When the obstetric patient says "no"

Have you ever wonder what is going through the patient’s mind when they say no as we approach them to ask for a history or to do physical examination? Some of them are obviously really sick; in that case just look back on the term empathy. But this is a real life situation of one of the patient I manage to get very close to in orange ward during my resit posting and this is what she requested me to share with everyone.

Praise to Allah The Almighty, Who had planned all the wonderful things in life in its many forms. Again, I say, resitting O&G could be the best thing ever as I manage to gain a lot of new information regarding the posting. Not only that the theory part of medicine was fed, but the PPD part was also filled with new experience. I manage to get close to one of the patient in orange ward. She was admitted due to cervical incompetence post cervical cerclage that apparently had loosened. She was diagnosed with threatened preterm labour. Because of this, she was one of those patients where the ward is their 2^nd home as she was not allowed to go home and had to be on bed rest until delivery. After more than 2 weeks, they changed her bed (as always) and she was put together among all those patients who are also “at home” in the ward, usually the patient with placenta praevia.

Madam L was used to entertaining the students and answering questions when she was at her previous bed but when she moved to the other bed, the environment become different. We know that most patients with PP don’t usually entertain students as they had probably seen us more than 10 times a day. Therefore, entertaining students had become an abnormality to them. In fact, words are circulating around that apparently these students, or us students were meant to be forgotten. When Madam L routinely welcome students to take history, the other patient asked her “kenapa dilayan budak-budak tu, lain kali jangan dilayan…” what on earth?? Thus, madam L feels like she was caught in the middle between the students and her friends. So the ward really is a place like home to patients and they have neighbors around. Whatever is going around in the ward, the story is circulating around like what neighbours normally do when they are living in a functional society. I thought… this is something quite new to me. I think it’s normal to think that patients can get bored entertaining students, but to think that they are circulating around a stigma against us? I was quite sad, at the same time happy as I managed to gain this information. If I were to write a case report…..hah!its going to be way spicy (I like my reflective writing spicy)

Luckily, I did not waste the chance to correct the stigma. In fact, not just to madam L, there are also some other patient that usually don’t like students especially guys to mingle with their tummies, asked the same question. Apparently, not all patients understand the function of us students the lowest being (and greatest in number) in the “ward pyramid”. Sure some make us feel like we are the parasites feeding on patient’s sympathy to gain something so that we can live today, but come on people, thou some of the lecturer like to condemn us and send us way down to rock bottom (the name of the lowest most darkest city in the cartoon spongebob squarepants), but believe me, we are much more than that. These are some of the points I told her

1. We are medical students that will surely become doctors, without us there will be no doctors to treat our children and the future generations
2. Your problem will be faced by us again in the near future, if we learn from you, and you let us learn a lot from your problems, it is the same like you are saving the patient in the future too. Take the credit.
3. Even though there are guys, but don’t see them as guys, see them as doctors. Just as much as girls need to learn, they need to learn as much. Please give them support as they find it very hard to get the O&G patient’s consent
4. We did not come just to ask question, palpate the stomach and go home empty handed, you, the patients are our best teachers and we learn a lot just from one patient
5. When patients welcomed us, it will be our most beautiful day and we will be very very happy. Making others happy is very good for the soul
6. We really need patient’s support, sometimes lecturers shouts at our faces, obviously we will be crushed if patient’s also turn away their faces to us
7. Don't worry much about what other people want to say, if whatever we do for others makes us feel good then just continue doing it. Let Allah be the Judge of our doings
8. Patient’s is our sun in this dark life of medicine, you make us happy, gives us hope, information, company and we are so grateful for that (well I did not exactly say this, but she get the point)

What can be done

This is what the patient suggested...

When patients are admitted, they will have sort of an orientation of the ward. During this time, they will be briefed regarding the do’s and the don’ts of the ward. Maybe entertaining student should be put under the do’s so that they will anticipate our presence. So anyone got a suggestion where should we raise this issues? (if we want to raise it that is)

The patient’s right to say no.

Of course don’t forget about this. All patients have their own rights. We don’t force the patient, but it is not us only that benefited from the patient, they also benefited from us. We need to make them see that and we also need to feel that in order to gain confidence to approach the patient.

As Mar suggested…

When approaching a patient makes it clear to them that we are students, learning to become doctors and we need their help in order to gain much knowledge (something like that). So what if our introduction is too long, if we can destroy the negative stigma against us, I say it’s definitely worth it.

Treat patient as a whole, become a better student so that we will become better doctors. UKM can produce many doctors that are intelligent, but how many of them are holistic doctors?? Lets us make it so that all of us are…

This article is made in hope that student-patient relationship will strengthen and students (especially to myself) will gain more confident to approach the patients.