From TMP Editorial and an anonymous and frequently-patronised ST3.
Its always interesting when you look at a patient’s notes and see the prefix Dr before their name – or worse, Prof. – or worse yet, you don’t see it – and they’re the kind of person who make sure they point it out. Patient Doctors / Doctor Patients often demand a lot of patience from their doctors when patients. Got it? No? Well, let’s have a closer look.
You’re Not My Type…
In my experience as a practicing doctor, I have come into contact with GPs, surgeons, and trainee doctors whilst at work, and I think they all fall into one of seven categories. Think deadly sins, but bound to make your shift that little more awkward.
Through my experiences I have met all these character types. It’s never easy being a patient and for medics being on the other side of the consultation it’s a strange and unsettling experience. I think we should all be patients at least once in our lives – so go easy on the your doctor patients and in return go easy on your doctors if you’re ever a patient.
Type #1 – The ‘Normal’ Patient
The ‘Normal’ patient is the kind of doctor who puts you completely at ease. Most likely to be heard saying things such as “I’m medical but don’t know the first thing about your speciality” (particularly common if you are an allergist or audiovestibular specialist), or “please, just treat me like any other patient”, the ‘Normal’ Patient wants you to keep calm and carry on as normal. They are sensible, well-informed, and know the where their expertise ends and yours begins. They should give you an accurate and concise history, and listen to your advice. These are by far the best type of doctor/patient and what we should all aspire to be like when we’re patients.
Type #2 – The Ross Geller
The Ross Geller is a non-medical doctor who enjoys ramming their title down your throat and correcting you when you call their name and title from the waiting room. Most likely to be heard saying something along the lines of “It’s doctor, actually”, Type #2s are nothing if not predictable. I always ask them what they are qualified in and with these patients its usually a PhD in the mating habit of an endangered blind albino fish – noble and vital studies completely irrelevant in primary, secondary, or tertiary healthcare centres. Do be careful to only ask this while walking into the consultation room, as the moving dynamic will limit them to a short answer. A colleague of mine once asked this question in 2013 once seated with the patient, and she’s still listening to the patient’s thesis. The best course of action is just to constantly refer to the patient as doctor, otherwise your consultation will take twice as long through their incessant interruptions and corrections. Never invite to a housewarming.
Type#3 – The Mentor
The Mentor is a kind and sensible doctor who successfully balances the need of a patient with the dignity of a doctor. As an A&E F2 I saw a patient who had been brought in by her next door neighbor, and was obviously presenting as a stroke victim. When I asked, as I always do, how the gentleman bringing her in was related to her, he told me he lived down the road and was also a professor of neurology and thought she was having a stroke and probably needed admission. So, as an F2, I was going to have to take a history and carry out a full neurological examination of this lady in front of a neurology professor. I’d felt less uncomfortable sitting the viva of exams and in my driving test. The kindly prof looked at me with pity and said he would step outside while I examined her. I’ll be forever in his debt. I’ve yet to learn how Mentor-types react when you muck something up…
Type #4 – The ‘Medal of Honour’
The ‘Medal of Honour’ type of doctor is an obvious badge wearer – usually the relatives of patients who have come in from home and popped their hospital badge on. The badge will usually be sitting not in the usual place, and at a slightly more obvious and awkward spot so you can just make out ‘NHS’, but not their speciality or grade. These are often F2s, no longer on the bottom rung, with a slight swagger and cockiness, and they are almost invariably male. The relatives they come with usually expect to be given the extra special treatment as their son is a doctor. This type often imagine other doctors saying “we look after our own, don’t we?”, despite having never heard a doctor actually say that. They expect to be seen straight away by a doctor of at least their grade, if not higher, and like to talk in medical jargon which just alienates their loved ones. Experienced ‘Medal of Honour’ types will ask what they think are relevant technical questions, but belie their ignorance of conditions outside their speciality.
Type #5 – The Covert Doctor
The Covert Doctor doesn’t tell you that they’re medical unless prompted. With a medical title, they are often easy to spot – but could of course be a surgeon, or recently struck off. The only way to find out if they are medical is after you have explained very simply that they are tired because their iron levels are low and that iron carries oxygen around the body to give you energy, they won’t be able to resist casually responding in perfect jargon. This always reveals their true identity. As if they were trying to catch you out. Which of course they weren’t. Of course.
Type #6 – The eDoctor
The eDoctor is very similar to the secret doctor. This type includes those people who have researched and learnt the medical jargon – or been in touch with online companies where you type in clinical information and, most importantly, pay a fee. The case then gets triaged and sent to a “leading expert” usually in America, who quotes guidelines and gives summaries of all possible treatment courses. Its amazing how patients and relatives can put so much trust in what has come out of their printer from a source they will never meet, in exchange for money. This type will typically doubt whatever their doctor, who could well be sitting holding their hand, says – especially if it is at odds with what their fax machine told them.
This type may or may not tell you about their research upfront. If they do come out with it straight up, you have a chance to run through it all point by point – which can be constructive. The more difficult scenario is when you have already spent 45 minutes talking them through the situation, all the options, and helping them come to a plan of action – and then they pull out the paper and let rip with, “well, this online medics suggests this.” Often you will get a suspicion they have been online because they will slip slightly incorrect jargon into the conversation, what does the EKG show, shouldn’t he have a cat scan, what about a turbot for his bladder? Take a deep breath, ask to see the documents they have and do your best, just know that you’ll never be as trusted as a doctor giving advice from 10,000 miles away in their office making a quick buck before their clinic starts.
Its never nice to feel that someone has set out to catch you out or test you, but it can often feel that way in these situations. Its frustrating to try and explain to the online doctor patient that we have all the recognized treatments and we are doing what we think is best in this situation, sometimes we might even do it better than other countries.
Type #7 – The Colourful Amateur
The Colourful Amateur is the patient who brings their own research with them, often a newspaper headline, and sometimes a research paper, never critically appraised. Take time to have a look at what they’ve brought in, you never know if it might stand up scientifically. Despite even broken clocks being right twice a day, it is still unlikely to be relevant or accurate, but dismissing it outright will most likely put your consultation on the back foot.