Monday, March 16, 2009

At the Clinic

Remember the Olden Days, when you were too ill to get out of bed and a doctor came to visit and - if he or she was a good one - made you feel better with the lovely bedside manner?

Not any more. Apparently you have to be either very elderly, or terminally ill, to get a home visit - I remember having an argument with some emergency doctor a few years back when my friend, who was then eighty-two, with flu - not a bad cold, proper flu - needed a doctor and I had to fight like mad to get them to come out to her. "No, I'm not taking her to the clinic in the car. There's snow on the ground and she has a very high temperature and can barely walk. If you're prepared to sign something that says it's your fault if she falls and breaks her hip, then I'll consider it."

The doctor came to visit her.

But on Saturday, although I felt incredibly ill, there was no chance of me getting a home visit, so Stephen put me in the car and took me down to the emergency clinic.

The doctor was mid-fifties, I'd say, and he was Chinese, though - as they say in the iconic comedy Airplane - that's not important right now, as his English was very good.

He asked what I'd been doing the previous day and I said, accurately, working to help teach medical students.

He asked what department. "Communication Skills," I said.

He looked bewildered. "What's that?" he asked.

"Teaching doctors how to talk to patients and explain things to them," I replied. Not a full explanation, granted, but I was still feeling incredibly ill.

"Why do they need that?" he asked. "Do you teach them to be assertive with patients?"

"Only occasionally," I said, "usually it's exactly the opposite. We teach them to listen to patients. All student doctors have to pass Communication Skills now or they can't graduate."

"Really?" he said, astonished.

"Yes, really," I said, "because it's really important, and I'm surprised that you don't know about it."

Now then. After this he took my blood pressure, and didn't tell me what he was doing, and didn't tell me the result until I asked. Then he stuck a thermometer in my ear. Luckily I knew it was a thermometer - it might have been a laser gun for all I knew, because he didn't tell me. Then he said, in passing, "You might have a kidney infection or because you're diabetic you might have kidney damage." KIDNEY DAMAGE?!! Thanks, mate!

Then he asked me to "pop up onto the couch so he could have a little feel of my tummy" (yes, I may have loved being talked to like that when I was three but I've grown out of it now) and then he prodded it all over, rather hard.

As a matter of fact, I knew one of the things he was checking for and it was the Murphy's Sign of an inflamed gallbladder, which in my case I had not got. But I knew how to pretend I had because I had to act it twenty-four times in an exam for doctors once. I could land myself in hospital any time I fancy, oh yes. But luckily I don't fancy, and I didn't have an inflamed gallbladder.

Medically he was, I think, adequate, but it was a good job that I know quite a bit about what he was doing or I'd have ended up even more bewildered than I was already.

And it was no place to be when you're ill. If I hadn't been feeling so dreadful, when he asked "Why do they teach Communication Skills?" I would have replied, "Because of people like you, who've been doing it badly for years and never give it a second's thought."

Just for the record: when the doctor takes your blood pressure, or your temperature, they should tell you what they're doing and why, and tell you at least something about the result. And they should "talk you through" any physical examination.

Also, they shouldn't mention any possible serious condition as though in passing, or lead you to think that you've got it, until they're sure that you have, and then they should break the bad news sensitively and carefully.

Younger doctors are much better at this kind of thing in general. Why? Because they're chosen for different criteria these days - as well as having a squillion A-levels at Grade A, they also have to be able to talk to people. Of course, in the Olden Days some doctors were brilliant at talking to people - - - but, because in many situations this ability was not regarded as at all important, many were terrible at it.

Some still are. But I hope things will change - - and they are changing - - though there's still some way to go.


Blogger Silverback said...

I'm going to ask my young friend (who is studying to be a doc over in Manchester) if he's heard of this Communication Skills business.
I hope he has.

I'm impressed you didn't tell this Chinese doc to give up medicine and open a takeaway instead. I'm not sure, given your roleplay training, that I'd have been so tactful.

And although you deleted the 'Sunny Again' post, I'd still suggest that it wasn't a good balanced diet today as there were no jaffa cakes !

1:23 am  

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