Sadiyya Sheik
Sadiyya Sheik

Do you treat your doctors as well as they treat you?

There’s an aspect of medicine called family medicine. It’s the part medical students love to hate. It’s the touchy feely bit where we care (or at least pretend to) about the things that can’t really be treated with a pill. We’re concerned about the impact your job is having on your life, we wonder how many cigarettes you’re smoking a day or if you’re drinking a bit more than is considered healthy. We draw elaborate genograms and ecomaps and try to understand your illness in the context of your life. We try to look at you and see more than a disease profile. Sounds attractive, doesn’t it?

If I really did this for every patient I saw, consultations would take an hour (with the infamous language barrier, maybe a few more). The queue outside my door would be a grumpy festering mass of sickness with a disgruntled expression. So, I don’t do hour-long consultations. I stick to the medicine. I use pills as my allies and treat what I can. This is not to say that I don’t care about the holistic management of the patients I see. Holistic care, but in moderation. So, if you come to me with the flu, I’m really not going to draw you a family tree and try to figure out how your controlling boss/ evil stepsister/ neighbour’s dog is the real root of the problem.

What I mean to say is that while holistic health care is the ideal, it is by no means practical in the public health system in South Africa. The clinics and hospitals I have worked at are overburdened and understaffed: a cruel combination. Add to this the increasing incidence of HIV and a continuing prevalence of tuberculosis and drug resistance, the public health system is, quite frankly, the unhealthiest place to be right now.

Family medicine also stresses the importance of a doctor-patient relationship.

Now, I have learned many lessons from working in the medical profession, not the least important of which is that people can be terribly mean when they’re sick. Case in point, the patient who recently barked at me at the medical out-patient clinic insisting that she be started on insulin for her uncontrolled diabetes. Headstrong, she refused to listen to other modalities of treatment and proceeded to direct all her complaints regarding the public health system (there were many) at me. On hearing that we would in fact, not be starting her on insulin that day, the woman snatched her file from my hands, shouted a range of insults, displayed a disgusted expression and boldly announced that she would henceforth be seeing a private doctor.

It is a real test of one’s patience to smile and calmly explain treatment rationale to a patient who is glaring down at you, hurling a string of criticisms at your face. It is also extremely unreasonable for a patient who neglected to adhere to both dietary and lifestyle modification as an aspect of therapy to demand insulin therapy when they haven’t held up their end of the deal. People often forget that while doctors are there to direct you towards good health, you have to take a few steps on your own.

In public hospitals a therapeutic doctor-patient relationship is largely fictional. More especially, in out-patient clinics, patients rarely see the same doctor twice, a situation that sometimes has adverse effects on the success of therapy.

Patients that visit public hospitals pay per earnings at a fraction of the cost they would pay at a private practitioner. Why then do they expect to be treated in public as they would in the private sector?

Perhaps these are some of the issues that the proposed National Health Insurance aims to address. For the meanwhile, public and private healthcare remain two ends of an unjust spectrum.

  • Benzol

    “Do you treat your doctors as well as they treat you?”

    The two occurrences of the word “treat” in your question have subtle differences in the meaning. The doctor “treats” to cure (1), while the patient’s “treat” most likely refers to social behaviour (2).

    The (1) requires education, knowledge and analysis to determine a solution or treatment. Social engagement can be limited to bare necessities to come to the heart of the problem.

    The (2) is the response of the patient and limited by language, culture and upbringing. Government facilities do not necessary attract the most sophisticated individuals.

    My opinion? The question seems to hint at higher expectations than the client has to offer. As the saying goes: “take it where it comes from” and concentrate on the job on hand.

  • Andrew Slaughter

    mmmm…Should I treat doctors as well as they have treated me? Should I then in whatever my profession, give a medical doctor completely wrong advice? Or should I brush off a problem that a medical doctor comes to me with, without really looking at the problem in depth? Because basically those are some of the experiences I personally have had with medical doctors. Not to mention what I have heard from others about unethical practices from doctors, especially in this country. My point? Don’t assume that doctors have your best interest at heart, or know what they are doing, just because they have a medical degree. Do some research, and find a good doctor.

  • Lu

    “Why then do they expect to be treated in public as they would in the private sector?

    How insolent and pompous can a person be?? is this article serving anyone a purpose or where you writing to merely indicate the fact that you were priviledged enough to attend medical school but clearly learned nothing from all those years???
    I pay over R4000 in tax on a monthly basis, although i cannot accurately state the figure, I am quite sure most of that money goes into health care…how then, do you have the nerve to tell me that if I go to a public hospital I should not expect excellent treatment??

    It is indeed silly and miopic attitudes like yours that people do not improve the status quo, but instead perpetuate the behaviour that one’s money gives them the right to respect and dignity.

    And whilst we are on the subject…clinical diagnosis is part of a doctors J.O.B!! You are not doing anyone a favour by assessing and diagnosing a patient, so do not tell me about long lines and the likes…your first and only priority should be the health status of a patient.

    As the person above indicated…your ‘treat’ as a doctor is to cure. You are paid to do that. Whether that money is enough or not, is an argument reserved for your employer, as for the patients, your duty is to serve them as they deserve!

  • Daniel Malan

    Many MBChB and MMed (Psych) graduates are just totally unscrupulous and have little respect for their patients – this in the private sector.

    When I was a patient at a psychiatric clinic my psychiatrist on the premises of the clinic tried to pimp me out to colleagues. He blatantly said that I should not bother laying a complaint as he is THE DOCTOR and I am the crazy person even though I have no delusional disorders, have pretty well functioning mental faculties and excel at my job, am a graduate and a student of the pharmacopoeia amongst other things.

    Said professional I never saw again.

    Many doctors in the private sector completely disregard the sincere and tactful input from patients and assess within a few minutes – a pure guesstimate (“Scrubs” comes to mind).

    I guess Pragmatism is chosen above analysis, inductive reasoning, deductive reasoning, empirical evidence and a good dosage of knowledge.

    It is the private sector after all and we fork out a lot for services, especially those with chronic ailments.

    I have educated myself to the level that I dictate what medications I will take and provide full medical substantiation – luckily my current doctor respects me and we have a cooperative relationship.

    The days of “yes doctor, of course doctor, just like you said doctor, thanks doctor” are long gone with the proliferation of information and the relinquishment of the sheep-syndrome.

    Never take things at face value…

  • michael

    Andrew you have spoken like a true rich boy. Your response assumes that people can choose. Many cant. Take a look at the poverty in our country, people attend the closest puli hospital to them because its the only place they can reach.

    The blog article directly addressed the issue of public health so it would probably be wise to criticise that system in your response. i get the feeling that you commented on the title of the blog without actually reading it.

    You cant do “research” and “choose” in the public sector. People attending public hospitles typically dont have the facilities to travel somewhere else if they dont like their treatment.

    I am a medical student and i can say the greater majority of my class have peoples best interest at heart. Those that dont, usually drop out by 4th year, or quit clinical work and go into research etc. There are very few doctors out there who dont care. And funnily enought you will find them in the private sector. No one works the hours, or in the adverse conditions of public health, without it being a calling or a vocation, rather than a living. They do care

  • Blip

    The one time any patient really could use a bit of that family-medicine tender-loving-care is when they are in-patients in hospital. At other times, a blood test analysis, a comparison with last year’s numbers, a quick listen on the stethoscope and a script for pills or creams is usually perfectly adequate. But when you’re in bed in hospital and feeling altogether grim, a good, attentive bedside manner is very, very important.

  • sadiyya sheik

    the truth is, if you’re not a doctor, you’re a patient: potential or current. I don’t mean to divide the world on such ridiculous grounds with this post. All I am saying is that while I don’t doubt that many patients have not been treated well (both in terms of medical practice and on social grounds) by their doctors, there are many patients who treat their doctors unfairly. I speak about patients in the public sector because this is where I work everyday. It is my opinion that the lack of a therapeutic doctor-patient relationship is far more prevalent in the public sector than in private.

  • MLH

    I used to see an Indian GP in the private sector who told me that all Indians become doctors these days…it’s the thing to do, she said. Beware of becoming one of those, Sadiyya. There are certain professions you’ll never be any good at unless you feel just a touch of ‘calling’.
    Frankly, once one is pitching up for a regular script, no GP fulfills the need. I pay, every six months, to be put on a scale, have blood taken for a test, my blood pressure taken. I hand over a list of the medications I am on. He copies the list out on his pad and hands that back. The last two times he has made mistakes; the first time four, last time two. And he wonders why I tell him to concentrate? That’s a whole heap of clerical work I’m paying a vast price for!
    I used to go to doctors when I felt at death’s door. New medical health rules mean we are simply becoming regular sources of income.

  • Sadiyya Sheik

    Lu, I think you’ve missed my point about patients being expected to be treated in public hospitals as they would in private. In the private sector patients (often via a medical aid) pay for consultation, investigation and management. Therfore, as in the case I mentioned, where a patient neglects to adhere to dietary, lifestyle and even oral therapy as aspects of Diabetic therapy, they can demand Insulin therapy form their private doctor. While Insulin may not be the most appropriate next step in therapy, the patient will ultimately be paying for the Insulin. Similarly, where a patient requests expensive investigations such as CT scans or an MRI, the private practitioner might advise the patient on whether these investigations are necessary or not but the patient has the final decision because they will be paying for it. We do not have these luxuries in the public sector. Modalities of investigation and management need to be undertaken based on their contribution to the management of the patient. It is easy to cry blue murder about doctors not doing their jobs when you are unclear about what those jobs entail.

  • suntosh

    Interesting article Sadiyya, I enjoyed reading it.

    “In public hospitals a therapeutic doctor-patient relationship is largely fictional”:
    I get the sentiment, and certainly the ideals of family medicine cannot be regular practice, but I think perhaps a “therapeutic” encounter need not be rocket-science.

    The psychologist Carl Rogers described 3 elements that he believed should underpin all effective psychotherapy (from his Humanistic paradigm):
    Empathy, unconditional positive regard, and genuineness.

    Even if a 10 minute consultation with a patient offered these three basic elements, I’m pretty sure an attitude of care will be conveyed and the patient will leave feeling that, at the very least, the public health system is serving them as best as it can. Perhaps.

  • itissaid

    You really should get out of the public sector, Sadiyya. Tell me why you feel justified in blaming a pissed-off patient for her health woes? Do you know who explained to her those lifestyle and dietary changes you blame her for not following? DID anyone explain it?
    Please go and stand in a queue in a public sector facility – as many of my friends are forced to do – and cope with the doctor who sees you at the end of a full day that has cost R24 in taxi fare, for a headache that has lasted two full weeks non-stop, and then tells you it’s a tension headache (no explanation of what that is) and tosses a script for Panado at you. True story, BTW.
    Angry patients are often scared – didn’t anybody tell you that?
    Get into research. Get into a lab, or somewhere you don’t see people. Patients don’t need a ‘pathological complainant’ (whatever that is – a complainant is actually a legal term) – they need someone who can walk a mile in their shoes.