A medical journal once published tips on how to conceal the truth from cancer patients who asked difficult questions
Tuesday 12 November 1996
Perhaps the most remarkable thing about doctors is that we've managed to avoid telling patients the truth for so long. Nobody even really considered it until 1672, when the French physician Samuel de Sorbiere concluded that it was a nice idea in theory, but would never catch on because it would "seriously jeopardise medical practice". Nearly three centuries of keeping mum later, and the Journal of the American Medical Association went a step further and published tips on how to conceal the truth from cancer patients who asked difficult questions. Today, most doctors will at least tell you what they think is wrong with you (if you ask nicely) and perhaps even what they'd like to do to you - but not whether it's been proven to work, whether they've been trained to do it or even whether they're sober enough to focus. Well, a new programme on BBC2 aims to change all that: Trust Me, I'm a Doctor is an objective, warts-and-all expose ...
I'm sorry, I couldn't help it. I've been under a lot of pressure recently. It's not easy being a media doc, especially when you've spent seven years taking the piss out of medicine and you find yourself presenting a serious health series.
So why do it? It's the eve of transmission and I'm still not sure. Media medicine is famous for stoking patients up with unrealistic expectations and making life hell for doctors for three days after each broadcast. TMIAD is more objective than most, which makes it even more unsettling. A lot of current medical practice has no scientific justification, and nobody is quite sure how much has. Bad backs, obesity, hyperactive children, foreskins and pain are all badly managed, and there's wide disagreement about what to do with prostates. Doctors have great trouble staying up to date, and it takes on average 10 years for research results to reach the surgery. About 15,000 people die unnecessarily every year because they don't have access to specialist cancer services, and surgeons are still dabbling away at operations they aren't competent to do. The more you analyse the NHS, the worse it becomes. There's a lot to be said for blind trust.
Or is there? I hate paternalism, and people who persist in seeing doctors as gods deserve to be offended. We're human, we're unwell and - most inexcusable of all - we're badly trained. Undergraduate medical education provides perhaps the worst value for money of any university course ever. Students are killed off in the first two years with such mind-numbing factual overload that many lose the ability to think critically, cope with stress and express empathy, for good. Perhaps the most damning indictment of medical education is that most bogus junior doctors get away with it because their consultants expect house-officers to be incompetent. It has always been thus - pounds 200,000 of public money and they're not trained to do anything.
Stopping the rot in the medical profession is a monumental task. As many as one in five doctors are "chemically dependent", but most would still rather soldier on than get help. With such a sick workforce, it's easy to see why we have trouble. The General Medical Council is in denial and vainly hopes to raise standards by churning out copies of Good Medical Practice to every doctor in the land. Not many make it out of the wrapping paper. The BMA, for its part, claims that "when a doctor is sick, the patient is the last person to suffer". I'm not sure on what evidence this is based, but from the alcoholic doctors I've known, I'd doubt it. Clearly, something must be done.
But is that something a TV series aimed at helping patients to avoid the inadequacies of medical practice? My only hope is that it does more good than harm. Blind trust has to be replaced by informed trust, unrealistic expectations with realism. If you calmly assert yourself and you know which questions to ask, there is no doubt you'll get a better service, at the expense of those who don't. But the truth that you may well be healthier than your doctor could blow trust out of the water.
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