Wednesday, May 22, 2013

Maintaining Composure During A Consultation

Doctors are human.  Some things we see will make us laugh when for the circumstances it is totally inappropriate.  I was recently reminded of an episode when I came close to losing all sense of professionalism during a patient consultation but survived.

A number of years ago, I saw a young man aged in his late twenties with lower urinary tract symptoms.  Although he was young, he looked much older and could easily have passed as a man aged in his mid-40s.  He had immigrated to Australia from a dispute ravaged country and probably had good reason for looking hostile and as if carrying concrete blocks of anger and despair on his shoulders.  He spoke no English and interpreter was at hand.  I think you get the scene – it was serious and we had better get on with the job of sorting him out.  Having asked a number of questions, I then asked as to whether he had any stage seen blood in his urine.  The interpreter then turned to him and spoke in his native language a question to which he gave a moderately long reply and to which followed alternating dialogue that went on for approximately five to ten minutes.  I was sat patiently expecting to hear a complex history of how he had indeed seen blood and the circumstances in which it had been observed and so forth.  The interpreter then turned to me and said “No”.  I dug the heel of my boot onto the top of toes of my other foot as hard as I could as I politely excused myself to go into the next office.  I think it took about 10 minutes to regain my composure before going back into my consulting room to complete the interview.  I think my eye contact with the young man was subsequently kept to an absolutely as needed basis.

At the end of the consultation, I did ask the interpreter about the nature of the discussion following my question about blood in the urine.  He told me that he had essentially given him an earful for not looking after himself since being in the country.  Okay.  Next patient. 

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