Last year the Malaria family cried out complaining about the constant persecution they face in Nigeria. They said that they are blamed first, for everything under the sun; for all headaches, all fevers, from brain tumours, to stroke and even cancer. This of course often leads to delays in rendering effective treatment for patients with these other diseases. You would think that most Nigerian patients sleep on the streets with the attendant high incidence of diagnosis of Malaria: even in newly born children!
This year, Mr Typhoid has sent me a huge petition asking for reprieve from similar injury to his revered name and asks that Nigerian doctors and laboratory scientists should please stop maligning his erstwhile ‘hollow’ reputation. The missive is entitled ‘Typhoid: Why always me’? This seems to be a parody of the much publicised story on the Italian footballer, Mario Balotelli.
Typhoid Fever
According to Wikipedia, Typhoid fever, also known simply as typhoid — is a common worldwide bacterial disease transmitted by the ingestion of food or water contaminated with the faeces of an infected person, which contain the bacterium Salmonella enteric. The occurrence of this disease fell sharply in the developed world with the rise of 20th-century sanitation techniques (proper toilets) and antibiotic treatment.
In effect, a correct diagnosis of Typhoid means that the patient has eaten food contaminated with ‘shit’. Maybe from the ubiquitous roast corn or roasted plantain or even sugar cane bought from the road side. Sometimes, I have wondered how the sellers, toilet at the road side or even wash their hands after. Do they clean their hands after handling those terribly dirty Naira notes? The bacterium that causes typhoid fever may also be spread by flying insects feeding on faeces. Flies and ants can carry the germ into unprotected food. Regardless, even vegetables and fruits can be contaminated with Salmonella and cause disease, if not cleaned properly.
Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. Proper toilet hygiene and antibiotic treatment has reduced or should have reduced the incidence of Typhoid in Nigeria. So, why is the diagnosis so common and applied to even someone just arrived from the USA?
The diagnosis of Typhoid fever is, of course, often wrong and due to slackness and misinterpretation of the results of tests by our poorly trained laboratory technicians and unsupervised laboratories. But there is another reason.
Doctor’s listening skills
Doctors are actually to blame for many of the wrong diagnoses. In quite a few cases this stems from not listening to the patient. The diagnosis is usually apparent after taking an adequate history from the patient. Doctors should listen attentively and piece together relevant points to make a diagnosis. The patients in many cases even volunteer the diagnosis by carefully explaining the chronology of symptoms and signs of the illness.
But, many doctors perform hurried, shoddy, confused and unsatisfactory consultations. Some behave as ‘know it all’ and therefore make terrible, costly mistakes leading to disability and death in some cases.
Listening to patients is tremendous mental work, requiring concentration and attention to find the right meaning and context of the patient’s story. In one study, on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms (Nirmal Joshi, New York Times, January 4, 2015,).
The need to train and test physicians in “interpersonal and communication skills” is very important. It is pivotal in quality consultations and treatment. Brief, rushed physician encounters are common, with limited opportunity for questions. A lack of empathy was often apparent: In one instance, after a tearful patient had related the recent death of a loved one, the physician’s next sentence was: “How is your abdominal pain?” Evidently, we have a long way to go
A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office.
The volume of work is also crucial in the well being and freshness of the physician. Exceeding a handy limit of operations or clinic patients, will certainly result in overheating of the brain, with a more fatigued and less tolerant attitude. So putting limits on the work volume is a key issue for a more relaxed performance.
Furthermore, many patients or relatives are simply not focused in their speech, occasionally hide important facts or keep talking about trivial issues. Some do not focus on your questions and like to answer a whole different story than what they have been asked for.
Why always me?
In effect, the reason Mr Typhoid is blamed for many conditions that have nothing to do with him may be because doctors fail to listen to patients and follow the clues. Further, relying on laboratory diagnoses devoid of inflection or reflection may lead many down the wrong path: towards the domain of Mr Typhoid!
