Sometimes, I have patients come to me and tell me things that make me think ‘Why are you here?’.
There are lots of times you hear doctors complaining about patients wasting their time or inappropriate referrals. You rarely hear of the patients that were a good use of their time or were appropriately referred to them. Nowadays, patients come to you with more expectations than previously, according to my seniors. This comes with the unlimited information available to people nowadays, with Dr Google or AI. Sometimes it’s well informed, and sometimes it’s the horror story in the news. I find it increasingly difficult to reassure someone because health anxiety is at, what seems like, an all time high. As is general anxiety about everything I suppose.
And so, when I find constant resistance to what I advise and say as a doctor, I tend to ask ‘So what is really the matter?’. Usually there is something else that’s causing their worries, but sometimes people don’t even realise they have health anxiety and constant worry and stress. The issue comes when what you think they have based off their answers to your history questions and your examination findings doesn’t match what they think they have. And if it’s a name of a fancy diagnosis that fits perfectly, that’s okay. If it’s simply ‘likely stress or lifestyle related’ causes, it becomes more difficult to have people leave satisfied. I think they feel some blame attached to those words, or feel dismissed, even if I’ve done a very thorough history and examination. I often find myself over-ordering investigations, such as blood tests, scans and samples for sputum, urine and stool, to rule things out or to put the patient’s mind at ease. Yes, rare things can happen, and yes, these investigations can be useful, but more often than not, these investigations do not explain the whole patient condition. This nuance can be difficult to portray to a person in just a few minutes.
Medicine and the human condition is unfortunately very multifactorial a lot of the time as it is so complex. We have more answers now than ever before, but we also seemingly have more questions than ever before. I guess that’s the beauty of modern day science, but nobody wants to be considered a science experiment either, and they shouldn’t get treated like that either. The truth is we are discovering more and more medical conditions and diagnoses, and there are more and more medications we can give and investigations we can order and interpret, and more and more specialists we can refer to.
Often, I need to tell myself that I am not a miracle worker, as much as I would love to be one. The most I can do is to try to understand and listen; make someone feel understood and heard. I can try and answer some questions along the way, and provide people with answers as and when I can, but sometimes I have to accept that I don’t know the answer, or I can’t help someone. The more you do for someone, the less they do for themselves.
It would be interesting to do a mass survey one day to ask people what they want or expect from their doctor…
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