Types of patients!

The poor old lady had difficult time in controlling the tied up rooster. In one hand, she was carrying her medical records and medicines and with the other hand she was trying to control the bird.

She took a sigh of relief as she entered the examination room and placed the poor fowl on my table.

She had been asked by my members of staff to leave the hen outside but she refused to budge! Everyone in the waiting area had to put up with the noisy chick, but she paid no heed to that. She was determined to present the 'home raised desi' chick to her doctor and nothing could stop her.

I was most grateful and moved by her love and appreciation. Our most precious gifts from our patients are eggs, vegetables, fruits and 'desi ghee' - which they bring with profound love.

"Doctor, I feel perfect and am able to walk a couple of miles, your drugs had a magical effect on me," sixty years old Shakeel Ahmed, said while holding my hand with love and tender. Words like these invigorate our soul and fortify our determination. Patients like this are not uncommon.

There are many patients who only come to perform a 'peeri mureedi' act-announcing in unclear words, "just came to see you and be blessed by you!"

"Doctor, you have a magical touch; you touch me and I get better," announced Shimaila Bibi, a seventy years old lady, suffering from multiple diseases.  "Here comes my Maseeha, now I will get better," my auntie would often say, having been unwell for a few days.

Some people have a firm unwavering belief in the 'healing touch' of their physicians - which may not be all that true but we all appreciate the unlimited powers of faith. These wonderful people have a knack for making doctors feel special!

We come across different types of patients, who we can broadly divide into four groups. First class being the grateful ones - who are happy with the service being offered and are obliged for that; second class being those who are satisfied - they neither expect more nor desire more; third class is of those who set very high standards for satisfaction and service and are most difficult to be satisfied; and then the fourth class, a special group who are determined not to get better, they remain unhappy and curse the services provided and the service provider. 

Above mentioned patients belong to the first class, who are most grateful, who make doctors proud and give them a reason to live.

There is a group of patients who strictly believe in 'customer relationship'.

They come for a service, they get the service and go back satisfied. They believe that that the job of doctors is to heal and it is part of their duty to heal!  It is more like buying potatoes, you pay for potatoes and you get potatoes; they do not believe in any personal interactions - for them getting better is a natural result and it's strictly a business deal. They belong to the second category.

"I am not feeling well, since I have started your drugs," stressing on 'your', complained Mohsin. "I have this strange feeling as if a cold wave runs through my body; I feel exhausted and cannot walk for more than three miles," she adds.

"OK, you came to see me two years ago, and at that time you had severe angina and you could hardly walk a hundred yards; how is the chest pain?" I ask her as I glance through her old medical record.

"That is a lot better, now I can walk and do my daily chores," she replies.

"And you did not bother to visit us in the last two years, in spite of our instructions for a review after thirty days!"  I ask her.

"Well, I was out of town and as I was feeling well, so I decided against 'bothering' you," she replies. "Your blood pressure is controlled, cholesterol is within normal limits and ECG is better; from our point of view you have made a good recovery and I am happy about your progress!" I inform her.

"But this cold wave and exhaustion is bothering me, though I feel hundred times better than before," she agrees half-heartedly.

This type of patients always remains ungrateful, even if they improve! On improvement of old symptoms they invent some new symptoms. They have to complain - come what may.

If nothing else, they will complain about weather, traffic on road or hassle they faced in getting the appointment. These patients belong to the third group.

A thirty-year old teacher presented in a moribund condition with severe heart failure a month ago. She was carried in on a stretcher. She improved remarkably due to Allah Subhanu Taala's kindness and walked in unaided on her follow-up visit. I could hardly recognise her! 

"Doctor, I am still feeling miserable, I cannot walk and climb stairs; my appetite is not improving," she complained.

"Bibi, you were fighting for breath and now Masha Allah you have improved a lot, shouldn't you be grateful to Allah Subhanu Taala for this?" I ask her.

"Can I eat kebabs and when will I be able to go shopping?" she adds while ignoring my suggestions. There are a few patients like her who are determined not to admit any improvement. They very strongly believe that they will lose all sympathy in the family if they admit to any betterment in their illness. They belong to the fourth class, who are determined not to get better.

Many a time they have psychological problems and they thrive on their pseudo-ailment.  They try to be the centre of attention of the family by exploiting their illness.

Patients present to us with different complaints, it can vary from an apprehension to a deadly ailment.

The presenting complaint may be same- such as palpitations. This may be due to anxiety and tension - being over worked or stressed or it may be due to serious life threatening irregular beating of heart. A chest pain may be due to mere anxiety or it may be a symptom of heart attack. There are heart attacks which people bear without any pain and consequences and then there are heart attacks which may prove fatal.

Interpretation of presentation is the most crucial step in determining the diagnosis. Exaggeration on the part of patient may complicate the issue.

Some people downplay their symptoms, which may result in missing the diagnosis. Some may over stress an unimportant component of symptoms complex, this may mislead the physician. Nausea and vomiting may accompany heart attack chest pain, some may get obsessed with nausea and may not mention chest pain hence give the wrong impression about the ailment. There are times when patients present with common presentations of disease hence they are easily diagnosable and then there are other times when the presentation is so atypical or weird that it might escape diagnosis. As we say, "diseases have not read the textbook and so have patients."

Importantly, just like patients present differently, similarly they respond differently to same group of drugs. A specific drug for an ailment can make a doctor hero and same in another patient with the same disease may reduce him to zero.

In the world of medicine, unfortunately, two plus two is not always equal to four.

It can vary from zero to twenty two! A doctor normally harnesses all the information he has into useful knowledge and employs it for the betterment of the patient.

We, as ordinary mortals, have little if any control on determining the response to drugs. Dispirin may play wonders in a patient with angina to keep him pain-free, a patient with stroke from recurrent episodes and a patient with implanted stent from occlusion of stent.

But the same patient may develop 'hyperacidity' and rarely have bleeding in stomach. Streptokinase -a clot dissolving drug, is life saving drug which does miracle in heart attack patients by opening clogged vessels. But the same drug may cause uncontrolled bleeding from any site. The worst scenario may be a stroke due to bleeding in brain.

Most times, patients determine our response. It is very important for doctors to have this feeling of being helpful to patients. Most doctors try to be supportive and put in their best efforts because at the end of the day their own reputation is at stake. To extract maximum out of doctors, it is perhaps in the best interest of patients, to appreciate the doctor's efforts and give him that special feeling. A small gesture like a 'smiling thank you' may prove to be more rewarding.