PS: This post was originally written on the Digital Health Africa platform on LinkedIn The recent decision by the U.S. government to freeze and potentially dismantle the United States Agency for International Development (USAID) has sent shockwaves across African nations. This move stems from shifting U.S. foreign policy priorities, debates over aid effectiveness, and domestic budgetary considerations. The reduction or elimination of USAID funding is expected to have far-reaching consequences, particularly in African countries heavily reliant on external assistance for healthcare and economic stability. This abrupt withdrawal of aid threatens to destabilize economies, cripple health systems, and undermine the efforts of countless non-governmental organizations (NGOs) that provide essential services. While this development is undoubtedly alarming, it also presents a crucial opportunity for African nations to rethink their approach to health financing and forge a path toward self-sufficiency. The Dire Consequences of Aid Withdrawal For years, many African countries have relied heavily on foreign aid to sustain their healthcare systems. Take Malawi, for example, where U.S. assistance accounts for 13% of its national budget and over half of its healthcare funding (World Bank, 2022). The immediate repercussions of USAID’s suspension include shortages of essential medications and disruptions in critical health services. These gaps will not only lead to increased mortality rates but will also place immense strain on already fragile economies. The impact extends beyond national governments to grassroots health initiatives. In South Sudan, halted food deliveries and shuttered health facilities have resulted in widespread malnutrition, further exacerbating an already dire humanitarian crisis (UNICEF, 2023). NGOs, which serve as lifelines for vulnerable populations, now face dwindling resources and uncertain futures. Without a rapid and effective response, millions of lives are at stake. Rethinking Health Financing: The Case for Public-Private Partnerships This crisis lays bare the urgent need for African nations to reduce their dependence on foreign aid and seek sustainable alternatives. However, this transition presents significant challenges, including the need for substantial investment in healthcare infrastructure, training healthcare professionals, and establishing efficient revenue-generation mechanisms. Many governments also face bureaucratic and political hurdles that slow down reform efforts, making the shift toward self-sufficiency a complex and demanding process. One such solution lies in strengthening public-private partnerships (PPPs). By leveraging the financial, technological, and human resources of the private sector, governments can create more resilient health systems that are less vulnerable to external funding fluctuations. The success of PPPs is not just theoretical. In Kisumu County, Kenya, a strategic public-private collaboration during the COVID-19 pandemic enabled the efficient mobilization of resources and enhanced the region’s healthcare response (Shannen van Duijn et al., 2023). This model demonstrates that by integrating private sector expertise into public health initiatives, governments can drive innovation and ensure the continuity of essential services. Moreover, a 2019 briefing paper from the IFC Public-Private Partnership Think Tank highlighted the critical role of private investment in building sustainable health infrastructure (IFC, 2019). For example, Rwanda has successfully implemented PPPs in healthcare by partnering with private firms to expand hospital facilities and improve service delivery. Similarly, Nigeria's partnership with the private sector in developing the Lagos University Teaching Hospital has led to enhanced medical infrastructure and access to quality healthcare. These cases demonstrate how targeted investments can significantly strengthen health systems. When governments actively engage with private stakeholders, they open the door to innovative financing models prioritising long-term health security over short-term aid dependency. Air-Travel: A Plausible Solution for Healthcare Financing Over the years, UNITAID has pioneered innovative financing mechanisms by leveraging both public and private funding sources to finance critical health interventions. One of its flagship approaches is the Voluntary Solidarity Contribution (VSC) , which allows individuals to opt in and donate while making purchases, particularly during international travel (The Voluntary Solidarity Contribution on travel products (VSC), n.d.). The funds received are then directed towards the management and treatment of communicable diseases such as malaria and HIV/AIDS.  The VSC complements the air tax levy , where select countries have agreed to earmark a portion of airline ticket fees to support health programs. The levy is described as dependable and robust, given assured air travel globally and varies depending on the class of travel, ensuring a fair contribution model (Unitaid, 2017b). This initiative has had a significant impact—funding from a single ticket can provide life-saving HIV treatment for up to 60 patients for an entire year. Air travel can offer a sustainable health financing solution By adopting such sustainable financing models within the African region, African nations can reduce dependency on foreign aid while ensuring continuous funding for essential health services like HIV and malaria treatment. A Defining Moment for Africa The withdrawal of U.S. aid serves as a stark reminder of the perils of overreliance on external support. However, it is also important to acknowledge that in certain contexts, foreign aid remains crucial for addressing immediate health crises, supporting vulnerable populations, and complementing domestic efforts. In regions where governments lack the necessary resources or infrastructure to provide adequate healthcare, strategic foreign assistance can play a vital role in bridging gaps and ensuring the delivery of essential services. However, rather than viewing this crisis as a setback, African nations must seize this moment as an opportunity to redefine their health financing strategies. By fostering self-sufficiency through well-structured public-private collaborations, they can create robust health systems that serve their populations effectively and sustainably. Now is the time for African leaders to act decisively. The health and well-being of millions depend on it. The future of Africa’s healthcare should not be dictated by the shifting tides of foreign policy but rather by proactive and innovative solutions that ensure long-term stability. The time for action is now. References IFC. (2019). Public-Private Partnership Think Tank Briefing Paper. Shannen van Duijn et al. (2023). Public-Private Partnerships in Kisumu County. UNICEF. (2023). Malnutrition in South Sudan. World Bank. (2022). Malawi Health Budget Report. The Voluntary Solidarity Contribution on travel products (VSC) [Internet]. [cited 2025 Feb 16]. Available from: https://www.uhc2030.org/fileadmin/uploads/ihp/Documents/Results___Evidence/HAE__results___lessons/Taskforce%20factsheet_-_voluntary_solidarity_contribution_on_travel_products_EN.pdf ? French levy on airline tickets raises more than one billion euros for world’s poor since 2006 - Unitaid [Internet]. Unitaid. 2017 [cited 2025 Feb 16]. Available from: https://unitaid.org/news-blog/french-levy-on-airline-tickets-raises-more-than-one-billion-euros-for-worlds-poor-since-2006/ ?

A few years ago, "self-care" felt like a luxury—something for the wealthy or those with too much free time. I didn’t think it applied to me. However, after experiencing emotional breakdowns and extreme exhaustion, I became a self-care advocate. Now, I firmly believe it’s essential, especially for busy professionals The Irony of Healthcare Work Clinicians live in a paradox. We tell patients to: Eat well, yet we barely manage three square meals Exercise regularly, yet we don’t know where the nearest gym is Engage socially to manage stress, yet we miss even family events We emphasise self-care for patients but struggle to practice it ourselves. I know this all too well You Are Not a Machine And even machines need maintenance breaks lest they break down! You also need a break For a long time, I ignored the signs of burnout. I worked beyond my limits, telling myself that rest was a luxury. One day, I woke up for work and thought, “I don’t know if I’ll make it there alive.”  My body ached, and I had dozed off at the wheel multiple times. That moment was my wake-up call I made a conscious decision to fight for rest. Here’s what worked for me—and what might work for you too Minutes of Ease Mindfulness practices are key and they don't take too much time if you're pressed for it. Mindfulness exercises are helpful for the de-escalation of emotions, sustained clarity and mood regulation which has long-term benefits. Breathing exercises, for instance, are extremely useful for helping centre oneself. Before you make a crucial decision in a busy shift, I'd recommend it heavily. I also practised "10 seconds of affirmation" . I would remind myself "I am capable. I am strong. I will get through this." And it worked! Work Your Body It is difficult to dissociate mental wellness and self-care with physical exercise. Physical exercise increases the circulation of feel-good hormones (endorphins) that help with a more positive mental head-space and also give you a different view outside the hospital walls and ceilings (this helps massively). Self-care and physical exercise are synonymous The Medicine in Motion  initiative was introduced to tackle the issue of physician burnout and stress through fitness, philanthropy, and interdisciplinary community building. By bringing together physicians who understood each others' journeys and encouraging them to get physically active, MiM hoped to improve the mental health status of the enrolled physicians and expose them to the benefits of a community (Seward et al., 2020) . The group is still active and helps us see that it is possible to bring clinicians together, build community around fitness and help them improve their state of being Set Boundaries! If there is any sabotage of health and progress in and out of the workspace, there must be weak boundaries that feature somewhere. Self-care is synonymous with saying 'no' when necessary. Delegating tasks, and ensuring sufficient time is allocated for rest and personal activities are also key boundary-setting strategies. A study in PubMed  emphasizes the importance of setting limits and sharing issues with family and friends as strategies to avoid burnout Be Open About Your Journey and Foster Community Support No one thrives in isolation. Talking to colleagues about shared struggles can provide relief and practical solutions. Even if you’re introverted, a supportive work environment helps reduce stress and feelings of loneliness You don’t have to do this alone It takes a village to live well- do not ignore the role of community in your self-care journey Institutional Support Self-care isn’t just an individual responsibility—it’s a systemic issue Healthcare institutions must create environments that support well-being. Leadership commitment, structural changes, and reduced administrative burdens  are crucial in fighting burnout. The paper, Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout  by Tait D. Shanafelt and John H. Noseworthy notes that addressing burnout requires organisational action, not just personal resilience. As you Go Self-care isn’t selfish. It’s necessary If you’re feeling overwhelmed, take that as a sign: You need a break Start small. Breathe. Move. Set boundaries. Seek support. Advocate for systemic change. Your well-being matters—because you can’t pour from an empty cup.

"You seem a bit too young to be a doctor, when did you graduate?" I nervously chuckled and punched at the keyboard a bit more aggressively. Maybe my patient meant what they asked, maybe they were trying to evade their own tension (because I delivered heavy-hitting news a few seconds prior). Whether light or not, this patient dug at a sensitive place in my heart. Unbeknownst to him, I had been crying almost daily that week on my way to and from work. I wondered whether I deserved the title "doctor". I felt like I made too many mistakes to progress professionally. Each call from a consultant made my head spin. "Hello, is this Dr Wanjiku?" In my mind: "Is this when I get found out?" "Have I missed anything this time?" Call ends: a series of instructions for the night shift. My Mind: "I hope the patient does not die because of me..." This patient did not know. The Imposter Phenomenon is More Common than You Think Imposter Phenomenon (IP) is a behavioural phenomenon which involves doubting your capabilities and failing to attribute success to your ability. People with IP attribute their excellence to external factors and not their strengths. In simple terms, it is self-doubt. It leads to psychological, physical and emotional strain on those affected by it. It is crippling and reduces productivity. IP is associated with high-functioning individuals, which makes healthcare practitioners an unsurprising group of people affected (Huecker et al.) According to a paper by Iktidar et al., the prevalence of the Imposter Phenomenon is over 30% for healthcare students. The high training stresses and expectations and the pressures of daily living may create unhealthy expectations for those affected to perform well across the board. When we consider this, we realise that this thinking is not realistic. We are human beings who expect to fail from time to time. The Imposter Phenomenon is common and is highly correlated with poor mental health The Imposter Cycle The Imposter Cycle describes the processing in the mind of someone affected by IP. The Imposter Cycle is exemplified when there is a task at hand. Individuals suffering from IP will either procrastinate or over-prepare. Procrastination mainly happens because of the fear of failure or being 'found out' as a fraud. What follows is a last-minute delivery which may be exemplary. However, despite the praise and accolades received, the individual may feel like a failure for procrastinating and may feel like they would have done a better job had they prepared earlier. This perpetuates an unhealthy cycle. Over-preparation involves a painstaking effort of overanalysis and the feeling that the individual must work harder than their counterparts. They, therefore, over-exert themselves, possibly experiencing negative effects on their professional and social circles. A lack of excessive effort makes the individual feel like a fraud. Both procrastination and over-preparation are harmful ways of coping and are associated with mental health illnesses and suicidality according to a paper by Johansson et al. It is also notable that people struggling with IP may become more withdrawn, and overly competitive, develop mood lability in the workplace and have strained interpersonal relationships. These worsen the fragility of their emotional states, thus worsening their mental health outcomes. Predisposing Features of The Imposter Phenomenon Here are a few predisposing features to the Imposter Phenomenon: Being hyper-competitive and perfectionistic Super-heroism (desiring to be seen as the saviour of the day) Fear of failure Feelings of inadequacy Unhealthy comparison People-pleasing Excessive sensitivity to criticism You Can Flip the Script Hope is not lost. Through commitment and self-awareness, you can overcome IP. I recommend a few things that have helped me so far: Speak to your mind: Speak kindly to yourself and do your best to frame situations objectively. Example: You get a patient with complex symptoms. Acknowledge the complexity of the patient's symptoms and remind yourself that you are part of a team and can reach out to your team members if there are any challenges to providing care. Remind yourself that you are in a learning process and you have the support you need. When you do this, you remove the pressure of achieving results for yourself Be gracious to yourself: If you make a mistake, redirect your mind gently. You are learning. Remember this Lean on support systems: Reach out to systems of support. This can be a licenced therapist, counsellor, trusted friends and family and so on. Tell them what is on your mind and allow them to give you objective points of view to balance out your thinking Pray: I have so far experienced much success through spending time with God in prayer. I have taken time to speak His Word to myself and have seen God reveal Himself to me as my help. I do not work for myself, nor do I aim to achieve results for my glory. I am being perfected by a living god who cares for me and who desires me to rest in Him. Knowing this keeps me grounded and keeps my mind in a healthy headspace concerning tasks. I would like to know your experience with IP in the comments below! And if no one else has told you, allow me to remind you that you are not alone and you are a capable and productive healthcare practitioner .

As a medical doctor who has worked under various levels of pressure (mostly high), I have seen many patients, families and sadly, many missed growth opportunities. I have seen patients and their families walk away from regionally renowned doctors because they considered them rude, and went to less renowned doctors because they felt seen and heard. Intelligence is valuable, but heart matters when meeting people is involved. Here are 3 conversations that could have been redeemed if more patience, kindness (and manners) were applied. The Walker 🚫 Patient: “Doctor, you have just done a round on my spouse, but have not told us what is going on. Do you have a diagnosis now” Doctor: “Oh. He has brain cancer.” *Walks away ✅ Doctor: “I’m sorry. I should not have done that. We can have this conversation privately right now. Might you have a few moments to speak, please?” The Know-it-All 🚫 *Patient complains about a symptom repetitively during a ward round. The doctor gets upset. Doctor: “Who is the doctor here, is it you or me?” ✅ Doctor: “I can see you are frustrated right now…. Stops the ward round and delegates leadership to the second most senior staff member after them. “What is the matter?” listens intently. The Runner 🚫 *After the ward round, family members of one of the patients come toward the doctor, seeking an update (the doctor has probably had a busy day) Doctor: *Hides or passes them without any word, or points to another medical professional behind them ✅ Doctor: “Hello, how are you?…”We have just done the ward round and have seen ABC, we have made XYZ findings, we are following up on EFG and expect a response by (a specific day, if possible). However, I need to tend to something quite urgent right now, but my colleague (insert colleague's name) will detail everything I have just shared and clarify anything else you may need to know. I come for ward rounds on (mention days), and I am available to update you on the progress at (specific time).” The negative scenarios above are situations I have witnessed first-hand. I have seen their negative repercussions as well. My point here is that things may not be easy on you as a medical professional, but as much as possible, try your best to be the person you would like to be treated by.  Lead with heart.

Someone close to me shared a poignant account of how her husband received the news of his cancer diagnosis. "The doctor had been making rounds for about a week, and Dan* was growing increasingly anxious from the prolonged wait. He just wanted to know what was happening," she began. According to her, the doctor, after reviewing numerous documents, muttered a few words under his breath while standing at Dan's bedside. He then abruptly turned towards the exit. Dan, in a desperate attempt to grasp the situation, called out loudly. When asked about his diagnosis, the doctor, with an emotionless expression, uttered, "Oh, it's cancer," and left. I refrained from probing into the depth of trauma Dan might have experienced during that encounter; it most probably was marked as a distressing moment that still haunts him years later. Fortunately, Dan underwent successful surgical and medical treatments, entering remission and living a cancer-free life thereafter. A Double-Edged Sword As someone in the medical field, I can assert that no doctor desires to deliver negative news to their patients. I vividly recall confirming metastatic liver malignancy in one of my favourite patients, whose cheerful visits to the clinic with his loving wife starkly contrasted with the grim reality of his life-changing diagnosis. Witnessing the pain my medical advice inflicted on his family left me with a lingering sense of guilt. Seeing posters of his family's fundraising efforts for his treatment added to my remorse, almost as if I had played a role in the illness that besieged him. Being the bearer of bad news is a daunting responsibility, and my heart goes out to clinicians who routinely face this challenging task. Death and pain have a profound impact on the mind and heart. Never forget this as you practice. Handle with Care Acknowledging this reality, there comes a weighty responsibility to manage one's emotions and approach. As a clinician, you must deliver health-related news with the utmost empathy, an integral aspect of the Hippocratic oath you took. May you never forget. Here are some tips to ensure professionalism and effectiveness in delivering difficult news: 1. Verify the diagnosis with relevant practitioners, ensuring confirmation through necessary tests like a biopsy for malignancies rather than solely relying on imaging reports. 2. Consider the atmosphere; the delivery of "bad news" is unforgettable. Control the setting to the best extent possible, opting for a well-aerated, quiet, and private room. 3. Have support on standby; involve a counsellor or therapist and keep them nearby for emotional support, but not in the room during the initial revelation as this may create panic which may make the process more difficult than it already is. 4. Maintain composure and dissociate from emotional outbursts; as a healthcare worker, remember that this moment carries with it implicit structures that state that you hold a position of authority at this point, and patients and their loved ones look to you for strength and guidance. 5. Speak slowly, avoid jargon, and use clear language, especially when conveying news of death, to prevent misunderstandings and foster clarity. I am guilty of this as many times patients' loved ones would ask me "So when can we see them?" after I broke the news of their loved one's death. This was because I would use colloquial statements such as, "He/she has rested now" which is misleading and unclear, leaving room for denial to fester. Try your best to be kind but direct as you express a factual statement. 6. Allow time for questions; don't rush away after delivering devastating news. Offer to address any inquiries and provide additional support, especially after a significant event like the death of a loved one. Opportunities for Growth In the ever-evolving field of healthcare, there's always room for improvement. Reflect on past experiences, seek feedback from colleagues, and embrace opportunities to shadow more experienced professionals. Learn from their approaches to this crucial aspect of clinical practice to enhance your skills in breaking difficult news compassionately. *: Not his real name.

In my years of clinical practice, I have messed up a lot of times and achieved success in equal measure. In all these years, though, I have learnt that there are things that do not change: Medicine is both art and science The heart of medicine is in the human heart Always keep pushing Your patient is your biggest teacher (who always has a trick up their sleeve, always be keen!) ALWAYS. EXAMINE. YOUR. PATIENT. We will address the fifth point today. General Examination often comes after taking a thorough history of illness from the patent. It involves looking at the patient and their behaviour and body language, feeling for anomalies on their bodies and possibly using instruments to further refine the examination such as stethoscopes, otoscopes, speculums etc. In the dynamic realm of medicine, the power of the general examination cannot be overstated. It serves as the foundation upon which accurate diagnoses, patient-doctor relationships, and holistic understanding are built. For junior medical practitioners setting out on their career paths, the art of conducting a thorough general examination might seem like a daunting task. However, the journey is well worth the effort. In this article, we delve into five captivating reasons why embracing and perfecting the general examination is an absolute must for aspiring medical professionals. 1. Diagnostic Accuracy: Unveiling the Hidden Clues Imagine a puzzle with missing pieces. The general examination is akin to that crucial first step of finding those missing fragments. As a medical practitioner, your keen observations and touch can reveal subtle cues that might otherwise remain concealed. The tender swelling beneath the skin, the barely perceptible limp, the whispered quiver of a heartbeat – these are the details that can lead to precise diagnoses. By mastering the art of the general examination, junior doctors equip themselves with the ability to piece together these clues, thereby ensuring diagnostic accuracy that sets the stage for effective treatment strategies. 2. Holistic Understanding: Beyond the Obvious Human beings are intricate entities, and their health concerns are often interconnected in ways that aren't immediately apparent. A comprehensive general examination can uncover these hidden connections. Consider a patient presenting with persistent fatigue – a symptom that might be attributed to various causes. By carefully assessing not only the physical aspects but also delving into the patient's medical history and lifestyle factors, junior practitioners can unravel the complex web of influences that contribute to their condition. This holistic understanding empowers medical professionals to formulate treatment plans that address the root causes, enhancing the likelihood of sustained wellness. 3. Early Detection: Nipping Problems in the Bud In the realm of medicine, timing can be the difference between a manageable condition and a dire one. The general examination is a powerful tool for early detection. By being vigilant and attentive, junior practitioners can identify the subtle changes that precede the onset of more severe ailments. A seemingly innocuous rash might be the harbinger of a systemic allergy, and a minor irregularity in a routine check-up might uncover an underlying cardiac concern. Armed with this knowledge, medical professionals can intervene promptly, potentially preventing the progression of diseases and ultimately saving lives. See this real life experience here! 4. Patient-Doctor Relationship: Fostering Trust Through Care Medicine is not just a science; it's an art that thrives on human connection. The general examination provides a unique opportunity to build trust and establish a strong patient-doctor relationship. When junior practitioners take the time to listen, to touch, and to genuinely care for their patients, they lay the foundation for open communication and mutual respect. Patients are more likely to confide in doctors who demonstrate empathy and thoroughness, ultimately leading to better cooperation and adherence to treatment plans. The art of the general examination, therefore, becomes a bridge that connects medical knowledge with the human experience. 5. Educational Opportunity: Cultivating Excellence The journey of a medical professional is one of perpetual learning and growth. Embracing the challenge of conducting a proper general examination not only benefits patients but also contributes to the practitioner's personal and professional development. By striving for mastery in this fundamental skill, junior doctors cultivate a mindset of excellence that extends to all aspects of their medical practice. Every patient interaction becomes an opportunity for learning, refining techniques, and expanding diagnostic prowess. This commitment to continuous improvement sets the stage for a fulfilling and impactful medical career. To Wrap it All Up In the intricate tapestry of medicine, the general examination stands as a cornerstone of effective patient care. For junior medical practitioners, the path to mastering this art may seem steep, but the rewards are immeasurable. Diagnostic accuracy, holistic understanding, early detection, enhanced patient-doctor relationships, and a commitment to excellence – these are the five compelling reasons to persevere in perfecting the general examination. As aspiring medical professionals navigate their way through the complexities of the healthcare landscape, they can rest assured that this foundational skill will be their compass, guiding them toward a future of success, fulfilment, and meaningful contributions to the well-being of their patients.

The time is 9pm. It is now two hours into my night shift. A call comes in. The nurse on the line describes a newly admitted patient who needs a doctor's review. I reach the ward and find the patient I had earlier been briefed about. He has a chronic medical condition that is notoriously associated with excruciating pain from time to time. He is wearing the pain rather well. He’s even smiling past the dry jokes that I am pulling (I think humour somehow lessens the blows of illness). We had a pleasant exchange and after the history, examination and brief explanation of some of the things he sought clarification about, he asked a rather odd question. “𝘋𝘰𝘤𝘵𝘰𝘳, 𝘸𝘩𝘢𝘵 𝘥𝘰 𝘱𝘦𝘰𝘱𝘭𝘦 𝘭𝘰𝘰𝘬 𝘧𝘰𝘳 𝘸𝘩𝘦𝘯 𝘵𝘩𝘦𝘺 𝘴𝘲𝘶𝘦𝘦𝘻𝘦 𝘮𝘺 𝘴𝘵𝘰𝘮𝘢𝘤𝘩? 𝘉𝘦𝘤𝘢𝘶𝘴𝘦 𝘮𝘰𝘴𝘵 𝘵𝘪𝘮𝘦𝘴 𝘺𝘰𝘶 𝘱𝘦𝘰𝘱𝘭𝘦 𝘫𝘶𝘴𝘵 𝘵𝘰𝘶𝘤𝘩 𝘮𝘺 𝘴𝘵𝘰𝘮𝘢𝘤𝘩, 𝘤𝘰𝘷𝘦𝘳 𝘮𝘦 𝘶𝘱 𝘢𝘯𝘥 𝘸𝘢𝘭𝘬 𝘢𝘸𝘢𝘺.” I almost laughed but for the seriousness in the air. He also said, “𝘺𝘰𝘶 𝘱𝘦𝘰𝘱𝘭𝘦” which implied negativity. At this moment, I am hit with guilt because I’ve done this too. I’ve let the awareness of the lack of time or urgency of the examination erase one of the most overlooked practices in patient examination: 𝗲𝘅𝗽𝗹𝗮𝗶𝗻𝗶𝗻𝗴 𝘄𝗵𝗮𝘁 𝘆𝗼𝘂’𝗿𝗲 𝗱𝗼𝗶𝗻𝗴. During OSCEs (Objective Structured Clinical Examination) in Medical School, you would be heavily penalised if you missed simple steps such as introducing yourself to the patient, washing your hands before touching the patient, explaining what you’re about to examine (briefly) and even caring to warm your hands before coming to contact with the body of the patient! These steps may seem time consuming but they go a long way in building patient-clinician confidence as well as slowing you down so that you increase your clinical accuracy. Do The Work: Do Not Fear! A simple “𝘐’𝘥 𝘭𝘪𝘬𝘦 𝘵𝘰 𝘦𝘹𝘢𝘮𝘪𝘯𝘦 𝘺𝘰𝘶𝘳 𝘢𝘣𝘥𝘰𝘮𝘦𝘯 𝘵𝘰 𝘤𝘩𝘦𝘤𝘬 𝘧𝘰𝘳 𝘢𝘯𝘺 𝘴𝘸𝘦𝘭𝘭𝘪𝘯𝘨 𝘰𝘳 𝘢𝘳𝘦𝘢𝘴 𝘰𝘧 𝘱𝘢𝘪𝘯 (𝘦𝘵𝘤)” creates a strong link of communication that can encourage the patient to give more history (often remembering things they may have forgotten earlier) therefore helping you get a better idea of what’s going on. The patient is one of your best teachers (experience is another!) Another key thing; when results to lab tests or imaging come out, do not find it wasteful to fully discuss findings with your patient. They are eager to know what is going on (perhaps even more than you are!). Going through this simple process helps alleviate anxiety and builds trust in your capacity as a clinician. You may not know it all, but inviting the patient into the process of treatment is crucial to your management. A Better Me Now this particular patient does not know this but he helped remind me of the basics that increasing knowledge can push off the cliff. He has definitely made me a better clinician. Dear healthcare professional in training, keep it simple! It is possible!

In my history as a Healthcare Practitioner, I have interacted with hundreds of patients who have seemed initially difficult to manage clinically only to peep further and factor in the existing confounding factors affecting treatment and circumnavigating the management issues successfully. Lady in Red I once had a patient who would come to the clinic every two or so weeks with the same complaint and would demand admission for specialised care. In a period of one year, the patient had been seen by over 5 specialists (a psychiatrist included) and now sought super-specialty recommendations. They had a diagnosis but it somehow was still not enough. I gathered this from her data on the Health Management System on the desktop before me. She seemed young and ambitious. She glossed over her presenting complaints with an assurance that I had already heard of her before. She dropped names of resident doctors easily and made casual statements about her multiple experiences in the psychiatry ward. She seemed alright until she started weeping when I asked her about her Social History. Her tears came from a deep place of pain and confusion. She was the breadwinner in her home but had become estranged from her mother on account of her romantic interest. She eloped with him and occasionally supported her family. However, her partner had begun physically and emotionally abusing her. He had access to firearms on account of his line of work and so he would occasionally threaten to kill her and then himself if she would ever leave. He would rise on her with violence after his regular visits to the bar and would strip her of her money in order to finance his indiscretions. She got signed in as a beneficiary in her partner's insurance scheme so she could manage to visit the hospital regularly. The hospital soon became her refuge when she had had too much. That night, the hospital was her home because she had been kicked out of their shared living space. She had been diagnosed with Major Depressive Disorder and was inconsistent with her regimen, most probably because of the scuffles in her personal life. Her symptoms were worsening and no one seemed to know why- until we met. Social Factors- et al When it comes to administering care, the clinician should always look at the patient standing before them as a whole person with a mind as well as a body. Oftentimes, illnesses mask a bed of worri some social (and other) situations and while the clinician may not be able to resolve them, it would go a long way in addressing the presenting illnesses holistically. It also matters to simply care for the human you are managing. I have found that many times some patients simply want to know that someone cares for them and once they see this, their illnesses somehow seem more manageable and less menacing. Take Time It is imperative to take time with each patient in order to fully address their needs. With the rise In performance-based assessments of clinicians and capitalism, a lot of softness has been eroded from care. Many clinicians gloss through the confounders of health (living conditions, financial status, geographical, cultural and social influences) and sign off patients as seen. What they do not know is that they have addressed just one part of the many that need consideration. For instance, your patient may not be taking ARVs (Anti-retroviral medications) because they face stigma when they do. You may keep wondering why their Viral Load is constantly off the roof and perhaps this is why. You may note an improvement in adherence after talking to their families or simply enrolling the patient into a HIV/AIDS support group. It may seem like a herculean task to try, but it is our work to make sure that each patient gets the best quality of care. May we remain vigilant and considerate in our quest for better care.