Panic in the Restaurant

I’ve heard it said before, that chefs don’t like to come home to cook dinner. I see the truth in some of that, as the last thing that I’d really feel like doing on returning home from work, is to focus on more medical things.

But sometimes, there is no other choice, and you just have to. Medical problems that my parents or grandma wants advice about are directed towards me when I come home. When things like “I’ve been getting cramps these last 2 days, what is the reason?” are asked, it’s an incredibly difficult position to comment about. So I try and take a history to glean more information, essentially to determine if it is something serious in nature, or something relatively minor that doesn’t require urgent treatment.

When it comes to things such as these, I don’t want to end up completely treating my family members. I’m happy to provide some advice, but when it comes to some medical problems, I don’t have access to diagnostic tests to confirm suspicions, and that’s why I think that if the issue really warrants serious investigations and treatment, it is best managed by their regular GP. I realized that a doctor without any medical equipment, diagnostic tests or medications is the equivalent of a medical student – just full of knowledge and differential diagnoses, but essentially unable to do anything much else.

This concept of being unable to do anything much was best demonstrated just a couple of days ago. My grandma had only been discharged from hospital for less than a day, but she was extremely keen for some lunch at a restaurant. So out we went to eat some greasy unhealthy Hong Kong food (which gave my Dad and I diarrhoea later that night by the way). Part way through lunch, my grandma turned a sickening pale, then blue colour in the face. She became limp, head starting to slouch. Her consciousness seemed to slip away as seconds passed by. I thought she was having a stroke. Fear seized me momentarily, with pure negative thoughts of gradual decline to a terrible quality of life, and what may be a painful slow death after what followed.

“She’s not responding” my father fearfully exclaimed in cantonese. I must have snapped out of my fearful state following that, and pounced into “doctor mode” after out. Bolting to my grandma’s side, I immediately thought of ABCD, checking for responses (COWS – Can you hear me, Open your eyes, What’s your name, Squeeze my fingers). By now, I mentally thought of hitting the MET call button, which translated to calling the ambulance. Enlisting help from the restaurant staff, I calmly told them that my grandma was in trouble and I was calling the ambulance. The manager took over my phone, continuing the call as I couldn’t give the exact address.

Throughout all this, I didn’t feel like I did a good job. I didn’t know aside from thinking about differentials and continuously assessing her conscious state, what else I could have done in that situation. I felt completely powerless removed from the hospital environment. One of the nearby nurses from a GP practice was called over, and helped to take a BSL and blood pressure.

As my grandma become more alert gradually, her only concern was that I attend my job interview with one of the hospitals that I was applying for next year. She urged me numerous times to attend. After what seemed to be about 5 minutes, she was more alert in herself, and the paramedics had arrived. My mum would accompany her to the hospital, and from my grandma’s urging, I ended up attending the job interview.

Perhaps what added to a particularly anxiety provoking day, was when the interviewer gave me a clinical scenario about a MET call patient. What a coincidence – I’ve just been through one already.

Suffice to say, I probably wasn’t performing at my peak after what happened. The interviewer felt I was too nervous, and felt I couldn’t control my nerves (I found it odd for some reason for an interviewer to specifically mention that). I thought the better of mentioning what happened to my grandma – I don’t want to be seen as someone who wants sympathy points.

I went home by bus, and went straight to the hospital afterwards. My grandma had perked up much more, and looked much better. But what a day that was. What a day!

On Being Genuine

The other day, my consultant saw me as we were about to do ward rounds and said “Hey doctor, how would you like to do a mental state exam on our next patient while we give you feedback later on?”

That was not a question at all I must say, in firstly, saying something like “no thanks!” would reflect badly on me. So I ended up saying “yea sure!”, and then felt the fear build up inside of me.

So in to the interview room we went, where there were two consultants, my colleague, one medical student, one nurse, one student nurse, and finally the patient himself. The patient himself was a man I had done the admission work for, so I knew his history.He is a man in his 50’s, who was brought in by police from his flatmate in regards to suicidal intent, and alcohol intoxication.

What happened next, was that I proceeded to establish rapport with him, asking basic things like “how have you been feeling lately?”, through a nervous bodily sensation. As I asked a few more questions, I felt more comfortable, and followed up on important cues such as his recent nightmares.

On closing, the consultant told me I did pretty well. He followed up with a few questions, such as “what specifically in hospital has contributed to your mood improvement?”. I wish I had asked that.

What surprised me next, was the consultant’s feedback that I was genuine in my interview with the patient. My interview persona was a reflection of how I interacted with others normally, and in a way, I brought my personality with me as the doctor, to how I am as a colleague.

In a way, it’s something I never really considered, but it’s something I feel is actually quite important. Being genuine with patients is a way of building rapport, and of being sincere to the patient. It helps to establish trust, in that in a way, it lets the patient know a little about the doctor’s true self. And I guess that being doctors, we don’t share our personal life stories, so the patient has very little knowledge about us as a person, other than their first impressions and the personality/persona we display to them. In that sense, to put forth a fake persona to patients, is really in a way distancing ourselves from the patient, in that a mask is worn so that patient’s don’t get to know the person behind the mask.

In a way, I guess my consultant has seen the fair share of other doctors who wear a mask, and adopt a different persona to patients compared to how they are normally. In my view, it isn’t authentic, and it would be difficult to maintain. Perhaps some feel the need to hide their true character between a persona to patients because of the fear of revealing too much? Maybe some try and adopt a more confident persona, or try and tailor themselves as a person similar to the patient to try and build rapport?

Now that I’ve come to it, I think I’d prefer a doctor who showed their personality through in a consult over someone who tried to be someone they are not. Eventually, it’ll show through that they are trying to be someone else.

But it’s definitely something I didn’t consider until now. From now on, I’m going to continue being genuine in my patient interactions.

My Chinese Put to Use

I learned mandarin out of interest, and till now, I’ve still felt that my Mandarin is still extremely limited.

Words in my vocabulary were probably limited to basic things like “我很 高兴认识你” （I’m pleased to meet you) and “你的电话号码是什么？” (what is your telephone number?)

I never expected to conduct an entire medical history in Chinese!

I tried to ask questions in English, which were met with a blank stare. “You speak Mandarin?” she asked me.

I knew I couldn’t avoid it. So, I replied reluctantly “我的中文不太好” （My Chinese isn’t that great.)

In the end, it was a great learning experience, and a chance to test my Chinese out. The patient understood my mandarin to a large extent, and I was able to tease out the main reason for her presentation; namely, that she had numbness and tingling of her right arm, secondary to repetitive manual labour as part of her farming work.

Performing the Tinel’s test and Phalen’s test helped me to confirm the likely diagnosis of carpal tunnel syndrome, which I couldn’t translate in Chinese, but for which the use of my $2 Chinese dictionary saved me a ton of effort.

I learnt a new word that day “麻痹“ (numbness). And that patient taught me that my mandarin is better than I thought it was. 2.5 years of mandarin, and I could conduct a basic medical interview. Now, that made me very happy 🙂