Today I learnt that listening with an open posture, engaging patient in small talks, and explaining in details do not help to build rapport if the patient is simply unwilling to do so. In fact, these things probably will jeopardise the fragile relationship.
So I had this patient whom later the family revealed has came to seek consult after delaying for weeks, with a deal struck with the family that the patient will deal with her own affairs whilst in the hospital. When I was asking for medical history and correcting her claim that her asthmatic condition was not childhood asthma since the last she used a MDI was days ago, I thought the interview was going well because I was engaging her with an open posture and offering explanations. It appears to me now that this might have been actually the start to the mistrust built later.
Not long after I went into details of the patient's complaint was I confronted multiple times why I did what I did, by both the patient and the family. Simply asking if it was possible to obtain urine sample from the patient was difficult because she would explain her pain all over again and conclude that unless it was absolutely necessary, she won't do it. While I was trying my best to keep my cool and explain to them things I asked and what I have said, and the patient displaying understanding, this was just the beginning. As I approach the end of my interview, the family member requested for the patient to be attended to earlier to facilitate prescription of painkillers. And as all other patients, I explained that we cannot prioritise her because there are other patients waiting longer hours than her, and while both showed understanding, the displeasure was probably building up. I did my best and offered for the patient to lie down on a trolley to wait for consultation, and after being confronted yet again the benefits of my suggestion, they finally agreed but on one condition - for the patient to do the registration herself.
So after waiting for the registration to complete, I reconfirmed with the patient if it was done despite me seeing that it was completed, the patient instructed me that "you better check with the clerk". And as a futile attempt to strike small talk on the way of bringing the patient to lie down, I asked the patient if she would like the family to help with transferring, since the family has to leave her side after she is settled. This is the final straw I realised after, because the patient started to strongly object whatever suggestion I made thereafter. So when I accidentally lowered the trolley sharply by about 10 degrees because of the patient's weight, I had the patient almost screaming in pain and cursing me that I did that on purpose to cause her pain. And I as the usual self, did not offer apologies because I felt myself not doing any wrong, if not been trying my best to provide comfort for the patient.
It may be because of the mistrust that was built from the first encounter, or the fact that our mother tongues were different, it was a complete failure in communicating and building of rapport, and an experience that I could only hope to learn from and never repeat.