Not Quite SIP – Patient Sensitivity

Perhaps it’s a Singaporean thing, but Singaporean patients seem to be exquisitely sensitive to comments.

Of course, there are the occasional incredibly trusting patients that make J. feel guilt-ridden to the core. Such as the youngish Indian man who called all the medical team “Sir” though the SIP students and even the A/Con requested that he not elevate the team member’s status so much. Heh. There’s the elderly Chinese man who, after consent is taken, goes “Whatever you think is best, doctor. You’re the doctor, you understand better. You guys have to poke me again after 3 times? If must poke must poke lah.” (the team was tracking his liver function with daily LFT & PT/PTT’s).

The younger generation, on the other hand, seems to have thin skin. And as a [future] healthcare professional with an occasional outgoing personality, J. has learnt that it is very important to watch what he says because patients, not having been medically trained or worked in a hospital, might not understand things the way he and others in the hospitals do.

Take this one example at a children’s hospital in Singapore.

J. was at an empty room in the cardiac clinic when the medical officer came in with a message, “Dr CardiacConsultant says there’s a patient there. Asked to stay for 5min. Come see.” J. drops the book he’s reading, narrowly missing his toes, and calls his groupmates (who were having lunch).

It’s a beautifully classic patent ductus arteriosus in a 2 year old boy, brought by the parents. Apparently they were referred by their family doctor to Dr CardiacConsultant, who is known to be a great paediatric cardiologist. Dr CardiacConsultant and J. thanked the parents for their time and apologised for taking up their time. The mother said that their doctor had told them that medical students would approach as their son’s heart was “classic”. J. quickly listened to the grade 3/6 continuous murmur, loudest at left sub-clavicular region, of a machinery-whir nature.

While the patient and family were waiting outside for their 2-D echocardiogram and Doppler scan (an intravascular closure of the PDA was planned), J. approached the patient’s family once more, speaking more to to Patient’s Mother (PM)

J: “Good morning again. Some of my colleagues are currently coming over. Would you mind letting them listen to your son’s heart?”

PM: “Oh, sure. Our doctor told us this would happen.”

J: “Ah… that’s true. That’s because it’s ChildrenHospital.” (ChildrenHospital being one of two public teaching institutions with paediatric departments in Singapore)

[listens to child’s heart again] [looks up to chit-chat with parents while waiting for colleages to arrive]

PM: “We don’t have to come to ChildrenHospital, you know?”

J: “Pardon?” [mulling over PDA self-closure prognoses]

PM: “We don’t have to come to Children Hospital. We went to Mount Elizabeth first. It’s only because the doctor told us Dr CardiacConsultant is very good that we came over.” (Mount Elizabeth is a private hospital. Children Hospital is a subsidised government hospital. J.’s personal opinion is that Children Hospital has the most kickass paediatric practices (not research) around.

J: “Ah. That’s nice, Dr CardiacConsultant IS very good.”

PM: “You should know that what you said is quite offensive, you know?”

J: “Pardon?”

PM: “It’s your hospital, you know. You’re bringing disrepute to your hospital. I don’t really care, myself.”

[ahh… the idea dawns]

J: “Oh! No, no, I didn’t mean it that way. It’s just that ChildrenHospital is one of only two paediatric hospitals in Singapore. And that’s where all the medical students are.”

PM: “We can say ‘No’, you know? It’s just because we think we should help students learn that agree to this. We don’t have to do this, you know?”

J.: “Oh yes, that is true. I agree, and we thank you. I didn’t mean it that way.”

PM: “It came across as offensive. I don’t mind actually, it’s your hospital’s name on the line. I don’t care. But just because we come to Children Hospital doesn’t mean we have to agree.”

J.: “I’m sorry. It wasn’t meant to be offend.”

PM: “You should be careful of what you say to people. It can sound offensive. Of course, it’s your hospital’s name, it doesn’t bother me.”

J.: “…”

[conversation lapses for 2 min until group arrives on the scene]

In these situations, there’s only one thing to do: suck it up, take the criticism in your stride and carry on being unfailingly polite. There is no justification for physicians, or trainee physicians to be anything other than professional, no matter how schizophrenic (J. has been scratched and more by psychotic patients), uncooperative (Munchausen’s syndrome patient jerking and screaming “Pain, pain!” at the slightest pinprick), or hypersensitive (no, J.’s not talking Type I-IV hypersensitivity) certain patients are.

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