The Super Cooperative Patient

Life is about checks and balances, positive and negatives, Ying and Yang. The negatives in life are many times balanced with something positive. If there are uncooperative patients such as in  ‘The Un-Cooperative Patient’ then there must be extra cooperative patients to restore balance in the world.

 

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

One of my very senior colleagues, Dr. Ramesh Sharma (Fictional name) recounted his experience during his MBBS exams.

When he appeared for his final MBBS Medicine ward clinical exam, Dr. Ramesh was allotted a patient suffering from heart (cardiac) problem.

On reaching the allotted patient’s bed, Dr. Ramesh become dismayed. The patient was calmly having his food and seeing the full plate it appeared that he had just started. Dr. Ramesh estimated that it may take 20 to 30 minutes before he will finish his lunch.

In India, the majority of the older generation treats eating food as a ritual or homage to Food God. Just like while praying to God, they do not get up, talk in between or take break once they started eating food. This will amount to disrespect to food and God who have provided the food.

The patient looked up and noticing Dr. Ramesh asked, “Are you a MBBS student?” Dr. Ramesh glumly nodded his head. “Have you been allotted my case for your exam today?” the patient enquired. Again Dr. Ramesh nodded his head in affirmation.

“Look doctor,” the patient calmly proposed, “You can either disturb me while I am taking my food and take my history and do examination on your own, or  you can wait I have my food. While you are waiting you can write my clinical history on your own. I am suffering from moderate Mitral Valve stenosis with mild Aortic valve stenosis (heart valve disease), symptomatic for last 10 years. You must have at least studied so much that you know what history to write in this condition. If you cooperate with me, I will tell to your examiner, that the history written by you is given by me, and confirm whatever you tell him. Once I have finished my food, I will also tell you what findings to write in my clinical examination, including heart sounds and murmers.”

In India, most patients (at least at that time), did not knew English language. So, they were not aware what the doctors and students discuss during ward teaching and exams. They were also not able to read what was written in their case sheet record.

But this patient was engineer by profession, well versed in English language and having a keen mind. Because of his clinically important disease he was discussed many times in the ward rounds, clinical classes and was allotted multiple times during exams.

The patient was now well aware what his diagnosis was, what was his clinical findings and what questions were asked regarding his illness from the students during exams.

Dr. Ramesh weighed the options of either disturbing the patient while he was having food, antagonize him and take a history and examination from an irritated uncooperative patient, or agreeing with the patient’s suggestion.

Finally Dr. Ramesh deicided to let the patient have his food in peace, while he constructed and wrote a fitting history.

True to his words, once the patient had finished his food, he checked Dr. Ramesh’s history, gave some helpful suggestion to enhance the history, and dictated his physical findings to him.

Once the examiner came, Dr. Ramesh presented his history and examination and needless to say, passed 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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