The third module of the Patient contact course gave us, for the first time, the opportunity to fully explore all the aspects of a patient with a chronic illness’s life and to delve into the adaptations that such a condition has forced upon them. I must concede that I was initially apprehensive about meeting a patient with a chronic illness, having a somewhat nai?? ve and apocryphal presupposition that all chronic patients would be in an ailing state of health, making it difficult to conduct the interview and obtain relevant information.
However such prejudices were very quickly quelled on meeting Mr G, a cheerful, easily comprehensible and pleasant 90 year old gentleman, the nature of whose condition, it was difficult to judge at first, as he seemed to be in, relative to his age, good health. Mr G has accumulated a number of health problems over his years of life, he told us of 7 different drugs he was taking for heart problems, his thyroid gland, cholesterol and what he termed as ‘problems with his waterworks. ‘
Mr G, didn’t seem to know very much about the nature of his health difficulties, on asking him what he understood about the problems with his health he confessed; ‘I listen to the doctor and take my medication seriously and vigorously but I don’t understand my problems a lot. ‘ This brings us onto an interesting debate, what is the best method of managing chronic illness? Anderson and Bury argue the need for a ‘reorientation of the focus for care from repairing damage caused by disease, to education, and understanding for living with chronic illness. (1)
If this school of thought is to be adhered to it would indicate, that the medical profession should pay more due regard to the broader aspect of chronic illness management, ensuring that patients such as Mr G, have a better education of their chronic illness, which will help them manage all aspects of their life better, pitching towards an improved quality of life, in the long term. It emerged that the most serious and debilitating of Mr G’s health problems were his angina, the history of which stemmed back to the early 70’s.
Mr G, told us of the first occurrence 37 years ago when he had experienced chest tightness and had collapsed twice, once at work and once when he was on the bus, sitting at rest, he had felt chest pain and subsequently collapsed. Taken to hospital he was told that he had had two suspected heart attacks, and was diagnosed with angina. It came as somewhat a challenge determining what the most limiting factors on Mr G’s lifestyle were; it was almost impossible to penetrate his intoxicating positive outlook on life.
He maintained that there wasn’t anything that he would like to do but he couldn’t, given his condition. I felt anxious and worried about asking a question that would insult or upset Mr. G at this point in the interview, so I took tentative alternative lines of questioning to unearth this, however fortunately the full nature of Mr. G’s condition and its limitations on his life gradually, naturally and harmlessly became apparent, on progression of the interview.
The most immediate impact on Mr G’s life after his coronary events had been at work, at the time he was working in a big storage warehouse and his work involved lifting and moving heavy equipment, fortunately Mr G’s employers had been sympathetic and understanding of his situation and so had lessened his work load. For a number of years he had been able to carry on with some level of continuity and normality to his life, however he told us that he felt his body was ‘wearing down’, and coupled with a number of other circumstances, including his wife falling ill and needing to look after her, forced Mr G to retire in 1979.
Mr. G’s condition has deteriorated significantly over the years; however this deterioration seems to have been a very progressive one, which has enabled Mr. G to adapt to his condition steadily and efficiently. Today Mr. G cannot walk, unsupported more than the length of a room without a very prominent chest tightness and extreme discomfort forcing him to stop, however, thanks to both his own adaptive behaviour and aid from a number of sources such as the local council, Mr G manages to, as he put it, ‘enjoy life best he can. ‘ I was extremely saddened as Mr. G told us of his familial situation.
He spoke with such fondness of the wife he had lost two years ago, and when we asked of any other family, this seemed to upset Mr. G profoundly, he told us that he had not spoken to any of his children in 30 years. This was not a case of familial breakdown connected to Mr G’s chronic illness, such as the common trend identified by many sociologists (2) among them Macdonald (1988), but rather because of ‘the way his children had treated his late wife. ‘ Seeing Mr G’s discomfort I was forced to move away from this topic, worried that it would upset him further.
Even still, Mr G has a prominent ‘web of care. ‘ Other than what can be termed as ‘informal carers’ who are Mr G’s friends who visit him regularly and are the source of emotional support in his life, he has home help with bathing, getting dressed and housework, five times a week and a social worker that visits him every few weeks, informing him of all the community support which is available and helping him with any paperwork he has.
The council have installed a number of mobility aids, such as hand rails, an electric bath hoist etc. n Mr G’s ground floor flat in a ‘Sheltered Unit,’ which is a block of 38 flats with a 24 hour warden on call, reached in an emergency by the push of a button. Mr G has also bought himself an electrical buggy, which he proudly told us, allows him to independently do all his own grocery shopping. In my interview with Mr G. I had the opportunity to use a number of interviewing skills for opening the interview, gathering information and building a rapport with the patient, which I had put into proficient practice in my interview with a simulated patient (part of our communications course).
Skills such as an appropriate opening, introducing myself and reaffirming confidentiality, to both settle my own nerves and put the patient at ease, and active listening, both verbal and non-verbal instances to gather information, are skills that have been extensively researched and proven effective by doctors and sociologists for many years (3) and once again they served me well, as they had done in my simulated interview.
A weakness that I had identified in my simulated interview was an inability to close the interview in an appropriate manner. This time round, I made sure to summarise everything we had covered, making sure all of the patient’s issues as well as my own had been addressed. I found that as the interview progressed I became more and more comfortable with Mr G, and except for the few moments of awkwardness described, the interview went smoothly.
I felt Mr G, opened up more, from an initially fairly reserved attitude, as the interview progressed and he became more used to me and the setting. As convincing as the simulated patient was in my practice interview, I felt that I was more involved emotionally with Mr G than I had been with him. For example, I was much more moved when Mr G told me his wife had passed away and described the effect this had had on his life, which co-incidentally was also a feature of my simulated interview.
This may have been because, in my simulated interview I was always aware on a subconscious level that the simulated patient was only an actor with a made up story rather than a real person experiencing real pain. I am very glad to have met Mr G, seeing how despite his health difficulties he has adapted in order to live a life which is as satisfying as possible, has been inspirational to me. Meeting him has also made me realise the importance of the adaptive nature of dealing with illness, which is fundamental when it comes to chronic conditions.