Having criticised, and criticised, I thought I should write something positive. So here is my dream of a consultation; what I would like my visit in a doctor’s surgery look like.
When I started thinking about what to write, things turned out to be more complicated than I had anticipated. I started wondering about what I really care about and what ‘would be nice’. It turned out that what I really, really care about can be summarised in a couple of items. What I would like, what I would describe as a consultation that leaves me ‘happy’, is something very different.
So, let me start with I what I really care about it. I really would prefer not to have to cope with the following things.
1. Interruptions. I really hate when people walk into the room when I talk to the doctor. You see, I would like to know that I can actually start crying or undress with the thought that I am safe in doing so. Of course, I do understand that sometimes interruptions are inevitable. If this happens, however, I never understand why the interrupting person apologises to the doctor. They should apologise to me! It’s not the medic who is interrupted, I am!
2. I hate being patronised, pathologised, undermined. Just don’t speak to me with God’s certainty, don’t tell me that I’m just anxious or that I’m looking for an illness, don’t make promises. Or better, don’t put your hand on mine, interrupting what I say, and sum it up with ‘Well, it’s complex, isn’t it?’. That really gets my angry. You just tell me that you don’t give a hoot. It’s important to remember that sometimes it is very subtle. Rolling of the eyes, the impatience in your voice, the curtness of the explanation.
Anything else? No, not really. I guess, I have low expectations. How often do these things happen? Oh, I don’t know, interruptions happen more often when I see consultants, much less often in my GP’s surgery. How often do I get patronised or undermined? No, it’s not every time, it’s probably almost every time. Last time it was today.
Sometimes, when it gets to me and I react, more often than not, I just don’t care. You will not listen anyway. Also, I keep repeating: I am an educated, well-spoken man, and I still find it difficult to rebel against the paradigm of power in which I am thrown in a doctor’s surgery. Imagine those who are not!
OK, so these are the basics. I’m now letting my fantasy go….
1. In an ideal world, my name doesn’t appear on a screen, with a computer voice mispronouncing it, but you come to invite me. But that can be cumbersome, I accept, so, especially, if you are younger than me, how about getting up to greet me. We can shake hands, but I don’t really care.
2. In this ideal world I don’t sit on this, I do beg your pardon, shitty chair, while you sport the comforts of yours, rocking in it, as I sit at the side of your desk like a pupil. Do I get worked up about it? Not really, but I’m talking about the ideal consultation. However, I must admit that I am puzzled that I am yet to be in a doctor’s surgery in which the crappy chair would be turned towards you, at least slightly. Oh no, I either have to sit sideways on the edge or turn my head towards you. I can still do it with ease. Can all your patients?
Oh, you might consider not turning away from me after the first hello, just because you start typing your notes. You could for example use your beautiful fountain pen and make notes as you look at me. Or have I left the ideal world and went to a parallel universe now?
3. The opening…I think this when it all happens. It’s not as easy, of course, as to say that you should have some small talk with me. I might be in pain and really not care about small talk. But, consider the opening question, ideally, not asking me about my ‘symptoms’. I guess, the only question that irritates me more is
What can we do for you?
I know that this is not the majestic plural, it’s more like relieving yourself of the responsibility of engaging with me. Still, the ‘we’ is so idiotic that I would prefer that you go all the way to ‘What can one do for you?’, really.
There are a couple more things. Please don’t use my first name, especially when you see me the first time. And don’t ask me what to call me, just call me Mr Galasinski. I understand, of course, that first names in English are different from those in Polish, still, let’s preserve some formality. You see, formality takes away your power; informality is when you take liberties.
Second, when you ask me your wonder of a question, listen to me. And by that I don’t just mean whatever happens in your head. Show me you listen. You know, you could nod your head, do some mhming, if you can think of nothing else. But don’t interrupt, wait with your question, you will not drop off your pedestal, if you wait. I promise. Even if it takes a minute or two, also of silence.
I suppose I should write about empathy here. But I’m not certain how one ‘does empathy’. Just show me you listen.
4. Here comes the messy bit. You ask me questions, listen to my answers, and then you will give me your pronouncement. How you do it is quite important. I would like you to remember that you are not God. You forget it surprisingly often.
A few details:
- don’t ask me the same question twice. Surely, your attention span is way better than in a fruit fly, so if you listen, you should remember. If you don’t, just say it;
- don’t tell me what I meant, said, thought. If you want to confirm, ask me;
- try not to lead with your questions and don’t dumb them down as if you were talking to a 5-year-old;
- don’t ask me about my ‘ideas, concerns…’; ask me things you would actually like to know; you could, I know I’m pushing it, explain why you ask.
If you ask intimate questions, consider mitigating them, for example, by saying that you must ask. Believe me, talking about things we tend not to talk about is not easy. You know, like stools, erections, sex, discharges or prostate examinations. I’m sure you can think of a number of others.
But to be honest, so many things can go wrong here…So, how about asking yourself the question whether you would like to be talked to like you talk to me. But when you do, remember to make one important mental exercise. Don’t assume that the person asking you all those questions simply ‘means well, so it’s OK’. No, it’s not and even though I do tend to assume that you mean well, it still doesn’t mean you can can say say whatever you want.
The final thing I would like you give some thought is your voice. No, you can’t change it, but when I am in distress, you could consider, for example, whispering.
5. We’re about to finish. I would like you to remember that whatever you said would be playing in my head after I leave. I will need to live with it. You will have another patient, I won’t. In some cases, I will be playing what your said over and over again. I understand that misunderstandings cannot be avoided and my anxiety will make things worse for me, but I would like you to remember it.
You could therefore ask me whether I have anything to add. I know, we’ve run out of time and you’ve decided it is a different matter any way. I should just go. My problem. But you could refrain from looking at your watch and longingly looking at the door.
So, that’s the visit. It’s more complex, obviously, still, this is what I could think of. There are a couple of things I would like to add. I really hate when you ask me, for example, how much alcohol I drink in a week. How on earth am I supposed to know? Do you really think I have an alcohol-intake monitoring device? Moreover, believe it or not, it does vary. I might be this strange person, but, astonishingly, my weeks are not clones of one another. So, when you insist on an answer, I will give you one just to get you off my back. And when I say that it varies, don’t tell me ‘Oh, we’re interested in the average only.’ Have mercy!
Second, I really appreciate when you say you don’t know – it takes courage. But do remember that I will be doing the waiting till you find out. You say it, I suffer the consequences.
Have I ever had a consultation like that? When I felt listened to, focused upon, without being patronised, just generally welcome? Probably not. But I had many consultations after which I was not (very) irritated. Remember – low expectations. If you just listen and we are not interrupted, I’m getting ecstatic! The rest is a bonus. But yes, I’m afraid the rhetoric of patient-centeredness is mostly just rhetoric for me. It falls so flat. Also, I would actually prefer if you were Dariusz-centred; when I am ill, I don’t really care that much about those you see before or after me.
There is one more final point, unfortunately, I’m afraid. It’s Dr House. The most obnoxious, patient-not-centred doctor you can think of. There is, however, one thing that he had going for him. He got things right. And no matter how nice you are and how you hold my hand and sing lullabies to me, at the end of the day, I want you to be right. It is, I’m afraid, the bottom-line. So, as much as I would like you to do all those things above, I would also like you to study medicine and to know what you’re talking about.