On this episode of DPP, I would be sharing useful thoughts on the 12 categories of patients a physician may encounter, in no particular order or rank. The list is non-conclusive, only based on everyday instances between the physicians and their patients. Almost everyone, on one occasion or another, has been referred to as a patient because he/she fell sick and sought a doctor’s attention. During this time, we also had put up some manners and behaviours—either because of the trauma of our sickness or because of our personality types, which had affected the way that particular doctor treated us.
Now with open mind, let’s go through the list below and pick the category we once fell..
No matter what the physician may try to ask at first meeting, what comes out of this patients’ mouth is,
‘Doctor, I have Malaria.’ ‘I have typhoid.’ ‘I think I have dysentery.’
And what used to follow such complaint is,
‘Sir/ma, you can’t teach me my work. Just tell me what and what are your complaints?’
And with more experience and better ethical practice, the patient may get a more mature response from the physician,
‘Well, you can’t be too sure of what you have, leave that to me to make the diagnosis, how and how are u feeling?’
This kind of patient tends to believe that a physician only treats malaria and typhoid or dysentery, hence, streamlines all his symptoms into these few diagnoses based on his knowledge. It is now left for the attending physician to explain to such patient that, asides malaria fever and typhoid fever, there is a possibility of a hundred and one other causes of fever and headache.
This category of patient is usually not the knowledgeable type and may however not be difficult to manage, he may only need that initial explanation that would calm his adrenalin rush. And then, the doctor-patient relationship goes sweet from there.
It is very normal to be in a hurry to recover from certain illness—anxiety would always have it place when one is sick. However, this kind of patient, irrespective of the chronicity of his condition, always wants to fully recover the moment he sees the doctor. If on admission, he or she tends to call the nurse on duty almost every 15 minutes for the same condition he has been nurturing for two weeks before presenting at the hospital. ‘Aunty nurse, my eyes are still cloudy o!’, ‘ Nurse Kike, this hand is not moving yet o!’. He often forgets that the hospital is not a Magic hub. As an outpatient, he comes back the second day for the same complain, not considering why the drugs are to be taken for a period of time. In fact this kind of impatient patient may even decide to bypass the first doctor and try out another. Such patient may not be overtly difficult after all, may be a few rounds of reassurance would calm his impatience.
This category of patient by himself may not be difficult to manage—because he is usually rushed in as an emergency, however, if as a doctor you have once come across this kind of patient and his relatives, you would take to your heels when you spot them on another occasion. Intimidation and threat are their survival technique. In fact if a physician is not careful they would place him on ‘duress’ to manage as against his professional ethics. A lady colleague of mine once crossed their way. She was a nursing mother as at that time and on call that night, while she cried her eyeballs out, her baby also joined her and cried his eyes out, well may be the baby’s cry was actually because of hunger. A man and a woman had brought a sick baby to the emergency unit where she was stationed, because there had been issues with power supply in the hospital and the administration seemed not to have found a solution to that, the staff of the hospital came to a resolve to see patients at night only when the government electricity supply was available. My doctor friend and the other nurses in her unit decided to comply, this was just for proper management of their patients. You can imagine how easy it would be to; assess whether a child is pale; set a line for a child; carry out a test; and transfuse a child with blood, all in darkness? After much explanation, the parents of the child were advised to take the child to the nearest tertiary health facility where they would get better-by-far treatment. So my friend went back to sleep. Few minutes into the midnight, these people brought the child back, this time with some other men—ready for combat I guess. They banged and banged at the emergency unit’s door,
‘where is that doctor that refused to treat our child. Where are you. You must treat this child now or lose your job.’
Another spoke with anger,
‘I’m the S. A to the governor, I know your employers, you must attend to us. Come on, get a lamp and treat this child, my friend.’
My friend was intimidated. She was told they would take her name to the state ministry of health and she would lose her job. She cried and obliged to their request using a local lamp. She was totally taken advantage of. Because doctors are humans, not all are bold enough to resist such challenge, especially the younger ones in the profession.
I have also had similar occurrences at the same notorious hospital where I was once told by a patient that before I was born, they contributed money to build the hospital—fairy tale indeed. Well, sure I didn’t let lose when another man and his wife brought their child to the hospital at 3:30am because the child stooled and vomited twice, which had happened before midnight. The next thing I heard was a man threatening to report me to the ‘commissioner for health’ for napping too long—barely 15minutes nap, after about 17hours of non-stop work. I was initially thwarted but then I laughed and told him my full names, I pleaded with him that he should take my name to the executive governor instead, in fact I told him to add that I refused to treat his child. Well, the consequence of my boldness was, the intimidation fell back on them, they thought they didn’t know the kind of person I was, hence they should mellow. I heard my own round of ‘shakara’ that morning, as it took some pleadings before I eventually saw the patient. The following morning, I spotted the father of the child just walking down the pharmacy to procure the medications I had written since 4am, immediately he spotted me, he took another route.
Well, the only problem this patient may have is to talk too much. He is usually not difficult, only gives too much of details including the ones a physician doesn’t need. This kind of patient may also be funny—sometimes annoying though—and are easily likeable.
This patient bears his/her physician with emotional workload. He may or may not be emotional, but gives the physician a load of non-medical burden. He/she tells the physician about, his family problems; her divorce; may even seek for financial assistance. If the physician continues to give desired attention to all these, it may get to a point that this category of patient would assume the doctor has an obligation to making him/her better by all means, including non-medical means.
By the virtue of this patient’s fearful personality, she may often demonstrate this while in the hospital. He or she shows fear for needle, fear for drugs, fear for sleeping on the hospital. She tends to radiate excessive emotion by crying at the sight of injection and I.V fluids. If such patient’s fear is not first eliminated by the attending health staff, good treatment outcome may be hard to come by.
This kind of patient may, after all, be my kind of patient. *smile* He asks why you check his eyes? Why you prescribe such a drug? Why you ask him to take it before meal? He asks questions on everything that’s not clear to him. This category of patient may not be refereed to as the ‘knowledgeable patient’ but would always ask to know more, even when the knowledge he seeks may be frightening. His physician should be prepared to answer his questions without freaking him out.
The difference between this category of patient and the ‘inquisitive patient’ is that this patient may be difficult to manage. He or she is the very enlightened type, seeks the Internet for his or her condition before presenting at the hospital. He raises question mark on his physician’s line of action. This type of patient would always tell his physician that his or her brother/uncle is a doctor and tells him that he can only use certain drugs for hypertension. He tends to tell his physician what to do… this kind of patient usually self-medicate, he says,
‘I don’t need a doctor to cure headache.’, ignorant of the fact that headache may also be caused by a brain tumour, and paracetamol would not solve that.
The rich patient is ready to pay any amount to get well while the poor patient is eager to be treated but cannot afford treatment cost. There is a little a physician can do to change this situation, however, there are times in our hospitals when the rich patients contribute to fund a poor patient’s treatment—amazing, isn’t it? This scenario happens whole lots of time.
This is an overtly difficult patient to manage. He or she has a negative attitude toward treatment, possibly because of personal, religious, or socio-cultural beliefs. No matter how well strategized your management line is, this patient tends to be non-compliant to your counsels and medications. For no obvious reason, or reasons far from the physician’s understanding, this patient tends to do exactly what the physician warns against. In this category, you find patient with hardened religious and cultural beliefs, despite all counsels, he or she still finds a way of secretly mixing herbal concoctions with his medications. In this category, you find patient who refuses blood transfusion because of certain belief; you find a diabetic secretly taking Coca-Cola drink at will, even while on admission. This kind of patient may not only be difficult to manage but may eventual frustrate a physician’s effort to achieve good outcome, and at the end, he eventually discharges himself against medical advice. He is later rushed back to the hospital as very critical case, after one or two months.
This patient is the best type of patient a physician can manage. He or she is overtly receptive to treatment. He trusts the managing team and their treatment line. He remains positive, no matter the severity of his condition. His noise or complaint is hardly heard in the ward, he is admitted quietly and discharged quietly, comes back for follow up without much noise.
Did you fall into this category?
Without much drama, this patient should be referred to a psychiatrist. A neurotic patient has certain level of emotional and physical disturbances, hence not mentally all stable. The attending physician, after noticing these signs and symptoms, may not react to this patient’s abnormal or annoying behaviour, however, the physician may just retrieve a referral form and refer the patient to a psychiatrist.
Thanks for reading this. On the next episode and subsequent ones, the doctors, nurses, and patients take on the challenge of sharing their awkward and embarrassing experiences with one and other. Please don’t miss out on this. Don’t also forget to leave in the comment box, the category you once fell into as a patient.