On Labeling and Stigmatization

In the medical world, as cruel and inhumane as it may sound, patients are often being referred as ‘cases’ by healthcare professions, especially by doctors and medical students. On a typical day in the wards, I often heard someone asking, “hey, any interesting cases today?’, be it my friends or even among doctors. I, too, am guilty as charged. Sometimes it just slipped off my mouth, and it is a terrifying idea that whether am I still looking at patients as humans or merely another ‘case’. The thought of being drowned in the world of academic medicine and forget about the initial purpose of studying medicine – treating and making someone feel better, often send chills down to my spine.

Recently I have seen a 5 year old girl, Cindy* who came in due to recurrent urinary infection, with a background history of Turner’s syndrome (a genetic disorder) based on clinical diagnosis. I had the opportunity to have a nice chat with the girl’s mother, Kelly*, who has been ever so helpful and willing to give a wonderful history. It seems that the poor girl has been admitted three times prior to this due to urinary infection as well, which worries Kelly*. Upon further elaboration on the diagnosis of Turner’s syndrome, Kelly* revealed that the doctors suspected it shortly after the delivery as Cindy* seems to have some syndromic features. A karyotype analysis (a laboratory testing to map out the gene) was then ordered which interestingly came back with XX gene (rather than XO in Turner’s syndrome), making the diagnosis of Turner’s syndrome on Cindy* unlikely. 

Despite that, Cindy* continues to be treated as a child with Turner’s syndrome even though she had a normal karyotype and minimal syndromic features (low posterior neck line, slightly low growth rate). When the mother asked me should she believe in the report or take the word from the doctor, it occurred to me that she actually was not being explained about the report and being brief properly by healthcare professionals for the past 5 years! It is sad that the mother was being kept unknown about her daughter’s condition and no-one has ever attempted to explain to her what was going on for the past few years. For the past couple of years in medical school, we have been taught how important communication is and how we should always keep the patient in the loop on the management of their health. Yet, often, inadequate or no explanation has been given to the patients in the hospital due to time constrains and several other reason. 

Another thing that I have observe is that how far labeling and stigma can go when a diagnosis is not being reviewed accordingly. Even though Cindy* is unlikely to have Turner’s syndrome, the diagnosis has been following her around for the past 5 years. Is it because the doctors were scared to whistle-blow? Or they just took the safer way out and copy whatever has been written previously? It makes me think how important an accurate diagnosis is to the patient, and if he or she has been diagnosed wrongly, the labeling goes a long way and he/she might just be stuck with it for the rest of his/her life! Besides, it also made me realize how important continuous reviewing of the patient’s diagnosis is, in order to formulate and deliver the most appropriate management plan. 

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I am extremely grateful that I had the opportunity to meet Cindy* and her ever supportive mother, Kelly*. I have learnt a lot, academic and ethics wise. It has been a lovely evening and I sincerely hope that one day, they will find someone to get rid of the label from her case notes for good! =)

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