The demanding patients

By Dr. Muhammad Hafizullah

“Doctor Sahib, do you remember me?" this is a very catchy question - usually loaded and most doctors hate to answer it straightway. Heart starts beating fast in anticipation of the next question. "Do you remember fifty years old Bibi Shareenai, who used to visit you about three years ago?" and then pauses meaningfully. One has two choices -either fall into the trap and say yes or totally deny that someone naming Bibi Shareenai ever existed in one's life. Regardless of the answer the gentleman continues, "She was ever so thankful to you and used to pray for you and your family regularly," so far so good but there is something more to it, and then he adds, "the poor lady kicked the bucket two years ago." "I am sure you have not forgotten that seventy years old Angoor Baba who used to bring honey for you," he fires another query. "When was that?" I struggle with my memory because there are many kind persons who have determined to sweeten our lives with homemade honey. "He has seven children and they all pray for you," he continues ignoring my question. "He died after a heart attack three years ago," he informs me and I nod trying to understand what did he expect of me and why is he informing me. "Waleed Khan was nearly dying when we brought him to you," he was determined to update me on all his family members and social history. "So how is he?" having killed his two previously mentioned relatives, I was hoping that who so ever Waleed was, must be now doing well. "He was very well for three years but then he died due to high temperature," donning a melancholy expression. And then he picks up the thread of introduction where he left, "I am the person who brought these patients to you." And I nod - even though I did not remember him or the so called patients he mentioned. He opens his mouth again, "And now I have brought this lady, who has been to all the physicians in the town." He looks at the patient as a victim - with a wry smile! With that introduction, I only wanted to ask him one question, "And now what do you expect me to do?"

"Sir, a patient naming Abdul Jabbar will be coming to see you please extend him your usual courtesy," I got a long distance call from Saudi Arabia. "A fifty years old lady needs angioplasty, please accommodate her on your list," someone requested from California. A dear friend of mine called me from Islamabad, "Jalil will be seeing you today, he is loaded with questions; please try to satisfy him," and I asked him a counter-question, "do you presume I will throw him out for asking questions - let me tell you these will be his questions and these are the answers."

Our run of the mill patients come to see us on someone's recommendation but the 'clever' ones find it more 'appropriate' to consult us with some introduction. Does it pay? Not really -  as every patient that comes to a physician is like a challenge and one has to put in all one has to get him better.

"Do you know Kaleem Khan?" the patient asks. I give it a serious thought but the mind appears blank. Without sounding discourteous I say, "Yes, but what's wrong with you?" "He was a good friend of your cousin, who used to live in Abbottabad five years ago." "OK but what brings you here," I try to put him back on the track and start the consultation. "But he said he knows you very well and he had tea with you," he persists - testing the limits of patience. "Gentleman, have you come to my clinic to discuss Kaleem or to get yourself checked up? Please leave him alone and tell me about yourself," I tell him in a stern tone. At times patients' impertinent queries get our head spinning and tire us down in pursuit of totally irrelevant and inconsequential "Kaleem Khans". References like him do not win any favours and it is better to let the physician concentrate on the ailment than waste time and energy on the 'reference'.

"Doctor Sahib, what shall I abstain from?" and to this ubiquitously asked question, we have a well rehearsed stereotype answer. This satisfies more than ninety percent of patients but then there are exceptions. "Please write it for me in Pushto, because my wife does not believe in me and needs evidence," is a popular demand. We point out to a diet chart, already prepared for ready reference, in Urdu. "No this has to be in Pushto as she cannot read Urdu," he adds. "I have been given a list and you have to personally tick mark it," Faizan insists as he pulls out a mile long list from his pocket. Another gentleman produces a battered piece of paper with a reference dug out from internet on Omega oils. A half literate lady tries her English on assessing the latest in cholesterol management while insisting on having cholesterol rich diet. Much that we encourage people to learn about dietary restriction yet some become obsessed about it. Many persons insist on knowing all dos and don’ts of diet, on every clinic visit, in the hope reductions on their restrictions. 

Every patient is special but some are too demanding! We, as cardiologists, recommend either opening of the vessel or bypassing the obstruction by prescribing either angioplasty or Bypass surgery in selected patients. Mechanical problems need mechanical answers. Many patients would insist on medical treatment for severe blockages. In spite of explaining the pros and cons some still ask for a 'wonderful drug' - which does not exist. And then there are other people, who insist on being recommended surgery without any indications. "But doctor I have been told by my neighbour that I need surgery," the patient argues.

Doctor-patient relationship is very unique! Though doctors charge for their services in private sector, the services rendered cannot be weighed purely in terms of money. The element of 'trust and faith' reigns supreme in this relationship.

Patients expect a lot more than mere services for money. Similarly, doctors are extended respect and love by their patients much beyond the professional relationship. Whereas doctors invest everything in this relationship yet some times patients expect rather too much. Some patients present as challenge and are sometimes difficult to handle. But they add diversity to patients' specter and offer a special test of our patience and efficiency.