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The art that is medicine

DR BOIMA

HEALTH ISSUES

When a friend of mine took to his facebook page recently to air his annoyance over a Doctor who asked him where the mother of the child was when he had taken his child to the hospital, an avalanche of responses started pouring in; both good and bad.

 

Some came out with guns blazing settling scores from their previous bad encounters with doctors, some out of ignorance derailed off topic and howled insults around, and some mostly in the health profession tried to come to the rescue of one of their own by explaining what might have prompted such a question.

Unless we were present we would not know exactly  how the question was presented, after how long into the converstation, how the rapport of the doctor and the patient was to begin with, and what the motive of the question was apart from speculating. What is however evident is that a lot still do not understand the artistry that is medicine.

The interpersonal encounter between physician and patient remains a cornerstone in the art of medicine. Considerable research has explored various aspects of this relationship, including physician-patient communication, difficult patient interactions, and what physicians find meaningful in their work.

As part of this art we ask questions, lots of them! questions that may sometimes seem or appear unfair, daunting, uncomfortable or even annoying to our patients but we are just really trying to understand and have an idea of what kind of a patient we are dealing with; nothing personal! So unless and until we ask, we wont know and we wont be able to give the right treatment.

That is just how medicine works, we rely largely on the history and the cooperation (or lack therof) from the patients or guardians to give us reliable answers in order to make diagnoses. A good doctor is the one who is holistic in their approach and touch each part of the patient’s history and not just focus on the illness presented infront of them. According to the late old English Physician, Caleb Hillier Parry "It is more important to know what sort of patient has the disease than what kind of disease the patient has".

In his 2014 publication, Thomas R. Egnew, reviewed the literature and delineated seven behaviors expected during a doctor-patient interaction  that foster more consistent practice of the art of medicine.He called these behaviors “ HYPERLINK "http://www.aafp.org/fpm/2014/0700/p25.html" l "fpm20140700p25-bt1" The Magnificent Seven ” and they have been nicely summarized below for a better understanding of what goes around in the consultation room:

1. Preparation – Before entering the consultation room, doctors usually need a moment to personally prepare for the encounter. This will set the stage for all that is to follow. They should be aware of what is going on in their own body and mind, whether they are feeling rushed or tense or are still thinking about the previous patient. If so, it is advisable to take a deep breath or even have a coffee break to let go of the tension or preoccupation so that it is not carried into the next encounter.

Then, focus should be on the patient infront of you. What do you know about him or her? Where are you in terms of developing your relationship? What would you like to learn about this person that you don't already know? What is the topic of the encounter, if known, and how might that drive what needs to be accomplished during the consultation? Becoming mindful of these details outside the consultation room is a precursor to being mindful inside the consultation room. Nothing personal!

2. Establishment of rapport – The first few minutes of the consultation are usually dedicated to connecting with the patient, even before opening the records. Connection occurs on at least two levels; interpersonal and intellectual. Interpersonal contact is aimed at developing rapport and generally begins by incorporating a short, non-medical social interaction to open the interview. This is a good time to get to know a bit more about the patient.

A good tactic that most doctors usually use is to refer to something mentioned in prior consultations as a way to reinforce the continuity of their relationship with the patient, such as “So how is your dog doing?” or “How is your garden coming along?”. These are purely and clearly non-medical questions but they often help the doctor find clues about their patient’s current emotional state.

Spending a small amount of time socializing with and listening to the patient is worth the investment, as it has been shown to yield higher patient satisfaction. The intellectual aspect of connection signals that a doctor is transitioning from the social/rapport-building aspects of the interview to the medical aspects. This usually involves taking time in addressing the most important reason for the visit and offering assurance.

3. Smile a lot (my personal favourite) – Medicine is a serious business, and doctors are seriously busy people but if one is too serious or too busy for comfort they are missing out on something powerful. Similing and a bit of humor can be helpful in establishing rapport, relieving anxiety, communicating messages and caring, enhancing healing, and providing an acceptable outlet for anger and frustration.  It has generally favorable physiological effects too but, like any other tool, it should be used appropriately and not be a consulation spoiler.

4. Good communication –  Renowned Psychologist Carl Rogers suggested that those who counsel patients need to display three things in their communication: Congruence (being authentic and letting the patient experience who you really are, instead of putting on a facade), Acceptance (showing that you value the person even if you don't agree with his or her thoughts or actions), Empathy (relating and being sensitive to what the patient is experiencing).


Rogers' research indicated that individuals exposed to a relationship with high degrees of these qualities grew in their potential. Patients who have problems of living (such as domestic problems, socioeconomic challenges, or emotional issues) that present as medical problems can be particularly difficult to communicate with and are often labeled “difficult patients.” Managing them will require a doctor to use two skills that can be uncomfortable.

The first is relational immediacy, that is, the ability to communicate about a dynamic or behavior that is happening in the present moment of the encounter (e.g., “I'm feeling frustrated, and I'm sensing that you are too. Can we start over?”). The other skill a doctor needs is to put their foot down and confront. This is one of the most powerful actions a doctor can take to make a change in a patient’s life because it focuses on areas that need  change. However, confrontation can trigger volatile, defensive reactions from patients if not applies with caution.

5. Being mindful – The diagnosis and treatment of a patient's illness is a core medical function, but what is more important is the impact of the illness and suffering on the patient’s daily life. Patient suffering is more than just physical pain. It is “the state of severe distress associated with events that threaten the intactness of the person.”

In other words, it affects their personhood. To assess a patient's suffering, doctors usually dwell on the patient’s profession, support structure, personal beliefs, spirituality, religion etc. These may seem irrelevant when asked by they all fit into the equation.

6. The power of touch – A general rule in medicine is to always touch the part that’s hurting, but never to touch the part that hurts first. A warm handshake or a pat on the shoulder usually helps calm distraught or anxious patients, and touch has also been associated with health benefits like pain relief.

However it is always advisable to use touch cautiously as some patients’ reactions may be unpredictable especially those who have been physically or sexually abused, patients who are psychiatrically or developmentally challenged, and patients who are seductive. Also, doctors need  be culturally sensitive. Full explaination detailing what the physical examination entails should be offered and permission sought before the actual examination.

7. Showing some empathy – As discussed earlier, psychologist Carl Rogers included empathy, as an important ingredient in communication. Empathy is described as putting yourself in the patient’s shoes and sensing their world “as if it were your own”. This attempt to understand the patient's experience not only helps to establish a caring relationship but also can affect physiological results. For example, patients with highly empathetic physicians have been shown to have a shorter course of cold symptoms and better glycemic (diabetes) control than those whose physicians are less empathetic.

The hospital is an environment in which physicians find themselves increasingly overwhelmed, burnt out and disillusioned. Utilizing the tactics above may help minimize the tension between the patient and the doctor and deepen their relations. There might be a lot of changes to existing perspectives, perceptions, connections and experiences altogether. For comments or questions please email agboima@yahoo.com.

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Export Processing Zones: How to Get SEZA to Sizzle

23rd September 2020
Export Processing Zone (EPZ) factory in Kenya

In 2005, the Business & Economic Advisory Council (BEAC) pitched the idea of the establishment of Special Economic Zones (SEZs) to the Mogae Administration.

It took five years before the SEZ policy was formulated, another five years before the relevant law was enacted, and a full three years before the Special Economic Zones Authority (SEZA) became operational.

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Egypt Bagged Again

23rd September 2020
Samson

… courtesy of infiltration stratagem by Jehovah-Enlil’s clan

With the passing of Joshua’s generation, General Atiku, the promised peace and prosperity of a land flowing with milk and honey disappeared, giving way to chaos and confusion.

Maybe Joshua himself was to blame for this shambolic state of affairs. He had failed to mentor a successor in the manner Moses had mentored him. He had left the nation without a central government or a human head of state but as a confederacy of twelve independent tribes without any unifying force except their Anunnaki gods.

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‘RO, ‘RO ‘RO YOUR ‘BOT

23rd September 2020

If I say the word ‘robot’ to you,  I can guess what would immediately spring to mind –  a cute little Android or animal-like creature with human or pet animal characteristics and a ‘heart’, that is to say to say a battery, of gold, the sort we’ve all seen in various movies and  tv shows.  Think R2D2 or 3CPO in Star Wars, Wall-E in the movie of the same name,  Sonny in I Robot, loveable rogue Bender in Futurama,  Johnny 5 in Short Circuit…

Of course there are the evil ones too, the sort that want to rise up and eliminate us  inferior humans – Roy Batty in Blade Runner, Schwarzenegger’s T-800 in The Terminator,  Box in Logan’s Run,  Police robots in Elysium and  Otomo in Robocop.

And that’s to name but a few.  As a general rule of thumb, the closer the robot is to human form, the more dangerous it is and of course the ultimate threat in any Sci-Fi movie is that the robots will turn the tables and become the masters, not the mechanical slaves.  And whilst we are in reality a long way from robotic domination, there are an increasing number of examples of  robotics in the workplace.

ROBOT BLOODHOUNDS Sometimes by the time that one of us smells something the damage has already begun – the smell of burning rubber or even worse, the smell of deadly gas. Thank goodness for a robot capable of quickly detecting and analyzing a smell from our very own footprint.

A*Library Bot The A*Star (Singapore) developed library bot which when books are equipped with RFID location chips, can scan shelves quickly seeking out-of-place titles.  It manoeuvres with ease around corners, enhances the sorting and searching of books, and can self-navigate the library facility during non-open hours.

DRUG-COMPOUNDING ROBOT Automated medicine distribution system, connected to the hospital prescription system. It’s goal? To manipulate a large variety of objects (i.e.: drug vials, syringes, and IV bags) normally used in the manual process of drugs compounding to facilitate stronger standardisation, create higher levels of patient safety, and lower the risk of hospital staff exposed to toxic substances.

AUTOMOTIVE INDUSTRY ROBOTS Applications include screw-driving, assembling, painting, trimming/cutting, pouring hazardous substances, labelling, welding, handling, quality control applications as well as tasks that require extreme precision,

AGRICULTURAL ROBOTS Ecrobotix, a Swiss technology firm has a solar-controlled ‘bot that not only can identify weeds but thereafter can treat them. Naio Technologies based in southwestern France has developed a robot with the ability to weed, hoe, and assist during harvesting. Energid Technologies has developed a citrus picking system that retrieves one piece of fruit every 2-3 seconds and Spain-based Agrobot has taken the treachery out of strawberry picking. Meanwhile, Blue River Technology has developed the LettuceBot2 that attaches itself to a tractor to thin out lettuce fields as well as prevent herbicide-resistant weeds. And that’s only scratching the finely-tilled soil.

INDUSTRIAL FLOOR SCRUBBERS The Global Automatic Floor Scrubber Machine boasts a 1.6HP motor that offers 113″ water lift, 180 RPM and a coverage rate of 17,000 sq. ft. per hour

These examples all come from the aptly-named site www.willrobotstakemyjob.com    because while these functions are labour-saving and ripe for automation, the increasing use of artificial intelligence in the workplace will undoubtedly lead to increasing reliance on machines and a resulting swathe of human redundancies in a broad spectrum of industries and services.

This process has been greatly boosted by the global pandemic due to a combination of a workforce on furlough, whether by decree or by choice, and the obvious advantages of using virus-free machines – I don’t think computer viruses count!  For example, it was suggested recently that their use might have a beneficial effect in care homes for the elderly, solving short staffing issues and cheering up the old folks with the novelty of having their tea, coffee and medicines delivered by glorified model cars.  It’s a theory, at any rate.

Already, customers at the South-Korean  fast-food chain No Brand Burger can avoid any interaction with a human server during the pandemic.  The chain is using robots to take orders, prepare food and bring meals out to diners.  Customers order and pay via touchscreen, then their request is sent to the kitchen where a cooking machine heats up the buns and patties. When it’s ready, a robot ‘waiter’ brings out their takeout bag.   

‘This is the first time I’ve actually seen such robots, so they are really amazing and fun,’ Shin Hyun Soo, an office worker at No Brand in Seoul for the first time, told the AP. 

Human workers add toppings to the burgers and wrap them up in takeout bags before passing them over to yellow-and-black serving robots, which have been compared to Minions. 

Also in Korea, the Italian restaurant chain Mad for Garlic is using serving robots even for sit-down customers. Using 3D space mapping and other technology, the electronic ‘waiter,’ known as Aglio Kim, navigates between tables with up to five orders.  Mad for Garlic manager Lee Young-ho said kids especially like the robots, which can carry up to 66lbs in their trays.

These catering robots look nothing like their human counterparts – in fact they are nothing more than glorified food trolleys so using our thumb rule from the movies, mankind is safe from imminent takeover but clearly  Korean hospitality sector workers’ jobs are not.

And right there is the dichotomy – replacement by stealth.  Remote-controlled robotic waiters and waitresses don’t need to be paid, they don’t go on strike and they don’t spread disease so it’s a sure bet their army is already on the march.

But there may be more redundancies on the way as well.  Have you noticed how AI designers have an inability to use words of more than one syllable?  So ‘robot’ has become ‘bot’ and ‘android’ simply ‘droid?  Well, guys, if you continue to build machines ultimately smarter than yourselves you ‘rons  may find yourself surplus to requirements too – that’s ‘moron’ to us polysyllabic humans”!

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