Phil Hammond MD

Smile, we're on candid camera. A good thing, too - most of us have very little notion of the effect we have on our patients
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Indy Lifestyle Online
Lights! Camera! Scrotum! Yes, the camcorder is coming to a surgery near you. From 1 September, all trainee GPs will have to submit a video of their consultations to a panel of experts to check their fitness to practice.

Are they empathic? Do they know their stuff? Where did he get that tie? Is that yesterday's lettuce stuck to the upper central incisor? This is nothing new - GPs have voluntarily subjected themselves to celluloid self- reflection since the video-recorder was invented - but in the brave world of consumerism, we have to take it a step further and demonstrate to you, the public, that we don't all mumble into our beards and hide behind the computer. At least not while the camera's running.

And there's the rub. Everyone tries harder when they know they're being observed by their masters, but whether GPs put in the same effort when it's just one man and his bunion watching is another matter. Most of us have very little notion of the effect we have on patients and, aside from Christmas presents and complaints, we don't get any feedback at all. Even these aren't reliable performance indicators - it's the ones you almost kill who buy you presents and the ones you save who complain - but it's a start. If patients don't come back to see me, I haven't a clue whether I've cured them or whether they've quit. This isn't critical just as long as they don't come back, but without any measure of patient satisfaction, it's easy to delude yourself into thinking you're doing a great job.

A hundred years ago, a doctor called Lord developed this technique called the Lord's stretch for people who found it painful to pass motions. He stuck 10 fingers up the rectum. And surprise, surprise, they never came back. They must have been cured.

A video-recording of the top end while doctors are delving around at the bottom is a tad unethical, but it would at least give us a chance to reflect on what it's like to be a recipient. Doctors who store their speculums in the fridge are usually far too busy trying to visualise the cervix to take in the grimace.

Immediate feedback along the lines of "Warm it up or I'll scream" would be just as effective, but most patients prefer to suffer in silence than trouble the doctor. He's a very busy man, you see. However, he'll have to seek your opinion to record your consultation and you have the right to have the camera switched off and the tape erased at any moment. (It'll be erased anyway after the panel of experts have seen it.)

Intimate physical examinations are excluded, although I once recorded a farmer who was very up front about his botty boil and had it in the view-finder before I could hit the off-button. It was as fine an example of non-verbal communication as you could wish for.

Should you consent to all this? Obviously not if you don't want to, but the motives are honourable and the exercise is useful. Doctors who have a chance to observe themselves in action can, with a bit of tutoring, improve their communication skills.

The exceptions are surgeons who have also used videos for years but they tend, perhaps unsurprisingly, to focus on the lump rather than the whole person. It's hard to judge the doctor's empathy by looking at the patient's gall-bladder. The GP trainee videos will take in your upper, outer half and be judged according to four criteria - listening, action, understanding and errors. Sadly, you won't have a chance to give your mark.

Panels of experts are all very well, but patients will always be the best judge of a doctor's ability. OK, you might not be sure why she's prescribed you a third-generation cephalosporin or why he squeezed your testicles and asked you to cough (the answer, of course, is because it's fun), but you know if it was done with care.

You know, too, if you've been patronised. You know if the doctor has at least attempted to find out the impact of the illness on you and what your worries are. Expert observers can be fooled by doctors who trot out "I know how you feel" or "What are your worries?" every time there's a pause in the consultation, but you're not. You can smell fake empathy. And if you're brave enough to give your doctor constructive feedback about his or her consulting (positive points first, recommendations later), it can only do good.

Or, if you're in playful mood, turn to the camera and say: "He hasn't listened to a word I've said, he didn't understand the first thing about my problems and his action plan is riddled with errors. Apart from that, it was great."

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