Tuesday, March 30, 2010

When doctors are too busy to care...

I'm not much of a worked up person when it comes to others feelings. I used to say, I just don’t care about what my friends say or think about me as long as they don’t say it right on my face. But even I happen to get emotional sometimes when I see how neglectful we can be.

I met this retired gentleman in the ward who came with right leg swelling about two months ago. Had been treated for filariasis in another hospital even when the blood film was negative and it turned to be a vain attempt. Fair enough. Let’s say the clinician made a "clinical" diagnosis and trial of treatment is just another way of "diagnosing" things, even though you wouldn’t like this kinda treatment on yourself.

He sought further medical attention in our centre (I mean the place where we go to study: P). His drs did the right thing considering other diagnoses and decided to investigate further. With extensive investigations it was found that he had cellulitis of right leg due to lyphatic obstruction, a right psoas abcess, and finally mycosis fungoides. Further investigations proves that he had "some kinda" malignancy going on with multiple lymphatic obstruction, satellite lesions in liver, kidney and pulmonary effusion as well. So let’s consider "it’s an advanced disease"- That is just excellent they managed to solve at least half of the mystery. Investigations are still going on to find the exact location of the disease.

I saw him again a month later; rarely do I get to talk to patients without a second tongue, so I was happy to see him again. Asked him how he is feeling, “want to climb a chair and jump off the building” he replied. I was taken aback by caustic remark. What happened? Is he terminal? Going through severe depression? He used to be such a nice gentleman, somebody must have broken him- I thought to myself.

Another friend of mine and I sat there at his bedside for an hour, not taking history, but just listening to him. He had lots of complaints about staffs at the hospital. Doctors, nurses, students,-anyone who walk in and out, basically.

“Yeah, he is a retired civil servant, what else do expect from old people like that” – you may think.

But let’s listen to what he had to say. “It’s been two months. They had been doing this and that, poking here and there. They don’t know where it is, what it is..made me eat medicine for Filaria, then say it’s not filarial, then say cancer, then say something else” I could see frustration on his face as he spoke with explosive tone and sometimes he paused for a deep breath- a sigh of frustration. We tried to explain to him the rationale of the persistent poking. How difficult it is sometimes to reach a definitive diagnosis when patients present with atypical presentations.

“I could accept that, but then why not say so, why do you have to be so ignorant of our feelings. We are not dead yet”.

Yep, he is right, this not a car which has a punctured tire that you take to a mechanic and point a finger to the tire-the mechanic would just fix it without saying a word. What if you took your car to the mechanic and you said it got a problem and the mechanic just started hammering the engine from sideways and didn’t tell you what he is doing? Would you be mad? Old man is not a car! He is a living being with feelings like howmuch we do.

The old man had more complaints.

“the nurses: they are not here to care for patients. They are too busy writing..Patient is sleeping..Patient is awake..Patient is not well today like other day” he elaborated on his statement.

“Sometimes I feel like doctors are just here to get salary. Only few are really concerned about me. They come in a gang..Like a group of flies..expose me and look at..and talk to themselves..write so many things. And then just go away. They tell me nothing.”

“ I asked them what is my problem, when can I go home, they said; have to talk to dr x (an old consultant), he is not around..look at my leg its getting worse, I cant even walk now, its so painful.. Sometimes I wonder what will happen to me if dr x is not here, he is the only one who actually care” – old man had a dry throat. But so much he had to say.

Finally he asked me “ what do you think? Am I just whining or do I really have a point- you are from IIUM, is that how they teach you to treat your patients” – Glad he expected something better from IIUM. I bragged about our “bio-psycho-socio-spiritual” model of management. But he knows that’s just theoretical crap and in reality nobody works that way.

“Sometimes I do wonder if we, people in health "care" profession are missing a heart. You may have the skill, knowledge and attitude but what if you don’t have an empathetic heart. what’s the use?”-I asked myself.

It’s understood that a busy HO or MO don’t get time to sit by the patient and talk about patients feelings-unless you are in psychiatry ward, of cause. But are we that busy for us not to even greet the dying old man when we see him and ask him how he is doing? Are we that preoccupied with commitments that we can’t even explain to him what we are doing and why we are doing it? I believe this has to change.

“ I want to help sick and those in pain, I want to make the old and dying person feel better” -You will surely hear this fancy answer when you ask anybody in medical school why do they want to be a doctor. But are we really doing it? Being busy is just not an excuse. Simply because you don’t want to be taken care by such a busy doctor when you are on the sick bed counting your last days.