Sunday, November 4, 2012

Iatrogenic Fear

What is the most common iatrogenic disease/morbidity?

Ask me and I'll tell you it's fear/anxiety.

You may laugh at it. You may either think it's not a morbidity or you may feel it's not so prevalent. Either way, I feel, is a wrong opinion.

So to prove my point I did a little experiment. I did this with goodwill hoping it would change someone reading this. I set out and randomly meet patients admitted in different wards during my Clinical Pharmacology posting. They ranged from simple cases of fever to cancer patients. I went to them and introduced myself as a student doctor. I spoke with them patiently and built a rapport with them.

As I was conversing with them, I came to understand that none of them were aware of what was going on to them, neither their diagnosis nor their treatment. Leave alone their prognosis. I could feel their anxiety. They were worried and were fearful of worse things that could happen to them. Some were even worried because a fellow patient with similar complaints was investigated with bone marrow aspiration (a invasive procedure). They were afraid that anytime their resident doctor would come and drill their hip bones too.

As I was still talking with them, they started bringing to me all the test reports that they had got done. They took out the X rays and CT films. They took out the big files containing all sorts of blood reports which were done in the private hospitals they visited before the came to JIPMER. They wanted me to tell them the diagnosis and the course of treatment.
(However their records were long and further I did not want to say anything to the patient that would hinder/disrupt their relationship with their treating physician)

And as positive controls I went and spoke with some patients in wards where I knew the patients were quite well informed. I could indeed feel a drastic difference.
Those with good prognosis were eagerly waiting to go home. Those with poorer prognosis were, of course, sad & worried. However they were well informed and they kept their hope alive.

Good communication is a strong foundation for any relationship and the doctor-patient relationship is no exception. It is even more important in relieving the patient of his unnecessary fears. Clinical rounds are conducted on a t.i.d basis in some wards (once by the final Yr resident, once by the SR and then by the consultant) but sadly very little information is passed on to the patient. Most often it is the resident doctor who keeps running around all day for patient care. However the patient is more impressed with the nurse who gives him/her the medicines ( the big-mouthed yelling sisters, I mean the sweeter ones:) because in communicating with her the patient finds care and compassion.

Cure occasionally, Relieve often, Console & Comfort always! - Anon
Thank you for patient reading.