During my Paediatrics rotation, I had the misfortune of being part of a firm that had perhaps the worst Registrar I’ve ever met.
He was cold to patients, rude to the nursing staff and completely ignored the students. I only was in his firm for a week, and I was alone because my clinical partners were doing a different subrotation, and we weren’t an even number ever since we lost our fourth member earlier this year. One of my group members–the one who was technically partnerless–had complained that she was always being forced to work alone, so I’d volunteered to take her place during Paediatrics because I felt it would be a welcome challenge, not having someone else to cover for me in ward rounds or share wordwork with. Being alone scared me, but I felt it was time.
Having swopped subrotations with my groupmembers, I was warned that the Register was a ‘tough nut to crack’, that he barely taught and that I’d have to be persistent if I wanted any kind of attention.
Steeled for the worst, I entered the firm on Monday. The Consultant was a dream, so patient and yet so persistant, challenging me and the student interns to think like doctors. I left that day feeling inspired and motivated.
On Tuesday, a second Registrar joined the team and we rounded on our patients. The Consultant was absent, so the first Registrar was technically in charge. He seemed pressed for time, ignoring our requests that he sign off on the changes we’d made to our patients’ feeds, unwilling to authorize that the weekly bloods be done on the patients who routinely had them drawn. He dismissed a nurse’s objections when he told a mother that he would discharge her baby who had been hospitalized for weeks and had recovered marginally, but was still experiencing loose stools, not tolerating oral feeds well and had failed to catch-up weight. I had to go to a long procession of Tutorials immediately after rounds, so I didn’t know what the final outcome would be when I left the wards.
On Wednesday, my last day in the firm (due to the public holiday on the friday pushing our test and OSCEs up to Thursday) we had a lightening-paced round. I had no idea what was going on to be honest, until we arrived in the room of the patient who had supposedly been discharged.
She and her baby were still there.
“Mama, what are you still doing here? You were supposed to leave yesterday,” he asked with a touch of impatience, paging through her nursing progress and pulling out the discharge form that he’d filled in.
“The other doctor told me to stay, she said she wanted to wait until my baby was better.”
The Registrars locked eyes, but the second Reg held her ground.
“I didn’t feel comfortable discharging her. I’ll take responsibility for her if you’d rather not.”
“I didn’t discharge her because I didn’t want to take responsibility. I discharged her because I don’t think the baby’s going to be getting any better here than at home. They’ve been here for weeks.”
“Then let’s continue management and investigate other causes. Maybe it isn’t *working diagnosis*.”
“Of course it’s *working diagnosis*,” the first Registrar snapped. Then, remembering he had an audience, he turned to the mother and said, in a low and persuasive voice, “Mama, surely you want to go home? I’m doing you a favour here. The sooner we get you out, the sooner you and baby can get home.”
I was so shocked by this exchange–really? That’s his reasoning?–that I hadn’t noticed that the mother had put her baby down and was now standing with her arms folded tightly across her chest.
“Doctor,” she began, speaking in informal Afrikaans so that I was able to understand, “I’m not leaving here until my baby is well. I’m not leaving here until the treatment works. I’m not leaving here until his tummy stops running. I’m not leaving here until he gets big again. I don’t care that you think we’re wasting space, my baby is still sick and if the nurses and the other doctor think I should stay, I’m staying. I don’t care about home. I care about my baby.”
At this point, I had to use all my willpower to suppress the urge to applaud her.
The doctor stood, thunderstruck, and then mumbled something about resources and overreactions before shooing us out of the room to continue rounds.
But my mind remained with the brave, young, uneducated mom who hadn’t let the tall, learned doctor bully or swindle her into doing what her instinct told her wasn’t best for her child. Parents rarely stand up to doctors in our hospital. After all, what would they say? They trust us, the healthcare workers and students, to make the best decisions regarding their children’s health and often feel afraid to speak up when they feel something isn’t right.
I had a patient the previous week who’d been in hospital for weeks, and yet neither she nor her parents knew what exactly was going on. They’d asked, of course, but the reply, “That’s what we’re trying to find out” had been all they’d received. And, feeling the doctors would speak when they had answered, they hadn’t pushed further since. Not because they didn’t care, but because they felt intimidated by these clever stethoscope wielding minigods and felt they wouldn’t be able to exert any real pressure or influence on the process.
If they were private patients, or educated folk, they would have no doubt been kept in the loop.
But because they were ‘regular folk’–a teacher and a domestic worker–the doctors had decided informing them wasn’t a priority, since they assumed they wouldn’t understand regardless,
I hate this attitude. I hate that paediatric patients from lower social statuses have their only advocates disregarded and end up being run through the system simply because some lazy doctor can.
I applaud doctors who will take the time to sit with patients and their families, to explain what’s going on even if they don’t have all the answers yet. Who treat everyone with the respect that is due them, regardless of educational background.
And I applaud the woman who kept her ears and eyes open, spotted the flaw in the system and then, more importantly, opened her mouth.
Yes, ma’am. Yes, ma’am.