Syeda Saba Irfan ( MBBS, Dow University of Health Sciences, Karachi. )
Zunirah Ahmed ( 4th Year MBBS, Aga Khan University, Karachi. )
Muhammad Zain Farooq ( Final year MBBS, Dow Medical College, Dow University of Health Sciences, Karachi. )
Bilal Ahmed Khan ( MBBS, Dow University of Health Sciences, Karachi. )
Aamir Hameed Khan ( Aga Khan University, Karachi, Pakistan. )
The medium of instruction for medical education in Pakistan is English, which results in several words being lost in translation due to the lack of equivalent words in English. "Ghabrahat" is one such commonly used symptom. We conducted a cross sectional descriptive survey of medical students and doctors from four tertiary care hospitals between November 2013 and April 2014 evaluating the term "Ghabrahat". Total 120 participants were interviewed. Of these, 65.8% had heard of "ghabrahat". Among those aware of this terminology, 60.8% believed they had a good understanding of it. Of the total 95% believed "ghabrahat" still needed further investigation. The participants classified, "Ghabrahat "as benign (18.3%), serious (23.3%) and as an indefinable/vague symptom (48.3%).We concluded that "ghabrahat" is a symptom commonly encountered in clinical practice. It has a wide variety of expressed meanings and should not be used as a term expressing a single entity, system or disease.
Keywords: Perception, ghabrahat, doctor, symptom, term.
Urdu is the national language of Pakistan, while English is primarily used as the medium of instruction for medical education. This bilingualism leads to many commonly used words to describe symptoms being lost in translation. Of all these words, the word "Ghabrahat" is one example. It is a commonly used patient complaint, the significance and complete understanding of which has yet to be understood. To the best of our knowledge this is the first study evaluating the perception of the word "ghabrahat" amongst healthcare professionals in Pakistan.
In primary health care, patients often present with physical and mental symptoms, which upon investigation, are difficult to classify in accordance with currently standardized classification system.1 This not only makes it challenging for the physician to diagnose but also leads to improper investigations and treatments. In Norway, it was established that in 21% of the cases appearing in primary health care, a symptom or a complaint was used for the diagnosis of a disease.2 In our setting, "ghabrahat" is one such vague term, which is often used to describe symptoms of unrelated diseases making it difficult to attribute this symptom to one disease or system.3 The word "ghabrahat" when translated into English means an amalgamation of multiple perceived meanings. It is generally translated into a list of vague symptoms like anxiety, worry, fear, restlessness, agitation, discomfort and confusion.4 In one study conducted in Zimbabwe on the topic of \\\'Depression in developing countries\\\' the author used the term "ghabrahat" for anxiety and depression5 while in another study it was used for palpitations alone.6 To different patients, "ghabrahat" has different connotations and they use it to describe symptoms related to the chest, abdomen or stomach.7 Since the word does not have a single meaning it cannot be used to attribute the problem to one single system causing ambiguity for the treating health care professional, especially if the perception of the caregiver is also vague. Therefore, it is imperative that this term and its usage is better understood by the caregiver in order to reduce medical errors, increase patient satisfaction and maintain good doctor-patient understanding. We therefore conducted this study to evaluate the perceptions of healthcare providers regarding the symptom of "ghabrahat".
Methods and Results
This was a cross sectional descriptive survey that determined the perception, knowledge, practices and opinion of medical students and doctors regarding the symptom "ghabrahat". The survey population included medical students and doctors from four University hospitals (Aga Khan University Hospital, Liaquat Medical University Hospital, Civil Hospital Dow University of Health Sciences, and the Jinnah Postgraduate Medical Centre). The participants who gave informed consent and met the inclusion criteria were administered a preformed questionnaire in Urdu/English languages. The questionnaire was divided into five segments. The first segment focused on the demographics. The second segment included questions on the knowledge of "ghabrahat" as a symptom, the third was about perception, and the fourth regarded the participant\\\'s practice, while the final part focused on determining the opinions regarding further investigation for "ghabrahat" as a symptom. A total of 120 volunteers were interviewed with 30 participants from each institution. Data was collected between the period of November 2013 to April 2014.
The mean age of the participants was 30.8±8.82 years. Medical students formed 14.2% (n=17), the remaining were doctors at different levels of practice. Of the group, 79 (65.8%) had heard of "ghabrahat" being used as a term during their undergraduate years. Of the subgroup that had heard of the term, 48 (60.8%) believed they had a good understanding of "ghabrahat" as a symptom. Of the total participants, 114 (95%) believed that the symptom "ghabrahat" still needed further investigation.
Table 1 gives the perception of the participants regarding "ghabrahat". Of the group, 53 (44.2%) reported that "ghabrahat" was not taught in the curriculum or just mentioned vaguely because of the complexity of the expression as well as the multiplicity of causality that it represented.
Figure-1 shows the perception of the participants regarding "ghabrahat" as a symptom. Of those who considered it to be a medical term, 58 (48.3%) classified it as indefinable vague symptom, 22 (18.3%) classified it as a benign condition, 28 (23.3%) classified it as a serious but not life threatening condition and 1 (0.8%1) classified it as fatal. With regard to association with a system, 100 (83.3%) associated "ghabrahat" with the cardiovascular system, 87 (72.5%) with psychological ailments, 42 (35%) with as a drug side effect, 20 (16.7%) with endocrines, 11 (9.2%) with gynaecology, 9 (7.5%) associated it with other conditions such as paroxysmal nocturnal dyspnoea, anaemia, dehydration and pulmonary problems and 6 (5%) associated it with gastroenterology.
When asked to explain "ghabrahat" as a symptom, 100 (83.3%) took it to mean anxiety or nervousness, for 79 (65.8%) it meant palpitations, 60 (50%) took it to mean restlessness, 55 (45.8%) perceived it as breathing difficulty, for 32 (26.7%) it meant pain/ discomfort, 23 (19.2%) took it as an expression of depression, 21 (17.5%) took it as irritability and 20 (16.7%) took it as fear of an impending disaster. Furthermore, 6 (5%) took it as butterflies in the stomach, 4 (3.3%) felt that "ghabrahat" referred to tremors, and for 1 (0.8%) it meant abdominal distension.
Of the group, 86 (71.7%) believed medical treatment is successful for "ghabrahat", 14 (11.7%) thought that "ghabrahat" was preventable, 20 (16.7%) thought that it was curable, 81 (67.5%) thought that it was manageable, 2 (1.7%) thought that"ghabrahat" does not require medical attention and should be ignored while 1 (0.8%) thought that "ghabrahat "was untreatable.
We conclude that the term "ghabrahat" is a symptom commonly encountered in clinical practice. It has a wide variety of expressed meanings and should not be used as a term expressing a single entity.
The authors declare that they have no competing interests.
1. Woivalin T, Krantz G, Mantyranta T, Ringsberg KC. Medically unexplained symptoms: perceptions of physicians in primary health care. Fam Pract 2004; 21: 199-203.
2. Ringsberg KC, Krantz G. Coping with Patients with Medically Unexplained Symptoms Work-related Strategies of Physicians in Primary Health Care. J Health Psychol 2006; 11: 107-16.
3. Chimthanawala K. Ghabrahat - \\\'A Controversial Manifestation\\\'. National J Homeopathy 1993; 2
4. Khan MS, Jafary FH, Faruqui AM, Rasool SI, Hatcher J, Chaturvedi N, et al. High prevalence of lack of knowledge of symptoms of acute myocardial infarction in Pakistan and its contribution to delayed presentation to the hospital. BMC Public Health 2007; 7:284.
5. Patel V, Abas M, Broadhead J, Todd C, Reeler A. Depression in developing countries: lessons from Zimbabwe. BMJ 2001; 322: 482-4.
6. Shakoor A, Shafqat F, Mehmud Te, Akram M, Riaz S, Iqbal Z, et al. Frequency of depression and somatic symptoms in patients on interferon alpha/ribavirin for chronic hepatitis C. J Ayub Med Coll Abbottabad 2010; 22: 6-9.
7. Sidana A, Sharma RP, Chavan BS, Arun P, Raj L. Psychiatric profile of patients attending General Emergency room services- A prospective study. J Mental Health Human Behav 2009; 14: 80-3.