What patients want from doctors

I very rarely have the privilege of speaking to a captive audience, and I must apologise at the outset for shamelessly talking about my own ‘condition’.   Not because it is at all interesting, except of course to me, but precisely because it isn’t at all interesting and clogs up waiting rooms across the country.  Since early childhood, I’ve had asthma, eczema and allergies.  In other words, I’m wheezy, itchy and blotchy.  

I’ve often been treated with steroids and now, therefore, I see an ophthalmologist every couple of years, to check that I haven’t developed glaucoma which can be a side effect of steroid use.   When I last saw this specialist, I was feeling quite unwell.  I had severe facial pain which badly affected my eyes, so I mentioned it.  He was uninterested.  ‘I am an eye doctor, not a face doctor!’ he somewhat witheringly responded, and I hastily retreated to that safe place inhabited long ago by well-brought-up children and now inhabited only by (some) patients -   ‘Be seen but not heard’, ‘Don’t ask silly questions’, ‘Speak when you’re spoken to’, ‘Do as you’re told.'  

When I saw my GP a few weeks ago, with a sharp allergic reaction, I found the rules had changed here too. 

‘My eyes are swollen, I can’t breathe, and…’  - I was in the middle of  explaining that I had also been very sick for the last 24 hrs, when he held up a warning hand, ‘Only two symptoms per consultation, please!’  The printer on his desk was already clattering out a prescription – more steroids. 

I turned as I stood at the door, clutching my script.  He was gazing, absorbed, at the computer screen.  I wondered briefly what he would think if I said  ‘Look, this is MY health we’re addressing in this four-minute consultation – my health, right now, and perhaps also my health five or ten years down the line’.   

I left, quietly.

Patients and doctors have different expectations of outcomes.  I wanted to be restored to health, with minimal long-term side effects.   My target had not been met.

The ophthalmologist had been asked to monitor for glaucoma, and had done so.  His target had been met.

My general practitioner had to get me through the surgery and dispense the routine treatment as quickly as possible, and had done so.  His target had been met.

I felt confused, unable to decide whether I’d been expecting too little or too much of these doctors.  Thinking over this issue, I turned to the Royal College of Physicians Patient and Carer Network for support.  There are around eighty of us, from many different walks of life but united in a passionate interest in health care.  I put this question ‘What do patients want from doctors?’ to them, and back came the responses.

It’s no surprise to me that the clear consensus was for LISTENING. 

We urge doctors to listen to what the patient is saying,  but perhaps also to what the patient is unable to say.  It takes confidence and time to listen, but without listening, an accurate diagnosis may not be made and the patient may not get the right treatment at the right time.  We are not laboratory mice, and one size does not fit all.

Kindness is also a quality highly rated by the Patient and Carer Network.   One Network member commented, however, that Dr Harold Shipman had by all accounts been quite good at all the touchy-feely stuff, so of course integrity is important too.

I’d like to finish with a bit of birdwatching.

Women of my age have, like me, usually spent much time hanging around in wards, waiting rooms and surgeries in support of the people they love when they’re up against it.   In this way, over the years I have met many doctors.  Doctors who are hawks, doctors who are doves.    However, there is a smaller but vitally important group of doctors, and these are the Owls.

Owls are the doctors who show a little wisdom.  Wisdom is defined in my dictionary as knowledge, thoughtful application of learning, insight, good sense and judgement.  It seems to me that wisdom is a quality imparted from doctor to doctor, handed down from doctor to doctor.

Francis Peabody demonstrated wisdom, back in 1927, and his insights are perhaps even more important today, in these times of complex, high-tech medicine.  Let me read to you what he wrote in this paper about hospitals. 

'Hospitals, like other institutions founded with the highest human ideals, are apt to deteriorate into dehumanised machines.'

I know of at least one senior doctor who feels that Peabody’s 1927 paper should be required reading for all young doctors, now, in 2007.  

To sum up, then, this patient would like to suggest that we want doctors clever enough to practise the science and wise enough to practise the art of healing.