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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