unhelpable patients

There are serious downsides to being seen as gods.

As Uncle Ben said, with great power comes great responsibility, and from the patient histories I have taken, these responsibilities are often not taken seriously. Many patients in the general ward have complained that their rural doctors are not up to the mark; one was a very similar case to one I described previously in the out patient department, where a patient with a chronic lung condition was prescribed an oral drug when an inhaler was more effective. Just as insidious as incompetence, however, is laziness and corruption. Patients and doctors alike have complained that there is a chronic poor work ethic in public hospitals. An example I was given was that ultrasound machines would just lie unused for months because a small bulb had stopped working and no one had bothered to order a new one because the red tape was too cumbersome. These impressions have come from second hand sources and are probably biased so I shouldn’t be too quick to judge.

The other responsibility that I experienced first hand was the greater extent that patients involve you in their lives. Patients are much more likely to reveal social and economic problems if they respect you. As I took histories yesterday in an urban slum I would begin asking about their chest pain or their tiredness but as soon as I would ask about their home life, or other things that were causing them tension they would immediately give me the grand tour of their lives. I had women telling me about their money problems, asking me what they will do if they cannot afford treatment, a man told me about their daughter’s children and how they were willing to forgo healthcare in order to pay school fees.

A case that really affected me though, was an old woman who came in with her neighbor into my preceptor’s surgery. This woman lives about 100 kilometers away which means that it costs around 200 rupees for the two way journey. The woman complained of chest pain, had a high blood pressure and uncontrolled type 2 diabetes. She was about 60 and lived on a farm with her only son and his family. She had two daughters, but as is the custom here the daughters live with their husbands families and have very little to do with their biological parents after marriage.

She began to tell the doctor about her tiredness when she broke down crying. She told us that her son now owned the family farm and had told her that since she was no longer capable of working, she was no longer any use to him. Rather that saving any money for oneself it is the custom here that ones children will look after you in your twilight years. If they do not, well, nothing….

It was so painful for me to see this woman so utterly broken. A broken body, a broken spirit, she was worthless to her son and because of that she believed she was worthless herself. It is a fear for all of us, sometimes conscious sometimes not, that at the end of our lives we will look back and be disappointed. We are by far our own harshest critics, and self disappointment hurts more than any other. I felt great sympathy for this woman who I knew was looking back on a life that she felt was wasted; that added nothing. My preceptor and I discussed her case over tea the next day and even if she doesn’t know it, I can be sure that that woman added something new to my perspective…..

So what can we do for her? Unfortunately not much, we can reduce the prices of her medicine, we can give her a larger stock of medicines that will last longer so that she doesn’t have to make the journey into town as often. But as for her psyche, we can empathize, tell her that we will take care of her health, and show her some of the compassion that her jackass son robbed her of; but we do not have the time or the ability to do family therapy or otherwise improve her social situation. More urgent matters occupy our time, our time is already stretched to the limit and well that’s it……. I’m out of time….