Today, I met an annoyingly rude patient. She was in bed and refusing to answer any of my registrar's questions till she 'got a wee'. She was complaining on and on about the nurses not being attentive to her needs. I had this feeling that they were ignoring her because she had lots of 'needs' and pestered them consistently. So our team saw another patient before coming back to her. This time, she was seated comfortably in the chair beside the bed demanding to be put back in bed. We couldn't do that because the nurses wanted to change the sheets. And so she refused to answer any of our questions yet again, till she got 'tucked back into bed'. When my registrar tried to explain to her that she was the doctor overseeing her care and that the answers were important, she barked that she DIDN'T CARE. She proceeded to ignore (or choose to reply after one whole minute) each and every one of the registrar's questions, even though she could clearly hear them and clearly knew that she was wasting our precious time. Daryl jokingly nudged me and said that soon I'd be like that grumpy old lady. I certainly hope not! But this has probably been the hardest patient I've seen so far. I realised that most patients are quite cooperative once they see that you're trying your best to help them (or possibly because they know that you hold the key to their health ;p), and I really actually thank them for that. It's harder for a doctor to do their job if provided with incomplete or truncated histories, and some patients hinder us by simply not thinking hard enough about what had happened to them. So now I'm definitely thinking that a patient's recovery stems from the combined effort of the doctor and patient, and certain patients should blame doctors less for their poor prognosis (reads especially the smoker with COPD). Some paradigm shift required for all the patients out there :)
Speaking of smokers and COPD, that reminds me. It's stupid when you see what some people are doing to their life. Another patient, an Aboriginal, came in with gross ascites (fluid in the stomach, estimated to be about 7L) and oedema (fluid in tissues in the body) up to mid-thigh, but hear his complaint: 'I noticed that my penis was swelling.' What?!! He didn't notice his grossly overdistended stomach, that made him unable to bend down and put on his shoes...but he noticed that! He told us he went around barefooted. 'Just as well, my feet were swollen and my shoes couldn't fit anymore anyway.' His symptoms were due to a history of chronic liver disease, and a friend of mine told me that these people drink Listerine instead of alcohol, because government grants for these poor people do not include alcoholic drinks. Sure enough, he'd even brought a humongous bottle of Listerine to the hospital. It was sticking out of his bag and I was wondering if the attending doctors would notice it and make a connection. However, I guess nobody would jump to conclusions and accuse him without the necessity to do so, and as much as I did not want to stereotype, I felt like evidence was slapping me in the face.
The above anecdote was meant to be humourous but I guess I cannot help but conclude that such circumstances do make the vocation harder. To act in the patient's best interest without stereotyping, to convey the message to the patient without losing his or her respect (nobody likes to hear displeasing stuff, right?), to even continue to want to help them when they don't want to help themselves. Takes alot of soul, and I think I'm far from that. More pruning, anyone?