Communication, patient-provider (photo taken from http://www.aafp.org/fpm/1999/0500/p23.html )

I was doing my usual morning rounds last tuesday when a watcher of one of my patients approached me before I saw their patient in his bed. This watcher mentioned that someone went inside their patient’s room and asked questions that raised the curiosity of the family. The watcher spoke a different dialect and though I understood most of what she’s trying to convey, she fumbled with words and was obviously concerned at the “questioning” incident. I asked about the details of the incident, but none of them can give me a clear idea what was the “questioning” all about.. All I can deduce from the watchers was that someone asked them and “implied” a question of competency  and thus are worried about their decisions in seeking my care.

Unfortunately, none of the watchers asked (they are probably too shy or too gentle) the name nor remembered the identity of the person. They describe the interviewer as wearing a white dress and was asking other questions like “Why go to this hospital?” or “Who told you or referred you to this institution?”.

I asked the family then if this did affect their perception of my competency. I heard a resounding “Hindi po” or “No, it didn’t”.

I suddenly remembered who the interviewer could be. None of these watchers realized  that the interviewer was actually  doing a sanctioned survey.  I have yet to encounter this response variance (meaning, the watcher doubted competency as a result of being interviewed) in any surveys I’ve been involved. This however pointed out one thing- a communication gap between the interviewer and the interviewee. The interviewer broke protocols by not introducing herself (blinding?) which rose suspicion and doubts on the part of the interviewee. Imagine what a simple mistake like this evoking a different response!

I  felt relieved discovering this fact but was bothered by the communication gap. I spent more time explaining the survey and placate these watchers apprehensions. This time spent explaining will go a long way protecting a provider’s image from a simple neglect of introducing oneself before any patient or watcher’s interaction.

So doubts? Nah. But I’m sure that staff will have something to learn from communications 101!

Copyright secured by Digiprove © 2011 Remo Aguilar

Patients with a bantay or 'counsel' photo taken from this site (http://www.umc.org)

It’s not uncommon to see a patient or a patient’s relative bringing along some unrelated individual as “counsel” in your clinic. This counsel is unique among my Filipino patients and such counsel’s role has baffled me ever since I started my medical career. Roles, that to my knowledge broadly range from just plain ambulatory assistant or worst, to a nagging and combative counsel to the patient. I have tolerated such roles before because at times they can be very helpful in educating patients and relatives who haven’t had any time to convene a family meeting on their health issues at hand. But a recent bad experience with a ‘counsel’ pushed me to institute a policy of “no non related guardians allowed” inside my clinic.

My patient was a 10 year old girl who sustained a supracondylar fracture from falling over a park statue where she was playing with her cousins. The kid was brought to my clinic after 3 days, on a makeshift splint and after 3 sessions with a known bone setter in the area. The elbow is already grayish blue in color and is still swollen. The kid is wrenching in pain but  I can still feel the pulses and there are no signs of compartment syndrome. The mom brought with her a “counsel” after the bone setter allegedly ordered an xray. In my setting here, even if we’re already an urbanize city with a tertiary level hospital at that , bone setters are primarily the first one being sought by patients or their relatives when dealing with fractures. It’s even very common to hear bone setters manipulating fractures and ordering x-rays! Anyway, what bugged me that time was the way this ‘counsel’ is disrupting my talk with the patient’s mom.

I was explaining the diagnosis and the treatment options to the mom, baring that a surgery is already needed in her daughters case. I could employ a conservative treatment (if cost is prohibitive to the parents) but the results, which I explained carefully to the mom, would be unacceptable and costly in the end. The ‘counsel” is impolite in drawing attention of the mom, and whispering barely audibles that as I can figure out was a urging the mom not to have the surgery done and bring back the patient to the bone setter. The mother was very much bothered and was in fact becoming inattentive to me because of the constant nudging of this counsel.  As it grew frustrating to me, I looked straight to the counsel’s eye but politely asked the mom what is this counsel’s relation to the patient or the mom. She was a neighbor, the mom told me. She was also the one who brought the kid to the bone setter for manipulation twice! I asked the mom again politely of course, to ask the counsel to leave the clinic now and just wait outside. I also urged the mother to call a family meeting and talk with her husband the treatment options I laidout for the patient.

Well, that didn’t happen. The counsel refused to leave and worst, she kept on annoyingly nagging the patient’s mom.  This prompted me to talk directly at the counsel, ask her that if she doesn’t stop disrupting our conversation, she’d answer for all the complications her constant nagging has brought to the patient’s condition. And she’d be thrown off the clinic’s premises for good!

Then there was this an uneasy silence. Everyone in the clinic knew that my usual cool composure got blown by this annoying ‘counsel’. Everyone was silent for at least 3 minutes. When the counsel was escorted out of the clinic, I apologized to the patient’s mom, not for throwing out the counsel, but for the disruption in our conversation. She just smiled and from that moment on. I know I won another loyal patron.