Bedside Lessons – 7. DNA

Labels are easily applied to people but are not always appropriate. DNA – Did not attend is one of the commonest labels that can be given to patients and often no attempt to check their actual circumstances is actually made. DNA is a label that sticks to someone and can bias clinicians against patients without allowing them a chance to explain themselves.

Here’s a story about a patient that I met on a home visit many years ago which changed my thinking about the DNA label and labeling in general.

In my second year of Palliative Medicine specialist training, along with one of the hospice community nurses, I visited a patient who lived in one of the poorer parts of the city. The notes reported that this lady had DNAed four Radiation Oncology appointments and had been discharged back to the care of her GP. She had metastatic breast cancer and was having worsening pain from bony metastases.

We entered the messy old home and the patient looked unwell with signs of major weight loss. She looked frail and far older than her age. She told us that she had always had a tough life but that she was trying her best. She had been diagnosed with cancer and had been referred for specialist follow-up but had a good reason for not attending.

Her daughter had three young children, but was unable to care for them because of recurrent drug abuse issues. The father of the children had similar problems, thus the care of the three kids was left to their maternal grandmother. Grandmother had prioritised the needs of the three little ones above her own needs, hence had missed all of her Oncology appointments.

She thanked us for our visit, as she would have had trouble attending a clinic appointment in the city. Lack of transport was another factor she faced. She promised to try taking the medications that we had discussed with her. After the visit we arranged for pain medications to be prescribed and made a referral to our social worker for further input.

Lesson Learnt:

It can be easy to judge people too quickly without even trying to understand the reasons behind their actions or lack of action. Everyone has their own side of the story to tell if you give them the chance to do so. Her selfless act of caring for the next generation meant that she could not care for herself. Would she have it any other way? No, she wanted to give her three grandkids a good start to life, to give them every chance possible to be their best selves.

It can be easy to label people, and it can be a shortcut of sorts. This DNA doesn’t deserve to see me. It’s not just three letters, it’s a real person with a real story and reasoning behind their actions. People deserve at least a second chance before they are totally written off. Could a bit of generosity be considered for our fellow human beings?

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