I am by no means bragging about being a resident because, really, seriously, it means nothing to anybody. We are still learning and searching and a lot of times, I feel helpless not knowing what to do as I look at the vast inadequacy in myself.
A few days ago, I encountered two annoyed/frustrated patients with two very different endings.
Clinical Scenario 1
Hungry Resident: S , Frustrated and irritable patient: I
Setting: Team clinic
S: So Mr I, your GM is 16.0mmol/L, I need you to optimize your diabetes before I can give you a date for cataract op. There is increased risk of infection (endophthalmitis to be more specific) should I proceed with your cataract op. (Verify BE Vision of 6/15 and was gonna start writing referral letter to his GP)
I: You are wasting my life and time. My sugar has always been <10.0mmol/L and I was waiting for so long. You can’t expect me to be starving and not eat.
S: Well, even if you have eaten, a post prandial GM>11.0mmol/L only signifies poorly controlled diabetes Mr. I. You might have good records at home but numbers don’t lie here so please understand that we have protocols to adhere to and the risks of carrying out an eye op in poorly controlled diabetic patients only outweighs the benefits.
I: You are being racist! You ALL XXXXX (labeling a certain race) are deliberately slowing me and delaying my op. I have been waiting for a cataract op since last year…….and I have to go up and down sending my bloods. You don’t understand my situation coz you CHIxxxx are rich and don’t have to wait in public! (Gaissss you need to see how upset I was and my friends consisting of 1Malaysia just stared at him waiting to breathe fire)
S: I understand your frustration uncle but I don’t think it’s appropriate to call me a racist based on your assumptions. And I can’t accept you calling me that. If you want to lodge a complaint or feedback, please do go to third floor to help us improve on the system.
I: My granddaughters are doctors you know……..
S: Sure sure uncle, but like what I said earlier, it doesn’t change my management as I am impartial to all my patients. Regardless of who your granddaughters are, I treat you the same as my other patients (Funny how he claims that we are racists while expecting special treatments because his family members work in the healthcare profession. Some double standard there, hey?)
Before leaving, Mr. I looked at me and said ok I will control my sugar….looked at my name tag and said “you are Dr. XXX)
To which I replied “ Yes Uncle, you do have quite good vision after all, so control your sugar and don’t let me catch you having a GM>10.0mmol/L the next time I see you.”
I: Don’t worry I won’t complain about you because I understand…..my granddaughters are doctors too.
Honestly, part of me wanted him to lodge a complaint so that people higher up can identify and rectify problems. Complaints or shall I put in nicer, ‘feedback’ is a way to identify problems in a system and subsequently actions can only be taken. We can’t be painting a rosy picture when the rot is overfilling. We need budget $$$$$ to buy equipments for running the clinic and can’t always be sending patients to other hospitals or private centers for images!
Clinical scenario 2
Setting: Eye casualty room
Hangry resident: S, Uncle in pain: I2
S: Mr I2, may I know what brought you here today to our eye casualty room?
I2: (Raised his voice) I am in pain IN PAINNNNNNN (jabbing his finger into his skull) and the GP told me to come here urgently. I have gone to A&E and they discharged me with no imaging. I had been relying on OTC medications to no avail.
S: (taken aback by his aggression) Mr L2, I just need to understand your history right from the beginning……(but honestly I took it real cool as I could tell his frustration from clinic hopping with a persistent headache but no solution given)
After a thorough ocular examination, I explained to him that his pain was not caused by any ocular conditions as I couldn’t elicit any positive findings and proceeded to write him a referral to his GP. He then started thanking me profusely and apologized to me with such great intensity that I found it puzzling. (He apologized for raising his voice at him in the first place) After all, I was not even offended by him so I brushed it off and waved at him and sent him on his merry way.
At the end of the day, these are common scenarios when patients become frustrated with our medical system, which is almost FOC and logically overloaded. While I have my fair share of being sarcastic, I would also like to make a note to remind myself NOT TO LOSE MY COOL when encountering such situations.
- In any situation, try putting yourself in that patients’ shoes. Explore his/her frustration and be civil. Yelling back in retaliation will only escalate the matter. You can never set a bomb off without fire ?sparks. We are BETTER versions of ourselves.
- Offer patients an avenue to lodge a feedback/complaint. This might defuse their anger momentarily and you can take a step back.
- If the situation does escalate (hopefully not into physical one, yet), find a chaperon. Your friends, your medical assistant, your nurses. Any of them can be an immediate help if the patient decides to turn violent against you. Get POLIS BANTUAN if necessary to escort the patient away. Keep yourself safe!
Aftermath, please document the incident and name as many witnesses as you can (No fabrication k!) so that when the complaint letter does reach you, you can address the issue based on facts NOT some vague memory as the incident might have occurred some time ago and you have conveniently forgot about it (while the poor patients continued to hold on for days……..)
Life is indeed not a bed of roses. But these are the ups and downs of life. Be it a doctor in training, or someone not in training hours, I just hope that I am a better person each day and praying that I won’t disappoint Him as I walk in faith with Him.
Doctor on FIRE 