The aphorism has been directed at generations of doctors and medical students. It may be hackneyed, but it has never lost its relevance. For the potential for doctors actually to harm rather than heal their patients is always there and always will be. Harm may come about as a consequence of omission (negligence or inadequate skills and knowledge) or over-enthusiastic, if well intended, intervention.
I often told my patients who were eager that “something must be done” that, while I acknowledged the discomfort or pain that their predicament was causing them, my first priority had to be that of their safety. Powerful medicine may have powerful – indeed sometimes lethal – side effects. Particularly so if the patient is very young or very old.
Not long ago a gentleman in his 80s came to see me. I was working as a locum – “helping out” on a one off basis at a surgery where one of the doctors had been taken ill. I invited him to tell me why it was he had come to see me. He did so at some length. He has seen both regular doctors in the practice and had been referred to hospital where he had had tests including scans to determine the cause of his abdominal bloating. He was on several medications including a pretty fierce laxative. My own view was that therein lay his problem. I noted that he emphasised that he had been told that there was “nothing wrong” with him but that he was unable to accept that to be the case. My own assessment was that his symptoms related to chronic constipation and were very probably compounded by the medications he was taking, and, of course, his age. But he expressed the view that no doctors had been of any help to him at all.
I expressed my concern and sympathy and assured him that I never tell a patient that there is “nothing wrong with you” (not least because there has to be something wrong with all of us, imperfection being the nature of the human organism). I then tried, tactfully and at length, to put across the ill-advisedness of what we, in the profession, call “doctor hopping”. This has the potential to be the most dangerous thing a frustrated patient can do. Some hold on to a common misconception that a “new” doctor can through a new light on to their symptoms. Sadly, this is rarely the case.
I went through his records and assured him that the opinions and investigations he had been given did not demonstrate the likelihood of any serious illness. I then went on to attempt to put across the fact that my first concern was that of “doing no harm”, something that might very well be the result were I to “try another treatment” or referring him for yet more tests.
I must have got it wrong. For he misconstrued my honest and genuine concern as dismissiveness and lack of interest. He threw the classical barb at me “so you’re not going to help me, doctor?” He then went on to make a personal comment about me that was actually quite rude. No matter. 40 years in the job mean that I am little hurt by these things.
It may be that I will be slandered in the pub or post office queue. I will take that in good heart as there is nothing I can do about it. But you may be very sure that I wrote a detailed and accurate account of the consultation and what I said to him in his records. For I have no doubt that when he returns to see his “regular” GP he will have things to say about the useless doctor they’d employed in his absence. And I am less tolerant of slander delivered about me to medical colleagues.