In my history as a Healthcare Practitioner, I have interacted with hundreds of patients who have seemed initially difficult to manage clinically only to peep further and factor in the existing confounding factors affecting treatment and circumnavigating the management issues successfully.
Lady in Red
I once had a patient who would come to the clinic every two or so weeks with the same complaint and would demand admission for specialised care. In a period of one year, the patient had been seen by over 5 specialists (a psychiatrist included) and now sought super-specialty recommendations. They had a diagnosis but it somehow was still not enough.
I gathered this from her data on the Health Management System on the desktop before me.
She seemed young and ambitious. She glossed over her presenting complaints with an assurance that I had already heard of her before. She dropped names of resident doctors easily and made casual statements about her multiple experiences in the psychiatry ward. She seemed alright until she started weeping when I asked her about her Social History.
Her tears came from a deep place of pain and confusion. She was the breadwinner in her home but had become estranged from her mother on account of her romantic interest. She eloped with him and occasionally supported her family. However, her partner had begun physically and emotionally abusing her. He had access to firearms on account of his line of work and so he would occasionally threaten to kill her and then himself if she would ever leave. He would rise on her with violence after his regular visits to the bar and would strip her of her money in order to finance his indiscretions.
She got signed in as a beneficiary in her partner's insurance scheme so she could manage to visit the hospital regularly.
The hospital soon became her refuge when she had had too much.
That night, the hospital was her home because she had been kicked out of their shared living space.
She had been diagnosed with Major Depressive Disorder and was inconsistent with her regimen, most probably because of the scuffles in her personal life. Her symptoms were worsening and no one seemed to know why- until we met.
Social Factors- et al
When it comes to administering care, the clinician should always look at the patient standing before them as a whole person with a mind as well as a body.
Oftentimes, illnesses mask a bed of worri
some social (and other) situations and while the clinician may not be able to resolve them, it would go a long way in addressing the presenting illnesses holistically.
It also matters to simply care for the human you are managing. I have found that many times some patients simply want to know that someone cares for them and once they see this, their illnesses somehow seem more manageable and less menacing.
Take Time
It is imperative to take time with each patient in order to fully address their needs. With the rise In performance-based assessments of clinicians and capitalism, a lot of softness has been eroded from care. Many clinicians gloss through the confounders of health (living conditions, financial status, geographical, cultural and social influences) and sign off patients as seen. What they do not know is that they have addressed just one part of the many that need consideration.
For instance, your patient may not be taking ARVs (Anti-retroviral medications) because they face stigma when they do. You may keep wondering why their Viral Load is constantly off the roof and perhaps this is why. You may note an improvement in adherence after talking to their families or simply enrolling the patient into a HIV/AIDS support group.
It may seem like a herculean task to try, but it is our work to make sure that each patient gets the best quality of care.
May we remain vigilant and considerate in our quest for better care.
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