Great Frustrations: Patients who do not take Responsibility

The thing that bothers me the most is when patients allow a disease to progress so far that almost nothing can be done – especially when something could perhaps have been done.

My surgery rotation has had numerous such cases.

Once, during a night-time call, the most horrible, moist stench filled the entire corridor of the casualty ward. The cause was a patient with anal carcinoma… so advanced that he had a 10x6cm lesion where his anus should have been. It had completely destroyed much of the muscle and all of the sphincter.

This image is the closest I could get on Google, but it is not nearly close enough:

The link is safe, but the picture is a bit graphic for sensitive readers.

Two days later a lady entered the ward with the worst venous ulcers I have ever seen (not that I have seen terribly many). I could see one of the metatarsals of her right foot. She was in so much pain, but that she had waited til now to seek help goes beyond my understanding.

The thing about the Western Cape is that the Department of Health here has gone through a lot of effort to ensure that there is a community health clinic walking distance from any settlement in the province.

So as much sympathy as I have for these patients, I simply do not think they have a valid excuse.


  1. Johan Marais says:

    wow that’s graphic, you might wanna warn people before you show that picture…
    just saying

    1. Apologies, I forget sometimes. I removed the pic and posted the link instead.

      1. Johan Marais says:

        nah that’s fine, i’m not squeamish so i didn’t mind. It was pretty interesting anyway, what would be done with anal carcinoma like that?

      2. I’m probably not the best person to ask – I need to rewrite my surgery test. But this specificncase, I believe, was beyond excision. I think radiation would be the best treatment. Probably with a stoma or something too.

  2. Nothing hurt says:

    I share the confusion with you! I worked in an ED for a year, and some of the cases that presented were intense, to say the least. The best that I can come up with is: 1. financial burden 2. passionately hating hospitals and doctors (likely from generations of thinking people go to hospitals and see doctors to die) and 3. just not knowing how bad some things are.

    1. Good thoughts. I wouldn’t say the first really applies to my patients as they are all able to access the (free) public health system. But that hospital is a place you go to die is still a very common misconception and I can imagine that to be a very big part of the reason. Also just not knowing… I suppose if a patient is not medically inclined it is understandable that they won’t know. So weird to imagine, though.

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