Are we treating the right person??

20160401_164356

Doctor Diaries….

Each department of medicine has its own challenges. If it is long tedious hours in emergency medicine, the unexpectedness in surgery or obstetrics, or the sense of futility which sometimes goes with oncology, I feel that in general, doctors have these “times” where you really start to wonder whether you are doing the right thing!

There are many such unique challenges which belong to the realm of psychiatry, when as a consultant, you feel as if you are bound by some invisible shackles which prevent you from doing the best for your patient.

Mental illhealth has always been considered with suspicion, even by some of the most intelligent brains in the world, mainly because of its slippery definitions. Also because of the fact that there are no diagnostic tests which can surely classify a patient as mentally ill. Other than the obviously aggressive or flagrantly abnormal patient, most times,  we need to tease out the the history from many of their kith and kin to arrive at a diagnosis by circumstantial evidence aka Sherlock Holmes!

And when we do so, many a times, we end up realizing that we may be, cut that, we ARE trying to treat the wrong person!

Let me elucidate…

Take the case of a woman who has been referred because of a near lethal attempt at deliberate self harm( which is just a fancy name for attempted suicide). The woman, on enquiry, confesses that she is tired of her life, and one of the main cause is the unnecessary amount of suspicion which the husband has developed, in part because of his alcohol habit. He does not allow her to talk with her friends, has made her give up the job she loved and beats her up when intoxicated. Her maternal family, expectedly tells her that she has to “adjust”. So here she is.

Take another example of a child who is sullen, angry and puts zero efforts into his study. The father who is a teacher explains that his son is so ‘dumb’ that he needs to be spanked everyday before he sits down to do his homework. He also explains that he gets so frustrated with his son that, on occasion, he has branded him with a hot iron for his follies. The son was diagnosed to be having learning disability.

In another case, the son who has been a patient of childhood schizophrenia gently chides his mother, who has accompanied him, not to interrupt me multiple times before I complete even one sentence of what I say. “Calm down, Ma” he says and looks at me resignedly. He has probably experienced this phenomena all his childhood, and I can pity him, for I am already exhausted by her!

Such situations are tricky.

If I go on the offensive and tell the relative that he or she is the one who actually needs help, they may dissappear with the patient and never turn up again! Such are the follies of a stubborn ego. Intent on proving the other person wrong and unconsiously expecting some praise for an apparent  sacrifice which has largely gone unappreciated.In the process, I lose out on helping a person who genuinely needs the help which I am qualified to give. Granted it may not completely cure him, but atleast I can lend a much needed listening ear and psychological balm.

On the contrary,when  I  go with the version given by the relative, and reach for my prescription pad, immediately, I see a look of betrayal in my patient’s eye. “Et tu, doc” it seems to say, “I knew no one would understand”. I feel so uncomfortable when I see this look. As though I have let him down badly.

So what we do is, to talk to both of them separately; tell both of them that we understand their point of view, and other’s mistake; and promise to help as much as we can! Sounds devious?? It does,but it also is the most honest answer, according to me.

It works quite a few times, mainly because, as  people, we have real fragile egos. If someone tells us outright,that we are wrong, we suddenly become extra defensive .It takes gentle prodding and many sessions of talking for them to grudgingly accept the fact that they may have played a part in making their dear one sick! Then, we have struck gold! They are amneable to suggestion, and if necessary, medication.And slowly we begin to see a steady improvement in the patient’s condition.

But, ever so often, this does not happen. Despite subtle suggestions, followed by obvious ones, some refuse to change. And sometimes become worse, for they miscontrue that the patient has complained about them. And the patient’s eyes steadily lose their lustre.

I know that we are human, and we can only win some and etc. etc., but each time I write out a presciption for a patient who is so, because of someone else, I still cringe a little at the unfairness of it all.

Why are we treating the wrong person???

Have any of you encountered such situations?

20160405_103108

Advertisements

8 thoughts on “Are we treating the right person??

  1. Asha Srikanth June 25, 2016 / 10:13 am

    Hi Preethi,
    As a Rheumatologist we are supposedly the ‘experts’ in treating Fibromyalgia. While this is still a poorly understood condition, and many believe it isn’t a disease but a ‘state of health’, I believe there are many that genuinely suffer from this condition (and the other similar Chronic Fatigue Syndrome) but I often find myself at my wits end trying to explain this to patients and relatives.
    We don’t have the resources to follow up these troubled patients, so we diagnose, refer elsewhere and discharge. I try to be optimistic in my consultation, sounding upbeat about the positive effects of graded aerobic exercise and food sleep. But the general feeling is one of dissatisfaction- both for the patient and me.
    So I’m never sure if we are best placed at ‘treating’ this group. The hope for an elusive cure that the patient comes in with does not exist. And as a physician we are hopeless at treating conditions of the mind that have physical symptoms…
    So I totally relate to your blog post!

    Like

    • preethishanbhag June 27, 2016 / 12:07 pm

      Hi Asha,
      I was just reading a book called DO NO HARM by a neurosurgeon called Henry Marsh. He has explained such situations in detail. Guess all doctors have these moments and slowly learn to live with it! Thank you for reading and responding to my post!

      Like

  2. Parul Thakur June 26, 2016 / 8:53 am

    Gosh! It must be so hard for a caring doctor as you are. What if your treatment terms and conditions state that you will spend time with the family to understand the case but you would like to spend private time with the patient and no exceptions allowed?
    Maybe you already do that but I am just thinking if this may work.

    Like

    • preethishanbhag June 27, 2016 / 12:11 pm

      Hi Parul,
      You are right, we often do this. Unfortunately, most times the relatives are financially responsible for bringing the patient, hence, we have to keep the relative at least calm to some extent and empathize with them. It is like balancing the scales without tipping it over on both sides!

      Like

  3. Lani June 28, 2016 / 7:29 am

    Wow. That’s fairly intense stuff. Did medical school prepare you for this? Or was this an unpleasant discovery of the job?

    I think it does sound like we are treating the wrong person, but if the patient is fortunate enough to learn how to handle such challenging and heart-wrenching circumstances then that can be a kind of treatment in itself. Also understanding their circumstances and that it is not necessarily them, but their environment, the other person, etc, can be valuable in helping them gain a clearer perspective on who they are and the role that they are in, at this time.

    Thanks for sharing your world, your profession and asking I think a question that can be applied to many other disciplines, even politics.

    Liked by 1 person

    • preethishanbhag June 28, 2016 / 12:34 pm

      Hi Lani,
      No medical school gave us no clue regarding this. Sometimes if a patient is older, then it is easy to gain perspective, but in case of children, it is heartbreaking to see them suffer unnecessarily. Thanks for stopping by and responding!

      Liked by 1 person

  4. Zephyr July 2, 2016 / 3:56 am

    I was thinking, ‘Thank God, at least one branch of medicine is not completely depending upon diagnostic tools as I read. Only yesterday I had shared an old post on family doctors and how sorely they are missed in a medical world dominated by diagnostic tools. I was going to ping you to read it 🙂

    But I can understand how hard it must be for those who treat the mind to be doing it just out of their experience, empathy and medical knowledge without a technical endorsement. But I am sure that you are doing the right and best thing for your patients. anyone who has such compassion and honesty enough to admit that they have fragile egos, can’t make a mistake. Carry on Doctor!

    Liked by 2 people

    • preethishanbhag July 2, 2016 / 9:00 am

      I did read the post M’am. Thank you for the vote of confidence.Sometimes even psychiatrists need counselling and support!

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s