Medicine is more than just a science

Garth A. Rattray

It was an impressive group of specialist and subspecialist physicians that presented to a consistently large audience at the Main Lecture Theatre at the University Hospital of the West Indies two weekends ago during the three-day 'Summer School' lectures.

Cutting-edge academia and research findings were presented and we all became more enlightened. However, as I looked around the room filled with medical personnel charged with the care of the sick, I wondered how many realised that the value of academics and technical skill are severely diminished or totally useless unless patients are able to communicate with us and trust us.

Last year, in preparation for a talk that I gave to a group of my colleagues, I conducted a limited (in-office) survey and learnt that a mere 19 per cent of patients had only good things to say about the medical personnel with whom they encountered. They didn't care about how bright the doctor was or the number of degrees attained; they wanted caring, empathetic, respectful, down-to-earth, honest, forthcoming, tolerant physicians willing to explain things in simple language.

One elderly patient, who had several bad experiences in a public hospital, put it extremely eloquently when she remarked, "Not every dakta a dakta, you know, Dakta!"

Fairly recently, one of my elderly patients, a gentle and childless 80-year-old retired nurse, fell gravely ill. The niece whom she loved, cared for and treated like her own took her to a local hospital. The nurses and doctors there performed well and were very caring, but had to transfer her to a larger, better-equipped hospital.

Her condition deteriorated by the time she arrived at the other facility. Her abdomen became swollen, she stopped passing urine, she had laboured breathing and was not responding to verbal commands. She was put on oxygen therapy. The niece reported that the medical staff there informed her that her aunt appeared to have some sort of 'blockage'.

Resources there were so bad that the niece said that the oxygen was transferred from her gravely ill aunt to a gunshot victim. She was eventually taken for X-ray but was unable to stand erect for the film. The very worried niece asked if there was another, more suitable machine capable of taking the urgently needed films. The radiology technician reportedly retorted, "A dis di Government give we fi wuk wid."

Eventually, her aunt deteriorated even further and began pulling tubes in her confused state. The concerned niece noticed that she was left mostly unattended and sought permission to remain and assist her aunt, but an unpleasant and obstreperous security guard refused her request.

In time, the attending physician summoned the niece and informed her that several essential tests were not available but they planned to operate anyway. Frightened, the niece asked if they could do the investigations 'outside'. This precipitated a brief exchange ending with the attending physician threatening, "I feel like leaving and going to another patient."

The tense interaction led to the cold-hearted eviction of the dying nurse's close relative. Only the arrival of another niece (who was also a nurse) got the anxious niece back inside hours later. But, by this time, the aunt that mothered her had died confused and apparently unattended (there were signs that she may have vomited while flat on her back). Only the head nurse tried to comfort the inconsolable niece.

We have many fantastic nurses and doctors here in Jamaica, but I get a surprising number of complaints about some (especially) within the public hospitals. Some describe them as callous, rude, spiteful, unprofessional and/or incompetent.

Even when pressured, medical personnel must never forget that it's only about the patients and their worried families. Medical care is far more than just a science.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.