The Stupidity Factor
Once in a while a poster makes a comment that I think deserves a new post in reply. This time it’s Anonymous’ comment on the post on stupid patients.
I’ll deal with the comment in parts.
"This is quite disheartening. One would think that with all the intelligence & hard work that it takes to get accepted into medical school, the admissions comittee would at least choose people with a heart, some common sense, and the tiniest inclination of empathic understanding…"
Like I said before, it is vain to imagine that you can in fifteen minutes tell if a teenager has the makings of a good doctor. Or that he or she has not, for that matter. If someone is intelligent enough to get the grades to qualify for an interview, he or she is probably also smart enough to fake sincerity for fifteeen minutes.
"… whether it be towards one's own culture, or the remotest culture on the face of this globe."
Yes, I too detect a racist undertone in Dr Pezzi’s account*. However, to expect us to have an understanding of "the remotest culture on the face of this globe" is probably asking too much.
(* - Please read Dr Pezzi's comment and my apology for this remark.)
"I, on the other hand, may be part of the intellectually vacuous group of people who hope, forgive how utopian this ideology may seem,"
It may not be an ideology, but your expectation is utopian. Not so much in that you expect all doctors to be compassionate, but that you expect heart, some common sense, and empathic understanding to allow us to do our job well in the face of a patient who cannot provide answers to straightforward questions. Empathic understanding only gets you so far. With some patients what is needed is telepathic understanding.
" … that physicians are capable of creating change in the world around them without disregarding all those around & below them."
I don’t think Dr Pezzi is hoping to change the world by disregarding those around him. Note also that while Dr Pezzi was angry, he did not (as far as the account went) let that affect how he managed the patient.
Politically-incorrect as it is, I think I agree with him that 'stupid patients' do exist, and they are a risk to themselves and a drain on the healthcare system because they tend to need more healthcare (because of stupid decisions they make, be it lifestyle choices or non-compliance to treatment and medical advice) and take up more time of the healthcare providers.
It doesn’t sound like your problem until the day you are waiting to be seen at the A&E and the guy before you is someone who is suffering from the result of non-compliance to a medication and it’s taking the doctor fifteen minutes just to find out what illness he is taking them for.
So my first question is: do we have the moral courage to admit that some patients are stupid and that they consume more healthcare, at the expense of the others?
If we do, the next question is: what are we prepared to do about it?
Well, my theory is that there are two main classes of stupid patients: those who can’t help it, and those who can. Let’s call them Type I and Type II.
Type I patients can’t help being stupid, but most of the time they are allowed to go through the healthcare system repeatedly with no remedial action taken because no one bothers about them. They can’t really be held responsible for their own choices and actions, so someone must.
Who? The family, I say.
Because so long as we allow them to carrying on getting their prescription and going through the follow-up visit without any way to check if they are compliant with the advice or medication, so long will the family continue to allow themselves to think they are not being negligent.
I think it’s negligent to let an elderly parent who is not in the best state of mind to take care of himself or herself to see a doctor on his or her own. (Experience tells me that these children who neglect their parents are the same ones who will kick up a fuss when something goes wrong, in an effort to compensate for their own guilt of neglecting their parents.) But those who live alone and without support? I guess that’s when we have to do the best we can and hope for the best…
And in some cases, I believe the doctor himself becomes negligent.
I once saw an old man who kept coming to the clinic every two months to get three months’ worth of medicine. When asked, he claimed that he was taking the correct dose. I could have just turned a blind eye and let him take another three months’ worth of medicine and possibly overdose himself (I'd be in another posting by then), but instead I told him I would not prescribe him any more medication unless he came with a responsible relative. The son came later loaded for bear but after I explained my reasons he agreed to collect the patient’s medication and parcel it in weekly doses to him and check on him to make sure he is not taking an overdose.
I think we as a profession must acknowledge that some patients are a danger to themselves and should be supervised, and that we should have a right to refuse to continue seeing them unsupervised if their care is compromised. Controversial, I know, but we don’t let children sign consent forms for surgery either.
As for Type II patients, they are the ones I typically deal with in my stories. They are not really stupid, but choose to persist in immature thought patterns because they get away with it. Because doctors do not challenge them when they persist in unhealthy lifestyle choices, or remain non-compliant to treatment or advice.
Different doctors deal with them differently, and of course each patient calls for a different approach. I don’t think there is a universal solution here, but admitting that they are a problem and that we should not reinforce their immature thinking would be a start.
I know in the private sector standing your ground may mean a loss in business. That is unfair to the doctors who try to 'change the world', but that reality may soon change when the Health Ministry starts auditing all practitioners.
As for Anonymous, my last words are for you:
From my point of view, there are a few things you can do to help improve the situation:
1. Continue to demand that doctors should be people of heart and common sense. Yes, it is your right.
2. Take responsibility for any stupid patient in your family, if there is one. Go with him or her to the doctor to make sure he or she gets the best care.
3. Go to medical school and make a difference.