Twitter has recently been delighted with another must-read paper, this time on five questions that every patient has but never asks. For me, well, let me put it gently, I quite dislike the article.
So, let me start with an account of what has been written. Dr John Whyte says that every patient has the following questions:
- Do you care about me?
- Are you the best?
- Can I trust you?
- Are you treating me differently than others?
- Will the medicine make my life better?
Let me first comment on the questions themselves. Do I have them? Well, not really. Moreover, I haven’t met a doctor about whom I would confidently say that they cared about me, nor do I actually expect it. Some, I’m fairly sure, care about doing a good job and, some, admittedly fewer, care about putting me at ease and show ’empathy’. Is it caring about me? No, I don’t think so and I don’t think it’s possible for a doctor to care about me. There isn’t and there cannot be anything personal about it, even if such a statement can be nuanced, my GP doesn’t care about me (the feeling is mutual).
And please, Dr Whyte, do not telephone me to check on me, and if you think that maintaining eye contact will persuade me that you care about me, do think again.
If I asked myself whether my doctor is the best, I would not go to see them. All I can hope for is that you are a half-decent and moderately competent medic and let’s leave it at that. Do I trust my doctor? Well, it depends on what you mean. Trust has layers, dimensions and is forged over time and there isn’t and there cannot be a simple answer to such a question.
I have never wondered whether the medic treats me differently than others. First, I don’t care, second, I assume there are more and more algorithms that doctors follow. The final question is just silly. No, medicine will not make my life better! Because there is, surprisingly perhaps, life outside medicine.
Now, that’s the questions. I don’t think they’re particularly helpful, I somehow doubt whether ‘almost all patients’ have them. But I dislike the article for two different reasons. First of all, it really irritates that the questions Whyte presents are constructed as ones I, as a patient, should ask. Through this, not only does it become my job to ask them, but also it becomes my failure if I don’t.
And can you seriously imagine asking such questions? Can you seriously imagine asking the question: Are you the best? Not only is it a rather silly question, but it’s also extremely face-threatening. But crucially, can you ask such a question in interaction laced with power in which you are the one without it!
There are doctors who I find it difficult to ask any question, and you, Dr Whyte, ask me why I don’t ask questions which directly challenge my doctor? Give me a break! I keep wondering whether doctors actually see other doctors.
So, instead of complaining that patients don’t ask such questions, perhaps it would be better to ask what you could do to encourage us to ask such them or, perhaps, what to do so that we don’t have them. And I am not entirely certain how to achieve this, however, significantly, Dr Whyte doesn’t even pose the question.
And here the second reason why I don’t like the article. What strikes me in this text is that despite its ‘patient-centredness’, the article is in fact anything but. It very clearly sets our two groups people – doctors and patients – with doctors doing everything for the patients, or perhaps to the patients. And it’s really astounding that the author doesn’t even stop to ask whether these questions are mine in the first place. He projects them onto me on the basis of one conversation with one person.
At the very end of the piece, the author writes:
As physicians, we are used to being the ones asking the questions; indeed, that is how we trained to be physicians. But let’s also try to address fundamental questions most patients have — even if they do not explicitly ask them.
This little snippet is, in my view, what’s really wrong with the article and, possibly, medicine. Patients don’t ask certain questions, so instead of asking what kind questions they have, I will answer them for the patients. I mean – can there be anything more patronising and paternalistic?
Yes, I accept that questions like those the author suggests are important for medics, but they are not my questions at all. No one asks me, of course, doctors already know what questions I have, however, if, on the off-chance, I were asked, I would come up with the following questions:
- Do you understand that I have a life?
- Can you listen?
- Who knows best?
- Can you respect me?
The roots of these questions are obvious. I want a doctor to understand that I live in non-medical contexts and, for example, just telling me to avoid stress is really unlikely to work (question 1). I want them to understand that communication is a two-way process (question 2), but also that listening doesn’t just mean shutting up and letting me say my piece. It also means considering what I say and understanding that I might know better, for example, how I feel (question 3). And I really hate being patronised (question 4). Obviously, there is more to those questions.
But all these questions are overshadowed just by one:
- Can you cure me?
If you can, I will care about the four above less and less, because after all, I don’t have to like you, I don’t even have to respect you. I come for help and that’s what I want the most. And sometimes, more and more often, I think, I wish medics stopped talking about being nice and fluffy, and started talking about medicine.
And finally, I keep repeating that my interaction with a doctor must be useful. What it means will change from one consultation to another, as I negotiate it with a person across the desk. And so, perhaps, there is only one question I really would like ask any doctor:
- Can you be useful, doctor?