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.