Promoting Responsibility in a Patient


Published: 07 December 2016

It’s 9:30 in the morning and I’m about to see my second patient of the day.

Before welcoming her into the consultation room, I browse her medical history and note another unfilled box.

Sadly, this is not my first encounter with this scenario, and each time, it becomes increasingly more perplexing.

I begin with the essentials: medication, breathing problems, followed by a long list of tick boxes.

Before I even ask the patient to answer the blank box, I already know what her response will be.

'Could you tell me the year of your last pap smear test?'

I watch my patient squirm awkwardly in her seat and respond sheepishly, 'I’ve never had one'.

At 30 years of age, she has escaped the system; slipped under the radar. She is the second patient this morning who has yet to attend a screening and I am certain she will not be the last.

I launch into my usual lecture - it sounds so perfectly rehearsed. 'Do you understand the significance of pap smear tests? Cervical cancer is often asymptomatic in the early stages'. At the end of my spiel, the patient turns to me and tells me she will make an appointment with her GP. I ask what has been stopping her from doing this earlier. The list of justifications starts with embarrassment, fear of pain, time restraints, forgetfulness and continues on. I wonder who the next professional will be to follow this up and fear how long this self-neglect could be sustainable.

embarrassed patient
Many patients procrastinate the need for regular tests due to embarrassment or feeling uncomfortable.

Despite notifications about screening dates, patients are still ignoring the importance of prevention.

What is it about a piece of paper that we find so easy to ignore? The tangibility is partially to blame. Letters are easily discarded, misplaced, or sent to an old address. More importantly, they do not present a sense of urgency.

The stigma surrounding screening also provides a strong deterrent. Frequently, patients have heard stories from friends about the discomfort experienced during the test, which enables further procrastination. Others find the thought of it embarrassing, and are unable to see past that to acknowledge the benefits. There are also patients who are not registered with a practice, preventing communication completely.

I recently read an article about addressing obesity in GP clinics. A study concluded that patients would prefer to have their weight issues highlighted by their doctors and would not be offended (Boseley 2016). If less sensitive matters are also not being discussed, it is hard to believe that this is something that will change overnight.

We should be empowering our patients and enabling them to take more responsibility for their health. Despite the obvious importance of it, our promotional role seems so drastically underemphasised. With prevention strategies playing such a core role in easing the pressure on the health services, the lack of public health-oriented counselling presents a major barrier to their success.