Tuesday, June 14, 2011

The 'Relative' Paradox

Its been over a month since my last post, but that’s mainly because I was having my ass handed to me in my I.Med posting. Now that things are somewhat back to normal, I’m going back to the short notes I took during these past few weeks for “blog-worthy” inspiration. Here’s my first attempt:

We’re often told by successful physicians that establishing a healthy doctor-patient relationship is half the battle won. No disrespect to those much more learned than I, but the trick is to win over the relatives. I know the ‘care’ in ‘healthcare’ centres around patients, but they’re usually irritable, loud, depressed, incontinent, have a dull sense of humour, unconscious, uncooperative & did I mention incontinent? Patients do not like doctors, irrespective of the broad grins they flash during rounds. As soon as we face the next patient, there’s the usual “She didn’t even touch me today”, or “Stupid fellow keeps examining me”, “That’s it? Who’s going to ask me about my symptoms again?” & my personal favourite, “That was your senior doctor? Even the intern seemed better than her!”. 

Patients do not care about what we have to say, they’re rarely bothered. It’s the relatives that do all the questioning, get complicated tests done, get consent & manage to keep the patient from absconding from the wards. I’ve seen people smuggling tobacco, bidis, & even alcohol into the wards for their relatives. Not surprisingly, these are the fellows with liver failure, kidney disease & lung cancers. This is only to repeat that patients are often just plain stupid & want magic drugs that cure them, without changing anything else in their life.

So, the most complicated thing a physician does every day is talk to the relatives. If only our patients weren't  so serious, everyone would see the awesome comedy that plays out (Wait, was that a pun?). Even when conveying that things are out of your hand, you must look like you’re in complete control. You must use complicated terminology when speaking in vernacular languages to convey that what you’re saying is so sophisticated, there’s no other way of explaining it. Conversely, for those cases that refuse to budge from their vices, you need to create a prognosis so grim that they crap themselves before you can utter “adult diaper”. Case in point - a man with severe alcoholic liver damage being discharged after he's relatively stable:
Patient: Sir, thank you for all the help, I am feeling great. I hope I will stay this way
Doctor: Stay this way? Feeling great? Do you know how much damage your alcohol has caused? How much difficulty we had in treating you?
Patient: What's wrong then?
Doctor: Everything! Your liver's fried, there's nothing I can do apart from giving you my own liver, which I won't. Your liver's going to rot slowly if you don't drink & you'll die quicker if you do.

Now, the resident did what was right, but without proper counselling who's to say that the patient won't drink away his stress *again*

I’ve found that you can broadly classify doctor-relative interactions into two distinct groups:
  1. The secretive doctor & over-enthusiastic relative: This is the most common sight in our hospitals. Residents are overly guarded about not just the diagnosis, but also patient prognosis, the cost of tests that need to be done & sometimes even about who’s actually treating the patient. Everyone wants to be top-dog. They’re usually all bark and no bite! 
  2. The over-informative doctor & dumbfounded relative:These guys will spend hours explaining rare procedures, disease etiopathogenesis, drug dynamics, prognostic indicators to the relatives, often unsuccessfully. At the end of this awesome conversation the relative innocently asks, “But what are we supposed to do now?” We quietly hand them a form & set of instructions for tests (after slapping our foreheads). These physicians usually have a successful private practice with a long waiting list for appointments or have studied abroad for variable periods of time. While they’re spending precious minutes away, the residents are usually grinding their teeth or trying to telekinetically blow their senior’s head up! Example below (just imagine they're doctors, not physicists):

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