Wednesday, October 03, 2007

In which Dr J has a bit of a moan...

This post has been quite hard to write and might be equally so to read. I’m afraid you’ll have to take my word for it that in no way is it intended as a whinge, however it turns out…

Tony called yesterday to update me on his progress. He was effusive in his praise of the surgery, and of the hospital team he was referred to. In charming and measured tones he took me through his last few weeks, from my referral to the initial surgical outpatients appointment just a few days after. Thence to CT scanning and back to a different, oncology, outpatients appointment where they gave him the expected news, that he did indeed have a carcinoma, and that it was too invasive and widespread for surgery. He goes for palliative radiotherapy in the near future.

He appreciates that the prognosis is poor, and yet is quite unreasonably grateful to the team that have made the diagnosis and given him that information. It may sound surprising, but in my experience such innate nobility and generosity of spirit is not at all unusual. Indeed I would go so far as to say I often feel most appreciated* by those patients for whom I can do the least.

Annoyingly, the converse is also often true, and patients for whom one has attempted impossible feats of logistics, who have then accessed the specialist of their , often quite unreasonable, choice and undergone the high tech intervention for whatever problem they have presented, return to moan about delays in treatment, parking problems and the quality of the hospital food. After consultations like this you will find me tearing what little remains of my hair out, and wondering just why it is I heave myself out of bed each morning to come here...


And then Mrs Archer will wander in for a review of her Diabetes and High Cholesterol, and with a twinkle in her eye, and not a hint of irony, hand over a box of Clotted Cream Fantail Shortbread, “for you Doctor, from my holidays…”.

Well at least it helps explain her sugars and cholesterol!


*Such utterly unwarranted appreciation comes with a large slab of guilt on the side.

6 comments:

orchidea said...

Now you're being hard on yourself. Have you, amidst the helplessness you probably feel in cases such as Tony's, ever considered that "unwarranted" appreciation might have something to do with your empathy and good communication skills, in short, your bedside manner?

Doctor Jest said...

orchidea-- I suspect the guilt and the empathy come hand in hand. I fear removing the one would substantially diminish the other :-(

Elaine said...

Dr Jest, youy have obviously done so well with Tony (and Mrs Archer too, some people are just incorrigible.

Empathy is very important in your life as a GP; however you need to ensure the accompanying guilt does not take over. :-)

Z said...

But that second group of patients still feel ill with, apparently, no cause. They may, by some (other) members of the medical profession have been given the distinct impression that their symptoms are imaginary or psychosomatic, when they are convinced there is a physical cause. In that, they might be right or wrong, but they still have no explanation to satisfy them. And they still feel ill.

Sorry, dear Doctor, this is no dig at you. The GP is not to blame for the patronising consultant.

Doctor Jest said...

elaine-- wise counsel, and thank you for your kind words.

z-- Actually those are not the patients I mean. i have a lot of sympathy for those that feel they are being "fobbed off" by seemingly uncaring physicians, surgeons or indeed GPs. At the same time there are occasions when even the most gifted of my confreres really can do but little to help.

No the patients that fall into my second category are those who have, in fact, received the very best of care for whatever complaint they have presented, have thereby been restored to full health and function, and yet continue to see only the negatives of state provided health care. Depressingly there are a great many of them, and year on year, as we loose the folk memory of a time before the NHS, the numbers will rise inexorably :-(

As an aside, I spend a lot of my time helping patients decode their most recent outpatient encounters, especially the Surgical ones. I find it a help, when they feel the Mr Hack, or Mr Slash weren't "very nice" to them during the consultation, to ask them to think about the type of personality you need to earn a living deliberately "injuring" people.

Nostrumdammit said...

Speaking personally I have often felt the same regarding patients who are undergoing the most horrendous circumstances with heroic strength of character. I have felt greatly humbled by their attitude.
It has always been the case that certain sections of the populace are ungrateful or they are incapable of grasping just how much damage their lifestyle choices are doing to themselves, their families and the economy of the Health Service. However, I have heard accounts of people slowly but definitely making small changes in their habits following on from taking my advice. Usually I hear second hand from a relative of friend of the woebegone, but I can assure you Dr J that you will be having some effect on the Archers of this world, it is just that they are not reporting back to you.

The ones who pay no attention are probably going to die young and I think that's called Natural Selection.