HEALTH / The healing touch that hurts: Doctors can seem indifferent and intimidating to patients. Anne Woodham finds women in particular are affected

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The Independent Culture
'REMOVE the rectum,' Sheila Inglis heard the consultant say at the foot of her bed. ' 'Remove the bladder. Take out this. Take out that.' He said all this in front of me, and then walked out,' she recalls. 'Disappeared. The nurses told me to get dressed.' Sheila, who was 38 at the time and had a 12-year-old son, had returned to hospital for what she hoped would be a routine checkup, following a course of radiotherapy for cervical cancer six months earlier. The growth had returned with a vengeance, spreading into her internal organs.

'Suddenly the room was full of people, and the consultant was summoned. They were talking about the drastic things that would happen to my body as if I wasn't there, and when he left I couldn't believe it. 'I want to talk to him,' I said. 'You can't,' they said. I got up and went scouring the hospital corridors for him, but I could only find his assistant, a younger doctor, and backed him against the wall. 'What does he mean? I want to know more.'

' 'We're only trying to help you,' he said, 'and we may not be able to help you at all.' The subtext was, 'be grateful, you hysterical woman; look up to us, we don't have to explain things.' '

Sheila was offered a two-month course of chemotherapy as a prelude to the radical surgery proposed, and she took it gratefully as an opportunity to find out more about her condition and, above all, to think.

She felt so antagonistic towards the consultant that for weeks she refused to see him. The staff, she says, were aware of her reasons, but no explanation was given for his behaviour. Eventually, with the date for her surgery booked, an appointment was inevitable. 'He must have read something in my notes, because the first thing he did was apologise. He'd been dragged back into the hospital as he was leaving on holiday. 'Okay,' I said, 'but you were still a real rude sod.' '

The brutality of her hospital experience, both in the treatment she underwent and the attitudes encountered, had shaken Sheila's faith in the medical profession. Meanwhile she found immense comfort and even courage in alternative therapies. Without an operation, the consultant told her, she could expect to live 18 months at most; with radical and debilitating surgery, maybe five or six years. To the doctor's astonishment, Sheila refused. 'They thought I was mad, and made an appointment for me with a psychiatrist. 'Don't you want to live?' they asked. Of course I did, I said, but I want to choose how.'

Nine years later, she is still alive - but that is another story. What is relevant in this context is that her decision was, in large measure, a result of the doctors' behaviour. Relationships between patient and medical professional are increasingly under scrutiny (on 30 November, the Royal Society of Medicine in Wigmore Street, London, is holding a one-day conference on counselling and communication in medicine) and just as the importance of sensitive communication and support is being recognised on one hand, so are the effects for ultimate good or ill of defensive, inconsiderate and authoritarian conduct.

Nowhere is this more apparent than in women's health services. According to Dr Myra Hunter, Head of Psychological Services to obstetrics and gynaecology, University College Hospital, London, women attending gynaecological clinics report high levels of anxiety and emotional distress, higher than those in the general population or among women at other out-patient clinics. 'A lot of this could be avoided,' she argues.

So could a drain on health service funds. One of Dr Hunter's patients, depressed, lonely, and emotionally confused about sex and infertility, was a 37-year-old woman who had been pressured into having a hysterectomy by an intimidating consultant. She was unprepared for the operation and unaware of the extent of the surgery until afterwards and as a result needed referral to a psychologist.

What health professionals often have trouble accepting is that a person's well-being involves the whole of the person - his or her psychological, social, economic, historical and cultural situation, as well as the actual medical symptom that may have brought them to the clinic in the first place. This can be particularly true for women. Society teaches women to regard their bodily functions with distaste: menstruation is disgusting, childbirth messy, hormones uncontrollable, and the menopause the end of all usefulness. A womb, in traditional medical mythology, is equated with hysteria and emotional instability, and too many women have been treated as wombs.

Couple these attitudes with the patriarchal manner of many doctors - even female ones - and no wonder women feel vulnerable. 'For me the problem was being talked to with my legs in stirrups while he was examining me,' one woman told Dr Hunter. 'I had no authority or control over the situation; I daren't move. I found myself saying things quite differently than I would have done if I was dressed and talking across a desk.'

In a new book aimed at both health professionals and interested lay readers, Counselling in Obstetrics and Gynaecology (BPS Books - The British Psychological Society - pounds 9.99), Dr Hunter urges three basic principles: women and health-care workers should attempt to work as equals; women should be told clearly about their problem and its treatment so they can make informed decisions; and women should be given as much control of their treatment as possible. Take the menopause, for example. 'Commonly held stereotypes about menopausal women come from doctors in menopause clinics where women tend to be more depressed and have more negative experiences. In general population studies, the menopause doesn't necessarily bring emotional problems,' she says.

In her current research study, a group of 45- year-old London women attended menopause preparation workshops and received individual counselling about their lifestyles. Three months later, their diet improved, and they reported less apprehension and greater confidence about their approaching menopause compared to those in a control group.

Childbirth is demonstrably an area where better communication reaps rewards - and traumatic experiences can blight family relationships. Julie Wales chose home births for her second and third daughters after the first arrived in what she describes as a nightmare high-tech hospital delivery. 'The next day when one felt like a lacerated blob, the doctor and her minions arrived and discussed me as if I wasn't there. I said, 'does she really need a vitamin K injection?' and the consultant said to the students, 'a little knowledge is a bad thing'. But only recently I saw another report linking vitamin K injections with childhood cancer.'

The home births, she says, were 'wonderful, different in every way. I felt more in control of my body and of the experience. The delivery is dependent on you and your partner being fully informed and the midwives are free to give you complete support.'

Medical students now learn listening and communication skills, but older doctors, even when conscious of their importance, can find them hard to put into day-to-day practice - leaving a woman no option but to acquire some communication skills of her own.

''Try to resist the all-consuming patient role,' advises Dr Hunter. 'Think of doctors and nurses as ordinary people who get ill too and don't know all the answers. Write down three or four key questions before your appointment; rehearse the interview and take a notebook, a tape recorder or a friend or relative along with you. The art lies in being calmly assertive. Remind yourself that you have a choice and a right to information.

'Sometimes bad news comes without warning and it's not given as well as it should be. If you're upset, say 'I may be crying, but I still want to know.' Ask if you can go out for a few minutes or make another appointment. A good thing to say is: 'I want to think about it and come back and discuss it further.' '-

(Photograph omitted)

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