The level of literacy is an important determinant of patient’s attitude and behavior. Poorly literate patient shows extremes of behavioral expression. From the extremes of “I do not like doctors” to “you are like God to me” is a common occurrence. Such patients are more observant of the behavior and attitude of the health care team than interested to know about the seriousness of the disease. It takes multiple sessions and days to explain and convince them for their treatment. In absence of any disease symptoms they are unlikely to pay attention to the illness. Also they are unable to take proper decision about their treatment and mostly relies on family or doctor to take call on final course of action. Most of the decisions are taken emotionally or else based on available resources. In extreme cases they may instruct the doctor to prescribe a particular type of treatment to them as perceived as appropriate. Lot of times doctors face the challenges to convince these patients to refrain from a particular type of treatment. Interestingly it has been found that such patients manipulate their symptoms to get the treatment of their choice. It could be dangerous for the patient safety. The doctor has to be vigilant and highly insightful to avoid any such situation that may arise due to patient’s ignorance.
The irony of such patients is also that they are usually from low socio-economic background and have limited access to even basic health care. Any impolite behavior of the doctor will put them off for further treatment. Further, there could be barrier of age, gender or family matters that would affect the patient desire to go for the treatment. It is also found that poorly literate patients usually refrain from asking too many questions from the doctor. This can compromise the appropriate treatment due to inadequate understanding about the medical problem and the treatment. background
Door Knob Consultation (By the way consultation): Patient with any educational background though slightly more in poorly literate patients, comes back to doctor’ cabin after detailed primary consultation. This brief returning of the patient may be absolutely irrelevant or herald a serious statement that would initiate reworking again. Quite often patient tend to state his most serious problem at the last moment of consultation to pretend a carefree approach or hiding his underlying anxiety. After initial symptoms of cold and cough as routine, that may utter about “ongoing chemotherapy” at door while about to exit. A depressed patient after counseling and getting prescription of antidepressants may come back and tell her psychiatrist that if not controlled now “I will commit suicide”. This will be bombshell for the treating doctor and would require to restart again from basics. Though doctor may be at fault of an improper dialogue with the patient during primary consultation to miss this serious illness, patient may deliberately choose to reveal at the last juncture. The patient may feel that the ongoing serious problem is incurable or has no better solution thus the doctor need not necessarily know about this disease. In such situations, doctor should not show any panic or exaggerated response as this would further unrest the patient. Doctor should equally keep cool and highlight only the point that are relevant for such cases.
Patient’s Denial of Serious Illnesses: It is a common observation that patient diagnosed with a serious (usually life threating) illness expresses denial at some point in their illness primarily shown as a defense mechanism to cope up with fear of death. It also prevents exaggerated anxiety related to the disease. The patient can show extremes of behavior like humor, forgetfulness, highly spiritual, and highly rationale. Excessive denial and unusual positive emotions in such conditions are the index for heightened anxiety and underlying depression. Though initial denial could be helpful to adjust and adapt to a new situation, it long term effect can hamper the treatment and clinical outcome. Contrary to this statement it has also been written and documented that such denial and emotional uplift have helped patient to do better or even improve the quality of life. The role of doctor to handle such patient is very tricky and require in-depth understanding of patient attitude and behavior. A gentle support and scientific approach can do wonders in these patients.