Towards patient-centred style of communication: A cultural-pragmatic study of doctor-patient consultative encounters at general hospital, Ile-Oluji, Ondo State, Nigeria

Abstract Medical humanities, as a sub-field in humanities, provide a ground for an in-depth study of medical practices’ narratives or discourses through linguistic and non-linguistic approaches. No doubt, most doctors, in Nigeria or other developing countries, were trained in the context of a doctor-centred style of communication. In recent times, the call for patient-centred discourse engagement in the hospitals has prompted attention, among scholars, to consider the best skills that could enhance and sustain such. It was, therefore, imperative to investigate the influence of socio-cultural contexts on doctor-patient consultative encounters in hospitals. Eight doctor-patient consultative encounters at General Hospital, Ile-Oluji, Ondo State, Nigeria, were purposively selected. The data were analysed through the linguistic approach of cultural pragmatics. The study employed both qualitative and quantitative methods in the analysis. As such, a questionnaire was designed to elicit information on doctors’ perceptions of a patient-centred style of communication. It was discovered socio-cultural context of both patients and doctors influence discourse engagement during consultation. Also, doctors are fast to adopt a doctor-centred style based on the belief that patients may not provide sufficient details needed for an appropriate diagnosis. This study, therefore, concludes that a patient-centred style of communication is appropriate and helpful in the hospital if the doctors have detailed knowledge and comprehension of the patient’s socio-cultural context.


Introduction
Nigeria, as a country, has peculiar cultural experiences considering the heterogeneous linguistic and socio-cultural context. Culture has been defined as the ideas, customs, behaviours and attitudes of a particular people or society. Notwithstanding what people think, how they think, and what they say or do constitute the culture. In Nigeria, there are customs, laws, pieces of knowledge, morals, art and belief systems that constitute the socio-cultural system (Ademola-Olateju, 2019). With over 400 languages and three major ethnic groups in Nigeria (Ayeomoni & Akinkurolere, 2012); Yoruba, Igbo and Hausa are the major ethnic groups with distinctive sociocultural features. This cultural diversity reflects all spheres of human endeavours in the country including medical practice. Doctors practising in a particular region may belong to a different ethnic group while patients seeing the same doctor may be from different ethnic groups. This is a common experience in medical practice.
In the past, criticism of social context was not given attention in medical studies but with the development of medical humanities, socio-context, through the conscious awareness or unawareness of the participants, becomes apparent and relevant in medical discourse. The importance of discourse in medicine can never be over-emphasised as consultation, therapy; and healing processes require a great deal of discourse, which has to be managed. Managing doctor-patient discourse is imperative due to factors or features that interfere with it. No wonder, "language use" is perceived as a process of generating meaning as a set of production and interpretation choices from a variable and varying range of options, made in a negotiable manner, inter-adapting with communicative needs, and making full use of the reflexivity of the human mind (Verschueren, 2008). Klugman (2017), cited in Wald et al. (2019), defines "medical humanities as an interdisciplinary field concerned with understanding the human condition of health and illness in order to create knowledgeable and sensitive health care providers, patients, and family caregivers"(3). Interpreting human experiences of illness is within the ambit of medical humanities but it is also apt to note that the integration of humanities/arts into medical education, as suggested by scholars, can support learners in developing essential qualities such as professionalism, selfawareness, communication skills, and reflective practice (Wald et al., 2019).
Culture is the human aspect of the environment. It is also the social system encompassing the values, norms and behaviours of a human in the society (Issa et al., 2016). From the different definitions of culture already stated, culture is perceived as crucial as people's language. Indeed, speech, gesture, posture, and other acts jointly produce meaning in medical interaction (Wilce, 2009). Interaction or communicative encounter in a hospital context has received much scholarly attention from different linguistic approaches. Interaction, which begins in the minds of discourse participants, goes through continual modification.
Socio-cultural factors emanate from different people, or a group of people, in relation to their habits, traditions, beliefs, ethnicity, race, attitudes, religion, language, sex and value systems. The diverse socio-cultural issues that relate to behaviour, thoughts, feelings and health outcomes are determinants of health and diseases (Gonzalez & Birnbaum-Weitzman, 2013). This has led to the observation that physicians are poised at the interface between the scientific and lay sociocultures (Kleinman, 1988;Wald et al., 2019). As such, it has been proved beyond reasonable doubt that socio-cultural factors are significant factors of health which are associated with some health issues and health behaviours. Therefore, patients and doctors are regarded as social actors engaged in a social performance-encounter, as determined by the established culture that influences such encounters.
Scholars have continually shown interest in medical discourse. Such include the study conducted by Aranguri et al. (2006) on the translation of patients-physicians discourse in a multicultural encounter. They discovered that the presence of an interpreter increased the difficulty of achieving good physician-patient communication. Hence, they recommended special training for interpreters and physicians in order to reduce conversational loss and maximize the information and relational exchange with interpreted patients.
Also, Hamilton (2004) examines the importance of considering the shaping influences of differences across medical concerns, both for discourse analysts in their quest to account for particularities within the physician-patient discourse and the realisation of attunement to each other's perspectives. While Paananen and Majlesi (2018) analyse the interactional work of interpreters from the viewpoint of patient-centred care. In the study, it was posited that interpreters can support patient-centred care by both translated and non-translated actions through a multi-modal analysis of interaction. Also, practices that enhance patient-centredness were presented.
Patient-centred care is manifested and realised through patient-centred discourse (De Silva Joyce et al., 2015). Patient-centred discourse involves communication that lays emphasis on the role of the patient as a participant in medical consultations especially, the extent to which patients' experiences, knowledge, and culture are acknowledged. Traditional consultative communication takes place in hospital consultation rooms where the doctors interact and provide medical services to both out-patients and patients but with the advent of technology, e-consultation and other digital health services are becoming relevant and acceptable. Any communication encounter that does not acknowledge the patients' socio-cultural factors is not patient-centred whether it takes place physically or digitally. Siouta and Olsson (2020) argue that patient-centredness may not be totally clear as scholars study it differently but Pluut (2016) and Hughes et al. (2008) acknowledge that patientcentredness has a value in healthcare delivery which involve cultural, social, psychological and ethical sensitivities. Furthermore, three different discourses on patient-centredness have been identified by Puttin (2016). These are caring for patients' discourse, empowering patients' discourse and being responsive discourse. Any of these discourses could be analysed to examine the extent of the patient's centredness in it.
A previous research was on patients-centred care (Rosengren et al., 2021) and the authors argue "The traditional model of healthcare is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be an expert in their own life based on their lived experiences (226)". Hence, the traditional consultative principles adhere strictly to interactions basically on the illness. It is appropriate to emphasise patient-centred discourse as an integral component of patient-centred care. The traditional consultative practices are changing in recent times to accommodate patient centre care due to research, awareness and improvement in healthcare delivery. Odebunmi et al. (2006) examines the pragmatic roles that illocutionary acts play in understanding the communication between doctors and patients in Southwestern Nigeria through John Austin's illocutionary acts. The data were collected through tape recordings of doctorpatient conversations and interviews of both doctors and patients (and/or their relations). It was discovered that locutions in Southwestern Nigeria bring standard lexical choices and local linguistic initiatives of medical practitioners into a pragmatic union while recommending that medical practitioners should master appropriate locutions for effective management of patients. Also, Alasiri (2013) identifies the speech act features of interactions between lecturers and studentnurses in selected schools in Southwest Nigeria. The identified speech act features of the interactions were related to the contexts with a view to describing the pragmatics of the classroom tutorials in the schools of nursing.
Furthermore, Meyer and Bührig (2014) study how doctors and ad hoc-interpreters communicate information that is risky to patients. This was conducted in both monolingual and multilingual briefings for informed consent, and, they also examined how the seriousness and frequency of risks are constructed. From the findings, medical doctors are often not concerned with the stochastic and legal aspects of risk information. Rather, doctors perceive risk information as a form of obligation with less importance for the decision-making of the patient. Whereas ad hocinterpreters face the challenge of struggling with modal expressions as well as with the embedding of risk information into the briefing.
On a cultural pragmatic approach, an investigation was conducted by Akinkurolere and Masereka (2019) on users and viewers of tattoos to bring to fore meanings that justify or invalidate the trend in Uganda. The study employed both qualitative and quantitative methods in the analysis. The study revealed that tattooing was on the increase despite the strong resistance as a result of meanings influenced by culture in Uganda.
Cultural distance has been identified as a major socio-cultural factor which could affect all kinds of human actions including communication. Others are temporal, geographical distances, and cultural dimensions such as power distance, uncertainty avoidance, individualism vs. collectivism, masculinity vs. femininity, long-term vs. short-term orientation, and indulgence vs. restraint (Vornanen, 2017). Cultural distance could also lead to misunderstanding especially when two languages come into contact (House, 2011). Hence, this paper deals with culture as a crucial context in medical discourse and its display in patient-doctor interaction. Analysing patient-doctor interaction is along the reasoning of Wald et al. (2019), who posits that medical humanities is "an integrated, interdisciplinary, philosophical approach to recording and interpreting human experiences of illness, disability, and medical intervention. More importantly, context plays an important role in determining meaning in communication since separate words and sentences alone are not sufficient for communication without interpretation within the context of its use and users (Nouraldeen, 2015). Therefore, recording and interpreting patient-doctor encounters at General Hospital, IleOluji, is appropriate for cultural-pragmatic analysis of patient-centred communication.

Objectives
The study investigated patients' cultural contexts in doctor-patient consultative encounters in the hospitals through the following specific objectives: i) To identify cultural influences in selected doctors' and patients' encounters.
ii) To relate the cultural influences to meaning-making in consultative encounters.
iii) To investigate doctors' awareness of patients-centred consultative encounters in the hospitals towards better management of patients. iv) To assess patients' awareness of patients-centred consultative encounters in the hospitals towards better treatment.

Methodology
It is the cultural-pragmatic perspective that has informed this work which was carried out in a Yoruba town-Ile-Oluji, Ondo State. It is premised on social performance model that social activities, such as discourse-making, are cultural performances. This theory is similar to cultural discourse theory which is designed to give special and detailed attention to two very general discursive matters, the exact terms people use when interacting with each other and the interactional forms in which these uses occur (Carbaugh & van Over, 2013). The adoption of Alexander's model is premised on the fact that the focus of this study is on meaning-making in the cultural context of patients.
Eight consultative encounters between doctors and patients were audio-recorded, transcribed and analysed for cultural features which are pragmatically significant. This served as the primary source of data while the secondary source of data included books, journal articles and the internet. The recorded interactions were carefully transcribed and analysed for socio-cultural features. In this methodology, physicians were the research subjects similar to patients, and all parties consented.
Some questionnaires were administered to doctors and patients which focused on cultural issues in their encounters with the patients. The questionnaire for doctors was administered at different periods from the questionnaire for patients at General Hospital, Ile-Oluji, Nigeria, through a research assistant. The patients that served as research subjects for qualitative data were different from the patients that were involved in the quantitative data. This allowed more patients to participate in the research. The questionnaire was administered to doctors in August 2020 and they were the same doctors that were involved in the qualitative data while the questionnaire for the patients was administered in July 2022. The patients that filled-out the questionnaire were the first ten literate patients that came to the hospital as outpatients after the public holidays in the month (10-12, July 2022).
To conduct this analysis, the doctors and patients were coded. For the recorded consultative encounters, the doctors were coded as Doctor A-Doctor J, and patients as Patient A-Patient J. Hence, there were consultative encounters A-J. The analysis involved two procedures. The recorded consultative encounters were descriptively analysed for socio-cultural features while the questionnaire administered to the doctors and patients was analysed through a quantitative approach using the software package of SPSS.

Analysis and discussion
The first stage of analysis involved the identification of cultural features which are presented in the table below: In the recorded consultative encounters, there are some pieces of evidence of patients' cultural influence on meaning-making. Greetings, initiated mostly by the patients, were attempts to establish a relationship with the doctors and in some instances, doctors initiated such greetings which were in consonance with the cultural practices of people in Ile-Oluji, and Yoruba people in general. It was only Consultative Encounter B that did not involve greetings but it was apparent from the name of the patient that it was due to cultural distance as a non-Yoruba patient.
In Consultative Encounter (CE) A, there was a reference to the patient's reading culture when she complained about her eye problem. The doctor must have identified the patient as a Christian, either from her name or bio-data in her file because people in Ile-Oluji and its surrounding towns are Christians, Muslims, and traditional worshipers. The question raised by the doctor was answered in the affirmative. Also, the repetitive use of the lexical item "Madam" was a politeness strategy employed by the doctor to reduce face-threatening acts in the encounter. It is also observed that in a quite short Consultative Encounter (CE) B, the patient was quite polite through the use of the word "sir" three times despite the fact that no greeting was initiated by both the doctor and the patient. This implies that the patient ended each response with the lexical item "yes".
Consultative Encounters C and D, also comprised greetings and repetition of the lexical item "sir" five times by the patient in each consultative encounter. Also, in consultative encounter E, the doctor was polite by referring to the patient as "Mama" as Ile-Oluji people usually refer to elderly women. The patient repeatedly used the words "sir" and "thank you" to express appreciation. It is a common practice to show gratitude in Yoruba culture, even if it is only for attention.
Greetings and questions about children and family on the part of the doctor in consultative encounter F related to the socio-cultural life of the patient. Indeed, the patient's socio-cultural beliefs are reflected in her argument that worms walked in her chest, and repetitive use of "sir", and greetings. The doctor vehemently opposed her argument and emphasised the need for diagnosis.
In consultative encounter G, greetings, instruction regarding the use of herbs and questions about the patient's family were indications of the doctor's consciousness of the patient's sociocultural background. The patient's opinion that she might likely have got the illness through her husband showed the import of her cultural belief. Indeed, IleOluji town is popular as a land of great physicians and herbal healers. Similar to CE G, communicative encounter H comprised greetings, a question relating to the patient's relative from the doctor, and the patient's reference to her generation and husband demonstrated cultural features evolving in the course of the encounter. Apparently, the various socio-cultural issues in the encounters portrayed various ways in which doctors' consciousness of patients' socio-cultural background manifest in doctors' discourse. More importantly, patients interpreted doctors' utterances in the light of their socio-cultural background. It is, therefore, striking and interesting that both Patients G and H claimed they must have contacted diabetes from their husbands whereas, they were different individuals who just realised their medical condition. They were able to give similar reasons because they shared similar socio-cultural backgrounds. No wonder, the doctors made frantic efforts to disabuse their minds.

Doctors' Discourse Patients' Discourse
The second stage, the quantitative approach, involves a discussion of frequency, percentage and cross-tabulation tables, which were derived from the data through statistical analysis. Tables were drawn for the discussion. The questionnaire was administered to ten doctors.
3 of the doctors were females while the other 7 doctors were males. Also, 7 of the doctors were within the age range of 21-40. This indicates that most of the doctors were still in their youthful age. It is also observed that 80 of the doctors were Yorubas while 2 were Igbos.
From Table 1, it is apparent that the ethnicity of the doctors did not affect their adherence to traditional consultative principles. Only 1 doctor posited that he sometimes complied with such while 1 doctor never did. 6 doctors, which implies 60% always followed the traditional principles, and 2 doctors often did that. The doctors were sustaining professionalism in their practice without realising that interaction, as an essential tool, should be creative.
It is indeed appealing that 100% of the respondents (mainly doctors) as shown on Table 2 posited that they took note of patients' socio-cultural beliefs during consultative encounters. It was possible that those beliefs naturally reflected and doctors immediately recognised such. In a situation where a woman suffering from diabetes ascribed it to the fact the husband was already diagnosed of such illness. This reason for this could not be better understood except in the context of her culture.
It is also obvious from Table 3 that patients' socio-cultural beliefs affect consultative encounters, whether negatively or positively. 10% of the doctors, which is quite minimal, insisted there was no relationship between socio-cultural beliefs and consultative encounters. The respondents (20%), who were not sure, were doctors that strongly affirmed the principles of traditional style of communication during consultative encounters. On Table 4, only 50% of the respondents were in support of patient-centred consultative encounters in hospitals. It is apparent that 40% of the respondents were against this position. This might be due to their personal feelings based on some perceived disadvantages of recommending such.
Despite the fact that 40% of the respondents felt a patient-centred style of communication should not be recommended in hospitals, it is quite interesting, according to Table 5, that 80% of the same respondents agreed that there are benefits that could be derived from the patient-centred consultative encounter. This further shows such a style of communication does not only deserve scholarly attention but a pragmatic application in hospitals. This style is not only beneficial to patients but also to doctors. Table 6 shows 80 % of the respondents agreed that patient-centred discourse enhances patients' emotional and psychological relief. Most patients experience conflicting situations in relation to their health along socio-cultural interpretations. When doctors are able to unravel the complexities, patients will definitely experience emotional and psychological relief. Such relief will hinder undue complications surrounding health challenges.
The doctor needs information as much as possible during consultative encounters. Information about a patient can never be overemphasised in diagnosis, treatment and recovery procedures. No wonder, Table 7 shows that 90 % of the respondents agreed that patient-centred consultative  encounters reveal adequate and more information on a patient's health condition, which helps in the process of caring for patients.
It is also imperative to state that patient-centred consultative encounters help doctors diagnose illnesses better. All information from the patients, even when flawed by socio-cultural beliefs, distance and sentiments provides the doctor with an insight into the nature of the illness. Therefore, Table 8 shows that 80% of the respondents agreed with this position while 20% disagreed. Table 9, which borders on the negative implication of the patient-centred style of communication during consultative encounters, indicates that 50% of the respondents agreed that patientcentred discourse wastes time while 50 % disagreed. No doubt, doctors do not have any business in the hospitals if not because there are patients. Any effort that could help facilitate diagnosis, treatment and healing is not synonymous with a waste of time or efforts. It is therefore obvious that patient-centred discourse should be promoted among doctors in hospitals.  Questionnaire B was administered to ten patients who had cases of hypertension and diabetes. The data was also subjected to SPSS analysis and Tables 10-16 were generated for the discussions of patients' opinions. For the purpose of eliciting quantitative data from patients, Table 10, below, shows that the patients' age groups were in three categories: 31-40; 41 − 50 and 51 and above. Four patients were between the age range of 31-40, two patients were within the age group of 41-50 and three patients were above 50 years. Also, 9 patients are Yorubas and only 1 patient is an Igbo. This is premised on the fact that the research community is a Yoruba community. No Hausa patient was involved in the research. Table 11 is a cross-tabulation of patients' support for patient-centred consultative encounters vis-à-vis their ethnic groups. 4 Yoruba patients strongly agreed and 5 Yoruba patients agreed that the consultative encounter. Also, the only Igbo patient agreed that consultative encounters should be patient-centred. By implication, all patients agreed that consultative encounters should be patient-centred. Moreover, in Table 12, 90% of the patients acknowledged that they were aware of patient-centred consultative encounters in the hospitals. This shows that the patients knew that it is an approach of consultative encounter.
During patients' consultative encounters, patients relate their illnesses to socio-cultural practices.
From Table 13, 70% of the patients affirmed they relate the socio-cultural practices to their health issues, and 20% of the patients indicated that they did not relate such practices to their health issues. However, 10% of the patients were not sure whether they had ever related sociocultural practices to their health status during consultative encounters. On frequency of relating socio-cultural practices to health status, 10% of the patients always relate discuss the socio-  Tables 15-18 reflect the opinions of patients on patient-centred consultative encounters. In essence, 100% of the patients agreed that patient-centred consultative encounters could give patients some relief as reflected in Table 15. This is premised on the fact that information on sociocultural factors received with empathy by the doctors could help patients experience some psychological relief. Also, in Table 16, the patients disagreed that patient-centred consultative encounters could be perceived as a waste of time. Any effort that is beneficial, even though, it requires some additional time is not a waste of effort.
From Table 17, 100% of the patients acknowledged that patient-centred consultative encounters provided the doctors with adequate information about the patients and their illnesses and 90% of the patients, according to Table 18, agreed that illnesses were better diagnosed through patient-centred consultative encounters.  The inclusion of patients, opinions in this paper has provided a further basis for the adoption and application of patient-centred discourse in consultative encounters in Nigerian hospitals. Even though the socio-cultural differences between both doctors and patients could be apparent, the importance and effectiveness of a patient-centred style of communication can never be over-emphasised.

Recommendations
No doubt, the traditional style of interaction between doctors and patients helps to elicit the information required but more could still be prompted by interpreting patients' responses through their socio-cultural background, which requires that doctors are flexible and creative during a consultative engagement. Indeed, patients' cultural differences could pose challenges to a productive realisation of patients-centred discourses in the hospitals. From the opinions of the patients, it was acknowledged that there are benefits of patient-centred consultative encounters. Hence, a patient-centred discourse is recommended which enhances care for patients with due attention and interpretation of discourse in the context of their culture.
Generally, human communication is often more innovative than structured. Therefore, patientcentred discourses help relieve patients' emotional and physical influence of background issues. Especially, the cultural context of patients. This indeed allows patients' compliance which enhances healing and recovery.
Patients-centred discourse requires that doctors are sensitive to patients' culture, and assumptions about race and culture, which doctors could use to enhance successful consultation in the hospital. Moreover, this style reveals the social context in which people manage their health and ill-health (Pulvirenti et al., 2014). Seen in this light, patient-centred discourses in the hospital become mini circumstances that help doctors unravel contextual sources of their patients' difficulties, which boost patients' conformity to the expected desirable behaviours once the doctors have won their understanding of troubling social conditions. Finally, the study should be conducted in more hospitals in Ondo State. This will further provide empirical evidence on the patient-centred style of communication in hospitals. Indeed, a comparative study of consultative encounters in public and private hospitals is strongly recommended.

Conclusion
The paper has shown the need for doctors to be sensitive to patients' socio-cultural contexts and the fact that they should balance between direct interpretation and culturally-mediated interpretation of medical conditions of patients in order to produce a clear diagnosis of illness. It is important doctors appreciate the benefits of patient-centred discourse and demonstrate how to give patients interactional space so that they can express difficult situations arising from their socio-cultural background. In fact, Issa et al. (2016) claim that all communication is cultural. This is premised on the fact that communication depends on factors like context, individual personality, and mood interacting with a variety of cultural influences and choices. Therefore, doctors should pay attention to the cultural background of patients in consultative encounters.  Doctor: How did you use these drugs?
Patient: 2 tablets in the morning and 2 tablets at night.
Doctor: Okay, we will have to reduce the dose to 11/2 tabs in the morning and 11/2 tabs at night.
(1) Meanwhile you will have to go and see an optician, we don't have one here at General Hospital Ile-Oluji here. So, I will give you a referral letter to the State Specialist Hospital Ondo.
(Doctor starts writing the referral letter). A nurse came in to ask question and left, as the doctor writes he continue with interrogation again to be sure of what he is writing in a referral letter so that it will be clear to the next doctor.
Doctor: Madam, you said the right eye abi Doctor called out for a secretary to bring a staple machine in order to make the letter confidential. He told the patient to show the doctor that attends to her at Ondo and she will be directed to the eye clinic.
In the content of the letter is the age of the woman health history, drugs that were used before, probably drug reaction on the eyes that leads to the doctor reducing the drug dosage, the patient presented the complaints.

Patient B
Doctor: Next patient, (calls patient's name Doctor: From our investigation how your BP is high, and it is advisable we place you on drugs fast.
Doctor: You will still need to do further test.
Doctor: A bigger file will be needed so that we can keep recording your BP and you will have to go to the laboratory for the test (a nurse came in and greeted the patient familiarly asking if her drugs has finished).
Doctor: Haa! Is she aware of having BP?
Doctor: This test confirms that you have diabetes and henceforth you will be placed on drugs and you will continue to use it, and I will advise you check your blood sugar of your children so that they can avoid or manage it as soon as they know their status, because that is why I first ask you if any of your people has it, it is nothing to be afraid about, because it can be managed and if not manage well managed, it destroys the kidney and, even the heart and there is an advantage in it that you knew early now.
Patient: I have not even heard of it before.
Doctor: Do you experience seizures in your legs seriously before?
Patient: Yes, but recently it has not been affecting me again.
Doctor: Okay, it's one of the signs anyway, but if you are on drugs at early stage it cannot cause a severe harm. It can be seriously controlled at early stage.

Patient:
The only thing is daddy, my husband, has it and I am afraid maybe I contacted it from him.
Doctor: So your husband had it where is he now? Patient: He is at home? Doctor: It is not communicable but it can only be inherited so don't think it is your husband that infected you, not at all, it's hereditary.
Doctor: (writing something down) then anything sugary should be avoided o especially coke and some people will even tell you that there are herbs that cure it, it is all lies o, so you will have to be coming to the clinic regularly now and whenever you come you will have to do some test. It is just like hypertension early detection and management saves a lot, don't take sugar again o and use your drug regularly test is blood sugar test and if possible get a glucometer so that you do the test by yourself before coming to the clinic.
(Doctors still writing something on the sheets) so you can get a folder in your next visit for the records of the management, so your next visit for checking is in the next two weeks

Patient H
Doctor: Good morning I asked you to run an investigation

Patient: Yes
Doctor: You have not eaten this morning you are asked to conduct DM test It has been confirmed that you are diabetic from your laboratory result.
You will start the management by taking your regular medication. When you start the medications you must not stop. Did any of your relative have it, it is inherited from single or both parents, your children should be carrying out laboratory investigation to confirm their own status. So, regular laboratory test should be carried out, the earlier the better.