Madder and badder than the 15th

Wednesday, 6 December 2006

Tell the patient the answer may fix her problem today, show them how to research the answer may fix her problems for a lifetime?

Dear Editor Belfast Telegraph,
Having just read a story in your online paper... (referred from the 6Minutes website) I read your Belfast Telegraph article "I Dread the Web Surfing Patient" .

The author, Mr Curtis sounds very much like a surgeon and promulgates the usual derogatory ideas of the status of General Practitioners sic:

"Broadly speaking, hospital specialists (such as myself ) tend to be less fazed by the internet-savvy patient than our colleagues in general practice."

As a General Practitioner (albeit, in the antipodes, far away from Mr Curtis) I found this article demonstrative of many problems in Medicine and why patients tend to prefer CAM, quactitioners, snake oil salesmen with charm and something to sell and doctors that are approachable and have reasonable interpersonal skills (usually female).
For example, I refer to the part of your article about the error between bupropion and buprenorphine, I can only imagine the doctor's hubris in opening his esteemed BNF! It is just a book as far as the patient would be concerned. I can just visualise the doctor stating something like "See!, I am right! and you are wrong and stupid". Therefore, I am not surprised the patient responded negatively and was even more deeply cemented into his own opinion.

As for the denigration I felt was expressed toward sufferers of mental health conditions, some of the most interesting discussions I have had have been trying to convince some that they may have an Axis II condition, eg "Borderline Personality".
This is typically used in a derogatory sense like Supratentorial (all in the head), GOMER and FITH syndrome(F###ed in the head). When we (the patient and I) go through the Wikipedia on "personality disorder" and actually follow links with the bits they feel correspond to themselves, it can be amazingly heartening. With some insight and a little Googling, it is amazing what an interested and engaged patient can come up with.
This old saying comes to mind “Give a man a fish; you have fed him for today. Teach a man to fish; and you have fed him for a lifetime”—Author unknown.
Tell the patient the answer may fix her problem today, show them how to research the answer may fix her problems for a lifetime? - BenedictXVI

The role of the doctor is to be not intimidated and defensive about the patients understanding (or even misunderstanding)
but to congratulate them on their enthusiasm to understand their own health, and perhaps be a bit of a teacher, and show them how to learn and use the resources they have (like broadband). If a doctor cannot outperform a diagnostic algorithm perhaps they deserve to be obselete?

And as a specialist I would expect you to be able to clearly* explain why a particular type of suture would not be appropriate, and not just reply with "Well, who is the doctor here"**
As a generalist, and not a specialist, I do spend a lot of time explaining why perhaps DTC, pharmaceutical company and special interest (pressure) groups information is at times not the best advice available.

Please please forward this on to Mr Curtis, he sounds like many of the old Consultants I experienced in Medical School!

Benedict XVI

* and sympathetically
** Hearsay only, but a patient described a particular specialist surgeon to have said "Well who is the doctor here" in response to a serious concern they had about stents versus CABG, and with recent data all I can think is that perhaps the patient was right and the specialist less so!


At 09 December, 2006 15:28, Blogger Juanita J. Sanchez said...

As a nurse, I strongly encourage my patients to "take charge" of their health, and to ask for exactly what they need. If that means standing up to the almighty doctor, so be it. It is/should be a collaborative relationship. That said, my doctor has been known to laugh at me when I come into surgery with a list of the drugs and the doses that I require pre and post-op. Versed, Toradol, Mepergan and/or Morphine, and throw in some Zofran for nausea. "Only you..." he chuckles, before he writes exactly what I've ordered.


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