A lesson learned

 

Lest I forget the lesson…….

This afternoon a patient checked in almost 30 minutes late for her appointment. My assistant is in the habit of taking in late patients after she takes in other patients who show up on time. Thus today I was seeing one patient after another as they arrived while this lady was kept waiting for her turn. Eventually there was no one else to be seen so my assistant brought in this one. 

She was in her late 30s. The booking notes said she was here for a sore throat. My assistant had already taken a throat swab from her before I went in.  I greeted her as I entered and let her speak about why she was here. She told me she had a stomach flu starting January 14th and it got a bit better. However her stomach never really settled. She has been vomiting when she sleeps and her throat burns. She nearly chokes when this happens. She also gets pain in her ears on and off.

She had a telephone appointment with a colleague on January 20th only to get a note to return to work because she didn’t go starting the 14th. Today she asked me for a note from the 20th till today. 

The first question that came to my mind is, if she was having diarrhea since the 14th, why didn’t she come in to see a doctor until now ? All the explanations she gave didn’t seem to make any sense to my mind. “ I thought I would get better “. “ My regular doctor wasn’t available “ “ I’ve had such diarrhea in the past”. 

15 days missing work without coming in for help was not ok in my books. Doctors are here to help you get better, not simply resources to provide a work note and validate your absences! 

I told her I can give a note for today but can’t back date it from the 20th. 

I examined her, recommended treatment based off what I saw and what I had heard from her until then. Just as I was about to wrap that visit she had few more things. She wanted to be checked for sleep apnea. I ordered that test for her and alongside counseled her for weight loss. She said she worked 3 jobs and had a hard time losing weight because she was always stressed and tended to eat under stress and had no time to exercise. Her doctor had sent her for endoscopy because of stomach problems. They didn’t find anything. I had realized what she had was irritable bowel syndrome! I could have taken another half hour to explain to her but I didn’t. It seemed like it would make no difference to her. What seemed to have become habitual for her was to miss work and come in only to get a work note! 

I concluded the visit and came to my office! I should have heaved a sigh of relief ! But I didn’t!

I wasn’t feeling good about that visit. Why?

I reflected on that interaction. It hadn’t gone well at all, in my opinion. And very likely in the patient’s opinion as well! Where did the problem arise? My demeanor changed from one of benevolence to that of passive aggression. And it did that in the fraction of the moment when I realized that she took more than 15 days off work without seeking medical attention. 

For the first time in my life I recognized where the problem came from. I perceived it to be deception. And my mind has aversion to such falsehood. There was no softening once it concluded that she was taking advantage of the system and situation.

May be she was taking undue advantage of the system. May be she had become accustomed to this over a period of time.

But I had failed myself! I had failed my duty! I had failed her!

Everything she had told me I began to piece it together:

She worked 3 jobs.

She had no time to take care of her lifestyle ( diet, exercise, weight)

She had these stomach problems for a long time.

She had noone to help her understand that everything she was doing was a maladjustment to the stress in her life!

There could be better solutions if she became aware and accepted these facts and got counseling to cope in better ways. 

I could have helped her understand. 

At least tried my best.

My reflex judgement came in the way of me helping her. 

It’s a costly lesson. I hope I will be able to catch myself next time when similar reaction is evoked in me. This should not repeat ever !! 

 

Saree today was a cotton silk with Dabu print in natural dyes and ghicha borders.