Advice from a patient

Unknown author

ThIs may be a normal day at work for you but it’s a big day in my life.

The look on your face and the tone of your voice can change my entire view of the world.

Remember, I’m not usually this needy or scared.

I am here because I trust you, help me stay confident.

I may look like I’m out of it, but I can hear your conversations.

I’m not use to being naked around strangers. Keep that in mind.

I’m impatient because I want to get the heck of here. Nothing personal.

I don’t speak your language well. You’re going to do what to my what?

I may only be here for four days, but I’ll remember you for the rest of my life.

Your patients need your patience.

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Newman, K mentioned in one of her blog posts titled “The benefits of being a patient person: Good things really come to those who wait”, 2016, April: patience is portrayed behind closed doors and not in the public eye. She continues to state that having patience means being able to wait calmly in the face of frustration or adversity – i.e. nearly everywhere – we have the opportunity to practice it.

Patience is a lifelong practice that we should include in our lives, especially being student physiotherapists, as it is part of our job description to interact with patients. Orloff, M.D (2012) from The Power Of Patience mentions that  “patience does not mean passivity or resignation, but power. It’s an emotionally freeing practice of waiting, observing and knowing when to act”. she continues by stating that to frustrate means to obstruct or make ineffectual, which in more simpler terms also means to prevent (a plan or attempted action) from progressing, succeeding, or being fulfilled (Oxford Dictionaries, n.d).

As practicing health professionals, more specifically student physiotherapists for the University of the Western Cape; we are placed at health institutions whereby subjective and objective assessments are needed to be conducted. Back at our lecture venues where our lecturer stands in front of our class, and explains that this is how a particular condition could present, and this is what the patient would likely complain of. To then applying that theoretical knowledge of a medical condition, to your assessment of the patient. This is where some of us fail to practice patience with our patients as we have fixated our minds on what the patient should tell you about their condition, in the subjective assessment. This can be rather alarming when your findings from your patient assessment does not entirely match with what we are taught. This is also where we need to remember that each patient presentation is unique and that we need to treat our patient according to our clinical findings, taking the necessary precautions and contra-indications into account, portraying respect for your patient and their dignity, and then providing them and those close to them with professional treatment.

In my experience of working at my first district hospital in what is still considered a coloured area in Cape Town, as a result of the forced removals in South Africa during the apartheid era (Unknown Author. South African History Online. May, 2016): I had the opportunity of meeting, assessing and treating a female patient. I will refer to this female patient as Mary. Mary was a 45 year old female who was RVD (Retroviral disease) positive, she was newly diagnosed with Chronic Obstructive Pulmonary Disorder, Cor Pulmonae, Bronchiectasis and she developed hospital acquired pneumonia. She was a poor historian, unmarried with four children (all under the age of eighteen) and she lived in an informal household, which she referred to as a “Hok” (Which according to Oxford Dictionaries is an Afrikaans word which is an enclosure for domestic animals, or a small hut”) which had no electricity, no access to clean water inside, it was damp living conditions and the communal toilet was approximately a block away from her home. During my initial assessment, I learnt that my patient had difficulty fully understanding one specific language (I.e. English) and I often had to change my words from English to Afrikaans, and vice versa, which made interactions with Mary rather challenging as she generally had difficulty following instructions and she constantly had to be prompted when performing exercises. After continuous re-education and demonstrations, seeking assistance from four different nurses, two different doctors and Mary’s daughter, she still could not seem to follow the instructions. I started to feel frustrated with Mary, as I felt that I had been trying my best to have her understand how to perform the exercises, but the manner which she had been performing it put her at great risk of causing further deterioration of her condition. Taking into consideration of her poor prognosis due to the state of her lungs, the muscle (upper and lower limbs) weakness from laying in bed for a  prolonged period, and the bed sores; my assessment and treatment had to be precautious of all these factors. After numerous feedback sessions with the physiotherapy chief, who was also the clinician of the hospital, decided to take over Mary from me as he thought that he might be able to be more effective with her. Three days later, he reported that she had died. Due to lack of information, he had not learnt about her cause of death.

Mary was the perfect example of why we would need to practice patience with our patients. Being in a hospital environment can be rather frightening and overwhelming for patients. Health professionals will come across patients with difficulty understanding and following instructions, but that does not mean that you should opt to no longer provide your health services to the patient. Health professionals might need to consider a different approach to the assessment and/or treatment of the patient. They are still entitled to the right of medical care (WHO: The Patients Rights Charter, n.d.).

It is very important that  student health professionals remind ourselves regularly that we are treating a patient and not a merely their diagnosis. They could possibly have been previously well, and being in a hospital environment could be something new and overwhelming to them. In government hospitals, patients are usually in a room with multiple patients. Have the patient understand and believe that you understand whatever feelings that they could be experiencing which could be rather overwhelming. Being a health professional also requires that our decisions and actions are ethical in the workplace, thus it is important that you introduce yourself to the patient and that you also explain your treatment plan, and thereafter gaining consent from the patient before commencing treatment (Artino, 2015).

Furthermore, this poem created feelings of being receptive, perceptive, empathetic and lastly that it was a vicarious experience as I gained more emotion-based knowledge . This assignment has influenced my ability and will to express myself to my patients and colleagues, and to practice patience in my everyday life. This poem was effective considering my initial individual review of it: I have resonated more towards considering patients emotions when they are in hospital, as it is vital to engage in a holistic assessment and treatment of the patient to ensure an effective recovery. While I was reading the poem, I was able to imagine myself standing at Mary’s bedside as she smiles at me with vulnerable eyes, yet highly motivated to recover and go home to her four children, even though this is sadly not how her story ended.

Furthermore, this poem has changed my views on patients in hospital. They are more vulnerable than ever, and it is important to understand that the patients could also be under the influence of strong medication, and they wouldn’t always refuse treatment without a valid reason to do so. I feel much more compassion towards the patients that I have already treated, even though the chances are great that I would never see them again.

This has encouraged the importance of empathy when dealing with patients in any setting. Gain and maintain a good relationship with your patient, and it is important that you gain your patients trust, and that you respect it once you’ve gained it. As I mentioned in the beginning of this assignment, it is important that you treat them as a person and not as a diagnosis.

References

Artino, j. N. (2015). “But how do you really feel?” Measuring emotions in medical education research. John Wiley & Sons Ltd. MEDICAL EDUCATION, 138 – 146.

Newman, K (2016). “The benefits of being a patient person: Good things really come to those who wait.” Mindful: Healthy Mind, Healthy Life. Retrieved November, 2018 from https://www.mindful.org/the-benefits-of-being-a-patient-person/

Oxford dictionaries (n.d.)  Definition of frustrate in English by Oxford Dictionaries. Retrieved November, 2018 from https://en.oxforddictionaries.com/definition/frustrate

Oxford Dictionaries (n.d) Definition of Hok in English by Oxford Dictionaries. Retrieved November, 2018 from https://en.oxforddictionaries.com/defintion/hok

Unknown Author (2016) “Forced Removals in South Africa” South African History Online: towards a peoples history. Retrieved November, 2018 from https://www.sahistory.org.za/article/forced-removals-south-africa