What is Keeping Our Patients Away?
His wife eagerly handed the results to the doctor, who scanned them. After a deep breath and tucking them away, he said, “We already know that what you have is a form of lung cancer. But I’m afraid to inform you that your tests show that your disease has reached a very late stage. At this point, we can try an aggressive treatment but due to the extent of damage and late diagnosis, the chances of complete recovery are very low”.
The next 20 minutes passed in a haze as the doctor laid out the treatment plan. Mr. Ali left the doctor’s office, with his head ringing, wondering; what originated as something as insignificant as a fever and cough could progress to something so sinister so soon?
As doctors and medical students, we chance upon several hundred patients who make us question ourselves, “Why did they show up so late?” It could be a patient with a severe symptom for months, or one that has an end-stage disease diagnosed on his first ever visit to us, or one who wished that whatever they have, would resolve on its own. The latter is the most commonly seen scenario – denial, the most common humane response to anything that goes wrong in life.
We are taught in medicine that denial is the foremost response to grief but what we fail to realize is that denial comes way before that. It is when one first feels unwell, has difficulty or pain performing daily life activities but refuses to identify or rather, “accept” it as something worth taking an action about. Those that do take actions, usually in our society, fall prey to the second reason for not showing up on time – “self medication”. The patients usually regard it as a way out of the weekly doctor visits, which equals to the time lost in a long waiting line in a hospital/clinic.
Only a few people in our society take the road down to a hospital clinic for fever, flu and other common symptoms while majority prefer to self-medicate. This alone does not only worsen the underlying disease but also acts as a barrier of seeking medical help on time by the patients. Lack of awareness, financial instability, limited access to vaccination and inadequate laboratory investigation facilities hinders the chances of an earlier diagnosis in our country, especially in the rural areas. We have thousands of people living below the poverty line and when faced with the dilemmas, to necessitate money expenditure, with the few bucks the family earns, is it a matter of doubt that they opt to ignore the extensive medical work up and buy food and shelter for themselves and their loved ones instead?
But, all the mentioned reasons aside, more often than not, we come across patients showing up late. They are literate and cognizant, they are financially stable patients, having no blatant reasons for not seeking medical help, it calls for us to take a step back and assess ourselves and go through a mental check list; could the patient be demotivated by our demeanor on an earlier visit, did we show empathy and expressed our concerns for his well being? Were we too mechanical in our approach? In short, did we get the message of humanity through to him?
When we become doctors, we all aim and oath to help all those in suffering and suffering of mind is of a far greater extent to that of the body. We, as doctors, play a capital role in making our patients feel safe and healthy. We can educate them, help them accept the things that they are going through on a mental and psychological level and scout them about their disease, the mode and duration of the needed treatment and reassure them to brace and cope with their pain, depression and anxiety during the whole process. Patch Adams’ character quotes: “You treat a disease, you win, you lose. You treat a person I’ll guarantee you’ll win.”
We can also join hands with the government to limit the extensive number of over-the-counter drugs available, so we can prevent our society from harming itself through the menace of self-medication. It is a Herculean task which involves struggle on everyone’s part but if we do ours, we can make an immense modification. There is an old monk’s story who attempted to change the world when he was young, then he sought to change the nation, then his town and then his family ultimately. With each step he failed. On his death bed, he said, “I suddenly realized that if long ago, I would have changed myself, I could have made an impact on my family, they could have made an impact on the town, this impact could have changed the nation and finally, I could have indeed, changed the world.”
We, doctors, are the front line warriors for our patients’ health and life and we should do all in our power to win this battle for them. In conclusion, the decision is up to all of us individually. What is it which is keeping our patients away? And what can we do to reach out and win this war of life for them? So patients like Mr. Ali can have a bigger and better chance at life.
About the Author: Rida Jawed is a fourth year medical student at Dow Medical College, Karachi, Pakistan with interest in the field of Emergency Medicine. She can be reached at [email protected]
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