This year, alongside our primary care placements we have started our portfolio on the life of a patient with a chronic disease. In the first week our new GP tutor took us to the patient's house so we could take a detailed history and to try and build up a relationship.
Our allocated patient 'Mr J' is a gentlemen in his 90's who claims he is 'just getting old'. He can tell us that he's been to hospital a few times and that he has angina. He is immobile and has daily carers to get him up in the morning. He lives with his French wife and dogs, spending most of his time on the sofa; thinking fondly of the times when he could go for walks and fix up his garden. We later found out from the GP that the patient also has chronic heart failure, AF and renal tubular disease. Mr J appeared to enjoy talking to us and telling us about his life and his family, however his wife was keen to stay out of the way.
I sensed from the moment we were invited that we weren't really 'invited'. The wife begrudgingly offered us a chair to talk to the patient and went outside to smoke and scowl at us. I must point out that patients are briefed by the GP beforehand so they know what to expect- it wasn't as if the visit was unplanned! Despite this, we felt we had made good progress with Mr J; that was until the wife came in to ask us not to come back! My GP partners and I left the house feeling frustrated, confused and a little embarrassed. We were all very friendly and polite and had never come across this before. What would our new GP think of us?
On our arrival back at the surgery, we swallowed our pride and gave the GP an honest account of what had just happened. Thankfully he was very understanding and offered us empathetic smiles. He apologised to us for not finding a suitable patient for us to study and said he would speak to the couple about them withdrawing from the scheme and potentially find us a new patient.
A week before our next primary care visit, we received an email from the GP informing us that Mr J was back on the programme. This made me feel uncomfortable; having to try and build up a rapport whilst knowing that we're not really welcome their home.
When it came to the 2nd visit, it was a similar experience as before with the wife hiding in the garden. We had already come to terms with her unfriendly mannerisms so we tried not to read too much into it. Things went well with Mr J and we only had a few things to ask before returning back to the GP practice.
As we were about to make tracks we were confronted by the wife who asked us what we were actually doing with her husband. She couldn't understand what we could learn from talking to him, she kept saying 'he could just lie to you'. She interrogated us further asking why we hadn't examined him if we were learning to be doctors.
This got us thinking on our walk back from the house; there could have been a number of reasons for her questioning. Could it be due to cultural differences? A biomedical view that a doctors' perceived role is to treat only illness? Or was there something she didn't want him telling us? It could even be her way of making us aware that she still wasn't happy with us being around.
This has made me really grateful that our curriculum includes a biopsychosocial approach. Treating patients as physical diseases is so old fashion, it's all the other stuff that makes us what we are. Of course it is important to address health issues, however we must have concerns and considerations for social and psychological contributions.
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