PPD-Approaching a Difficult Patient

Usually a patient refuses to be clerked for one(or more) of the reasons stated below

1) Too many medical students clerked them before you

2) Bad experience with another medical personnel

3)their idea that it is useless talking about their pain to medical students who can do nothing about it. They want to see the Senior Consultant.

4) They are stressed about their condition and would rather not talk about it

5) they have seen medical students being reprimanded by a doctor( Registrars or Consultants) and lost confidence

6) Medical students appear not so confident

7) They may be in pain at the time u ask them.

Sometimes, these type of patients have very rare conditions(e.g. Ventricular Bigemini) that makes it all more necessary for you to clerk them. So how to approach? Here's a few tips.

1) Always approach patient by 1st asking them "How are you today?""How do you feel today?". This will give the patient a good impression. They know you care for them. This question also sometimes makes the patient tell you their current (acute) problem. If they do, say to them"I see...but what happens in the first place when you are admitted?" Most of the time they will tell you everything :)

2)While the PPD style "Selamat pagi encik, saya So&So, pelajar perubatan tahun 3" introduction may work well for some patients, most of the time it will not especially if the student looks timid. Patients will not have confidence to confide their problem to you. Therefore, always look confident. Don't hug your clipboard or notebook or whatever while introducing yourself to your patients. Because even for me it reflects that you are afraid. Put your clipboard on the table, walk to the patient, shake hands and introduce yourself, confidently and politely.

If your supervisor had asked u to clerk the patient, all the better. Say " Saya pelajar di bawah Dr So and So, saya nak tahu keadaan puan/encik untuk dilaporkan kepada beliau". 100% success.

3) The patient may reject you because they are occupied with something else at that time. In this case, make an appointment. Ask to clerk them after tea, after lunch etc. Usually patient may agree.

4) Some patients refused to be clerked because sometimes, medical students take a long time to clerk and they felt bored. Therefore, give them a time limit. Tell them " Pakcik, saya nak minta masa 15 minit untuk pakcik beritahu saya keadaan pakcik, boleh tak?". Make sure you adhere to time limit and if you exceed, please apologise. Normally the patient will not scold you. It is also a good practice for long case because in long case you only have 10 to 15 minutes to take full history.

5)Always visit the patient till he is discharged. Treat him like a human being.

Lastly, even if you are not clerking a patient, always flash a smile at them. A smile can bring lots of comfort, especially to the sick. Don't do catwalk in the ward and act as if the patients are not there. Your whitecoat is not a nice dress to be in for catwalk. After all, you will never know when you have to clerk those patients, and having been friendly and warm to them, it will make your job much more easier.

Goodluck!