Patient encounters: The scared sufferer-manipulator.

It happens routinely in 100% literate God’s own country. Maybe, even more so.

***

A healthy-looking lady walked in to the clinic.

“Doctor, I’m feeling much better”

(She was in a near-crippling state 1-2 months ago).

“I want to stop medicines now”.
(She had been explained about VERY severe hypothyroidism when it was diagnosed; that her severe sleepiness, constipation, weight gain, puffy look, high BP and cholesterol are all probably because of that, the need for long term but simple and low-cost treatment, careful follow-ups, good chances of improvement, safety v/s minor risks of the medicines earlier. Cost of the medicine was NOT AT ALL an issue).

***

I am usually very liberal with patients- very much to a fault at times. Both with listening, time, and explanations. Hypothyroid people are frequently sleepy and less alert, and forgetful, and may not remember everything discussed during initial visits. So maybe that made her forget our previous discussion, and re-think now?

Dr: “Do you remember the last conversation. We’d discussed it in detail”

Well-educated Pt: “Yes. You’d told me that I’d need to take medicines for a long time.”

So our lady remembered it pretty well.

Dr: You could hardly walk last month. You say that you feel much better. Do you really want to stop the medicine?

Pt (proudly): In fact I already stopped it last week. I’m going back to *****pathy. I just wanted you to see the lab result before that.

Dr’s thought bubble: “See” the lab result, and then what? You go back to *****pathy, a well-proven hoax which kept you in distress for all those months, promising “cure without side effects” … “if you waited patiently long enough”?

And mind it- they cost her multiple times the cost of her current, simple thyroid hormone replacement therapy.

Her lab report suggested excellent improvement- which meant that she was well on track.

Dr’s words: What do you want me to do for you now?

Pt: Tell me to stop the medicine.

Dr: Why?

Pt’s summarized narrative: Gives the usual story- heard of side effects, no guarantee of cure, “knowledgeable” neighbours, friends, and media articles pushed by quacks.

Last week another learned patient told me: “We keep hearing that all you doctors are working for pharmas and for hospital targets and don’t really want people to get totally cured, because only then you can keep writing medicines for our lifetimes.”

I had thanked him for his frankness in divulging that.
Being frank with most patients is something I love to do 🙂

***
(Back to this Pt)…

The Dr listened patiently and discussed. Urged re-consideration.
No luck.

Dr (puts it bluntly in the end): Sorry, I understand that you wish to stop the medicine, but I cannot advise you to do that, since it’s very likely that you’ll slip back into the previous state.

Pt (suspiciously- and was there a threatening tone in it?): Dr, I’ll go for a second opinion.

Dr (Politely): Please, go ahead.

Pt (the bluff is called; now on second thoughts): OK, then I’ll take your medicine for 2-3 more months.

Dr: All all these discussions, if you conclude so, proceed as you wish. You are free to decide the mode and course of your treatment. I just hope you stay healthy and safe.

A short discussion follows, about testing after 3 months.

Pt nods head, says OK, gets up and leaves.
Not a word of thanks- that’s a rarity anyway. Its business. Give money, get the service. Where the scope for a “thanks” there? 🙂

Dr: Thanks for coming for an opinion today.

No word. Walks out. Almost slams the door, but the next patient has been eagerly waiting outside, and he stops the door from closing with a bang. He walks in smiling, happy with his results, and goes on to unknowingly make this doctor’s day back to a GREAT one!

***

Similar encounters routinely happen in day to day practice with most doctors. Its nothing special. But they seem to mock the concept that “educating patients” and “literacy” will pretty much ensure that commonsense and trust will arise by default.

OK, lets keep away from extremes of judgement. In any case, we’re used to it and live with it 🙂

Feel sad for such needless sufferers, though.
The “sufferer- manipulators”, a not-much-mentioned breed.

***
But sometimes, one is left speechless. 100% literacy. At times, it is worth a re-think before tom-toming literacy alone as a panacea for all social ills and unhealthy attitudes.

Jai Ho 🙂 !

Advertisements

About drbijayraj

Physician l Learner l Learning facilitator l Satirist
This entry was posted in Family Medicine, General, Medical Policies and tagged , , , . Bookmark the permalink.

One Response to Patient encounters: The scared sufferer-manipulator.

  1. Venkatesan says:

    I have nurses telling me that “only prescribe for my back pain. For diabetes, I am taking treatment from ——– pathy. ” The worst part of the story is that the same nurse recommends the same ______pathy doctor to patients admitted in ward. Finally both patient and nurse ending up with A1 C of 11.

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s