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Patient Doctors Part II

Have a little patience…

In a response to our first piece on dealing with doctors when they are admitted as patients, another junior doctor shares their experiences with patient doctors.


On Your Level

It’s not often you encounter patients who are also doctors. From time to time, you come across relatives who are medical, and take a peek at the drug chart when you’re not looking, and act polite yet mildly condescending when you talk to them about their loved one. Only on one occasion, however, have I actually had to treat someone who’s also a medic.

I was halfway through my afternoon clinic during my GP block and I was informed that the next patient was a senior registrar at the local hospital. The name on my consulting room door clearly read “FY2” so he too would also know exactly what level I was at.

One of the first things he said was “By the way, I’m a doctor.” I waited to see if he would add anything to make this more relevant to his appointment: “…so I work in an environment full of contagious diseases and I was wondering whether this cough I’ve had…” But no, I guess he just wanted to make sure we were on the same page.

Symptomatic

He told me how he’d been feeling a bit tired of late and we agreed that it would be reasonable to arrange some blood tests to find a cause. He then asked if I would be happy to also request tumour markers as part of these blood tests, “just to be sure it’s not cancer”.

Tumour markers are produced in high concentrations in certain types of cancer and can be detected in the blood. However, they are incredibly expensive and incredibly non-specific: there are multiple non-cancerous reasons why your tumour markers might be raised. For example, PSA (which is classically raised in prostate cancer) can be increased if you’ve been for a long bike ride.

As such, measuring tumour markers are only ever advised if the clinician truly suspects that the patient might have cancer and even then, they should only be used to support suspicions rather than make a diagnosis. And they can’t be used to detect all cancers. And did I mention how expensive they are? And so on.

(un)reasonable

I was a little bit shocked at this request, because I assumed that a doctor of his seniority should have known that this was an unreasonable request. He had even admitted that he thought cancer unlikely. I explained my reservations to him and said that I wouldn’t do this, to which he resisted and tried to persuade me to change his mind. During the debrief with my GP supervisor at the end of the day, he too was taken aback by this and said that he’d have had a strong word to say if he’d been there.

It’s always difficult to confront an unreasonable expectation from a patient, especially if it’s driven by anxiety. This difficulty becomes even more pronounced when you expect the patient to know better than you do what is or is not unreasonable. I suppose, then, it’s a vital lesson to learn when to back yourself and have the confidence to challenge your seniors.

From an anonymous F2 doctor hoping his patient isn’t a regular TMP Pro reader.

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