Monday, 18 June 2007

The beautiful game

Today I saw one of my favourite patients. We have known each other for many years and for some reason I always feel more cheerful after she has been to see me. There is probably some subtle flattery going on that I have not been aware of. Ostensibly her visit today was because was worried about her blood pressure, but really it was to tell me about her father's death. They had been close, and as he was the last of his generation she has had to make all the funeral arrangements herself. Once more I was acting as the clerk of the records, bearing witness to an important life-event. One thing she was pleased about was the floral arrangements at the funeral, which are to have a football theme. It was important to her father and all the family enjoy it. I nodded to indicate my approval of the arrangements and of football in general.

The next patient was a little old lady, still extremely bright and sprightly for her advanced age and with pertinent opinions to match. I can't remember how we got on to the subject, but she was telling me what a waste of time football was. I nodded to indicate my approval of her sentiments.

Does it matter that I was implying two different points of view in two consultations? There are some topics where it might be important for a doctor to state his or her views clearly, for example if the patient started making racist or sexist comments. But in most cases I don't think it matters if am vague about my personal opinions. Sometimes patients will use the doctor as a sounding board, and at such times it is probably better if the doctor is a “blank canvas”, or at least someone who does not have dogmatic opinions. If I were known to be a rabid right-winger, would a trade unionist be happy to consult me?

You may be wondering, dear Reader, whether I am in fact a football fan or not. I can do no better than to quote the statement attributed to Calvin Coolidge, when asked to endorse a certain product.
“People who like this sort of thing will find this the sort of thing that they like.”


A. said...

I don't think it matters in the least. It just shows you are able to see alternative points of view. We all behave differently in different situations anyway.

I think it's wonderful that you know your patients so well and feel you can have off topic conversations. That type of relationship is something I miss since we moved from a rural practice to a city one. Perhaps it will come in time.

Anonymous said...

Interesting post; A while back on placement, a fellow colleague was convinced the GP was in agreement with him over politics despite the fact I'd noticed that the GP had never actually said anything specific either way. It makes sense- why alienate a patient, or in my case- student, when you don't have to!

Ms-Ellisa said...

I believe you are very right, and I think what's most important is for the patient to feel that the doctor is understanding them... And even little details as such can be either helpful, or ruin the overall perspective.

The Shrink said...

. . . at such times it is probably better if the doctor is a “blank canvas”


We establish rapport with folk, and over years some patients know a fair bit about me since banter is shared and it's got to be positive that folk can relax enough to disclose what so ever they wish to. And in secondary care we've the time to let them ;-)

But although some folk do chat with me sharing information both ways, that's not how I work with folk when we're just starting out.

I agree it's better to be more neutral and non-judgemental. If there's a belief that you have certain views it prejudices what people want to say, until they know you well enough to understand differently. I know one patient who wouldn't talk about the upset a termination of pregnancy in her teens had caused 'cause she knew the medic was a Catholic (and presumed she'd have strong views and condemn her further).

Like any relationship, in or out of medicine, I feel it's best to start our being courteous but non-judegemental, largely a "blank canvas" as you say, but then as rapport is gained over time more is shared between you.

The Shrink said...

And as an aside . . football?!

Grown men cavorting about in the grass playing their ball games? I mean, come on! ;-)

Dr Andrew Brown said...

Thanks to all for your comments.
A. You are right that continuing contact with patients is one of the plus points of general practice. I don't think it's just a rural thing.
LondonMedicGirl. Well spotted. You're obviously GP material!
Ms-Ellisa. You're right about making the patients feel understood, which will help you even if you insist on becoming a surgeon. :-)
The Shrink. I'm sure you're right that it's OK to give out some information as time goes on, indeed it would perhaps be rude not to. And I'm always reassured when you agree with me. :-)