I’ve been ill. I’ve seen four doctors in two countries and they disagreed (interestingly, along national lines). One of them was a GP here and she asked me to ‘watchfully wait’. In this post as I give you part of my ‘illness story’, I also want to write about a clash of expectations I experienced.
A couple of days ago I wrote about broken promises. They undermine the trust between the doctor and the patient and even if they offer reassurance, they are not a good idea. That’s the gist of the post. But I wrote it as an academic, so what if I had written the blog as a patient? I would have written it differently, of course.
After over three weeks of feeling seriously unwell, having already seen two doctors, I saw a GP in my practice. I was still feeling ill (although somewhat better), weak, my muscles aching, with complete lack of clarity as to what was actually wrong with me. And, to be honest, most of what I wanted was the GP to offer me a promise that everything would be fine, to reassure me that the next day, the following week I would be back to normal.
I wanted it so much I could taste it. And, gosh, was I was fishing for it! And yet, the GP was unmoved, saying she didn’t know what was wrong with me and ordering a battery of blood tests. The following day, she said she didn’t know even more and said my blood suggested I was actually healthy. As I insisted I was feeling unwell, she offered me…. watchful waiting. Bloody hell! As I was getting more and more irritated, I remembered the ‘watchful protector’ quote from a Batman movie, so I said, she didn’t look like Batman (I really did say it). Somewhat bewildered, she smiled.
Batman or not, she insisted we should wait, as I went home inconsolable, unreassured, largely panicking that something really wrong was with me (I do tend to panic). I could see she was empathising with me, but still I was worried and angry. Incidentally, some time later I got a text asking me how I rated my experience (or some such) and I responded with with “Dr X is wonderful.”. I guess, I started thinking.
As I feel better and reflect on my encounter some more, I despair how easily I gave up all I know about clinical communication. She was right. Of course, she was! Knowing myself, I know that if I hadn’t started feeling better (immediately), I would have gone back and thrown an angry: “But you told me…!!” right at her. So, yes, Jonathon Tomlinson (him again) is right saying:
The effects of reassurance can be intoxicating. The most addictive drugs: alcohol and benzodiazepines especially, are potently anxiety relieving and many patients who are addicted have a history of anxiety. When the drugs wear off, the rebound effect is a heightened and more intense anxiety than before. Reassurance can be addictive too. A clinician can, like their patients, be intoxicated by the short-term relief that comes from repeated reassurance, but they soon discover that over time, the effects are diminished and shorter lasting.
And yes, words of reassurance would have worked like a dream with me. It would have been a quick, if somewhat short-lived, fix
So, what’s the conclusion? Unfortunately, I don’t think there is one. I just wanted to know I would be better. Ideally, with the margin of a couple of hours. Unrealistic? Of course it is. Except I understand all that only after the pains, the tiredness etc. have gone down and I think things look up.
Perhaps it is important to accept that there are moments when the expectations across the desk in the doctor’s surgery are so divergent that we cannot meet in a happy(ish) place. The clinician cannot say what I want to hear, however much I want to hear it. But then, perhaps it is this that needs to be said. An acknowledgement of my wishes to hear the unsayable. To be honest, I don’t know.
But there is a postscript here. I actually do not know what constitutes reassurance. Is it only in the eye of the beholder? Would, for example, a careful run through my blood tests have been reassuring (assuming there was time)? I don’t know. But if reassurance is a clinical skill, as JT suggests, then I don’t think we should simply leave it in the realm of doctors’ empathic selves which somehow will make it happen. So, in contrast to what he says in his blog, I actually think more (linguistic) research is needed, so that we (and the medics) understand better what can (or needs to) be said in order to reassure the patient. Or perhaps to acknowledge that reassurance is impossible.
But, finally, there was one thing, one thing only that I did find reassuring. It was the GP’s calm voice. There was no anxiety in it. If something was really wrong with me, she surely would have been worried, wouldn’t she? I hoped. Was I right? Am I right? I guess I prefer not to know.