Clinical genericness

Here is the link to to a recent BMJ opinion. I’m not entirely sure how to describe it in a word or two.  So I decided to write about 800 words.

The opinion, written by Suzanne Gordon, a healthcare journalist, is quite simple. Basically, she describes two instances in which a doctor says ‘Thank you’. The first instance is when a doctor makes a point to thank a nurse joining the rounds; the second was when a doctor thanked the patient for ‘sparing the time to talk’ to medical trainees. Gordon ends with:

I thought about the number of situations where more systematic and deliberate use of the words “thank you” would enhance self-esteem, as well as remove some of the many obstacles that lead to conflict, frustration, and discontent in the healthcare workplace

It’s difficult to render what I was thinking when I read the text, because I need to tread carefully.  Let me phrase it like this. Are doctors so different from the rest of us that they need to be reminded about  basic social graces? Just stop to think what it means. I mean, we have a journalist who is singing praises of doctors who said ‘thank you’! For pity’s sake, we are talking about highly educated professionals and not 3-year-olds. What’s next: potty training for medical students?

But things are more serious, actually. You see, the praise for two doctors saying “Thank you”, as well as the fact that the BMJ decided to publish it,  suggests that the behaviour of worthy of note, perhaps even rare and certainly not default. By praising two medics who deigned to thank a nurse or a patient, the author also shows up all those who don’t. Is their name Legion? Well, you tell me.

And so, I started thinking about my own experience of healthcare and, indeed, the ‘thank yous’ or “Hello….s’ happen much more rarely than not. I also remembered one of my favourite NHS stories, as this was probably my first encounter with the (so very very important) NHS consultant.

Many years ago I went to see a consultant with my son, who at the time was a toddler. So, with my son on my arm, I entered the surgery and the man I saw didn’t raise his eyes. I said hello and waited to be invited to sit down, but the man didn’t respond. As I was waiting, getting more and more angry, I was thinking that I had never been so ignored and disrespected. Eventually, his consulting highness did raise his eyes from what later turned out to be my GP’s letter of referral and something amazing happened.

He focused on something on my blazer and said something like:

Oh, I’m so sorry, hello, do sit down, please.

I quickly looked at my breast pocket and all became clear. I had forgotten to take off my ID card on which my name was preceded with….yes, you guessed it, ‘Dr’. I have no idea whether he thought I was a fellow physician or just someone who could write a half-decent complaint, but his attitude changed completely. He became very polite, I didn’t become impressed.

The obvious interpretation of such behaviour is in terms of power. Only children (and adults in special contexts) or powerful people can simply ignore social practices of politeness with impunity. Not reacting to me, making me wait standing or, indeed, not saying ‘thank you’ or ‘hello’ are exactly that. As a patient I am right at the end of the medical food chain, so I can be ignored with gusto. I am just about powerless.

But I think there is more. I think that there is something behind the clinician identity that allows you to stop being John or Mary and become ‘doctor’ or ‘psychologist’, perhaps also ‘nurse’. You slip into the role and hide behind your stethoscope or questionnaire. And whenever I tell trainees that as a patient I actually can dislike the sound of their voice, their perfume or hairstyle, they tend to be surprised. It’s as if the moment they get into their surgery, they become invisible.

Saying ‘thank you’ or ‘hello’ pulls you right from that state of ‘clinical genericness’ and puts you into a person-person relationship, it’s you and me, and not only a doctor and a patient. And here is a paradox. Both medics and psychologists talk quite a lot about focusing on the individual (and not the illness), seeing the person sitting in front of them. In contrast, I keep wondering whether they think about themselves in such a way. In other words, perhaps clinicians should also start talking about themselves as individuals.

You could start it yourself, tomorrow. You know, when you come to your surgery, you could say to yourself:

“I’m an individual.”

It’s just a thought.




  1. Very interesting discussion. I must say I felt incredulous at all of the praise that doctors on social media heaped on the “my name is” campaign designed to get healthcare professionals to introduce themselves to patients.

    From the point of view of a patient/fellow human being, it seems like basic social decency to introduce oneself when meeting a new person yet doctors acted like the message of this campaign was some fascinating new revelation (as if the basic rules of social politeness don’t apply to medical professionals).

    I think these issues with politeness (or lack of it in the medical profession) are enhanced by the NHS system as doctors get paid however badly they treat patients and have a captive market.

    In countries where patients pay – they are seen more as people whose custom should be cultivated to ensure further income.

  2. Since using my professional title (I’m a psychologist not a medical doctor) the symptoms I’ve had for 10 years have been diagnosed as a rare genetic condition rather than “anxiety”. I chose to use my professional title as it means I’m taken more seriously in a medical consultation. Sad but true. The power dynamic in a medical consultation is marked yet it saddens me how few clinicians seem to be aware of it.

    1. Dariusz Galasinski

      Thanks! After my encounter with the consultant, I systematically ‘forgot’ to take off my ID. It worked like a dream. The moment the doctor noticed “Dr DG”, the consultation changed.

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