Tuesday, 17 February 2015


When I was in clinical medical school, there was one thing I was sure of doing whenever I went home for the brief holidays. It was the simple task of checking my grandma's blood pressure, then of course, that of every person in the house, (whether they needed it or not). Grandma was hypertensive and some reason, my mum always told me to tell her that all was well with her no matter what recording I got. When I asked why? She'd simply reply; that's what the family's doctor does. His explanation for not telling her the truth picture of her ailment was that it would scare her, or cause her more anxiety and as such elevate the blood pressure to an even higher and more dangerous level. To me at that time, it was a perfect reason and a wonderful practice. I pocketed it as one of the lessons learned on my way to becoming a great doctor. Nobody wants to be mediocre!

As I progressed in the medical field and started to practice, I saw that this was a practice by many people. A man is sick, on admission with cancer or whatever terminal illness you can think of and the family says; "don't tell him, he'll die faster". Another person has diabetes or hypertension (high blood pressure) and the same story goes. I began to wonder how the relatives can manage them without them (the patient) realizing that he is sick. Is it possible to give a person drugs or change the diet without him asking why? Well, unless that person is unconscious.

Overtime, I discovered that there was a high percentage of patients who weren't adherent to their treatment plans. Whether it was medications or a change in diet or even exercise. They come back every clinic day with the same problems, the blood pressure or blood sugar is going higher no matter how many drugs these patients are on. For example, you see them today, give then 2 drugs and give a 1 month appointment. They show up with elevated BP, you add another drug and another and another until you can add no more. Lol. The simple thing that has happened is that you prescribe drugs, they leave your consulting room (sometimes dissatisfied with services rendered), hiss and dump your prescription till the next clinic day. In a place like the one I work, you can come 4 times and meet 4 different doctors. Sometimes, they hope to me a different doctor and hope for a different approach.

My choice to go for a residency training in family medicine is one that I won't regret anytime soon. In family medicine, we are thought to look at the patient's illness from the patient's point of view, then treat using medical knowledge. We realized that a patient is a human being just like anyone of us and would desire to be treated as such. If you are a medical doctor and your are reading this, ask yourself this simple questions;

  • How would you like to me treated if you fall ill?
  • If it was any of your friends or relatives on the sick bed, what would your reaction be?
We are thought to look at the patient and his illness in the context of his family and vice versa. We do not forget that the patient has religious beliefs especially in a place like Nigeria. We learn how to communicate with people, counsel them and break bad news. The act of managing a "difficult" patient is not something you can do without. With all these said, we have one problem. It is a problem that plagues every doctor and infact the health sector. It is TIME! Patients are maybe the only group of people who have been wrongly titled. Have you ever heard the phrase, "patients are not patient?" so true. They are in the waiting area, ranting that the doctor is taking up so much time with one patient, then they go in and refuse to come out and the cycle goes on. Lol. The doctor tries to compensate and then misses out on the need to adequately counsel the patient and just prescribes drugs, hoping to get a better chance by the next visit, and..... then we are back to the scenario painted earlier.

The moment I realized this defect, I decided it was time to refresh some of the things I'd learned over the years. In my mind, it was time to empower these people with the simple truth they deserved. Why hide information and continue to mismanage a patient? To tell you the truth, contrary to what had been in practice, these people want to know the truth. I adapted a few strategies to work around the time constraint and patient's demand.

First, I divide the patients into 2 major groups as the consultation begins;

  • The ones with acute illnesses that will recover completely with medications and no sequelae e.g. people who present with strictly malaria or straight forward urinary tract infection. 
  • Those who have chronic diseases, terminal illnesses, emotional or family problems. E.g. diabetes, hypertension, asthma, peptic ulcer e.t.c.
The first group I see in a bit of a hurry, minimal counselling and off they go. The second group, the reason this post, I have to counsel extensively, sometimes over several visits. They are always the reason a developed my rule to counselling a patient. It is my 80/20 rule.

Secondly, I apply my 80/20 rule. The 80/20 rule is simple. Just let the individual know from the onset that his recovery is totally up him. I tell my patients with chronic diseases this so they can step it up a notch. Many come to me feeling dejected and I let them know that the battle is up to them to decide if they fight and if they want to win. My favorite line simply corresponds to "when life throws you lemon, you make lemonades". Sometimes, I tell them that my job ends with making the right diagnosis and implementing the correct treatment plan, but it is entirely up to them to follow through or not.

Thirdly, I do not fail to employ something I learnt about counselling a patient with a chronic medical condition while in medical school. They need to know the cause of the illness from you the expert. You don't want them getting infomation from relatives or babalawo (native doctor), that will be the downfall of your management. They need to know the course of this illness. How will it progress? Any there any complications? What are the treatment modalities?

The patient leaves the consultation feeling satisfactied, empower and much better. They leave you with many thanks and a heart full of joy for a job well done. This post is to tell you! that you have every single right to know what you are been managed for, the right to know to names of the medication(s) you are given. People have died from not knowing the name of their medications. Families have been torn apart because the bread winner didn't get to know he was dying enough to make a will before the time.

Empower yourself today and take charge. The CURE is in your hands......

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