In Dr Roberta Lamptey’s experience, most doctors who come in to the Korle Bu Polyclinic as patients simply want a routine medical examination as part of a new job application. In this respect, this particular doctor was different. He had a fever, had treated for malaria but did not feel better.
Screening him for diabetes among other tests, he was found to have an elevated random blood sugar. But perhaps because he was completely symptomless, he attributed it to the fact that “he hadn’t been feeling too well and he had also had a few sugary drinks lately.” To confirm diabetes, fasting plasma sugar and HBA1C tests were ordered. Both tests returned results that not only confirmed a diagnosis of diabetes mellitus but also dispelled any fancy notions that this was some sudden development that somehow started out of the blue.
Even so, after six months, not much had happened –doctor did not quite agree with the diagnosis although he fully met diagnostic criteria and treatment was certainly not being contemplated! Welcome to the complex world of the doctor-patient, where judging from the response of some doctors to ill health, it would appear that some doctors struggle to come to terms with their own ill health, its complications and from death!
Dr Lamptey and her doctor-patient agreed to do a second confirmatory test. This also put the diagnosis beyond dispute. At this point, the doctor accepted that he had diabetes. With this opening in the relationship, Dr Lamptey did a series of tests to enable her assess the state of the kidneys, cholesterol levels, checked out the blood pressure and the state of the patient’s eyes etc.. Suffice it to say that all these tests returned highly disturbing results which she subsequently factored into his diabetic care plan.
Appreciating how important it is to work with each patient through whichever psychological state – denial, acceptance of diagnosis, compliance with treatment plan etc., --Dr Lamptey has tried to draw the doctor-patient’s spouse into the care plan. Even so, another six months later, although doctor now accepts to take his medication, challenges still remain with nutritional management and physical activity.
Why are some doctors, knowing what they do about disease and the effects of their complications, comparatively such terrible patients? And why do some so stubbornly refuse to comply with the rigorous treatment plans outlined by their doctors? It would appear that on this score, Dr Lamptey has seen it all— doctors with high cholesterol who will not comply with their statin therapy, doctors with hypertension whose fathers and grandfathers had cerebrovascular accidents but who will not do anything about their own conditions, doctors who know that pre diabetes and early diabetes are reversible but will not comply with the treatment plan, doctors who clearly do not have control over their high blood pressure but are quick to blame it on dumsor (power outages) instead of agreeing to a medication review, doctors who on experiencing some blurred vision, see an optometrist for new spectacles but never bother to have the underlying retinopathy or its root causes diagnosed!
Are these doctors different from other patients who suffer these conditions? Can’t doctors also fall ill? Don’t doctors die? Dr Lamptey has a hypothesis for this unique challenge with the doctor-patient.
“You know that as a doctor, your role is to take care of your patient. The challenge is relinquishing that role when you become that patient. I think that being able to step back and say that I can’t take care of myself and that I need you to take care of me is a huge challenge for some. Many doctors find it difficult to let go of the doctor role and take on the patient role. How many doctors have a family physician? I mean as for surgery, when it becomes critical, you will certainly go and have the operation, but to have a family physician, especially as you hit 40, that will provide all round care for you as a doctor, seems to be a challenge.”
Doctors counsel their patients on the need to increase physical activity and yet in Dr Lamptey’s experience, many doctors actually live a most sedentary life. The above challenges notwithstanding, Dr Lamptey, a family physician, has had great success managing many doctors. She seems to have achieved this through a combination of skills acquired from balanced training as a family physician and from endearing interpersonal relations. I ask her to share what strategies and approaches she has found most helpful over the years in the clinical management of the doctor-patient.
Continuity of care – doctors, perhaps like other patients, like to be seen by the particular doctor that they have finally become comfortable with. So if it is Dr Lamptey they are seeing, they prefer it to stay that way or in her absence, to be seen by someone in her team. The Korle Bu polyclinic likes to be sensitive to this and to meet the expectations of doctor-patients in this regard.
Open communication – establishing open channels of communication where the doctor-patient’s views on the medical condition are respected helps. Basically, the aim here is to get the doctor-patient to see what you are seeing, especially as family physicians are trained with the big picture including all potential complications in mind. So while the doctor-patient may not immediately agree with the need for an ophthalmologist’s review after years of being hypertensive and/or diabetic because “he’s fine”, you may need to discuss this sensitively with them and agree on next steps.
Family support – the presence of a spouse during diagnosis and discussion of a management plan yields great results, in Dr Lamptey’s experience. Even so, the observation is that “it is very difficult to get doctors to come along with their spouses” and it is necessary to have a specific conversation around this.
Keep the medicines simple – if it is possible to give treatment regimens that minimally disrupt the doctor-patient’s busy schedule, you are most likely to get compliance.
Understanding the doctor-patient wherever he/she is mentally in their treatment – be it in pre contemplation, contemplation or action phase, the ability to assist with appropriate advice relevant to that mental or psychological state helps to carry the patient along and indeed makes a difference. In this regard, one will not be talking about different types of exercise when the patient is yet to come to terms with the diagnosis.