Common Challenges to Care

1. Positive Review of Systems:

   Often because patients want to make sure they get lots of medications

2. Lack of understanding of Chronic Disease:

   Patients tend to treat only when feeling unwell; thus, teaching is critical. They may believe diseases that educated people know are chronic as curable and need to be told otherwise.

3. Stockpiling medications:

   Patients may not use meds as prescribed and instead keep them for a home pharmacy for their family

4. Expectation of tests:

   Complaints may be given because the patient is, as we may find out with further questioning, worried about a certain disease and desiring a certain test (eg, ultrasound) that will “prove” they are well.

5. Symptomatic treatment only:

   See “Lack of understanding of Chronic Disease”. Hypertension is often only treated when it causes headaches.

6. Expectation of “Magic Pill”:

   Patients tend to overvalue pills and undervalue preventive health and their own work in becoming well

7. Avoidance of “Bad News”:

   Cambodians, like many Asian cultures, often think that “bad news” will hasten a bad outcome by increasing depression. Delivering bad news, often to a family member first, can be a wonderful bridge to sharing about eternal hope. See “Palliative Care” in the Patient Care Protocols.

8. Overreliance on IV Fluids:

   Patients often errantly believe IV fluids are necessary and they want IV fluids. IV fluids will typically make a dehydrated or sick person feel better, so this expensive myth is perpetuated and exacerbates poverty.

9. Perpetuation of Misunderstandings by Unregulated Care:

   IV fluids, “Psom Tnam”, and steroid use are a few of many ways that unregulated care that is focused on medicine as “business” rather than “service” perpetuates poor healthcare practices

10. Non-compliance despite “Yes”-to-please-authority:

    Cambodians will generally say “yes” to please the HCP whom they perceive as authoritative (higher in the hierarchy). Yes often may not really mean yes. Our approach to and timing of sharing the gospel should consider this issue, as well.

11. Lack of records or labeling:

    It is very common for patients to have baggies of medicine that are unlabeled or prescriptions that are difficult to interpret.