Friday, 7 October 2011

Medical Stereotyping and Misinformation

Not long ago I read a blog entry that referred to doctors (general practitioners) habitually greeting their patients with "And what can I do for you today?" while at the same time reaching for the prescription pad.

            I began to wonder how such stereotypes originate, and how they persist in people's perception when common experience has to be that this sort of cameo is anything but commonplace in the real world. Perhaps it never was. Or maybe it is a creation of medical "soaps". I wouldn't know - I never watch them.

            Doctors are not quite the fools that this image might suggest that they are. For the notion that they can help at all in a fair proportion of cases presenting to them is a false one. "Help" implies an intervention of some sort or another, and this is usually unwise unless one knows exactly what the issue is that one is dealing with, and with a clear objective in mind. What doctors really do of course is to try to make sense with the patient just what is going on that caused the patient to come (so best to start along the lines of "so please tell me what it is you have come to see me about today"). They will try to identify reasons why the situation has arisen or might have arisen, to suggest what might be the outcome if left to itself, and finally to consider what, if any means might be utilised to modify the outcome. This last is the "help" if you like. And the wise doctor who sticks by the aphorism "first do no harm" will be circumspect on the subject of, say, ordering tests and, yes, putting pen to the prescription.

            "Advice" is another two edged sword in the doctors repertoire of interventions. It should not be given incautiously, particularly if it is the "if I were you" sort of advice. Because the doctor is not the patient. Only the patient can decide, in the end, how to address their problem. The best a doctor can do is to put the patient in a position to make the choice that is best suited to her or him out of perhaps several choices (for example: to take medicine/not to take medicine; to embark on a series of tests/adopt a "wait and watch" approach).

            Those situations where a reason (diagnosis) can be established unequivocally may indeed have limited or no choices of management for a safe and effective outcome are actually not that common. But your everyday coughs, colds, backache, piles, anxiety states and sadness will by and large get better by themselves - and so the patient must be given the option of allowing a natural recovery to occur in its own time. All of them, of course, are amenable to interventions that may be more or less effective. And all interventions have the potential to cause adverse effects, a few of which may leave the patient worse of than he was. Or dead.


  1. My doctor does always greet me with something like 'What can I do for you today?'He doesn't automatically reach for a precription pad though - he listens to the problem and discuss it before suggesting any action or medication that might help or explaining why none is needed.

    Maybe the problem sometimes lies with the patient? I know of several people who feel cheated or fobbed off if they leave a GP's surgery without a prescription.

  2. Patsy's comment reminds me of working in Zambia years ago. Some patients refused to go way unless they'd had an injection, and found that sterile water worked a treat! Bad medicine, but happy punters.

    On the subject of "help", aren't you being a bit hard on yourself? Don't you think that for many (perhaps lonely/elderly) people, someone just listening is, if not a cure, a considerable help? My lovely daughter-in-law is one of the best listeners I know, and a GP. Her patients adore her.

  3. Patsy - yes, I think that your doctor is very much more typical than the stereotype I referred to. As for patients feeling fobbed off, well, I would hope that if the doctor can get her rationale over to them through sensitive listening and explaining, they might feel better about it.

    Frances - I may have been a little deliberately hard, perhaps in an attempt to weaken the foundations of that old shebbolith: the doctor for whom status and power matter more than actually attempting to do some good in one's daily life and work. My point is that "helping" people is not a matter of profession: it is more to do with the sort of person you are. Good social workers can do more to "help" people than many doctors, as can good milkmen. And, of course, good nurses.

    Perhaps it is that helping and humility go hand in hand.

    Much of all this has to do with ritual, of course, and the issuing of a prescription is for some doctors and some patients a part of a ritual that is fundamental to the "complete" consultation.

    One of the privileges of working as an NHS GP was that there was not incentive to prescribe other than that it should benefit the patient.