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 Medical intimidation and duress: The dark side of healthcare

 Medical intimidation and duress are two phe­nomena that can have a profound impact on patients’ experiences and outcomes in the healthcare system.

These behaviours, often per­petrated by healthcare provid­ers, can take many forms, from subtle manipulation to overt coercion.

In this article, we will explore the complexities of medical intimidation and duress, their consequences, and strategies for prevention and mitigation.

What is medical

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intimidation?

Medical intimidation refers to situations where healthcare providers use their authority, expertise, or position to coerce, manipulate, or bully patients into making decisions that may not be in their best interests.

This can include verbal aggression, condescending language, or withholding in­formation to influence patient decisions.

Medical intimidation can be overt, such as yelling or belit­tling, or subtle, such as using technical jargon to confuse or intimidate patients.

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What is medical duress?

Medical duress occurs when healthcare providers use coer­cive tactics, such as threats or pressure, to force patients into undergoing specific treatments or procedures.

This can involve explicit or implicit threats, such as withholding necessary care or services if the patient does not comply with the provider’s rec­ommendations. Medical duress can be particularly damaging, as patients may feel trapped, anxious, or fearful, which can negatively impact their physical and emotional well-being.

Consequences of medical

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intimidation and duress

The consequences of medical intimidation and duress can be severe and far-reaching. Some of the potential consequences include:

Decreased trust: Medical in­timidation and duress can erode trust between patients and healthcare providers, making it more challenging to establish effective care relationships.

Poor health outcomes: When patients feel coerced or intim­idated, they may be less likely to adhere to treatment plans or disclose important information, leading to suboptimal health outcomes.

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Legal and ethical implica­tions: Medical intimidation and duress can raise legal and ethi­cal concerns, potentially violat­ing patients’ rights to informed consent and autonomy.

Prevention and mitigation strategies

Fortunately, there are strate­gies that can help prevent and mitigate medical intimidation and duress. Some of these include:

Patient-centered care: Fostering a patient-centered approach, where healthcare providers prioritise patients’ needs, values, and preferences, can help prevent medical intim­idation and duress.

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Clear communication: Ensuring clear, respectful, and empathetic communication can help build trust and reduce the risk of misunderstandings.

Support systems: Establish­ing support systems, such as patient advocates or counseling services, can provide patients with resources and guidance to navigate complex healthcare situations.

The role of healthcare pro­viders

Healthcare providers play a critical role in preventing and mitigating medical intimidation and duress. Some strategies that providers can use include:

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Active listening: Providers can use active listening skills to ensure that patients feel heard and understood.

Empathy and compassion: Providers can demonstrate empathy and compassion, ac­knowledging patients’ fears and concerns.

Clear and respectful commu­nication: Providers can commu­nicate clearly and respectfully, avoiding jargon and technical terms that may confuse pa­tients.

The role of patients

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Patients also have a critical role to play in preventing and mitigating medical intimidation and duress. Some strategies that patients can use include:

Assertive communication: Patients can communicate assertively, expressing their needs and concerns clearly and respectfully.

Seeking support: Patients can seek support from family, friends, or patient advocates if they feel intimidated or coerced.

Advocating for themselves: Patients can advocate for themselves, asking questions and seeking clarification when needed.

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Conclusion

Medical intimidation and duress are serious issues that can have a profound impact on patients’ experiences and outcomes in the healthcare system.

By understanding the com­plexities of these phenomena and implementing strategies for prevention and mitigation, healthcare providers can create a more supportive and respect­ful environment for patients.

Patients, too, can take steps to advocate for themselves and assert their rights. By working together, we can build a health­care system that prioritises patients’ needs, values, and preferences.

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By Robert Ekow Grimmond-Thompson

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Features

 Beyond the polished glass: everyday scenes at Accra mall trotro station – Part 1

 Just outside the polished glass doors of Accra Mall, a differ­ent reality unfolds. Amid the traffic, street vendors, commuters and child beggars, the city’s energy flows in sharp contrast to the calm and luxury within.

It is 4pm on a humid Wednesday afternoon outside Accra Mall. In the traffic surrounding the mall, Toyota Corollas, Nissan Navara’s, Kia Morn­ing, Trotros, Mercedes-Benz cars crawl bumper to bumper. They inch their way around the roundabout connecting Spintex Road to the Tema Motorway. Drivers tap their horns repeatedly as the wait grows longer. Passersby slip between the vehicles, weaving their way to the trotro station, roadside stalls or side streets leading to their desti­nations.

Just beyond the traffic and noise, Accra Mall rises at the heart of the city, bright and busy with shops, eateries and cinemas gathered under one roof. Inside, the contrast is immediate. The air-conditioning hums steadily, keeping the space crisp and cool while shoppers move between stores with bags in hand containing new clothes, gadgets, perfumes and other small luxuries paid for in clean cedis. At the food court, children giggle over ice cream while friends lean over pizza boxes. The smell of fresh popcorn hangs in the air near the cinema entrance.

Since opening in 2008, Accra Mall has stood as one of the city’s most visited commercial hubs. But the calm inside ends at the door. The atmosphere shifts from cool air and clean cedis to constant movement, long waits, and daily survival. Just beyond the mall, the air is thick with heat, blaring horns, and ex­haust fumes. It carries the struggle of people whose day does not end with a shopping receipt.

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According to MIT’s Atlas of Pop­ular Transport, Trotros carry over 3.5 million passenger trips each weekday and remain the dominant form of public transport, serving more than 70 per cent of Greater Accra’s commuters. Even without precise daily figures, their presence is unmistakable in the routines of Accra’s residents navigating work, school, and trade across the capi­tal.

This scene plays out daily along the busy stretch near Accra Mall, where traffic slows to a crawl and “trotro” queues stretch along the roadside. At the roundabout, be­neath a weathered police canopy, a plus-size policewoman in a bright green traffic vest has surrendered to sleep. She lies stretched on a long bench, mouth wide open, chin tilted skyward, as if the whine of horns and coughing engines were lullabies. A few steps away, a male officer in a matching vest, tasked with directing the traffic, stands by the roadside with his hands buried in his pockets, eyes fixed on the parade of cars inching forward and honking in frustration.

Across the street, Accra Mall’s Street commerce bursts into ac­tivity. Makeshift stalls are lined up tightly along the roadside. Racks of ready-made African clothing sway in the dusty breeze. Sandals are arranged neatly on plastic sheets. Beaded necklaces in red, blue and gold catch both sunlight and the attention of people passing by.

With Eyram, the Tale Berear

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Monsieur’s daughter —(Part 5)

By the time he returned to Ghana, David had gained solid financial muscle. With his wife as project director, he established Plant Warehouse, a company which rented out equipment to construc­tion and mining companies.

The head office was in Accra, but most of their equipment were based in Kumasi and Tarkwa. With solid links with firms in Germany, he had no difficulty mobilising equip­ment, and clients were pleasantly surprised at the range of machines available, and the quality of ser­vice.

Although he had become quite wealthy, he kept a low profile, spending most of his free time with his wife and two daughters. In addition to taking good care of his parents and numerous relatives, he did quite a few charitable works in his hometown, Aboso and other parts without drawing attention to himself.

He donated computers and a pick-up truck to the Aboso Senior High School. And of course, he do­nated books and audio-visual ma­terials for the study of French. He insisted that no publicity whatso­ever be given to these donations, apart from the formal handing over to the Regional Education Director.

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His two daughters, Abrefi and Adaawa, had more than compen­sated for the treachery he suffered at the hands of Gladys, the woman with whom he had had that unfor­tunate false start in life.

Regrettable as that episode was, it had given him the momentum to relaunch his career. He had closed that chapter, as his parents had advised.

Once in a while he was tempted to reflect on the daughter that was quite clearly his, but he stood on the declaration made by his father, that if she was truly his, God would take care of her and she would return to him. So far, there was no sign of her. Well…

After the company was fully established, Adoma stopped partic­ipating in management to concen­trate on managing the home, and providing effective support to the children.

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But she established good rapport with the company’s drivers, techni­cians and other technical workers. Very often, she would go to the offices to support her husband.

As they were retiring to bed one evening, Adoma raised the issue of their past at Aboso.

‘I sometimes wonder what would have happened to me if you and Gladys had enjoyed a peaceful marriage’.

‘A very handsome young man would have met you, taken you to Germany, raised some capital and returned with you to start a com­pany, and a family. And you would have enjoyed a very peaceful marriage’.

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‘And who would that man be’.

‘He would have been called Da­vid’. She collapsed with laughter’.

‘I used to wonder whether I did right by leaking information about Gladys to you’.

‘I would certainly have gotten to know. You know the kind of revul­sion people feel when a recently married person gets involved in a scandal, especially in a small com­munity like Aboso.

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Some of our colleagues knew, and were about to tell me anyway. I would certainly have gotten to know. And I would have taken the same action I took. I certainly didn’t deserve to be treated like that. And as to whether I should have attempted to take Sarah away from her, that woman would have done anything to make my life miserable.

She could have moved her from place to place to prevent me find­ing her, and she would have refused to cooperate with any agency we reported her to my parents’ advise was the best’.

‘I wonder, though, whether we should make some effort to find out about how she is doing. After all, she is your child. Of course, we should do this very carefully. I don’t think she has forgiven you for leaving her’.

‘I’m sure she hasn’t, but she did it to herself, didn’t she? What was the guarantee that she wouldn’t be see­ing him later in our marriage? That kind of behaviour is often repeated. I don’t regret the decision I took, at all.

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I would do the same thing today, given the same situation. And don’t forget, you and I were destined to be together as man and wife. It should have happened earlier, but it still happened. Thank you very much for marrying me’.

‘I’m also grateful to you for marry­ing me. But before you fall asleep, shall we take some careful steps to find out about Sarah?’

‘Yes. You know, I’ve been receiv­ing snippets of information every now and then, but I’ve forgotten to update you. You already know that she’s in JHS three in a school at Koforidua, Research Basic and Junior High.

It’s quite a good school, run by the research institutions in the Eastern Region. She’s doing quite well in class, from what I hear, so hopefully she will qualify for uni­versity.

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Gladys and Simon are still mar­ried, and they have two children, so Sarah will be growing in some kind of decent family situation. I hear though, that all is not going well with Simon’s job, and the marriage is not a very strong one. I hope they are at least managing to take good care of their kids.

I will certainly make a direct effort to contact Sarah after she’s completed JHS. She would be old enough to make a decent choice, and I hope that in spite of whatever feelings she has against me, Gladys will realise the financial advantage of allowing me to take my child’.

‘I’m happy she’s doing well in school. But I hope we can get some inside information on her emotional status. Unstable marriages often have a significant effect on kids, especially stepchildren’.

‘You are right. From what I have learnt, Gladys is the one who runs the show in the house, so I don’t think Simon will get the opportunity to mistreat Sarah. But as I said, I will start sniffing for more informa­tion’.

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‘We do have to start preparing for the possibility of her joining us here, sooner or later. I’m not talking about material stuff. We can certainly take care of her. But she needs to blend well with her siblings. I’m glad we’ve already told them about her’.

‘Many thanks for that. We should have another discussion with them quite soon. I’m sure we can inte­grate her smoothly. There may be difficulties, but we will overcome them’.

‘One very final thing, David. Shouldn’t we speak to Lawyer Ache­ampong, just in case one or two legal issues arise?’

‘Yes! Of course! How come I never thought of that? I will call him first thing tomorrow. I don’t think any such issues may arise, but it will be wise not to take precautions. Thank you, sweetheart’.

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‘We do have to start preparing for the possibility of her joining us here, sooner or later. I’m not talking about material stuff. We can certainly take care of her. But she needs to blend well with her siblings. I’m glad we’ve already told them about her’.

By Ekow de Heer

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