Imagine lying to your doctor about your phone number and/or address. They attempt to contact you and, surprise!, you’ve vanished.
We visited a primary health care centre last week, and one of the issues we discussed was prevaricating patients.
Patients can’t register without an address, and there is a not uncommon practice of supplying a fake one.
The centre uses addresses to promote health in the community. If a TB patient doesn’t show up for a dose of their 6 month therapy, they provide home delivery. If a child misses an early childhood vaccination, a health promoter will go taptap on their door to find out why.
Perhaps I overly apply the lens of logic, but I can’t believe there isn’t some kind of legitimate rationale behind a conscious decision to supply fake coordinates.
I can imagine at least 3 potential reasons to prevaricate:
#1: Many simply don’t have a fixed address and, understandably, may want to maintain some level of dignity rather than disclose this openly.
#2: For those who do have coordinates, I wonder if they may have a premonition of inability to fully comply with therapy. Out of desperation, they hope a one-time visit might afford them a diagnosis and perhaps a few pills to get them feeling better.
#3: Maybe they fully intend to complete therapy, but having a health care worker tapping on your door for 6 months is perceived as a loud announcement to their neighbours that they’ve contracted a communicable disease, and one that is highly stigmatized.
In Western medical education, there is a movement towards patient autonomy and a poo-pooing of paternalism. If the patient doesn’t want a certain test or treatment: so be it. We will not hand-hold. We respectfully accept their decision to decline.
In the realm of communicable disease, where your lack of treatment could lead to another’s demise; however, we straddle an awkward ethical dilemma. Should we force someone to undergo treatment in order to protect the health of others?
Despite my agreement with the basic right of human freedom and autonomy, I have to commend the health centre for their approach and exceptionally humanitarian efforts.
Rather than pedantic, home-based health promoters give me a vaguely “family” feel. We all live in the same community, we all struggle to keep a work-life balance and keep ourselves healthy. Health is often what falls through the cracks when other responsibilities overcome us. To have a safety-net checking up on your health at home, is, in my mind, revolutionary. In truth, if I could get the pharmacy to deliver direct to my door in Canada, I would take it.
Some call it accountability, others call it nagging, but we all need reminders sometimes.
Communication is the most important medical instrument of the future. We may have solid scientific evidence proving that efficacy requires ‘x’ number of doses in order to achieve prevention or cure. But I wonder if, one day, we will have a fancy scientific study design that will get to the deeper questions of human behaviour.
I can just imagine it now, the headliner on PubMed: “An evidenced-based approach to prevaricating patients: how to transform transgressions into treatment triumph.”
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