HOW MUCH TO TELL THE PATIENT?

Should patient be told about all the complications and dangers of the treatment and surgery?. As per the guidelines in certain countries only side effects which can occur in 10% of the patients or more should be told. And in some other countries side effects which can occur in 1-10% of patients should be told......BUT WHAT ABOUT COMPLICATIONS WHICH HAVE LESS THAN 1% OF INCIDENCE.....
WILL THERE BE INCREASE IN ANXIETY IN PATIENT WHICH CAN HARM WHEN PATIENT IS ON OPERATING TABLE
Note......not every patient is operated in general anaesthia.....some times patient is awake ....

DOCTOR SHOPPING

DOCTOR SHOPPING

Shoppers are defined as patients who change their doctor more than once in same course of disease. Following factors are being assumed for doctor shopping:

I. Cultural beliefs and poor medical knowledge of the general public. For more than two thousand years, the concepts and practice of medicine have been influenced by the traditional medicine philosophy.  Psychology of patient still gives the image of magical cure.

II. Poor doctor attitude and doctor-patient communication - inadequate patient education. Doctor’s knowledge, skills, attitude, reputation, availability, office location and fee charges etc.  

III. Poor patient understanding and recall-ability.

TRY THIS

Right to information and importance of information-provide enough information to understand.

Details of advice and instructions should be explained in serious conditions.

Written handouts.

Total number of revisits can be increased to counsel the patients who has poor recalls or memory of instructions given by hospital staff.

Average percentage for all questions forgotten was 46.4% with verbal advice without leaflets, while 31.9% forgotten with verbal and written advice.

PATIENT WITH SHOPPING LIST AND SYSTEM ABUSERS

PATIENTS WITH SHOPPING LIST OF SYMPTOMS

Mostly females.

Time consumers.

Mother coming with a child of allergic conjunctivitis with a list of symptoms and observations in child’s eye.

TRY THIS

Allow the patient to speak first.

Unfolding a real symptom from your side might neglect a hearing of a complete list by patients.

SYSTEM ABUSERS

These take many forms but include:

•Repeated use of emergency appointments for non-urgent problems.

•Repeated instances of 'did not arrive' (DNAs) (including hospital appointments, following demands for referral).

•Repeated lateness for appointments but still expecting to be seen.

TRY THIS

These patients can be told to come at scheduled time strictly and can be erased from the list of appointment for wasting time if they still not follow the schedule.

DIFFICULT PATIENTS-INTERNET AWARE PATIENTS

INTERNET AWARE PATIENTS. ⁴

Patient’s attendant with nearly mature cataract asking for medicine or drops instead of surgery. When told that surgery is the only answer for cataract he started telling the references on the Internet describing cataract can be treated with medicines only. Such patients are to be told for -

1.      Checking, that the site is regularly updated.

2. Checking, that information is supported by references.
3. Observing whether an individual or an organization compiles the site.
4. Looking at the 'About us' information to see who sponsors the site and whether commercial interests are involved.
5. Seeing whether the site has presence other than online - e.g. an address or other contact details.

6.      Looking grammatical or typographical errors indicative of a poorly edited site.

7.      Not using the information on Internet as Consultation because information on Internet is generalized.

DIFFICULT PATIENTS-SELF DESTRUCTIVE DENIERS

Self-destructive deniers-whilst suffering from a potentially serious condition will make no effort to alter their self-destructive behaviors, eliciting and then frustrating medical efforts to help them. Only a small amount can be done for these patients.  Consultation for depression in chronic ill patient can help. Patient with severe non-proliferative diabetic reinopathy with IHD with hemiplegia making no effort in taking a medicine or following instructions.

TRY THIS

Counseling a patient for how much pain he is giving to care takers might help in some cases. Educate at each step. Importance of treatment should be told.

DIFFICULT PATIENTS-MANIPULATIVE

Manipulative patients-rejecters are not thankful not hostile but filled with tank of emotions. With each and every effort of the physician, disease severity increases. Multiple visits, to a multiple or same hospital with multiple problems. Most of these patients are depressed with broken relationships. They appear to meet a secondary gain of their disease for hanging relationships. Another term is being used now days for some of the manipulative patients-frequent attenders with medically unexplained symptoms.

DIFFICULT PATIENTS-ENTITLED DEMANDERS

Entitled demanders are also inexhaustibly needy but, rather than using thanks and flattery, will use intimidation, devaluation and guilt against the doctor, frequently complaining when every request is not met. The patient may try to control the physician by withholding payment or threatening litigation. Patient’s impulse for this might be due to non-earning in life both health wise and socially.

TRY THIS

Their anger should be directed on to other directions. They should be told politely that your disease has given you enough fight because of which you are angry. But you should not fight with the people who are trying to help you. “Of course medically and ethically you are entitled for the best service and we are here to do that at our best.” You should not indulge with logical or illogical (legal) conversation with such patient.