Dr Phil Hammond, GP, lecturer and presenter of the BBC2 programme Trust Me, I'm a Doctor

Why do some doctors stare at you, while others seem incapable of eye contact?

I'm not sure if any studies have been done on this, but I guess it depends on the personality disorder of the doctor.

Starers either have mild psychopathic tendencies or they've just been to one of my communication skills lectures.

Or they may have had their eyelids removed in a Freshers' Week prank.

Or it may just be a function of the doctor's specialty: anaesthetists spend a lot of time staring at you in the vain hope you'll wake up; psychiatrists do it to put you to sleep.

Of course, the staring may be down to the fact that you've got something to stare at, like a big lump or jug ears or a Bowie knife.

What about the ones who won't look at you?

These are the poor sods who sailed into medical school with three grade A science A levels and the communication skills of a dead skunk. They're great with Grey's anatomy, but not so hot with Mr Grey.

They may glance at patients at the beginning of the consultation, but if you've got something awry in the emotional department (grief, anger, despair, hyperventilation), they start shifting on their seats and fidgeting with their fringes and you won't get a whiff of a pupil.

Occasionally, averting eye contact can be entirely appropriate, like when you're banding a haemorrhoid or you stumble across someone undressing.

It's an odd thing, undressing.

Doctors are allowed to see you buck naked or fully clothed, but if we catch you in the process of removing your Wonder-truss, it becomes horribly inappropriate.

Do you think the process of de-robing is ritualistically sexy?

I don't know, I never look.

Why do doctors look at you anyway?

Ah, well, as my mentor once said…

Who's that then?

You won't have heard of him.

Try me.

Dr John Evans.

Never heard of him.

See, I told you. As John said in 1936…

How can he have been your mentor if you qualified in 1987?

I failed a few exams on the way, OK?

Anyway, on the subject of looking, he said: "The jaw line reveals inheritance, the lips show what life has done to the patient and the eyes reveal the emotions of the moment."

So you can tell if I'm a Plantagenet by looking at my chin?

Yes.

Well, actually I'm from Purley.

And so was Richard II. The point is that there's far more to looking at a patient than spotting the diagnosis.

But you can do that as well?

Oh yes. Say you're stranded on the Jubilee Line and you notice that the man opposite has yellow eyes…

Does that mean he's a Midwitch Cuckoo?

No, it means he's got jaundice. So what you do is you brush past him and whisper "I think you might have Gilbert's syndrome".

Does Gilbert not want it then?

Boom, boom. Gilbert's syndrome is a familial unconjugated hyperbilirubinaemia due to an inherited deficiency of UDP glucuronyl transferase.

How do you know that's what he's got?

I don't. It's just that it's common, affecting 2% of the population, and it's harmless, so you won't upset him needlessly.

Anything else to look out for on the tube?

Well a swelling at the front of the neck could be a goitre…

Or a misplaced Femidom.

And coarse skin, a large tongue, prominent eye sockets and a protruding lower jaw with wide spaced teeth could signal an excess of growth hormone.

Or ancestry in the Channel Islands.

Well, yes, a lot of Channel Islanders do have prominent jaws.

So John was right?

John was always right.

Guidelines in Practice, December 2000, Volume 3
© 2000 MGP Ltd
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