Misfortune has its funny side, and doctors see a lot of it. But a patient who hears that he faces salami surgery will not see the joke

"Hello sir. You don't mind if I teach the students on you, do you? Jolly good. Now, this chap's got peripheral vascular disease and today I'm going to chop his toes off. Of course, that'll only be a temporary solution. He'll be back with gangrene in a few months and I'll have to take off half the foot. Then the whole foot, the lower leg and gradually over the course of the next few years I'll be working my way up to the knee and above. I call it salami surgery. Any questions?" I've got one. Do consultant surgeons really still speak to patients like that in 1997, or have I just made it all up for a cheap, sensationalist, column-opening? Well, I wasn't there at the time but I'm reliably informed by a medical student that this particular incident of bedside teaching really did take place. Last week.

Shortly afterwards in the doctors' mess, the same student stumbled across some junior surgeons discussing their career options. "Do you put wife before knife, or knife before wife?" "Knife." "Before wife?" "Of course." "Absolutely." When she pointed out that comparing a life soul-mate unfavourably with a scalpel was a tad disrespectful, she was treated with derision. "Oh no, we've got another lefty lesbian on our hands." I could go on but you get the picture. There are still plenty of surgeons out there who make Martin Clunes seem like Germaine Greer. And they're proud of it.

To be fair, you do need to make enormous personal sacrifices to reach the top in surgery, and brainless hectoring is one way of coping with a very stressful job. Likewise, laughing at misfortune. When I asked a group of medical students whether it was possible to have a sick "salami surgery" sense of humour and be a good doctor, most not only agreed but declared it essential. As one put it; "All humour is laughing at misfortune, and if you're surrounded by it every day you're bound to laugh at it more than, say, someone who works in Thorntons." "Surely if you work in a chocolate shop you see lots of unfortunate fat people?" "Yes, but they're not going to buy your chocolates if you laugh at them, so you don't do it. At least not in front of them."

And there's the rub. The students decided it was both ethical and practical to have prejudicial or disrespectful attitudes in the privacy of your own mess or coffee room in a "you've got to laugh or you'll go under" sort of way, provided they don't spill out in a consultation. This, it appears, is where surgeons fall down. "Some of them say exactly the same things in public as they do in private." "Isn't that just refreshing honesty?" "Not when it causes so much distress. It's as if they're so powerful and unaccountable that theirs are the only feelings that matter." Although in theory every patient has a right to a second opinion if a doctor upsets you, the practical reality is that it's very difficult. Much more difficult than say, switching chocolate sellers - unless you're prepared to pay. I'm no great fan of private medicine, but it's amazing what the promise of lucre does to a bedside manner. No one mentions salami surgery in the Balmoral Clinic.

All this surgeon bashing is enough to make us GPs feel smug, but we're not in the clear by any means, especially when it comes to obesity. After smoking, this is the biggest single cause of premature death in the UK, and much more besides. Overweight patients have lower self-esteem and more psychological problems than any other single patient group, including cancer sufferers. Many of them never go near a chocolate shop, and many eat no more than slim patients. Yet virtually every obese patient I've met has had a doctor say to them at some stage "there were no fat people at Belsen". This a typical arsey doctor's way of saying "If you ate less, you'd lose weight" - which is undoubtedly true - but the message is lost in the gag and patients leave feeling more stigmatised than ever. Alas, they rarely tell the doctor how upset they are. It took the Daily Mail to blow the whistle when a doctor told a woman that "nobody fat walked out of Auschwitz", without realising she was Jewish.

I recently met a woman who had conquered her obesity but said at the time how it took over her life. "Every decision I made was coloured by my low self-esteem. I was buying a pair of shoes and the sales assistant asked me if I wanted some polish for them. She chose a shade I was certain was wrong, but I didn't say anything because I'm sure she'd have thought "Silly fat cow, what does she know" - so I let her sell me the wrong one." If over-weight patients can feel so threatened by shoe fitters, imagine what doctors do to them

Life and Style
tech

Sales of the tablet are set to fall again say analysts

News
A Brazilian wandering spider
news

World's most lethal spider found under a bunch of bananas

News
people
Sport
Mario Balotelli pictured in the win over QPR
footballInternet reacts to miss shocker for Liverpool striker
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Voices
Sol Campbell near his home in Chelsea
voices
News
i100
News
Kimi the fox cub
newsBurberry under fire from animal rights group - and their star, Kimi
Sport
Fans of Palmeiras looks dejected during the match between Palmeiras and Santos
footballPalmeiras fan killed trying to 'ambush' bus full of opposition supporters
Arts and Entertainment
filmsIt's nearly a wrap on Star Wars: Episode 7, producer reveals
Life and Style
fashion
News
i100
News
<p>Jonathan Ross</p>
<p>Jonathan Ross (or Wossy, as he’s affectionately known) has been on television and radio for an extraordinarily long time, working on a seat in the pantheon of British presenters. Hosting Friday Night with Jonathan Ross for nine years, Ross has been in everything from the video game Fable to Phineas and Ferb. So it’s probably not so surprising that Ross studied at Southampton College of Art (since rebranded Southampton Solent), a university known nowadays for its media production courses.</p>
<p>However, after leaving Solent, Ross studied History at the School of Slavonic and East European Studies, now part of the UCL, a move that was somewhat out of keeping with the rest of his career. Ross was made a fellow of the school in 2006 in recognition of his services to broadcasting.</p>
TV

Rumours that the star wants to move on to pastures new

News
i100
Arts and Entertainment
The cast of Downton Abbey indulge in some racing at a Point to Point
tvNew pictures promise a day at the races and a loved-up Lady Rose
News
people

Comedian says he 'never laughed as hard as I have writing with Rik'

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

ES Rentals

    iJobs Job Widget
    iJobs General

    Lead Teacher of Thinking School Drive Team and Year 3 Form teacher

    Competitive: Notting Hill Prep School: Spring Term 2015 Innovative, ambitious ...

    Operations Data Analyst - London - up to £25,000

    £20000 - £25000 per annum + Benefits: Ashdown Group: Operations Data Analyst -...

    Programmatic Business Development Manager

    £35 - £40000 per annum: Sauce Recruitment: As the Programmatic Business Develo...

    Year 5 Teacher

    Negotiable: Randstad Education Hull: Randstad Education is currently recruitin...

    Day In a Page

    Oscar Pistorius sentencing: The athlete's wealth and notoriety have provoked a long overdue debate on South African prisons

    'They poured water on, then electrified me...'

    If Oscar Pistorius is sent to jail, his experience will not be that of other inmates
    James Wharton: The former Guard now fighting discrimination against gay soldiers

    The former Guard now fighting discrimination against gay soldiers

    Life after the Army has brought new battles for the LGBT activist James Wharton
    Ebola in the US: Panic over the virus threatens to infect President Obama's midterms

    Panic over Ebola threatens to infect the midterms

    Just one person has died, yet November's elections may be affected by what Republicans call 'Obama's Katrina', says Rupert Cornwell
    Premier League coaches join the RSC to swap the tricks of their trades

    Darling, you were fabulous! But offside...

    Premier League coaches are joining the RSC to learn acting skills, and in turn they will teach its actors to play football. Nick Clark finds out why
    How to dress with authority: Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear

    How to dress with authority

    Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear
    New book on Joy Division's Ian Curtis sheds new light on the life of the late singer

    New book on Ian Curtis sheds fresh light on the life of the late singer

    'Joy Division were making art... Ian was for real' says author Jon Savage
    Sean Harris: A rare interview with British acting's secret weapon

    Sean Harris: A rare interview with British acting's secret weapon

    The Bafta-winner talks Hollywood, being branded a psycho, and how Barbra Streisand is his true inspiration
    Tim Minchin, interview: The musician, comedian and world's favourite ginger is on scorching form

    Tim Minchin interview

    For a no-holds-barred comedian who is scathing about woolly thinking and oppressive religiosity, he is surprisingly gentle in person
    Boris Johnson's boozing won't win the puritan vote

    Boris's boozing won't win the puritan vote

    Many of us Brits still disapprove of conspicuous consumption – it's the way we were raised, says DJ Taylor
    Ash frontman Tim Wheeler reveals how he came to terms with his father's dementia

    Tim Wheeler: Alzheimer's, memories and my dad

    Wheeler's dad suffered from Alzheimer's for three years. When he died, there was only one way the Ash frontman knew how to respond: with a heartfelt solo album
    Hugh Bonneville & Peter James: 'Peter loves his classic cars; I've always pootled along fine with a Mini Metro. I think I lack his panache'

    How We Met: Hugh Bonneville & Peter James

    'Peter loves his classic cars; I've always pootled along fine with a Mini Metro. I think I lack his panache'
    Bill Granger recipes: Our chef's heavenly crab dishes don't need hours of preparation

    Bill Granger's heavenly crab recipes

    Scared off by the strain of shelling a crab? Let a fishmonger do the hard work so you can focus on getting the flavours right
    Radamel Falcao: How faith and love drive the Colombian to glory

    Radamel Falcao: How faith and love drive the Colombian to glory

    After a remarkable conversion from reckless defender to prolific striker, Monaco's ace says he wants to make his loan deal at Old Trafford permanent
    Terry Venables: Premier League managers must not be allowed to dictate who plays and who does not play for England

    Terry Venables column

    Premier League managers must not be allowed to dictate who plays and who does not play for England
    The Inside Word: Brendan Rodgers looks to the future while Roy Hodgson is ghost of seasons past

    Michael Calvin's Inside Word

    Brendan Rodgers looks to the future while Roy Hodgson is ghost of seasons past