Only human: Getting patients on your side

Only human: Getting patients on your side

I have had my share of brickbats thrown at me after more than three decades of being a doctor. But to be fair, there were also bouquets tossed my way. It makes for a rich and colourful professional life.

My failing as a doctor is my impatience with the pronouncements of alternative and traditional medicine.

Before I start each workday, I say a secular prayer (is there such a thing?): "Oh Father Hippocrates and my Lord Aesculapius, let me not be patronising and condescending to my patients and their relatives. Give me the strength to be patient and understanding when they tell me about their food taboos. Let not their talk of 'angin' rile me."

Sadly, the gods only answer my prayer now and then.

I feel bad each time I try to explain science to my patients and know that at times I have hurt their feelings. I draw a picture of the Petronas Twin Towers (easy enough because of the iconic sky bridge) and the Airbus 380 to illustrate what science and technology are all about.

I then link these pictures to biology, medicine and oncology to bring home the point that science is seamless, be it physics, engineering or how the human body works and fails. Physics and mathematics underpin all sciences.

"Doctor is so condescending and patronising." "There is no need to point out our science illiteracy." "How dare he speak of something that goes against the grain of 10 millennia of civilization?"

Mea culpa. I deserve all these vituperations. I try hard and I think I am doing better. Age and illness have mellowed me. The patient's sensitivities are not a trivial matter.

A patient comes with all her cultural beliefs and baggage. It is a package not easily deconstructed and disassembled.

A doctor must be accommodating and tactful. This is not to say a doctor should encourage harmful beliefs like an ultra low protein, no sugar diet recommended by some alternative medicine practitioners to a patient undergoing cancer treatment.

The art of getting a patient on your side is a work-in-progress. No doctor ever masters it. Not even on their last day of doctoring.

The bouquets have made it all more than worth it though.

The wife of an American expatriate underwent chemotherapy for colorectal cancer under my care. It was a straightforward thing. She had early cancer and was very well.

The chemotherapy sessions (once every two weeks for six months) lasted hours and were uneventful. The husband was always there. He was a lawyer by training and we got to chatting about law (his field) and biology (mine).

I illustrated to him the Bush of Life, about how all life forms (extant, extinct living, dead) are interconnected by DNA, about how we are all housings for DNA, about the accidental emergence of Homo sapiens, and about the inevitability of decay and death.

He did not take offence to the pictures I drew. In fact, he paid me one of the highest compliments I could ever receive. "If my biology teacher in Texas had not been so boring, I would have been an evolutionist instead of a lawyer."

The rights of a patient matter a lot to me. This includes the right of privacy, and the right not to undergo treatment.

One patient was grateful to me because I refused to tell his wife (on his explicit request) that he had cancer, and approximately how long he would live. His reason for not telling her was his own. I kept my lips sealed despite the wife's pleas, persuasions and placations. He wrote a heartfelt "Thank You" note to me just before he died.

A polished, demure, educated 70-something did not want to undergo chemotherapy for stage four pancreatic cancer (liver, lung and nodal metastasis) despite the incessant cajoling of her children. We made her comfortable with adequate doses of opioids and other symptomatic medication. I reinforced her decision (about not wanting chemotherapy) and incurred the wrath of her children.

To me, it was her fundamental human right: to be treated, not to be treated, to map the rest of her life, to die at a time and manner of her choosing.

I will not do it any other way. I will not trade this technicoloured, kaleidoscopic life for any other. It is a tapestry of many fabrics and many hues.

Dr Albert Lim Kok Hooi is a consultant oncologist. For more information, email starhealth@thestar.com.my

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