As I opened my GMC renewal certificate (yes, I am a proper doctor), I chanced upon a summary of the duties of a doctor on the inside cover. I'm not sure who compiled them, but I suspect it might have been the Professor of Common Sense at the University of The Blindingly Obvious, e.g. doctors must treat every patient politely and considerately.
Other musts for doctors include be honest and trustworthy, make the care of your patient your first concern. Did anyone ever argue otherwise?
I suspect the GMC is hoping that if every doctor glanced at the inside cover every now and then, it would provide a quick attitudinal spring-clean and wipe away the cynicism, self-interest, boredom and burn-out.
Doctors behave badly for lots of reasons. Whom we recruit, what we teach them and how long they go without sleep are important. I don't know many doctors who set out to be deliberately rude to patients, but the few I know of are unlikely to be swayed by a must-do ticklist.
But that hasn't put off the educationalists. In medical communication, there are hundreds of guidelines ranging from psychobabble attitudes (you should have unconditional positive regard for your patients) to simplistic behaviours (always smile appropriately).
When is a smile appropriate? Does it depend on the number of teeth bared or the emotion of the moment? In truth, only patients can judge appropriateness, but how do we get the truth from them? Mrs Pemberton, you may have noticed I'm smiling at the moment. Does it seem appropriate?
Even if we could teach every medical student to smile appropriately, would it make them better people? A man, as Hamlet observed, may smile and smile and be a villain. And so may a doctor. We like focusing on simplistic surface skills because it gives us things to count and papers to publish, but without a deeper understanding of what doctors are about, such an approach is pointless.
Another tactic is to ignore the academics and develop your own guidelines based on a focus group of punters. Thus the Maudsley User Group has come up with Recommendations for the Conduct of Ward Rounds for doctors working at the Bethlem and Maudsley NHS Trust, e.g. explain the purpose of the ward round. Tricky one: to massage the ego of the consultant while his minions arselick in his wake?
Introductions are essential. The patient should be told the name and discipline of each person, and why they are present. Hello, I'm Piers, I'm a medical student, I've got a stinking hangover and I'm here to learn. Give the patient an opportunity to ask questions before ending the interview. Any questions? Jolly good.
Sensitive matters should not be discussed in a ward round. Alas, it's left to desensitised doctors to decide what's sensitive or not. What we're going to do is put ten fingers in your back passage...
Simplistic guidelines aren't completely useless, especially when used as an antidote to panic. The good folk at Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry have been sent a fascinating guide on how to respond to a bomb threat. You don't, apparently, drop the phone and run. You ask these questions:
1. Where is the bomb right now?
2. When is it going to explode?
3. What does it look like?
4. What kind of bomb is it?
5.Did you place the bomb?
7. What is your name?
8. What is your address?
9. What is your telephone number?
If 9 is fruitless, try automatic number reveal. Then phone 999 and report it. Jot down your best guess at the sex, nationality and age of the caller. Was the threat language well spoken, foul, irrational, incoherent or taped? Was the voice calm/nasal/rapid/hoarse/clearing throat or lisp? If the voice was familiar, who did it sound like? Were the background noises street/house/motor/booth/office or animal?
I'm not sure who compiled these guidelines, but should the situation arise, I just know they'll have a profound effect on my behaviour. Not.
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