LATE DIAGNOSIS: THE PATIENT FACTOR
One of the most frustrating and stressful aspects of medical practice in the Tropics (and indeed in any part of the world) is when treatable disease conditions lead to death. Such a situation may arise as a result of what Doctors call “late presentations” of disease. In nine out of ten cases, this is due to the “Patient Factor”. The “Patient Factor” is simply a set of events or actions imputable to the patient that could result in a delayed diagnosis or treatment. Let me emphasize that the aim of Medicine, aside alleviating pain and suffering, is to ensure that death that could have been prevented does not occur.
In spite of progress in the field of Health Education, a worrying proportion of the population tend to seek medical attention as a last resort even when accessibility or affordability is not an issue. The fact that advances in the field of Science and Technology have revolutionized Medical Practice does not mean that Medicine is about performing miracles or raising people from the dead. The truth remains that early diagnosis and treatment of disease is the sine qua non condition for a better prognosis.
Major medical achievements such as organ transplants, laser surgery, endoscopic surgery, etc have been touted over-enthusiastically as “miracles”. What such new techniques have brought on board is simply to offer new possibilities in the management and cure of disease. While in our developing world, we are still waiting to have some of these hi-tech things, we need to remind ourselves that Disease (man’s worst enemy by the way) is a dynamic process and that every illness always begins with signs and symptoms that progress slowly but relentlessly from mild to moderate and then severe. There is a cut-off point for every disease where no matter what means are deployed, it cannot be reversed.
With the exception of rural communities where healthcare facilities may be scarce or even non-existent, it is difficult to understand why some people seek medical attention as a last resort even when they live in urban areas.
“Because of Poverty, of course” I can hear someone say.
While Poverty is the first reason that come to mind, let us also agree that socio-economic factors alone cannot explain why even knowledgeable people report to hospital late. So, clearly, considerations other than poverty must be at play. I propose we examine at least two of them.
Firstly, what is our understanding or perception of disease symptoms at the individual level? What is the import of say a minor headache or a sudden onset nose bleed to you? What is it that frightens you or gives you anxiety and sleepless nights and what are you likely to dismiss as “small problem”? What is the threshold of your “self-preservation instinct” or in other words, when do you have the feeling that your life may be in danger?
The simple answer to all this is that except for accidental injury and other bodily harm, we are likely to delay medical consultation when we don’t consider what is happening to our body as life-threatening. Ignorance may play a part in this and justifiably so, because not everyone knows Pathology (in the same way that not everyone knows Law or Architecture). Generally, situations not causing Pain or Discomfort or Impairment of vital functions are likely not to receive early attention. Again, what difference does it make to you to have a nagging headache or an erectile dysfunction? Which one is likely to prompt you that you need to seek early medical attention? The key phrase here is “early medical attention”. I can safely bet that while you would be quick to blame the headache on work related-stress, you would not sleep three nights over your erectile dysfunction!
The second aspect is the interpretation of the cause of the ailment. Is it (as we say in Ghana) “natural” or “spiritual”? This is a cultural thing which will determine the specific healthcare orientation or choice. Once you become convinced that your old Auntie who is now 80 years old is the witch responsible for your barrenness and for that reason you need to seek help, do you first go to the witchdoctor or the prayer camp or the clinic/hospital? Better still, you may choose to try out each of these options in your quest for good health until you have come back to square one. By then, naturally (and unless you have already received your healing on the way), disease would also have progressed by leaps and bounds. And finally, one day you find yourself face to face with a Doctor after a protracted illness and as he gazes at you in utter bewilderment wondering what it will take to restore you to good health, you are left counting how many goats and fowls have been slaughtered and how much incense and anointing oil have been burned. And lastly, the most painful part comes when you hear the words: “Mr Oshimashie, how I wish you had reported here three months earlier. You see… there is a cure for this type of cancer when it is diagnosed early”.
“Had I known…” you would say to yourself.
One day, in a not too distant future (hopefully in our life time) hi-tech Medicine such as genetic engineering, cloning and genome mapping would become available and affordable and, who knows, may be able to reverse disease. Till then, remember this: when your symptoms persist for more than two days, go to a hospital and live long!
Stephen A. Akangah, MD
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