The session started with the taking of her medical history asking relevant questions, followed by a physical examination. My check found nothing wrong with her abdomen, so I started asking life questions which I hoped would bring me to a reason for the visit or, even better, a diagnosis.
Unfortunately all my suggestions and offers of support were met with a road block; but there was an urgency about her as she would be travelling the next day and kept asking for assurance as to the correct way to proceed. I learnt she was taking anti-malarial tablets which could have caused the abdominal pains and also the anxiety; but she didn’t want to stop taking those as she might catch malaria. I offered supportive medicine but this was met by panic because now she was taking too many tablets.
To and Fro
Some patients don’t want to take medicines — but they don’t want to tell you that. I tried to understand her attitude towards medication; she didn’t want to take medications, and didn’t really understand that taking one pill wouldn’t give her the desired effect. I tried to get a sense of her medication philosophy so I could work with the individual to motivate her in the best way. She then continued to open up and explained about the other antibiotic tablets she was taking — one packet already expired.
The quality of the food at the hotel was worrying her, and bottled water scared her. Which was the correct brand to drink? Which were the best convenience stores? She was concerned about staying too long talking to me as her friends were getting ready to leave and she was scared to be left on her own.
Seeing her opening up with her problems made me realise she may have needed additional support. This wasn’t going to be a short consult and I went on to explain to the patient she was an adult and travelling on your own opens you up to personal risk. I explained she was clearly brave enough to start the journey and needed to remain strong. The clinic was here for her if she became too anxious but she should take the opportunity to enjoy Hanoi. She relaxed a little and went on to explain she wasn’t usually like this but feeling unwell had left her with low confidence.
Somebody who is under high stress may not be controlling their medications; they may not be taking time to pay attention to their diet and lifestyle and may not have time for exercise. They may fall into bad habits. A lot of people turn to alcohol or eat too much junk food. Plus, the body responds to stress in different ways.
Medical doctors now offer a more integrated service; the solution here was building the relationship, having the conversation, seeing what the competing agendas were, and providing the support to the patient. Travelling and being out of your comfort zone is difficult, but remember there is always someone ready to listen.
Dr Rory Keith Fernandez So is a general practitioner at Family Medical Practice Hanoi. For more info click on vietnammedicalpractice.com