They may not have money – Suggesting them to join a gym or eat organic foods may not be possible for them. They may be dependent on WIC or food stamps.
They may not have support – You may require them to have someone who can drive them back after the procedure, but they have no friends or family around town to do so, and thus opt out of getting the procedure.
They may not have a car – What time (and whether or not) they can make it to their appointment may depend on what time their ride gets off work, or fixes their car. They may have had to walk to your office, on roads without sidewalks, in the rain, with a walker.
They may not know how to read – They may be too embarrassed to tell you that they cannot read the patient education packet you just printed out for them to learn about their condition, or the directions on the prescription bottle, or the developmental screening questionnaire you gave them, so they just randomly circled their answers.
Their priorities may be different from yours – You’re thinking they need to stay in the hospital at least overnight to be observed, and they are thinking of leaving against medical advice so they can go home and feed their dog.
They may not care about what they cannot see – They may not understand why taking their blood pressure medicine is all that important because they cannot see or understand what blood pressure is. However, they may care a whole lot about trying to get rid of the relatively benign and harmless keratosis pilaris on their arms.
They may not want a treatment for their problem, but an answer – Pain pills may not be what they want for their chronic pain. Sometimes all they want to know is why they are having pain, and if it’s going to be forever, and they’re fine with just dealing with the pain. Sometimes they may refuse to take an antibiotic empirically without first knowing which bacterial species exactly is causing their symptoms, fevers, and elevated white blood count.
They may not want to know what’s going on – They may not want to know about their HIV status or workup that nodule. They may prefer not knowing, because they fear getting bad news.
They may want a say in their care, or not – They may just want to hear options from you and decide for themselves what to do. Or, they may prefer you to make all their decisions for them because after all, “you’re the doctor.”
They may know more than you on certain things – You may not have children of your own, but they may ask you questions like how to make their kids eat their broccoli, or what can they do for their kid’s temper tantrums. You may be a man, but they may ask you how to breastfeed a newborn who has trouble latching.
They may not like medicine, or even doctors – They may feel like every time they come to you, you will always tell them something is wrong with them and give them medicine they do not want to take, even for the smallest problems, and all they really want is for you to reassure them they are fine.
They may want to be heard – An adult with Downs’ Syndrome or Autism may have a caregiver legally making decisions for them, but they may still have their own goals in life and desires like other adults do. They may appreciate it if you to speak with them directly and respect their wishes as an adult rather than only conversing with their caregiver.
They may not want to be rushed. Or, they may be in a rush – Maybe a more detailed explanation is what they need to understand what they are supposed to do. Or conversely, maybe they don’t have time to listen to preventative counseling.
They may not use the same vocabulary as you – Maybe they’re afraid to ask you to re-explain something you just explained because they don’t want to trouble you or feel embarrassed. Maybe a more simple explanation is what they need.
My name is Benji Ho and I am a family physician and 2013 graduate of the American University of the Caribbean School of Medicine (AUC), located on the Dutch side of the beautiful island of St. Maarten. My time at AUC has been quite a worldwide adventure, studying two years of Basic Sciences on the island, then completing my clinical rotations in the US as well as the UK. I completed my family medicine residency at Mercer University School of Medicine / Navicent Health in Macon, Georgia. Today, I am a board-certified family physician practicing outpatient family medicine in Macon, Georgia. I hope you enjoy my site as I share with you my journey. Thanks for visiting Diary of a Caribbean Med Student!
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