Last week I completed my very last clinical rotation for this semester. My group rotated in the psychiatric ward of the hospital. I met a lot of intriguing patients with all-too-familiar stories. Before medical school, I worked for three years at a state psychiatric hospital. In fact, the experience at the psych hospital is what gave me my first thirst for medicine.
Having met so many psychiatric patients in the States, I was very interested in discovering the kinds of patients I’d find here in Dominica. Surprisingly, the patients’ stories, experiences, and struggles with mental illness were strikingly similar to the ones I’d seen in the States. The ward was also set up comparably to the hospital I worked at and psychiatric wards that I’d seen in the States. The treatment team still consisted of almost the same group of people: a psychiatrist, a psychologist, a nurse, a social worker, and a nursing assistant. The pain and frustration that the families were experiencing was also sadly familiar to me. I immediately recognized their wrinkled and fatigued faces and knew that they’d encountered endless challenges and setbacks while trying to help their loved ones.
There was only one thing that I noticed that was prominently distinctive about the psych ward here in Dominica: the patients were not verbally or physically abusive towards the staff. Not only were they not abusive, but they were relatively pleasant. The patients actually listened to the nurses and doctors. They rarely defied them. The chief psychiatrist confirmed my observation. He said that it was exceedingly rare for a patient to attack a staff member and that the majority of patients respected the staff immensely.
I can’t emphasize how shocked I was by this revelation! For three years I came in to work prepared to deal with abuse. I worked on the acute unit and most of the patients were very unstable. I was continually verbally abused, and physically attacked on more than one occasion. We did everything we could to ensure a safe unit, but sometimes the abuse was just inevitable. All of the staff were on constant alert. We knew that at any moment a patient could take their rage out on one of us.
Not only were the patients aggressive at times, but they rarely listened to the advice or encouragements of the staff. Getting a patient to take their medication voluntarily was a daily battle. Convincing them to take a shower or change their clothes was no easy task. There were definitely some cooperative patients, but most patients downright hated the staff.
The contrast between the trustful Dominican psych patients and the distrustful American patients is profound. A common phrase uttered by Dominican patients is “yes, doctor.” The first time I heard it, I didn’t think much of it, but over this semester, I’ve heard it over and over again. It’s almost like a patient mantra. At first I thought they were saying it mockingly, but I’ve since realized that they actually mean it. They really do put all of their trust into their doctors’ guidance.
I’m so fascinated by this that I’d love to research how the differences in patient trust have evolved. I’d really like to know how the cultural aspects come into play. And the big question I have on my mind is how patient trust in their doctor might affect patient outcomes. Are the trusting patients more likely to be compliant with their treatment plans, and hence have better outcomes? Or is a little distrust important in keeping the patient super vigilant? How much do you think patients should trust their doctor?