On medical ‘discoveries’
A few days ago, my Twitter timeline was full of references to and praise for a short piece by Anya de Iongh, who writes about her medical appointment. De Iongh’s piece is very moving in offering a patient’s perspective on what a 10-mnute conversation with a senior physician feels like. A perspective that starts way before the appointment and continues well after it. The author describes an experience that quite a lot of us, patients, know only too well. Myself included.
As might be expected, because the article is well written and it is moving, it became quite popular (the tweet with the text had 148 retweets when I was writing this), with patients expressing solidarity and understanding of what the author wrote. But when doctors started doing it, I was thinking something was off. I kept reading reactions of Twitter medics, extolling the virtues of the article (which very quickly became a ‘must read’), suggesting the text was revealing something quite unknown to them.
And to be honest, I started despairing. I think that the popularity of de Iongh’s article is a cause for concern, it is worrying. In a nutshell, if a doctor tweets amazement with the discovery of a patient perspective, I want to ask: What have you been doing for the last two decades or so?! Both social media and medical journals are full to the brim with expressions like ‘empathy’, ‘patient-centred’, ‘person-centred’ and what not, and you still need an article to tell you that your patient is emotional before and after a consultation?!?! I mean, really?!
In contrast, instead of the choir of praise, I would like physicians to say: We know this! We’re on it! We do x, y, z to respond to such concerns. For every time you’re amazed a patient is a feeling person who has a life before and after a consultation, I just want to weep with anger! Every time you discover that what you say can have impact on me and my emotions, I really think there is something seriously wrong with you. It’s like you either discover that I am human, or you are actually not human. And I can’t decide which is worse.
So, to be honest, as long as texts such as de Iongh’s are necessary, every time one is published, it’s a very sad day for medicine. It means that they are still needed, that to a considerable extent the rhetoric of whatever-centeredness is empty and it is used to make you feel better. You, not me! So, I dream of a moment when an article of patient’s experience which says:
The appointment comes and goes. My parents and I walk in silence to a nearby cafe. I hardly slept last night, and I’m tearful, overwhelmed, and exhausted, and rerunning the appointment in my head means I will struggle to sleep tonight. The consultant listened to me about my symptoms, but didn’t acknowledge my emotions. Even “How are you feeling about this?” or “I know these appointments can be stressful” would have helped me to feel understood, relax, and probably engage better in the consultation.
is greeted by the medics with irritation with their colleague! And instead of tweets-discoveries, tweets-amazements, I will be reading tweets expressing anger with how the patient was treated! I’ll go further. I really have serious problems with medicine which is still discovering or needs to be told about basic humanity in the doctor-patient relationship. If you need to be told that patients are worried about an appointment with a medic, that the appointment may have consequences also on patients’ emotional well-being, perhaps medicine should have a long hard look at itself. Because there is something seriously wrong with it.
A few days ago, I went to see a doctor. Ever since I started ‘looking for an illness’, I’ve had problems with a sore throat (Internet tells me that it is not uncommon in CFS). After moaning about it for long enough (and I am being very kind in describing what happened), I was referred to a specialist, the specialist said the issue was not laryngological, putting me back in square one. Fortunately, my throat ache comes, goes, I have learnt to live with it. I’m not certain I should, but there you are. Anyway, my throat played up recently, so I went to see a doctor.
When I mentioned my throat, the doctor chuckled. I suspect it was reference to our history of my throat ache, I hope it was meant (somewhat) kindly, but I didn’t like it. I looked at him with some surprise and he immediately added that we have a history of my throat. I didn’t respond to that, but said:
Medicine is the art of tolerating well someone else’s suffering, isn’t it?
He laughed at first, then I think it reached him that this was not really a joke, it was not something to get him to laugh. In fact, it was meant as unkindly as I could muster at that moment. There is something precious in seeing the doctor’s smile disappearing from his face.
And that’s the point I want to finish with. If I ever go off Twitter, it will be because I cannot bear its saturation with self-satisfied, narcissist references to how centred physicians, of whatever ilk, are on me, my experience, personhood, obviously in its social context. This is because I’ve seen British doctors for over a quarter of a century and I am yet to hear anything of the sort Anya de Iongh describes as absent in her consultation. Let me just add that the introduction of computers into the surgery has meant that most doctors don’t even look at me anymore.
So, please, let’s at least stop kidding each other about your centeredness on anything other than yourself.