Health: Lessons in rude health

Doctors can be arrogant, crass and insulting, but then patients can be just as bad. Below, William Evington looks at what can be done to improve doctors' bedside manner and our health editor (right) reports on how abusive patients can ruin GPs' lives
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Which of the following anecdotes about what doctors say to their patients is invented?

"Your child will be of restricted growth. But look on the bright side - he could be a circus dwarf".

"I am delighted to say you do not have cancer. Oh, yes you do - I was looking at the wrong page."

(To an 80-year-old lady) "If you don't stop being sick, I shall have to open you up from gizzard to navel and pull your insides out."

"I know you think your child is ill, but frankly he's well off compared to the one in the next cot."

Answer - none of them. Much as they may seem like out-takes from Doctor in the House, each is a genuine example of the Great British Bedside Manner. Almost everyone seems to know a similar story, often from personal experience. For a further selection, try the coruscating book by medic-turned-comedian Dr Phil Hammond, Trust Me I'm a Doctor.

Rodney Ledward, the Kent consultant struck off the medical register for incompetent surgery, who styled himself "the fastest gynaecologist in the South-east", was alleged to have made frequent rude and suggestive remarks to patients. On one occasion, after he had performed a hysterectomy, he told his patient's husband that he should be grateful because he (Mr Ledward) had sewn her up "like a 16-year-old".

Conclusion: some doctors can be appallingly crass. Most, obviously, are not. All too many, however, can be rude, arrogant or insulting.

Why should they get away with it? After all, most doctors either sub- contract to or are directly employed by the state. Until recently, many at least had their fees at university paid. Even today's levy represents only a fraction of the true cost of training. Excepting the issue of out- of-hours cover, doctors are not that badly paid, without even considering the question of vocation. What other public employee, trained from your taxes, would be allowed to get away with being so crashingly ill-mannered as these examples?

What, if anything, should be done? The medical profession is already under attack as never before, from both within and without. Dr Richard Horton, the editor of The Lancet, has famously gone on record attacking the arcane and Freemasonlike professional bodies, the Royal Colleges and the General Medical Council.

Quack-knocking is a venerable pastime. Pliny, Voltaire, Proust, Moliere, AJ Cronin, Montesquieu, Montaigne, George Bernard Shaw and Sidney Webb have all kicked medical ass.

Dylan Thomas wrote in The Doctor and the Devils: "When I take up assassination, I shall start with the doctors and work up to the gutter."

Probably the most damaging attacks ever levelled at the Western medical profession were made by social scientist Ivan Illich and hospital administrator Thomas Mckeown. Both argued that the main function of the doctor is to hijack the language and control of health care and prevent people from making sensible decisions about their own well-being.

So what? Compared to medics, lawyers get it much worse. The point is that Illich and Mckeown have already said that the emperor has no clothes, and nobody has taken any notice. A few anecdotes relating to crass "communication skills" are tantamount to saying that we do not like the emperor's tie, and are unlikely to cause much damage.

Since the Bristol disaster and so many other high-profile scandals, the medical profession has made some effort to put its house in order. Despite some opposition, the General Medical Council has announced the introduction of checks for doctors in practice with a system of reaccreditation. While this is admirable, it tackles only the issue of professional competence, not deportment - short-sighted, given that research published in The Lancet has shown that doctors' chances of being sued are more related to manners than competence.

So what will make arrogant, rude doctors change their tune? One often suggested solution is to teach "communication skills" in medical school. While it is hard to fault the intent, the facts are less straightforward. These "skills" are usually taught at the idealistic, pre-clinical stage, before patients are encountered and the fabled cynicism of the knackered junior doctor is adopted as a battle-honour.

Besides, defective attitudes often filter down from the top. On one teaching ward round I recall, a consultant used medical jargon to describe a patient to her face as practically an ape ("phylogenetically degenerate"), proceeding to explain to us that she was too stupid ("hypobettsic") to understand him.

Another answer is to alter the intake to medical school so that A grades are not the only entry criterion, and to select students who have caring, communicative personalities but less good results. Unfortunately, during tight times for academia this is not cost-effective. Training a doctor is expensive. Universities select candidates with high grades simply because they have a track record at passing exams and are less likely to become costly drop-outs.

My suggestion? Doctors usually dismiss criticism like this on the grounds that it is "anecdotal", a cardinal sin in the scientific and medical canon. I may be wrong, but almost everyone I speak to has a story like the ones above.

What if every Independent reader who has ever been insulted or offended by a doctor wrote in with their stories, and we printed some of them? Would they sit up and take notice then? I believe they would. Trust me. I'm a doctor, although I'm writing this under a pseudonym, because I've got my career to think of.

We are interested only in stories of crass or insulting behaviour, not stories of medical malpractice, negligence or mismanagement - these may be taken up through more conventional routes. Anecdotes may be published anonymously, and individual doctors will not be named. Write to: Health Page, One Canada Square, Canary Wharf, London E14 5DL. Or e- mail your stories to