Friday, July 27, 2007

Seeing the Nurse?

It appears our diabetes nurse has found a new motivational technique, at least so far as my last patient of the morning is concerned. He is a little over 60, has obesity, and was diagnosed formally diabetic a couple of years ago. He now attends an endocrine clinic for help both with his weight and his diabetes.

Today he has been sent by the nurse for an overhaul of his treatment. His consultant endocrinologist has also sent us a letter advising he start medication to assist with his weight loss. He tried the same medication a few years ago, without success, but this time he feels he is better motivated to make a go of it. The reason…

Nurse has told him that if he can shift some weight she is more likely to fancy him!

Needless to say, this has got me thinking about the behavioural standards we observe as professionals. I am quite sure that the remark reported above was made in all innocence and in good humour. I also suspect it came at the end of what was probably a challenging consultation where he was again being confronted with a compelling need to loose some weight to improve his health and thereby his chances of longer term survival without complications.

Now, stop to consider how this scenario might have played if the patient were female and it had been a male clinician making the remark. I cannot imagine a situation where this might happen in todays litigious climate. And I find that a rather sad proposition. As many regular readers will know I am a firm believer in allowing humour in to the consulting room whenever possible, and yet I would involuntarily shrink from making such a suggestion, however well I felt I knew my patient. This may speak more to my grammar school educated, male only, formative years, but I suspect not.


Wendz said...

That sort of comment, coming from a doctor of either gender, would be out of place.

But from a nurse, again of either gender, I find it perfectly acceptable.

Know why?

Nurses are human. Like their patients.

Doctors, sad to say, are not.

Sorry - that sounds awful but you lot are just perceived differently,whether male or female. There's a line drawn in the sand, I think. A line of professionalism and discretion which calls for more modest and restrained conversation.

Anonymous said...

I wouldn't find it acceptable from a nurse. Patients can be vulnerable and such comments can be taken the wrong way.

On the other hand, I can see that there are ways in which some light hearted comment such as "You'll have all the women wanting to go out with you" would be ok.

orchidea said...

It depends on the situation and the personality of both nurse and patient. Context is everything, also the subject of the consultation. If my gynae suggested I was fanciable while he had his hand up my t**t, I'd be more than a little taken aback and he'd be on his way to being struck off.

Prudence is wise and the balance of "power" - for want of a better term - is probably more in the patient's favour in a female nurse-male patient equation than in one of male doctor-female patient, which makes light-hearted banter more acceptable.

(Will he lose weight for her, do you think?)

Dr Andrew Brown said...

I agree with the comments already made. Power balance is less extreme with nurse/patient than with doctor/patient. It is more acceptable coming from a women because in our culture women are seen as less sexually aggressive than men.

However, in this case you are reporting the patient's account. We do not know what the nurse actually said. She may well have said something like "women are more likely to fancy you", which the patient heard as "I am more likely to fancy you". Chinese whispers!

sooz said...

It's a dodgy one - I found myself cringing as I thought about it because so many older men are delusional about women fancying them anyway - they don't see themselves as they actually are, do they?

I don't think I'm comfortable with it - full stop. I know my Late Grandfather would've been buying her chocolates and asking her out on dates and behaving inappropriately lolol! (in his orange sports shorts...)

Doctor Jest said...

Thanks to all for that straw poll. It largely confirms my own attitudes, which though thoroughly unscientific, will do for me.

So no more fancying the punters for this lad ;-)

Mr Angry said...

In just about every other walk of life, "sex sells". So I'm not surprised it works in medicine too.

If I was offered a course of treatment and the reasons on offer were;

a) You might live a bit longer and not be so out of breath when going up the stairs.


b) You will be swimming in poontang.

I know which I would be more likely to respond to.

Nostrumdammit said...

For me the big problem here is simply that of defining and discerning "appropriate behaviour" from the standpoint of normal behaviour between normal people be they clinician and patient or any other combination.
Sadly there are many people who have no shame, no sensitivity , no understanding of when humour is inappropriate. There are others who have no tolerance to innocent and harmless humour.
However, there are many people who DO have the social and emotional graces to utilise humour in motivational or difficult circumstances - and I feel that aspect of social intercourse has almost been lost due to pc and the sad people who cannot see things in any light other than the negative. These are also the people who demand litigation, public enquiries and resignations rather than accept that no harm was intended in many such situations, rather the opposite - for good.
I would hate to live in a society where all nuance of humour, teasing, risk and such like had been sterilised from our communal life by the killjoy police.
I shall continue tickling young persons less than 30 under the chin, calling all older ladies 'girls', older men 'lads' and using any means at my disposal to engage with and motivate my patients towards good outcomes during clinics which I am leading.

Incidentally my case comes up at the local assizes on the 24th, I'm sure the beak will be a humourless soul.

Doctor Jest said...

Angry-- You know you might be on to something there. Although I fear it will turn consultations into the equivalent of a Viagra spam email...

Nostrum'-- best of luck afore the beak. I'll be happy to offer a character witness or med cert for the appropraite fee ;-)

Advanced Practitioner said...

I must admit that it made me uncomfortable when reading this. I'm all for humour also in the consultation, but as a professional it is not something I would have said.

Enjoy your break