It sounds obvious really, and of course it is, but a huge proportion of complaints against doctors arent about medical errors leading to ill health, but rather about doctors communicating poorly or not listening. One of my colleagues in A&E tells me that he always makes an effort to be ridiculously attentive to his patients however exhausted or frustrated he feels. Regardless of how rude, demanding and ungrateful the patient, he makes a huge show of bending over backwards to be gregariously charming. Speaking to patients is like acting, he told me. The only difference between me and a film star is that Im too short, fat and bald for Hollywood. I try to follow his advice, but often my acting lets me down. It can be hard to be incessantly charming for an entire 12-hour night shift, but when I do manage it, my patients love me, regardless of how little I actually improve their health. This is why medicine is so often described by those in the profession as an art rather than as a science.
Having established the overwhelming importance of good communication skills when interacting with patients, it can be astonishing to witness some health-care professionals doing it so badly. Most catastrophic is when they have absolutely no idea how bad they are. Perhaps the oddest example I ever came across was as a student sitting in with a vascular surgeon. A nervous-looking gent in his 60s shuffled in with some smoking-related damage to the arteries in his legs. The very pompous surgeon asked him if he was still smoking. Defensively, the gent reassured the doctor that he had cut down from 20 cigarettes per day to just five. Hmm, said the surgeon. Thats hardly the greatest of achievements now is it? If I was a rapist who used to rape 20 women a day, but I had just recently cut down to raping just five women a day, Id still be a horrible little rapist now wouldnt I? The poor patient simply nodded aghast and I meanwhile had to pick my chin up off the floor. Perhaps it helped the patient in question give up those last five cigarettes, but even so, Im not sure it could ever be recommended as a suitable technique for offering health promotion.
My personal worst moment of communication was about eight hours into a busy A&E shift some years ago. Corresponding to each patient sitting in the waiting room was a small set of paper notes headed with their name and the medical complaint that had brought them into the emergency department. Hour after hour, the routine was the same: I would pick up the top set of notes from the endless pile, walk into the noisy waiting room and shout out their name. For some reason, on this one occasion, instead of calling out the name, I shouted out the patients medical complaint instead.
SWOLLEN FACE, I bellowed at the top of my voice.
I was absolutely mortified as this was a terrible, if accidental, breach of patient confidentiality. Oddly enough, though, the patients didnt seem to bat an eyelid and up stood a gentleman at the back of the waiting room with an impressively swollen face. He then proceeded to trudge unperturbed through into the treatment area. My terrible violation of his privacy had gone completely unnoticed, although I do wonder whether if I had shouted out TWISTED TESTICLE or FOREIGN OBJECT IN ANUS to a full waiting room, the fallout might have been rather more noticeable.
Its not just doctors who can be so horrendously insensitive. I once heard of a young couple going to have the all-important 20-week ultrasound scan of their first pregnancy. The sonographer performing the scan apparently kept looking at the screen while tut-tutting loudly and shaking her head. The understandably anxious parents-to-be asked what was wrong. However, the sonographer replied that she couldnt possibly say, but that she would book them an appointment with the consultant for a few weeks time. The dad at this point, in his own words, lost it a bit and demanded the sonographer tell them what she could see. Astonishingly, her response was, Well, you know those funny people you sometimes see in the street? You know like those Oompa Loompa midgets in that Willy Wonka film. Well I think your baby might be one of those. The disgusted parents demanded to see the consultant straight away who quickly reassured them that the scan was in fact normal and also reassured them that the sonographer wouldnt be doing any more baby scans!
Maggie III
Maggie phones me up quite often in the middle of the day when she finds herself alone and scared. Im honoured that she confides in me, but I cant deny that I find our conversations difficult. I cant make everything fine with a prescription or a referral to a specialist. I spent so many years studying how to make people better that I still find it hard to accept that some patients are only going to get worse.
How are things?
It always seems an awkward question to ask someone who is dying. Its not like shes going to say, Brilliant thanks, Doc, but Im yet to find a more appropriate way of opening a conversation with her, so I stick with it.
Actually, Dr Daniels, I think Ive found a bit of peace with it all. Dont get me wrong; Im not happy about dying from cancer. Far from it. If truth be told, I would love to have a few more years to wander about the place, but in the big scheme of things I cant really complain about the life Ive had. There have been ups and downs, but mostly ups, and I did always say that I never really planned to get old. In fact, Id have made the most appalling cantankerous geriatric, so all in all its probably for the best that I wont be around to see that through!
Well, thats one way to look at it.
Im worried about my husband Tony, though. Hes not really handling things very well. He just cant really accept that Im on my way out. He keeps looking up things on the internet trying to find miracle cures. Now believe me, Id fucking love a miracle cure, but Im no idiot. These quacks are just after our money and I know that my cancer cant just vanish with a few vitamin pills and an Indian head massage. I just want to spend this last time I have with people I love around me. I dont want to be chasing miracles that dont exist.
Im worried about my husband Tony, though. Hes not really handling things very well. He just cant really accept that Im on my way out. He keeps looking up things on the internet trying to find miracle cures. Now believe me, Id fucking love a miracle cure, but Im no idiot. These quacks are just after our money and I know that my cancer cant just vanish with a few vitamin pills and an Indian head massage. I just want to spend this last time I have with people I love around me. I dont want to be chasing miracles that dont exist.
Have you told Tony how you feel?
I cant bear to crush his hope. He needs hope to deal with this. It is his focus and at the moment its the only thing driving him on. The latest one is this bloody ridiculous essential oils diet. I have to drink these oils hes bought on the internet and then mix them with organic celery and carrot juice. Its not exactly what Id choose as my last supper, I can tell you. When hes out I get my daughter to sneak me in some fried chicken and doughnuts!
I think you need to tell Tony how you feel. You need to be really honest with him.
My husbands not one of those sorts of men, Dr Daniels. He doesnt really like to talk about his feelings. Im sure hed just clam up.
Funnily enough, my wife might say the same about me, Maggie, but here we are talking about some quite intimate, personal things. Sometimes you just have to try and see what happens.
Ill give it a go over the weekend and give you a ring on Monday to let you know how it goes.
Maggie IV
Hello, Im here to see Maggie.
Come on in, Doctor. Shes just having a facial done, but go on through as the make-up girl is just finishing up.
It seemed odd to think of Maggie having a facial. I always considered her a robust Yorkshire lass and had never associated her with beauty regimes. As I entered the room, Maggie was getting the last of her blusher applied. Im no expert on such matters, but it looked a bit overdone to me. Her cheeks were excessively rosy and her lips a dazzling ruby red. The young girl applying it looked up and gave me a smile. The family are coming to visit soon so we want her to look nice, dont we? She added those final dabs of blusher with genuine pride, although I did rather wonder if there might be good reason why she only applied make-up to the deceased rather than to the living.
Despite the make-up girls best efforts, Maggie still had the yellow tinge all corpses seem to have. Id come to complete the paperwork, and as the last doctor to see her alive I was supposed to do a final examination of her body. Maggie had been at the undertakers since Saturday afternoon and it was now Monday morning. If my examination revealed anything other than a diagnosis of death, something had gone very, very wrong.
I nodded at the undertaker to confirm that it was definitely Maggie lying on the metal trolley in front of me. I left my stethoscope in my bag, but stuck on some gloves and had a prod between her ribs on the left side of her chest to make sure she didnt have a pacemaker fitted. I knew Maggies medical history well enough to know she didnt have one, but I checked just in case. We are always told that cremating a body with a pacemaker still inside can blow up the crematorium. I imagine this is in fact a bit of an exaggeration and its more likely that the grieving relatives dont really want to find the remnants of charred batteries while spreading the deceaseds ashes over her favourite rose bushes in the back garden.
I did mention to the undertaker that Maggie had had a silicone breast implant following her mastectomy some years before. There is no risk that the implants will blow up the crematorium, but they do leave a damaging sticky goo on the walls of the incinerator. Nowadays, most undertakers will remove them, which was an idea that tickled Maggie when she was alive. She told me she had suggested to her husband that he put her implant on the mantelpiece next to the urn containing her ashes, but apparently he hadnt found it funny.