Cautionary tales - Dr Naomi Harris

Dr Naomi Harris reflects on the importance of never assuming a patient’s medical knowledge.

STRANGELY enough it seems that while we consider cautionary tales to often originate from our early years as a doctor, I ran into one about four months ago, disappointingly, involving a common pitfall that I warn my medical students about on a daily basis.

One evening a 34-year-old female patient came in to see me. She was university educated, currently completing postgraduate studies, professionally employed and very well spoken.

Her principal complaint was that she had six weeks of light brown, odorous vaginal discharge, supra pubic pain and what she described as ‘pelvic fullness’.

On enquiring about the possibility of pregnancy she adamantly denied that it would be possible as she had not had intercourse for 19 months.

I explained to her the possible differentials – bacterial infection, thrush, chlamydia, and gonorrhoea – and how I would be testing her for them.

Perhaps I was tired or in a rush, but I did not pick up on her change in mood when I started explaining the STIs to her. I asked routine questions and explained I wanted to complete a PV exam and take a high vaginal swab.

Embarrassingly, I assumed that as a 34-year-old professionally employed woman, she would have knowledge surrounding these STIs I was testing her for.

At the conclusion of the consultation, after collecting an HVS and the patient producing a ‘first pass’ urine collection, I instructed her that the results would be available in about 48 hours. I remained oblivious to the gravity she was experiencing and went to make a follow-up appointment with her for the result discussion.

It was not until this point, when her increasing level of distress became obvious, that the ‘penny dropped’. 

She was concerned that she may have an incurable sexually transmitted infection that was going to be with her for the rest of her life. I had not realised she had no knowledge about chlamydia – a condition that I see up to 10 cases of per week.

I reassured her that if the test for chlamydia/gonorrhoea came back positive I would treat her with the appropriate antibiotics and she would not be plagued with an illness for eternity. I informed her that we would also retest her in four to six weeks to show resolution of the infection.

I now noted an immediate calming of the patient’s demeanour. I gave her some information to read on all of the possible diagnoses and sent her on her way.

This case taught me volumes about not assuming your patients have knowledge. 

They may align with your own demographics – age, race, education level, religion – but remember, you have the advantage of being a medical professional.