On blaming the patient

This will be a controversial blog. I still think the issue is important and I want to write about it. It is about news some time ago of a doctor who killed herself after being suspended by her managers. The suspension resulted from a complaint by her patient. The patient had seen the doctor’s blog where she wrote about her bipolar disorder. The patient decided that a mentally ill doctor should not be a doctor.

I’m not going to give a link to the news story. I do not wish to make this post about a particular person. Also there are no words which I could express how sorry I am about this tragedy. It should never ever have happened.

The reason why I decided to write about it is because I engaged in a number of exchanges about the news. Every time the complaining patient was said to be the unequivocal culprit of the suicide. Time and again, mostly medics were saying things like: “I hope you’re satisfied.”  Time and again I disagreed, time and again I was told I was wrong. Needless to say, I don’t know what ‘really’ happened. In what follows I draw upon media coverage of the suicide.

Paradoxically, the issue is about communication, this is, really, why I chose to write about it. There are two issues: what can be said and to whom; the message and the process of communication.

So let me first consider what is said. There are two main messages. First, it is what the doctor said (the blog), second, it is what the patient said (the complaint). And here is the first controversial thing I will say. I have absolutely no doubt that the doctor has an unfettered right to have a blog, also about her illness. But I also have absolutely no doubt that the patient has the right to voice her or his doubts, or in the institutional terms:  make a complaint.

Are there contexts in which to consider either message? Probably. If you write about your mental difficulties, you must consider that this might result in stigmatisation. Does it mean that the doctor should not have written about her experience? For a thousand times: no! I refuse to blame the person subjected to stigma for the stigma. And that ends the discussion on the matter for me, actually.

Is there a context in which to consider the patient’s ‘complaint’. Yes.  The power imbalance of the doctor-patient relationship means that every patient’s complaint means breaking out of this relationship and taking on someone powerful (what the doctor in the relationship might think about it is irrelevant)

But there is another context of what was said. The context which seems to have been never created. And here comes the first important point which I want to make here. I keep wondering whether in all this tragedy someone actually sat down and talked to the patient. Did anyone actually bother and explained how stigmatising was what they said? Did anyone explain about research into mental illness, its ‘nature’. Did anyone actually try and help the patient understand?

But there is more. This third context also could and should have been provided by the recipient of the patient message. Why was the patient’s complaint not recontextualised into a stigmatising accusation which undermines a doctor who happens not to conform to her or his expectations of medics? Had nobody thought about this? With a sensible conversation the patient might have understood what was happening.  To be completely clear – I stand by the patient’s right not to understand. And I think it behoves the NHS, doctors and, in fact, us all to offer understanding which would prevent the patient from complaining.

If, after all, so many of us want a humane doctor-patient relationship in which I share my experience with my doctor, why can’t one particular patient share her worries and fears about a doctor with bipolar disorder. Was she wrong? Yes. But the crucial question is: has anyone tried to explain? Stigma is not only an abstract idea in academic paper. This is it – this s how it works.

And here we come to the issue of the process of communication, and the second important point I want to make. It seems that in these dramatically tragic events, the process of communication is always unidirectional. The patient talks to the NHS managers, but they don’t talk to them. The managers talk to the doctor, but do not open the channel of communication the other way. The only two people who do not talk to each other at all is the doctor and the patient. In fact, the doctor is stopped from communicating altogether. How much more dramatically unhelpful can it get?!

The process of communication that appears in media reports suggests that the patient’s complaint simply triggers communication (suspension is communication after all) from the managers to the doctor. Oh yes, and it also triggers ‘investigations’ (in plural). I know, ‘conversations’ somehow don’t sound right, do they? It’s all as if communication were not about negotiation of meaning, contexts and, above all, about real people really talking to each other. Moreover, as if communication were not managed, both socially and institutionally.

The tragic events are mostly about closing channels of communication. No one TALKS. They pass information one way only, as if it were sent by pushing an electric switch. It is a total communicative abomination.

And this is why I completely disagree with all those who blame the patient. It is so bloody easy to blame the patient. And, perhaps controversially, I’d say that if it must be about blame, it is squarely at the door of those who are responsible for processes of communication, and how they are managed. Do guess, who they are. So how about, for once, not crucifying the patient, who, I’d imagine, must be in drastic distress (I would be). It’s so bloody easy to blame the patient.

And instead of using this verbal baseball bat, I wonder whether someone is thinking about creating a situation in which all three parties sit down and talk. Just an idea.


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