Every ward round comes with its own dose of drama and special characters. DR THOMAS GRAY walks us through some of the everyday interactions between doctors and patients at state hospitals.
Human contact is one of the greatest draws to medicine. Whether it’s dealing with patients, their families or colleagues, a doctor is often thrust in the middle of someone else’s life story. And we have many stories of our own – the good, the bad and the downright ludicrous. The human drama we are often ensnared in is endless, but the characters we encounter are fascinating. And with each drama we learn more about ourselves, our own shortcomings, and the tensions in the system.
Patient-doctor interactions aren’t always the sterile exchanges we see on American hospital dramas. People don’t come to hospital on a whim; they are in pain, bleeding, or may have body fluids leaking out of an orifice. Others may have come to check a lump or bump that can no longer be ignored.
And these interactions say as much about a doctor’s bedside manner as they do about the inequalities informing the greater socio-economic reality which we inhabit.
It may be 20 years post-apartheid but the segregation and structural inequality that lumped people of the same skin colour together still plays out in wards today.
So let’s take hypothetical patient X. A fungating mass on the body, complete with maggots? Apparently this is no need for alarm and the mass will not uncommonly be seen months only after it first started.
I’m always drawn to ask: “But why did you wait so long to come in?” The usual response is: “I thought it would go away!”
Due to inflexible work commitments, a lack of money for transport or medical care, living in a deep rural area, or a host of other reasons, many impoverished patients are not able to pop down to the GP’s rooms or the local clinic to have some ailment checked before it gets too bad. But when it does worsen, they end up in hospital – often a result of a complication from a minor ailment that should have been treated with a couple of pills some months ago.
I rail with frustration against the system, until I realise I am party to it too.
For those of us who don’t speak an African language, the patient interview would be comical if it didn’t severely complicate the patient’s care.
Doctor: “So, baba, when did the pain start?”
Patient: “Yeah there is a pain.”
Doctor: “Yes, when did it start?”
Patient: “Oh, it starts next week?”
Fortunately some medical schools have introduced an African language as part of the curriculum to better equip us in these interactions. And it’s about bloody time too. In the meantime, and this is an all too common interaction in state hospitals: a poor black man (who ought to have been treated much earlier) could not access healthcare, and now when he does reach trained medical help, he’s not even able to voice his pain in his own language.
And then we wonder why black people are so angry.
On the next bed we have Hypothetical Patient Y.
Ah, this is a patient from that curious class of South Africans who think their street-smarts and ability to hustle can be used to magic their way through the system in a state hospital.
Some of them even manage to pull it off. With some deft nagging of a sympathetic doctor with a shared surname or hometown (referred to as “Uncle”) to please “make a plan” for them or the sweet-talking of nurses into allowing their families to visit outside of visiting hours, the system is successfully manipulated.
And you’re going to accuse me of stereotypes but this wont for manipulation seems to be a particular feature of Indian patients – and their sizeable posse. Whether it’s in casualty or admissions, if there is an Indian patient, you can be sure that the patient’s entire family – including extended family, distant cousins from Botswana, neighbours, the neighbour’s family, the high school principal, and the nephew who wants to get into medical school – will all be there.
Dealing with patients like these means you must survive the tunnel of death, carefully navigating between this crowd of concerned, extended family members before you reach the patient himself. It’s like walking out of a courtroom during a high profile case – reporters lying in wait ready to jam a microphone and a camera in your face to get information. Each person wants to know the finer details about their loved one, but having to explain the same thing two hundred times can be exhausting.
Which leaves us with hypothetical patient Z.
People of colour in South Africa have spent decades enduring poor treatment from the powers that be, so they’ve been trained to suck it up. Been waiting six months for a chest x-ray? Best wait quietly lest you upset an administrator who’s punch drunk on his own power.
But then hypothetical patient Z isn’t used to sucking it up at all.
He’s already announced his entrance with a screaming match in the middle of the ER, and he’s showing signs of another tantrum any minute now. Without looking up from my files, I can already guess it a white guy. If something’s out of line, you can rely on white patients to make sure everyone knows about it. Grievances range from waiting times to staff attitudes and the quality of the food.
It’s understandable that particularly older white people had become used to the exclusive and efficient health systems they were privileged to enjoy under apartheid. For many, it’s a bit too much to swallow to have to wait in line with their darker-skinned brethren.
But the doctor’s job with a white patient is constantly under scrutiny. You can be sure that the patient has already done exhaustive searches on Google and Medscape online to dig about for info on their condition long before you get there. Then comes the arduous task of enlightening them about the quack information casually paraded around as “medical knowledge” on the internet these days.
But hey, I’m just the doctor here.