Are we treating the right person??


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?