THE title of the workshop was ‘The Difficult Patient.’ Every doctor, be they a GP or consultant, has examples. But the irritating habits change over time.
Twenty years ago, at a similar workshop, one GP earned a round of applause when he went cuckoo bananas about the girdle. He hated women who turned up in his clinic wearing it.
The girdle was an obstruction to a thorough examination, he opined. Either the GP directed the patient to go behind the curtain and remove the girdle, which took forever (and again at the end of the consultation to put it back on), or the GP could investigate her anatomy below the waist with the garment still in place, in which case his hand was likely to get trapped by the elasticated strength of the girdle, or his hand could be injured, if the girdle had ‘bones’.
All women, he suggested, should go to their GP braless and girdle-free, while wearing some loose outer garment. I thought he meant female patients should arrive naked under their fur coat, that being the time when people wore fur coats without fear of paint attack.
But, no, what he wanted was a loose dress, kimono, or muu muu, which would save enormous amounts of time and trouble.
Last week’s workshop had no problems with the girdle, presumeably because it has gone out of favour as a figure-shaper. Nobody mentioned Spanx, so we assume today’s female patients don’t fight their way into neoprene body armour before visiting their doctor. That may be because they are too busy consulting Dr Google before they arrive.
Today’s doctors hate Dr Google with the same passion their predecessors hated the girdle. They see it as time-absorbing and troublesome.
“They arrive in with printouts,” one GP complained. She said she had yet to find a way to skip reading the printouts and make the patient realise that self-diagnosis based on health websites was inappropriate. One older GP said he never read the printouts or discussed Dr Google’s recommendations, going straight to examination, prognosis, and prescription.
“I had one patient, who told me my diagnosis was wrong and that she wouldn’t take the prescription I had handed her. I took it back and told her no problem, that she should consult Dr Google on any of the complications that would ensue.
“She went out the door in a marked manner, and I went on to deal with the next patient. Then, she knocked on my door and said she’d had second thoughts and could she have the prescription. I told her certainly and that she was very wise.”
The dangers posed by Dr Google were described to me last year by an oncologist who, having diagnosed an aggressive form of breast cancer in a patient, outlined the treatment she would need. OK, the patient said, but she couldn’t start it for a few weeks. It was imperative she started it immediately, she was told by the doctor. Nah, she said, first she wanted to do a blueberry cleanse that Dr Google had recommended.
Between Dr Google and media coverage of unproven, alleged ‘side-effects,’ one has to wonder how many deaths result from confident decision-making by the incompetent.
The HPV vaccine is a fascinating case in point. The side-effects associated with the vaccine by young women and their parents have led to a marked national decline in its use here — a decline that concerns the WHO, which, understandably, is bothered because unvaccinated girls are much more likely to die of cervical cancer.
Some of the doctors present last week, while shrugging ruefully over the impact of Dr Google, and of media coverage, on their patients, didn’t readily come up with examples of the difficult patient mentioned in the title of the session.
What they did come up with, early and often, were accounts of the difficult relative. Relatives are the real problem. Of course, some relatives are towers of strength, models of discretion, and fantastic supporters of their sick sisters, brothers, children, partners or parents.
But many others are not. Midwives, for example, with a few decades of experience under their belts, roll their eyes when couples having their first baby turn up with a birthing plan developed in partnership with a personal trainer or yoga teacher.
One midwife, faced with this scenario, cuts right to the chase, remarking that when she needs advice on her kitchen extension, she goes to an architect, and when she needs financial advice, she goes to a financial advisor, but if the couple wants to be led by someone whose only expertise is putting people in the lotus position, well, good luck with that.
Another kind of relative hated by hospital staff is the chart reader. Good hospitals put on the wall the names of the nurses, nursing sisters, and care assistants for the day, together with some goals for the patient, but all medical staff dread arriving into the patient’s room to find a relative studying the chart, because, for some nit-picky relatives, it serves as a check-list against which to negatively measure staff performance.
Inevitably, the most vivid complaints about difficult relatives involve patients who are hitting what we’ll laughingly call the golden years.
Now, when an aging patient has dementia, nobody knows that patient as well as their daughter or husband or son does.
But every one of the GPs and consultants whose discussion I was facilitating last week mentioned the relatives who make their lives miserable.
Oddly, those relatives don’t tend to be the permanently-present carers of elderly patients. The permanently-present carers are appreciative and understand suggestions that their father’s or mother’s condition could be dealt with by intensive and aggressive medical intervention, but that leaving them alone and keeping them comfortable might actually be the most humane option.
The ones who want everything done for their failing relative, I learned, tend to be those who are less involved in their care, or not involved at all.
The relative who has never had much of a relationship with the patient and who currently doesn’t do much in the practical way of caring for them, is usually the one who ensures that the patient’s suffering is extended by demands to “do everything possible for my mother/father.”
And by far the worst example of this is the relative living overseas. Those present had an acronym for how these relatives behave. They call it AIDS.
No, not acquired immune deficiency syndrome caused by the HIV virus, but absent interfering daughter syndrome.
Today’s doctors hate Dr Google with the same passion their predecessors hated the girdle