Case study part 4

Two years ago, Mr Rahman went to a doctor who told him that smoking was the main cause for his symptoms and advised him to quit smoking as the first and foremost step of care. The doctor prescribed some inhalers and tablets, which he used for a few weeks. Then he followed free advice from a local pharmacist who sold him some more medication.

Clinical judgement: Why do you think Mr Rahman stopped taking the doctor’s advice and prescription?

Doctor’s practice:

There may be some conflicts between the doctor and the patient’s concerns and beliefs: The patient’s concern was to relieve his symptoms, and he may have thought the medication was a ‘cure’ – either temporary or permanent.

The doctor’s concern was pathophysiology, so the doctor advised the patient to quit smoking.

“One of my patients, whom I advised to stop smoking, commented at the front desk after leaving my consultation room, ‘This doctor could not understand my problem, I have been smoking since my childhood, my father, grandfather and other relatives were lifelong smokers with good health! So what’s wrong with me?’”

“The good physician treats the disease; the great physician treats the patient who has the disease.”

Pharmacist/informal care provider:

In many low-and-middle-income countries (LMICs), in shops that sell pharmaceuticals (where owners do not have a basic training), pharmacists prescribe medicine and advise patients without any consultation fee.