Saudi Journal of Kidney Diseases and Transplantation

DOCTORS DIARY
Year
: 2005  |  Volume : 16  |  Issue : 2  |  Page : 233--234

Medical Traditional Etiquette


Abdulla Ahmed Al-Khader 
 Division of Nephrology, Hypertension & Renal Transplantation, King Abdulaziz Medical City, Saudi Arabia

Correspondence Address:
Abdulla Ahmed Al-Khader
Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia




How to cite this article:
Al-Khader AA. Medical Traditional Etiquette.Saudi J Kidney Dis Transpl 2005;16:233-234


How to cite this URL:
Al-Khader AA. Medical Traditional Etiquette. Saudi J Kidney Dis Transpl [serial online] 2005 [cited 2020 Sep 20 ];16:233-234
Available from: http://www.sjkdt.org/text.asp?2005/16/2/233/32943


Full Text

The surgical resident was waiting for me at the patient's bedside two of whose brothers were present as well. I said to the relatives, "can you please wait outside while we are seeing your brother"?

I then began to ask myself as to why we doctors ask the relatives to leave the patient when we want to speak to him. I believe that this has become a tradition of sorts and is not always necessary. Sometimes, however, it is advisable to do this. This is to make sure that the patient is free to talk and complain. It may be difficult for him to speak freely in front of his family, especially if we are dealing with psychological problems. Often, there are bits of his past history he may not want revealed to his family. Also, the patient may not want to worry his relatives by listening to the seriousness of his condition. Moreover, it is generally not a good idea to examine a patient in front of his family. The patient is more likely to speak to you freely than to his family. This is a privilege we doctors should appreciate and treasure. On the other hand, you should allow the family to be present if this is the patient's wish. You should also take care to have a member of the family or a female nurse present whenever you examine a female patient.

As if reading my thoughts, the resident wanted to know what we should do if the relatives insist on being present and what a doctor should tell the relatives about the patient's condition?

I told him, "then you should seek the consent of the patient. If you perceive that the patient is too embarrassed to say no, then let the relatives in but do not get into potentially embarrassing questions (e.g. drinking habits, psychological questions, sex impotence etc.) and come back again when the relatives have left. As to how much you tell the relatives about the patient's condition, the answer is "as much as possible", but only after taking the patient's permission. Omit things that you feel may be embarrassing to the patient. Incidentally, never tell non-relatives about the patient, unless the patient specifically requested that".

The resident then asked one more question about handling patients and relatives. It is often noticed that when we explain something to the relatives, even when they appear to grasp the situation, they still go and ask the same question to another doctor in the team. Also, at times they may go to the extent of saying that nobody has told them what is going on.

I told the resident, "this is really quite universal and commonly met. It should not bother you. Indeed, you should be sympathetic to this view. There are a number of reasons for this. Relatives and patients want constant repeated reassurance or, they may want to hear better news than what has possibly been told to them before. Sometimes they want to hear it from a more senior doctor. This is under­standable. You look so young, lucky you, and don't be surprised that patients may sometimes read inexperience in a young face (although this is not always true). Often, the doctors are to blame because they use medical terms and assume the patient will understand them. I often hear doctors, for example on television shows for the public, use words like "pulmonary edema" when the listener will understand "water in the lung" or "cardiac ischemia" when they should say "reduced blood supply to the muscle of the heart". Finally, the doctors' approach when explaining things to patients or relatives leaves a lot to be desired. They are often in a hurry, abrupt and lack a smiling face. The ideal situation is to take the relatives to an empty room, sit them down and also you should sit and force yourself to appear as if you are not in a hurry (this is possible with training). Above all, give them a chance to get all questions out of their chest".