Good Doc, Bad Doc

Medical practice changes you. Countless young idealists discover a limit to their previously boundless seeming well of compassion.

I am a nice doctor. If ever I am asked why patients continue to come back to see me, I can’t vouch for the quality of my medical care, though I do my best and constantly strive for improvement. I can look you in the eye though and tell you that I am well and truly kind to my patients.

I do have my limits. Being relatively new to the game I still tend to be defensive and can get my hackles up if I or the medical profession in general is accused of incompetence, lack of compassion or knowledge, among other transgressions. I think this in part is the reason I get so het up about anti-vaccination myths. Thinking back to the few times I have lost my cool with patients, they were all occasions where my experience or degree of care was questioned. These days I am more zen about it, thank goodness.

I am trying to think of a not-nice doctor now. They certainly exist, I just don’t have one in my immediate circle of colleagues, luckily. I certainly know doctors whose manner would be considered abrupt or glib. Where one patient is offended, another may be charmed and trumpet to the world how brilliant they are, saying something like ‘his bedside manner could use a bit of work, but I appreciated him telling it to me straight.’

I think it is possible to be a good doctor and also a nice one. I am not as certain that you can be a good doctor and not be nice. Are you truly providing the best possible care if your patient feels worse for having seen you, belittled, not taken seriously, interrogated or judged?

I would like to have channeled a no-nonsense, I-run-the-show doctor during a recent general practice session. Four of the eleven patients I saw had single appointments (fifteen minutes) booked but should have arranged double or even triple spots. Two were for new mental health issues- these are never quick to sort! One just can’t stop talking, and has the hide to criticise me for not asking about his back pain today or offering him a skin check lately. I refrained from saying ‘well, if you’d ever let me get a word in edgewise!’ The other had two long issues to discuss and one short one. She did the short one first. Then a long one- wanting to lose weight. I thought we were done after that. Then it came to light that I also needed to arrange emergency contraception, discuss long term contraception and order a chlamydia test.

I know I could have been more kick-ass today. I could have said ‘take this today then see me next week about all the rest’. No guarantee they’d come back next week, though. I could cut off my garrulous patient and probably alienate him. I could say ‘this is a complex issue. We only have three more minutes now, but I’d like to see you again in three days time for a longer discussion.’
All valid options.

The thing is- I want to be a nice, thorough doctor. I want to give the illusion of being unhurried and having all the time in the world for you. I want to do this while secretly being a stickler for efficiency.

I am sure I have a different persona at work to outside. My partner notices it when I phone her from work, formally greet her and inquire after her health and well being, using my ‘work voice’. I am sure I use a different manner with my elderly patients compared to my adolescent patients, for example. This is not being fake or pretentious, it is tailoring your approach according to the needs of your patient. At other times a change in manner is about self protection.

A much loved colleague of mine was talking about a GP we know up north, who ‘is the same with everyone’. At work, at home, with friends, ‘he is just himself’, in the words of my colleague. When that self is so wonderful, I can see that working really well. I certainly do not want to be the same person at home as I am at work sometimes. But being as relaxed with your patients as you are elsewhere could improve the quality of care.

I would be interested to hear your thoughts and whether any of you have good cop/bad cop personae that you utilise in your profession or in daily life.

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