This week was rather exciting, conversation wise. The topic of using Ritalin came up (one of my classmates is using it to study). Its use is generally widespread in the Health Sciences faculty because many people turn to "self" medicating because they did not get the results that they wanted.
I think that it is not really something that people should mess around with. Firstly, I really do think that it is equivalent to doping in sport. If you really did need the drug, a doctor would prescribe it to you. If it hasn't been prescribed to you, then sit down and work...
Here is a copy of my recent portfolio piece, I'm already tired of them...
They say that it is difficult to appreciate life until you are put in life or death situation. For many people in the renal ward at Charlotte Maxeke Johannesburg Academic Hospital it is very difficult to not appreciate life. With only two hundred dialysis places for the whole of Johannesburg, many people are forced to go home without life-saving treatment. It was after one of the patients had been discharged that I spoke to them about their stay in hospital. Thembi is a middle-aged woman that happily stood at her bedside, all your belongings packed and ready to go home. She had just been told that she didn’t qualify for dialysis because she was HIV positive and had not been on ARVs for at least 6 months. The smile was inexplicable, unless my assumptions were correct in that she didn’t understand what not getting dialysis actually meant.
It came to me then that perhaps this was an example of doctor-centred bias. With so little time to talk to all of the patients in the ward they were unable to address any concerns or questions that they patients may have. Another patient in the ward had recently demised because they had refused dialysis citing that they believed that they could “fight it [renal failure] themselves”. It is beliefs such as this that make me ask questions about the health profession, and not just in South Africa. The dynamic of health care is such that the doctor’s knowledge is usually superior to that of the patient. I think that that is especially a problem in the public health care sector in this country because understaffing often prevents doctors spending more time with their patients.
It is a problem that seems to plague hospitals and clinics around Johannesburg in general. At my community site there are two nurses and one doctor that treat over six thousand patients every month. It was at this clinic that they linked non-adherence to the lack of staff. The nurse in charge said that often she could treat forty patients in less than half an hour. With very little time to spend counselling and providing information, it is understandable that often patients are not given information about side effects and procedures.
When asking my patient how their stay had been in hospital and how they had been treated they didn’t seem to want to say more than that they had been treated well. I am not sure if it was to do with the person trying to come to terms with the fact that they would be going home to die or if the person was afraid that we would tell the staff working at the hospital about their response. I didn’t think that it was appropriate to delve any deeper in this case and I left it at that. I didn’t really feel that it was my place to try and explain the situation. She may have understood it all along.
The renal ward has been a very difficult ward to work and learn in. At times it is not easy to see past the good that the doctors and nurses in the ward are doing. The nature of renal medicine makes it such that life and death decisions are commonplace. Although this is the nature of medicine in general, it is very difficult to work in an environment where the very limited resources often determine, directly or indirectly, whether someone will live or die. It would be a lot easier to accept in an area of medicine where resource use can be maximized, but with something as complex as dialysis, it is usually the patient’s only hope.
I am really bothered by the fact that most doctors go into private practice without even being bothered by the problems currently plaguing the public service. For me it would be unethical and inhuman to practice medicine in the private setting. This case was merely the first of many that could have been solved by there being more doctors in the wards. Even if the person could still not have been given dialysis, the doctor may have been able to come up with another treatment that would have given them a longer life. Medicine by nature is a career about people; perhaps we need more “people” to study medicine.
Although patient-centered care is something that all doctors should be striving for, I do not believe that it is something that will be achieved, at least in the public setting. I think that what doctors should strive for is not a complete hybrid between patient and doctor-centered care, but rather doctor-centered care with only a slight emphasis on the patient side. If one question is answered it is better than none and in an environment where doctors are working 36-hour shifts it seems a little optimistic to assume a completely turn around in patient care. The emphasis on some of the patient-doctor themes in fact seem to be channeling individuals into the private sector which seems a little counter-productive. In all honestly, I believe that the medical school should be showing individuals the current problems with the health care system in South Africa and engaging with the students to solve the problem. One trip to a local clinic should leave most prospective doctors with a social obligation to go into the public sector. Too many medical students are focused on making money. The Wits Medical School currently has three hundred GEMP I businessmen and women; it’s about time that they had three hundred GEMP I doctors.
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