I’ve become chronically ill. Officially

I recently got a letter from my GP practice. It says that I received it because I have a long-term condition and I am invited to attend a ‘long term conditions clinic appointment’.  Here are a few comments.

First, I started wondering about the point of the letter. Ostensibly, it is an invitation, the practice now has a new system for ‘managing long term conditions’, so they invite me. Simple. And yet, I don’t think this is all there is to it. You see, I’ve taken hypertension (mentioned as one of the conditions) tablets for quite some time and no one has ever asked me to attend a long-term condition appointment. So, something must have changed. Regardless of what it is, the letter has ‘officially’ created a ‘long-term condition. Better than that: I’ve become a patient with a long-term condition.

And that’s an entirely different matter. Because I think I received the letter not because of my hypertension, but because of a new ‘condition’ I’ve been struggling with since the summer (I’m not prepared to talk about it openly, yet). And if this is the case, the letter is scary, annoying, irritating and during the appointment I will tell the doctor where they can shove it. For after months of uncertainty, ‘watchful waiting’ and beating around the bush, the status of the ‘condition’ from ‘who knows’ to chronic has been changed by a  letter! Yes, a bloody letter! Oh, do let me read about empathy some more, please! Such a lovely counterpoint.

I must admit that I generally don’t like a system in which doctors ‘manage long-term conditions’, because I prefer doctors caring, tending, treating, but I’m too irritated to care.

Then I read this:

1. If you have more than one condition, we will now review them in the same appointment.

Bloody hell, I thought (actually, my thinking was somewhat more emphatic), that’s the selling point?! I can speak of two things at the same time? Gosh, how kind of you. I just don’t know whether I will manage to handle it. And it just doesn’t bear thinking what happens with three conditions! Can you handle it, doctor?

And then I thought, this is 2017, half the medics I follow on Twitter tell me daily about empathy, patient-centred, narrative evidence and I keep wondering who lives in an alternate universe. You, my Twitter followees or the doctors I see, who really do have their hearts in the right place, but still cannot see me, but my conditions. And the progress is that now, I will be able to talk about all of them in one visit, rather than make sure that I discuss only one. I mean – I really don’t know whether to laugh or to cry.

But then comes the linguist. Have you noticed the pronoun ‘we’ in the above sentence? Who is it? Who is ‘we’? There are two options, of course. One is that it will be the doctors themselves who will be doing the reviewing, the signatories of the letter; the other is that it will be me with the doctor I shall see. Tough choice, you think, but not really, I go for the former. The doctors will kindly review things for me. Have look at the previous sentence:

2. (The Practice) has adopted a new system for managing long term conditions and we would like to invite you to attend review

while the one after is

3. The review aims to help you to look after yourself….

There is a clear construction of ‘we’ which is separate from ‘you’ (which refers to the patient) in sentence 2,  immediately above, there is no indication that it changes identity in the sentence that follows, i.e. 1. Sentence 3 situates me outside the review. The review is for me, but not with me and I can only say that your medical kindness knows no bounds….I might add, oh, for pity’s sake, can someone for bloody once think about communicating with me in a way which will not scare me, irritate me and patronise me? Is it really too much to ask? Also, let’s not talk about shared decisions or any such things. It’s just annoying.

So, is it really too much to write something like this:

We have adopted new ways to care for persons with long-term conditions and we would like to invite you to see one us for a discussion about your condition or conditions. You and the doctor will able to go over any issues, questions or concerns you have. Through this we hope to help you to look after yourself….

Just to make it clear, it took me 20 seconds to write this, it’s far from perfect. Also, I wanted to stress partnership and care, you can focus on other things.

So, that’s the letter, which, I do understand, is aimed at helping me. And I do appreciate it. But just because you write it, doesn’t mean it’s great. Just because you communicate with me, doesn’t mean that I read you in the way you intended it. I look at what you say to me from the other side, the powerless and hurting side, and so, I focus on different things. This is why it is so important that you stop to think not only about what to say, but also how to say it. Everything you say carries assumptions upon assumptions and, as your patient, I really would like you to reflect on them.  You could start with every use of the pronoun ‘we’ you use.

And finally, my ad-nauseam paragraph. Language is not only about words, language is not only about ‘representing reality’, it also creates reality, it also makes relationships and so many other things. Do me a favour, doctor, think before you open your mouth (or put your pen to paper).


1 Comment
  1. Helen Wilkinson

    Fabulous critique. The real reason for the letter is due to the GPs getting paid for your attendance under QOF. You have to attend once a year or they have to Exception Report you. If they Exception Report you the powers that be doing like them doing that at all. The GPs clinical care can be scrutinised as they have been unable to persuade you to attend. There is very little informed consent in QOF. If you look at NICE reports on individual GP Practices they applaud Practices with low Exception Reporting. It is seen as a great success if GPs can persuade patients to attend these long term clinics. I fail to see how informed consent can be obtained when GPs are blatantly not explaining the reason for them wanting patients to attend to patients. I am no longer an NHS patient due to these issues. I am an ex GP Practice Manager with no faith in the system anymore.

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