My patient was also helpful because she was happy to exteriorise her thoughts. She initially made some light-hearted but candid remarks concerning her anxiety about having the examination, and (flatteringly) said afterwards that it hadn't been as bad as she had feared. She explained why the comments of the ultrasonographer had alarmed her. And I could hear her thinking through the problem, following the lines suggested by my readers. She was revising her understanding of my explanation about what is going on biologically, and deciding how much faith to have in my judgement. Finally she put the key question to me: “if I were your daughter, would you think any further investigations were needed?” This was the crux of the matter. My explanations made sense to her, she knew I had been reliable when dealing with her a decade earlier, and she made a provisional decision to trust me. I accepted the rôle of surrogate father and gave the reassurance, which she accepted in turn. The deal was done.
This outcome was very satisfactory, because requesting another scan would not only have consumed further NHS resources but would also have prolonged her agony of indecision. Furthermore it might have still been inconclusive, in which case a gynaecological referral would have become necessary causing further expense and delay.
I found this case interesting because it is not often that you get such an open view into what the patient is thinking. More commonly the patient behaves in what appears to be an irrational way and one is left guessing. It required a certain amount of flexibility, and willingness (on both sides) to drop the pretence that “doctor knows best”. Patients often collude in this pretence, perhaps because they don't want to hurt poor doctor's feelings, or are afraid of his wrath. (I suspect that female doctors may suffer less from this problem.)
What I did find a little hard to take was the father rôle implied by her question “if I were your daughter”. Technically it would be quite possible for someone of her age to be my daughter but I'm not that much older than she, and I had initially seen our relationship as adult-adult. But clearly the father rôle was of therapeutic importance. I shall have to resign myself to being a quirky but reliable elderly GP who really does look remarkably young for his age!
Thanks to Cal, Beattie and A Mom Who Thinks Too Much for the feedback.