you really quickly and I'm 97% sure you have the flu, so I'm pretty sure that between your headache and chills you're not likely to expire within the next hour. Allow me to attend to this head injury patient who's so banged up that he lacks the capacity to even complain about his situation.

Scenario 4: All hospitals are definitely not created equal! Every person working in a hospital is particularly aware of their hospital's degree of competence, and perhaps more critical of the hospital than an outsider might be. Be that as it may, we are sensitive to being criticized by an outsider. It's very much the same way you might feel comfortable calling your sibling an idiot, but God protect the individual who tries to heap such disrespect on the very same sibling.

As an intern, I once had the misfortune of having the uncle of an MCA (Member of County Assembly) admitted to our hospital to undergo prostate surgery. This was tragic on so many fronts:

  1. An MCA is, for the most part, an overpaid but practically useless political post that we've somehow been saddled with since 2013
  2. Many of the individuals chosen as MCAs take it upon themselves to lord the position over individuals in government institutions, like hospitals.
  3. The limited staff we had in the surgical ward ended up being diverted to the VIP patient's beck and call...and he wasn't even thankful in the least.
In my opinion, if you really can pay for admission at a better hospital, why would you feel the need to game the system, and then mistreat the people who are trying to help you?

Scenario 5: The dysfunctional family. There are few experiences more trying than having to deal with a sick patriarch/matriarch who's admitted in your institution, but is pretty much in the middle of a "custody battle" that gets dragged into the hospital. Sometimes it feels like their relatives are already counting the spoils even prior to the patient's demise. Never have I run into a bunch of entitled individuals who will frustrate your management of the patient, and seem ever eager to drag the hospital into a lawsuit at the slightest perception of an insult.
For your sake (and that of the hospital), make sure to DOCUMENT EVERYTHING! Your notes had better be crisp and concise and up to date. Lord knows you don't want to be sucked into the black hole that this debacle will turn into. On many an occasion, don't forget to emphasize how inadequately your institution is equipped to handle any serious emergencies that may befall the patient, and be on hand to provide them a referral to a top-notch medical facility of their choosing.

There are a myriad of other situations, but this is all I can summon up from memory at this juncture. The commonest string that binds them all seems to be "the demanding patient"; thus, it is in your best interest to always be able to pick out those patients that are likely to be the most demanding.

 Take home message: this life can be hard, but the more prepared you are to face the other awkward stresses that come your way, the more bearable your medical experience will be.

Take care and God Bless.

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