Fillers A memorable patient

The importance of being understood

BMJ 2003; 327 doi: (Published 09 October 2003) Cite this as: BMJ 2003;327:836
  1. Iona Vlad, medical student
  1. University of Medicine and Pharmacy, Iasi, Romania

    I have not yet graduated from medical university, and my experience with patients is therefore quite limited. However, I am sure that I will never forget a patient whom I met in my fourth year of study. During our clinical years at the university, we students assist in ward rounds every day and get involved with patient care. Each of us is responsible for a patient and must report on the daily course of his or her disease.

    It was early morning on a winter day during one of my internal medicine ward rounds. It was still dark outside, and the patients were just waking up and getting ready for a new day. My patient was an old lady from the countryside—her simple rural background meant she was none too familiar with modern medicine. That morning, I saw that she had a running nose, so I asked her innocently, “Oh, dear, have you caught a cold?” She looked suspiciously at me, so I thought that she had not understood my question. “I can see you have a running nose,” I said, trying to explain myself.

    “Oh, no, miss,” she replied, “It is because of these new medicines I have just put into my nose, they melt very easily.”

    Those “new medicines” were indometacin suppositories that my patient had been given for renal colic. I suppose that neither I nor the staff (the doctor who prescribed the drugs and the nurses) paid enough attention to explaining how to use suppositories. I still wonder why she did not swallow them. By their shape, she must have assumed that they were to be fitted into her nostrils.

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