Helping a patient is more than treating their disease - my first encounter regarding the importance of the impact socioeconomics have on patients

I was walking along the corridors of Ward 56 of KKH (a paediatrics hospital), peering into the different cubicles for a patient that I could practise my clerking history skills. It was Friday evening, and most parents did not have time to talk to a medical student; they were busy packing up, glad that their child was being discharged before the weekend.

Hanna caught my eye, sitting on an elderly woman’s lap, smiling through big round eyes. I quickly made my way over and introduced myself to the lady in Malay as she could not speak English. A young man, who was her son, soon came along with a toddler mid conversation.

Hanna has a naso-gastric (NG) tube inserted through her nose. I found out she suffers from dysphagia, and been tube fed since 5 days of age. Next to her cot is a mountain of gifts, all nicely wrapped in shiny paper and bows. A mobile adorned her crib, the kind that had different animals rotating to a lullaby. A small TV screen peered down, displaying whatever the Disney Channel deemed appropriate for children today. But for all that, my attention was fixed on the little 5 month old sitting directly in front of me on her grandmother’s lap. Hanna was smiling, not anxious that a stranger in a white coat and mask was peering at her intently. The NG tube was not bothering her at all and a cursory developmental assessment assured me that Hanna was of appropriate age.

As I set about asking my questions, it became apparent that the elderly lady and young man were not great historians for Hanna – they did not really know what Hanna was suffering from (“She cannot swallow. The doctors said her neck is weak but will become better soon.”). They do not know of any other conditions she might have. They were sheepish when I asked about Hanna’s pre-, ante- and postnatal status. They could not tell me what feeds Hanna was on, only that it was given 2-3 hourly. Going through my checklist, a fleeting thought came: maybe reading Hanna’s file would be more productive. But something caught my eye. It was Hanna, and her smiling big round eyes.

A simple “How are things at home?” from me brought forth a long and equally heartbreaking tale. Hanna’s mother was in prison, and so was her father; the young man was her maternal uncle. The young toddler is Hanna’s older brother, and is being taken care of by grandmother. Uncle was learning how to feed Hanna through the NG tube, hoping to be able to bring her home next week. I learnt that grandmother and uncle were not doing well financially, rejected for loans and had to seek help. They shared with me many things; how they are worried they might lose Hanna and her brother to Child Services; how they sometimes feel that doctors do not make an effort  to communicate effectively with them because they do not speak English; how they had to write to an MP just to be able to send Hanna’s brother to school.

As I got up to leave, I waved good bye to the family. Hanna was still smiling. She did not once cry while I was there. As I rifled through her file, the words glazed over and I could not concentrate. Here was a child, a healthy smiling 5 month old, who was of appropriate developmental age ready to be discharged after an arduously long hospital stay. She has an NG tube yes, but was ready to go out and start her life. I should be happy.  And yet, I could not help but worry for her future.

I had assumed that Hanna was from a well to do family – she was after all staying in a paying ward. She had a tower of gifts and an expensive looking mobile. But they were just that, gifts. Gifts from nurses and other families who knew about their situation and was lending a helping hand. Assumptions are a medical student’s bane, and it was a further reminder that I am so far away from being a ready and working doctor.

But no, I was not upset about it. Tailoring your assumptions will come with time. What really bugged me, what got me glazed over, as I was reading Hanna’s file was that I was ready to walk away from Hanna and her family just because they could not give me a good history. I was ready to walk away because they did not ‘fulfil’ my needs as a student. I was ready to walk away because I just wanted to clerk cases, and that I viewed Hanna and her big smiling eyes as just another case that I had already clerked.

Hanna’s family shared with me intimate details of their life. For that, I am truly grateful. Maybe it’s because I speak Malay. Maybe it’s because I took time to talk to them. Maybe it’s because I did not just ask medical questions, but asked that simple “How are things at home?” 

Social, financial and familial problems – all of these add up to little Hanna’s prognosis. We are taught to ask cursory questions to screen for these problems, but do we really take time to talk to patients? It took me a good half hour talking to Hanna’s family. Would consultants, registrars, medical officers or house officers take that much time to do so? I have been trying hard to fit into the culture of medicine that I lost track of the fact that patients are at the very heart of what we do. It is frustrating that I had lost my belief, and I hope to never lose it again. Little Hanna has thought me one thing – that it is perfectly alright to take time out of your schedule to just talk to a patient. Even though they do not have a medical learning benefit that you can fill up in your log book, I believe that this little act of humanity is what it takes to becoming a truly great physician.  

This is a  Public reflection which is publicly available for anyone to read.

Created on 22 October 2017 by Albert Teo