What kind of patient are you?

She walked into my office looking terrified and shivering. I quickly estimated her age at about 40 give or take two years. What kind of patient is this? I asked myself. Behind the door, in my consulting room, I had heard the exchange of words between her and my receptionist. The receptionist had asked for her age and she had responded angrily by saying, “What has age to do with my eye problem?”

“It is important to state your age. The doctor needs it,” she had replied politely. “Just put down any age you like,” she had snarled back at her. The receptionist realising that it was a no go area had left the relevant portion in the registration questionnaire blank and attached a little note to it saying, “Patient refused to state her age.”

Is it appropriate to ask for a patient’s age? Certainly, yes! Age is such a vital index of disease that cannot be ignored by a doctor. The adage, “Common things occur commonly,” is true of medical science. Common things occur commonly at certain ages. Age helps in clinical decision making. And when we talk about age, we mean the true age, not the official or the ‘cosmetic’ age! Quite often, there may be no record of the date of birth of a patient for one reason or another, but from historical events or the date of birth of childhood friends his age may be computed with near accurately.

I asked Ruth, “How long have you had the headache?” “It’s been going on for some time,” she replied. She tested my patience when I insisted on knowing at the least an approximate duration. Symptom duration is vital for clinical diagnosis. It is based on the knowledge of Epidemiology which is the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone for making a clinical diagnosis, determining relevant investigations which will subsequently refine the clinical judgement and help in predicting the plausible outcome. Failure to provide a near-accurate duration of illness may lead to the doctor ordering more expensive investigations and further delay in treatment with worsening of the prognosis.

I certainly can’t remember how many interviews I have conducted since becoming a doctor – possibly hundreds of thousands. Once in a blue moon, I still run across patients who are shifty, lie or are insincere about their symptoms. It may be for sheer lack of trust, insurance purposes, or outright malingering. Such patients often forget that doctors are like detectives, trained to go through a problem-solving process or set of rules (like a computer) and finding the greatest common divisor. Be honest with your doctor. Remember, he has taken the Hippocratic Oath and he, therefore, has both a moral duty and a legal obligation to keep your secrets even after your death. Do you trust your doctor? If you don’t, look for a doctor you can trust.

I had told Mr Danike he would go blind except he accepted to have glaucoma surgery having lost nearly 90 per cent of the visual field in his right eye. The medicines were either not working well or he wasn’t using them regularly.

“A stitch in time saves nine. This is the time to save the left from going the way of the right,” I had pleaded with him at every visit for about two years. He was probably nervous. Please, confess to your doctor you’re nervous. He will put you at ease and remind you that he is working in your best interest. Ask him about the possible complications and he will explain them to you in great detail. He may even arrange for you to meet some of the patients he had operated before.

Are you afraid to ask questions? Don’t be afraid and don’t ever think your doctor will be embarrassed by your questions. But you cannot ask meaningful questions without knowing something about the disease. A good patient, therefore, must be educated and knowledgeable.  You should be an active participant in your health care. Go to the web, search and read all about your problem and treatment options. Don’t, however, take all you read as Gospel truth! There is also a lot of trash out there! Go back to your doctor and ask questions. You have every right to seek a second opinion if you don’t agree with him or are in doubt about anything at any stage. And in seeking a second opinion, especially after having received some treatment, make a request for a written referral to the doctor of your choice or one recommended by him. Do not just walk off to another doctor. First, the signs of the disease might have changed because of the treatment received and the new doctor may be seeing a different picture. Secondly, he may have to repeat some of the tests already done costing you unnecessary expenses and a waste of valuable time.

Finally, if you are meeting a doctor for the first time, it is not out of place to ask for his qualifications. Specifically ask, “Are you an eye medical doctor (medical specialist – ophthalmologist) or a doctor of optometry whose main thrust is the detection of visual problems and prescription of optical appliances?