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– Many people trust only information from the Google search engine and recite what they read on the Internet from the door – says Dr. Anna Andrukajtis, a family medicine specialist with 30 years of experience. Such patients come to the office only to confirm that they have chosen the right path by treating themselves according to their own ideas and to ask for a referral for free examinations. Then I have no choice but to write in the card that the patient has decided that he will heal himself and has been notified what it may result in.
- Patients expect that as part of the insurance they will go to facilities they saw in the series “For good and for bad”, and the therapy will be fast, effective and painless – doctors complain
- The bane of healthcare professionals are demanding patients with enormous requirements who trust Google more than the words of a doctor
- – I listen to paeans on hydrocolonotherapy, dehydration pills or Dr. Dąbrowska’s diet – says Dr. Anna Andrukajtis, family medicine specialist with 30 years of experience
- – I answer then: if these spells worked, you would use them in all hospitals and clinics, instead of enduring invasive tests and exposing yourself to tomocomputers – he explains
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Coronavirus, disease and death are already inseparable elements of our daily lives. The pandemic has weakened faith in our health system, which is not very strong, and has sparked harsh criticism against medicine in general. However, it is not the patient’s disease, and his behavior may now become the greatest challenge for doctors.
Far from the hospital in Leśna Góra or the department of Dr. House
For several years now, the bane of healthcare professionals has been a demanding patient, a person with requirements that are excessive in relation to the capabilities of the system. She expects that as part of the insurance, she will go to a facility similar to the elegant hospital from the series “For good and for bad”, and that the therapy will be fast, effective and painless. Just like in American series, where suntanned and constantly smiling specialists deal with difficult cases, sitting in a study with obligatory leather furniture and paintings decorating the walls.
Psychologists explain the excessive expectations with the growing hedonism in society, which manifests itself in the search for easy and effective solutions in every area of life. In conjunction with the fashion for self-presentation, it causes a real rush of home-grown authorities. Proof? A sharp dispute on the air of windsurfer Wojciech Brzozowski with dr. Michał Sutkowski. Or the public statements of celebrities – Edyta Górniak and Viola Kołakowska – the first questioning the need for vaccinations, and the second the existence of the pandemic.
– Everyone knows best and expresses their opinion loudly – says Marta Boczkowska, health psychologist. Doctors are increasingly confronted with resentful, aggressive patients, so they must have a coping strategy at hand. It is impossible to forcefully persuade, but you have to get out of this relationship without feeling losing your authority.
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Especially in primary health care facilities, there is an increase in faith in alternative therapies, negation of the need to take medications, vaccinations or the use of modern medicine in general. Patients find online or learn from friends about miraculous treatments that are a panacea for all suffering.
– I listen to paeans about hydrocolonotherapy, tablets for dehydration or the diet of Dr. Dąbrowska – says Dr. Anna Andrukajtis, a family medicine specialist with 30 years of experience from the Pomeranian Voivodeship – and I say: if these spells worked, you would use them in all hospitals and clinics, instead of enduring invasive tests and exposing yourself to tomocomputers. However, hardly anyone believes me …
– Many people trust only information from the Google search engine and I hear from the door that statins kill – he adds. – Patients have become smarter than doctors, and they do not show willingness to cooperate. Then I have no choice but to write in the card that the patient has decided that he will heal himself and has been informed about what this may result in.
Some associate the decline of the authority of traditional medicine with the country’s political climate and sectarian behavior. They give examples of mothers demanding a written guarantee from their pediatricians that their baby will be fine after being vaccinated, despite having been warned about the possibility of a fever or a vaccine reaction. The necessarily limited time spent visiting the clinic does not allow for an agreement, and patients often take this as a sign of reluctance to provide information. So they start looking for conspiracy theories on the internet.
The patient has and uses free will. He often comes to the office only to confirm that he chose the right path by following his own treatment, so he asks for a referral to a free examination.
– I ask then, do you want to check? At the nurses, there is a notebook in the surgical room, where all the studies of the world are written – says Dr. Andrukajtis. – Please choose some and buy them. This way you can be diagnosed every week. You probably don’t know, but the tests are to help the doctor so that he can cure you quickly and painlessly. You’re not incapacitated, so use your therapies as you see fit, but without me.
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– Patients who overdiagnose themselves are also a problem of our imperfections as doctors – says Dr. Paweł Basiukiewicz, cardiologist from Primula Clinic in Grodzisk Mazowiecki. – Healthy, but looking for diseases within themselves, insist that they will probably die soon, so it is necessary to do such and such tests. It is not easy to work with them, but I will not say that I would like to get rid of them. They also need help, although I do not understand this behavior and that’s probably why I find it difficult to reach them, because if the patient does not understand something, it is usually, unfortunately, the doctor’s fault.
The purpose of the visit is to solve specific problems during the visit
A primary care physician working in a clinic in Silesia recalls that a visit to his office usually begins as follows:
- Hello, I’m listening, how can I help you?
- Because you know, doctor, I was with my family last week. And with my husband, sister and brother-in-law we went to the mountains. And I normally feel bad in these mountains, but now it kind of felt good, I won’t say, even good, you know the doctor …
The story could easily last an hour, and he would first like to hear specific information about his ailment.
Dr Katarzyna Śleziak-Barglik, head of the POZ clinic in Ruda Śląska, appreciates patients with a task-oriented attitude:
– A patient close to the ideal is a person who has prepared for the visit – he says. – Firstly, she is punctual, secondly, she thought that she would be examined by the doctor, so she should dress in such a way that it is easy to undress. It sounds prosaic, but a lady in office clothes with a narrow dress fastened at the back and a button-down blouse underneath takes more than five minutes to undress. Third, he knows what to expect from the doctor. Nothing prevents her from rethinking her visit. She planned how to tell what’s wrong with her, since when and whether it gets worse or better, or maybe nothing changes. Finally, a person would like the patient to listen to him.
In addition, the work of a patient who knows the names of the medications taken makes it much easier for doctors. Older people are usually treated by several specialists and each of them must know what drugs they are taking, if only so as not to duplicate them.
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– Sometimes I ask the patient to bring all the medicines he has at home, because I feel something is wrong – says Dr. Śleziak-Barglik. – And when I look at them, I discover a few with the same effect, because once he bought a replacement in a pharmacy, then he did not realize it and as a result, for example, takes three statins, hurting himself. I recommend that you carry a list that is updated with the change of medications in your wallet. The list may come in handy if an accident occurs, such as a patient falls in the street and needs to call an ambulance.
– I teach students about the phenomenon of “questions at the door handle” – says Marta Boczkowska. – It verifies that the visit has been well conducted. If the patient, when leaving the office, asks key questions, it means that the specialist did not take care of its proper course. He did not ask, summarized, did not check whether the patient remembered everything. And research shows that only about 30 percent remember the visit. information. Specialists should have such a check list in mind with the most important things that the patient is to receive from them.
The treatment process is also about building mutual understanding and trust
Dr. Andrukajtis emphasizes that the relationship is built by both sides and it must be based on truth. The most important thing is that the patient should be honest, not lie, make up ideas, color and stretch. Even if he needs a few days off to dig.
– I remember that I prescribed my patient medications for diabetes – she recalls. – During the control, I check the tests, and there is 300 sugar. So I ask, how is it possible that your sugar is so high? And I hear the answer that he is not taking drugs because he is afraid. Trust ran out. She did not believe that I was treating her in such a way that she would live long, without complications and that she would not go blind in six months. I proposed to change the doctor.
– The patient always receives a card from me – says Dr. Śleziak-Barglik – but many times I found out that writing everything down does not help if he does not understand it, so I explain and explain again.
Paweł Basiukiewicz: – We should not be proud and believe that only we are infallible. A patient completely unproblematic would be like a computer program, some sort of bot programmed to obey our orders; do regular tests, bring a file of results in chronological order, always remember what medications you are taking and in what doses, follow all our recommendations, listen, understand everything, don’t have your own ideas for therapy and don’t ask questions. If someone counts on a patient who behaves like a computer program, they will be disappointed. Everyone is different and each requires patience and multiple translations. And also humility, because if there is a misdiagnosis or misconduct, we should admit and say that we made a mistake.
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The ophthalmologist, professor Zofia Michalewska from the Jasne Błonia Clinic in Łódź, adds: – In ophthalmology it is best to cooperate with patients who are willing to co-decide about their health. A well-read patient with whom different treatment options can be discussed is highly appreciated, especially when considering the doctor’s opinion. When it is necessary to decide how far he will be able to see well after cataract surgery under the National Health Fund, in other words, he will either drive a car or read without glasses, it is better if he decides himself than to say: choose it. Ophthalmology, however, is a specific field, without detailed research it is impossible to make a diagnosis, it is impossible to treat serious eye diseases based on knowledge from the Internet.
– The patient is responsible for recovery and the doctor is responsible for treatment – says Marta Boczkowska. – This is a very clear division. If their relationship lacks empathy and understanding, suspicion and resistance to therapy will arise.
It’s a lot of fun that it helped
Cooperating patients, those who regularly show up at the clinic and react positively to the doctors’ efforts, are really common. Good relationships translate into the effects of treatment, and at the end both parties feel a lot of satisfaction.
– In the era of teleporting, for a few days I carried a note from the patient in my pocket, saying: “Doctor, I am asking for such and such drugs. What you wrote me recently is wonderful. I breathe normally and sleep! For the first time in a long time, I got a good night’s sleep ”- says Dr. Śleziak-Barglik. – Whenever I can enter in the file that it is better, I feel happy that I helped. The usual “thank you” gives me wings – he adds.
Dr. Basiukiewicz also thinks that he is not original, saying that all the hardships of his work can be rewarded with the words: “Doctor, I feel so well. Revelation! I did more tests and I am healthy. “
– I remember today, I had a patient once, no spectacular case, a young person with high obesity – he recalls. – It seemed to me that the first visit was a complete failure, although I talked with her for quite a long time. In a year she came back slimmer … by over 20 kg. When she walked in, I didn’t recognize her. It was only when I looked at the card that I found out who it was. My body weight was recorded there – 110 kg, which is pathological obesity. This result gives you wings. Anyway, she thanked me, although this is no special merit, I just made a visit, and how much work this woman put in, only she knows and everyone who has lost 20 kg during the year.
On the other hand, Dr.Anna Andrukajtis claims that the response to respect and the heart is automatically answered with the same:
– Some patients call me: “Mrs. Anna”, “princess” or “sweetheart”, which does not bother me at all. Those who perform the tests, keep notebooks with blood pressure and sugar measurements, are polite, always come clean or even with a tie, I answer calls at any time of the day or night.
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