In South Africa we have something called the Patient’s Rights Charter. It is a set of rights and responsibilities for all patients, regardless of age, race or social standing, to ensure that all South Africans have access to basic health care. One of the rights that a patient is entitled to is the right to refuse hospital treatment. This means that at any stage of a patient’s treatment they may refuse further treatment, care or admission. For example, patients who are Jehovah’s Witnesses will not accept any blood products as it goes against their beliefs. This means that that patient will refuse a blood transfusion, and they are perfectly within their rights to do so, no matter how dire the situation may be or how desperately they need the transfusion. The good doctor will counsel the patient through this process, and offer alternative solutions.
In my short time of working, I’ve noticed something about doctors (myself included). Patients who refuse hospital treatment (or sign RHT as we usually say) really piss us off. We’ve been taught that we are there to do our job, regardless of whether or not the patient wants us to. That we know better than our patients. That we studied for a really long time and we are working really hard and if you sign RHT then you actually shouldn’t have come to the hospital in the first place. And so doctors just get so darn furious at the poor patients for refusing hospital treatment. I know I do. It used to drive me completely insane after I had spent a significant amount of time clerking a patient, filling in all the paper work to admit them, taking blood samples and placing an IV line, and then a few hours later they signed out of the hospital. I would get upset because I felt like I had wasted my time. I would get upset that the patient had wasted their own time and money coming to the hospital. I would get upset that the patient wasn’t going to receive the care and treatment that they needed.
When a patient wants to sign RHT a form has to be filled in and a doctor has to go and discuss with the patient about why he or she no longer wishes to receive further medical care. Theoretically this is a time when the doctor counsels the patient fully about the extent of the decision, and provides alternative solutions. As fate would have it, these kind of things always happen when you’re right in the middle of something which you deem to be more important. You have a queue of 10 patients that need to be seen. There is a resus in the ward. You have to go assist in theatre. So you rush through this process, which feels like more of a hassle than anything else, shout at the patient, and then hurry back to do your work. In our (my) defense we are usually so overworked and crazy busy that we don’t have a lot of time to spend with patients. But that is no excuse for getting upset with patients and giving sub-standard care.
This week a patient came to see me at the clinic. I’ve seen him several times throughout this year and we’ve built up a good doctor-patient relationship. At his previous visit I had noticed that he had a fracture which was not healing and there were signs of sepsis, so I referred him to the local hospital for further care. When I saw him again this week I was eager to know how it had gone at the hospital and if he was doing better. He sheepishly admitted to me that he had signed RHT the day before and he was back at the clinic because he was in excruciating pain. He had received no analgesia when he left the hospital and just wanted something to feel a bit better. This time, I didn’t let my temper get the better of me. I listened patiently to this patient, and he told me his reason for refusing hospital treatment. This patient hadn’t left the hospital because he didn’t care about his health. He didn’t do it to spite the doctor. He didn’t do it because he is uneducated and doesn’t know anything about his own body. He left the hospital because he desperately needs a job. He is younger than me but, like so many South Africans, heads up a household. He feels responsible for taking care of his family, and wants to earn a salary. He left the hospital that day because he had a job interview lined up.
I felt like the world’s biggest asshole.
All those patients I had gotten cross with, and never bothered to hear their story.
All those patients I had dismissed, thinking they didn’t care enough about their health to stay in hospital.
All those patients I had looked at simply as a disease which needed to be treated, as opposed to a human being with a life outside of their illness.
I learnt a really valuable lesson this week, and I am going to do my best to have more patience with my patients. Not always easy, but certainly important. We have no idea what our patients are going through, and providing holistic care is about so much more than just admitting to the hospital.
Thanks for stopping by ❤