The Un-Cooperative Patient

Medical students are allotted patients during their ward postings and practical exams. The medical students are supposed to take detailed medical ‘history’ of the patient’s illness and do a detailed examination of the patient. They are assessed on the basis of this history taking and examination skills and viva based on their findings in history and examination.

Sometimes the patients are very cooperative with the students, but often they find the learning process of the medical students as intrusion in their privacy and unnecessary for their treatment. 

This problem becomes further compounded if the patient is staying in the ward for quite some time and has been seen by other medical students.

These patients become uncooperative and refuse to talk with the medical students or give any detail of their illness. They refuse to let the students examine them superficially let alone in detail.

One such patient who was examined by batch of student two days ago was allotted to a student from a new batch for history taking and examination. The patient was uncooperative and refused to even talk with the student or let herself to be examined.

The student reported her problem to Dr. Jolting. (Dr. Jolting is so called by his friends for the weird and shocking statement he makes).

Student:      Sir, the patient is very uncooperative. I am not even able to get a proper history from her.

Dr. Jolting:  I feel very sorry for you.

Student:      Because, I may fail in exam as I was not able to take a proper history?

Dr. Jolting: No. I feel sad about your future. If today you are not able to get out the history from a patient’s mouth, tomorrow, when you will become a doctor, how will you get out your fees (professional charges) from the patient’s pocket?

Jokes apart this is a serious problem for the medical students and a nightmare if this occurs in exam. 

When faced with an un-cooperative patient if efforts to convince him/her to cooperate in the learning process by appealing to their higher nature fail, the student should first try to find out the cause for this non-cooperation. 

Has the patient has been kept in exam before today? Is the patient in actual physical pain or discomfort therefore cannot cooperate? Does the patient consider himself VIP for any reason, such as connection to some consultant or staff member, or he himself is some high ranking officer or politician. 

Faced with such patient, the student should immediately contact the senior resident or the consultant allotting the cases and bring this problem to his attention. 

While telling about the non-cooperation of the patient, they should tell the probable cause for this non-cooperative behaviour, otherwise the consultant may blame the student that it is his fault that the patient is not being cooperative. He may hold the student responsible that he does not know how to talk with patient, win their confidence and form a rapport with the patient.

Dr. Jolting recounted a case told to him by one of his fellow surgeon, of such a non-cooperative patient and how the doctor dealt with him. 

For the sake of medical ethics and doctor-patient relationship such behavior cannot be recommended. Therefore read only for fun and knowledge and not for practice.

In the state of Rajasthan in India, the entrance to post-graduate (PG) courses after MBBS is through an entrance exam. To attract more doctors to government medical services, there are some seat reserved in this entrance exam only for those MBBS qualified doctors who have at least worked for three years in the government medical service. Also the upper age-limit is also raised for those doctors.

One such doctor, Dr. X (fictional name) after more than a decade of government employment and multiple attempts in the entrance exam, got selected for PG course in  MD Medicine, while in his forties. 

For his final MD exam, he was allotted a case of chest infection. When he approached the patient flatly refused to give any history or allow himself to be examined by him. On inquiry it was found that he was allotted to many students in the final MBBS exam just few days ago and was irritated by the process.

Dr. X attempt to appeal to the patient higher ethics met with flat refusal and hostility. 

Not knowing what to do he asked the patient where he was from. The patient replied he is from Bundi. Dr. X warmed up as he had lived and worked in Bundi for many years and had many contacts there. He further what work he does there? The patient replied that he works in a factory and told the name of the factory.

A smile broke on Dr. X’s worried face. With a new found confidence and authority he said, ‘The factory you mentioned is owned by the father of my good friend Mr Z.’ ‘I am going to phone my friend and get you kicked out of your job for your non-cooperative behaviour with me.’

The patient became crest-fallen. With folded hand he requested Dr. X, ‘Please Sir, do not do such a thing. My family will die of hunger.’ ‘You may ask me a thousand questions and examine me thousand times. It will be my great honor to be of any use for the friend of chote saab (the young boss).

With the now super-cooperative patient Dr. X was able to pass his MD Medicine exam with flying colors.

(Based on true incident)

— ND

© Author. All rights reserved. 


DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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