I make a point of communication with my patient. Obviously if he is a child, I use the same measure of effort in communicating with the parents. But few things irritate me more than some or other family member that insists on forcing their way into the fairly personal interaction between patient and the guy that in all likelihood is going to carve him up in the very near future.
I refer to the person who insists on answering my questions directed at the patient as if they know better. I mean if I ask what the pain is like and, before the poor patient can express himself, his well meaning irritating wife or mother begins to describe to me what he is feeling as if she is feeling it too. I often want to tell them to get sick themselves before I give a damn what they feel or think. I’m usually at least slightly more diplomatic.
I was a senior registrar. A private consultant friend of mine asked me if I could look after his patients while he was on leave for two weeks. Apparently he did not trust the other private surgeon working in that hospital. To be frank neither did I (but we’ll keep that story for another post, shall we). We went on a sort of handover round together and I got a feel for what was going on. After rounds he mentioned to me that there was still one more patient coming in from a general practitioner that apparently had a bowel obstruction due to a previous operation as a child. The patient was apparently going to be admitted via x-rays. I could evaluate him and operate if I felt it was indicated. All seemed well. He would be my first ever private patient.
The patient arrived and I was called to evaluate him. I walked into the room and took in the scene before me. The patient, a young man that I estimated must be about 26 years old, was lying in bed and what had to be his father was standing next to him. I greeted them both and introduced myself. I then turned to the patient.
“What seems to be the problem?” I asked, looking at him. The father answered before the patient even had a chance to open his mouth.
“Well doctor, he started with…” I cut him short right there.
“Uhmm, excuse me, but I did not ask you. I asked him.” I said. then turning towards the patient with possibly too much of an ostentatious flick of my head I started again.
“What seems to be the problem?” The moment the patient opened his mouth was the moment I became acutely aware that he was mentally retarded. He very nearly could not string a sentence together and certainly couldn’t express himself in terms above that of about a five year old boy. I felt like a total idiot and could feel my cheeks flush in embarrassment, but what could I do? I just had to soldier on. I mean I could hardly now turn to the father and admit that after careful consideration I did want to hear from him what sort of pain the patient was experiencing, especially seeing that I had just brushed him aside rather unceremoniously.
The entire interview and examination was painful (I think the patient also experienced a bit of pain) but I just kept on slugging through it. I then looked at the x-rays. It was a clear case and I knew I needed to operate. For the consent I fortunately could turn to the father. It was clear the patient didn’t have the mental faculties to sign his own consent, if he even could write at all.
Fortunately the operation and the post operative phase went well and quite soon I discharged the patient into the care of his parents.
Just over a week later I followed the patient up. Luckily everything was in order and I informed him and his father that all was well and they could go in peace. They left the consultation rooms, but then the father turned back to me. I had been expecting something like this from the first moment I had realized the patient was mentally retarded. I was just surprised it had taken so long in coming.
“Doctor, I’d just like to have a word with you in private.” Oh, well, I thought. It’s not as if I don’t deserve some backlash for my unintentional indiscretion at our first meeting. I braced myself for the worst.
“Doctor, at our first meeting, from that first moment when you refused to hear from me what was wrong with my son, but instead insisted on speaking only to him,” I cringed. “Well from that moment I knew we were with the right doctor. Thank you so much for all you have done for him and for the respect you showed him. We as a family will forever remember everything you have done.”
I didn’t see that coming. I decided to just keep quiet about the fact that I hadn’t realized the child was mentally retarded. We all went our separate ways, me with my pride and hide intact and the family chuffed at how I had treated them. I was relieved.
“bongi” is a general surgeon in South Africa who blogs at other things amanzi.
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