Tuesday, May 5, 2009

Verbal spankings

Mostly - I love my patients. I really love them. People are so interesting and have such varied characters. I am also privileged to be able to learn intimate things about patients in a space where I try to make it easy to express themselves.

But sometimes , when in the clinic, one is forced to consult with that one hardcore poisoned apple of a patient. That patient manages to infect one's entire day with irritation and frustration, despite the fact that when you woke up that morning you promised yourself you would spread love and joy and compassion to everyone you met.

Of course, one tries hard not to let it show, but that patient - oh that cunning patient knows just how to get under your skin. There are a number of ways they do this - they can be rude, they can be sexist, they can be racist, they can be stubborn. Whatever it is they just know how to push one's buttons in a way that makes you want to start busting out some martial arts moves.
Of course, we can't inflict karate wounds on them. Even if we do know how to patch them up afterwards.

No see, WE have to be professional. WE have to suspend our human qualities and emotions. WE have to be the solid rock that despite being abused in all sorts of ways by our trade, is never ever allowed to be flustered. Doctors=saints=superheros.

Let me tell you about my button-pushing patient. Let's call him, Mr FU. Mr FU was patient three of the day. So there was no reason for me to be irritated. I was fresh from a good night's sleep. I woke up in time for a healthy breakfast. I even managed to watch a bit of morning news before heading off to work.

That day I endeavoured to be a healer. I would be a holistic wonderful western/eastern healer and heal physical and spiritual problems. I would do this by really listening to the patient and by being non-judgemental. I would be awesome.

However, in walked number 3, Mr FU. MR FU was about 66 years old. Average height, previously owned a farm in the Boland, was stinking of cigarette smoke and started sighing before I'd even greeted him.

"Oh shame", I thought, "this man seems troubled- perhaps I can get him to open up with my soothing voice and gentle nature."

Wrong babe. Wrong . Fail. try again.

I open up his file - a known hypertensive and diabetic. A smoker. ( that was obvious). Has already had two heart attacks and a triple bypass operation which probably cost thousands, but which he paid nothing for as he is now an unemployed pensioner. After being discharged post-surgery he had a team of specialists come up with a comprehensivve treatement plan. He has defaulted on this treatment for the past three years.

Oh-oh..I started to hear the clang of distant warning bells...

I began in my standard way.

Me:"Goodmorning, how can I help you?"

MR FU:"Agh Jesus man, just do what you is supposed to and write out my tablets? None of you doctors is even helping me. So don't blerrie ask me any questions. I'm sick of questions."

Right. Ok. This one was going to be a toughie. Not only because I wanted to correct his English but also because he was proving to be difficult from the get-go. But, No problem, I thought, I can handle this.

Me: Sir, I sense you've been very frustrated by our health service thus far, is there anything I can do differently to help you? Perhaps explain something to you that you didn't understand or maybe try to treat a symptom that is bothering you?

Mr FU: I has burning feet. You probably has no idea how to fix it so I don't know why I is even telling you this.

Me: Actually, I know exactly why your feet are burning and I AM going to try to fix it.

Mr FU stared at me for a few seconds, suddenly a little interested in what I had to say.

Do you want to know why?

Mr FU: Ja fine. explain to me why my feet is burning.

: You have Diabetes. The sugar level in your blood is very high. It's affecting the nerves at the end of your body.I see you haven't taken your medication, and this is not helping you to keep the sugar level from affecting your nerves, you see....

Mr FU suddenly interrupts me:
Um... doctor?

Me: Yes, am I going too fast for you?

Mr FU:
Kry net klaar, my klimeid, en gee my my medikasie.

That was in Afrikaans. It's pretty damn rude in Afrikaans. In English it's the equivalent of saying, "Just hurry the hell up, and give me my medication, you little girl."

Except that the word he used for little girl, "klimeid" was a word used by the Afrikaners when referring to their Coloured housemaids or farm workers. It's pretty derogatory.

That's when I decided I'd had enough. Peace, calm and spirituality went hiding under the table.

Me(enraged, and with blood spurting from my eyeballs):

MR FU! YOU were the one who just asked me to explain this to you and now you're telling me to shut up!? Furthermore, you will not EVER speak to ANYONE in this hospital that way or we will refuse to see you. Jy is ombeskof! ( you are rude) WHAT exactly are you doing here? You've already had a triple bypass operation, that saved your life, but it doesn't seem like that made an impact at all.I do not have to treat abusive patients. So I'm giving you two choices now. You either leave my office immediately and go home to have another heart attack in your own bed, or you take off your shoes and get on my examination bed immediately so I can try to help you.

I expected, and unfortunately actually wanted, him to get up and walk out.

Amazingly - he obeyed my instructions and got on the examination bed. He was dead quiet for the rest of the examination and history taking. He was all, "Yes, Doctor. no Doctor, thank you , Doctor".

As I suspected, he had peripheral neuropathy and I managed to talk to him about how it was caused by his lack of glucose control. I also asked him if he wanted me to prescribe something for the burning sensation - which he did.
I asked him to come aback for a check-up in a months time - to which he agreed.

The clincher was that at the end of the consultation - he apologised to me and thanked me for sorting his problem out so thoroughly. He claimed I was the only doctor who took the time to help him. I'm not sure if he was being sarcastic or not. I have pretty good sarcasm radar - and mine wasn't going off.

Was I wrong in telling this man off? I think that in this case, no. The answer is no because the outcome was good. He actually came back and at that consultation his glucose level was lower and the burning sensation in his feet was less troublesome.

So what am I saying? I'm not saying we need to lay into all the non-compliant patients. And before you accuse me of wanting to bring back corporal punishment in schools and the death sentence, all I'm saying is that maybe, just maybe - people need a little verbal spanking from time to time to help them realise the seriousness of their behaviour.

We really have to try every angle to get through to our patients...a little whipping with words unfortunately DOES sometimes do the trick...


Ketan said...


From my experience in India, many patients tend to see doctor's courteous behavior and gentleness in manners as covers for incompetence.

I suspect, same was the case with your patient. Or maybe he felt comfortable only when you got down (momentarily) to his level ;)


Geraldine said...

Good for you, girlie :)

Lauren said...

Brilliant! Loved that. Hope your tirade was every bit as vexed in reality.


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