What doctors really need to do is become better actors - then patients might even think they know what they're doing

Phil Hammond MD
Some while ago, as a virgin lecturer in medical communication, I proposed a course called "Acting skills for doctors". I got as far as the fliers when my head of department put the brakes on it. "You can't possibly call it that," he mumbled into his lap-top. "But why not, sir? Everyone knows we act all the time." "Yes and everyone knows we drink like fish, but it doesn't do to advertise the fact. Now, I suggest we call it `How to enhance your caring skills'."

Great suggestion. Two months and no applicants later, we were forced to conclude that all doctors must already have excellent caring skills. What other explanation could there be? I've since moved on to another head of department, so it's time to dust off those old ideas and present them as new. Only this time I've got the Lancet behind me. "All doctors need to be better actors," say Canadian researchers in a recent issue. "Only then can we respond to our patients' emotional pain."

There are many obvious comparisons between doctoring and acting: mumbling, hiding behind the props, upstaging the central character, being in the wrong play, forgetting your lines, ad-libbing with inappropriate humour and, worst of all, getting the entrance wrong. Yep, despite nature's helpful colour-coding, there are still a few doctors who try to visualise the cervix through the back bottom, or check for piles in the front one. Some call it gross professional incompetence, but I prefer bad acting.

Even the General Medical Council has jumped on the acting bandwagon with its proposal to check up on incompetent doctors using fake patients. Aside from providing a glimmer of employment for drama graduates, it sets up the tantalising prospect of bogus patient meets bogus doctor. "Good morning. And what seems to be the problem?" "I've no idea." "Neither have I." "I'll say goodbye then." "Goodbye." It'd be funny if it didn't bear such a close resemblance to my own consultations.

I like to think I'm reasonably honest with my patients - I give them as much factual information as they seem to want and I try to get them to realise that medical science doesn't have all (or many) of the answers. A few brave doctors do extend the concept of honesty to include sharing all of their emotions and attitudes with their patients. Usually it's the old self-disclosure-plus-reflection routine. "You're making me feel quite frustrated Mrs Robinson. How does that make you feel?" But occasionally you get a GP who'll go the whole hog. I know a senior partner who summons patients over the intercom with "C'mon Mrs Morris, you great jelly belly. Get your big flabby arse in here." I'm reliably informed that this brightens up the waiting room no end and that even the victims love him all the more for his earthiness.

Clearly, professional decorum dictates that emotional honesty can go too far and there are times when it's wise to disguise your true feelings, eg "I've always admired your upper body" is not the thing to say when you're listening for a heart murmur. So that's when acting comes in. On my courses, doctors are taught to disguise inappropriate attitudes and emotions and "enhance-out" later. One practice I worked in has a "heart- sink" patient football team comprising the 11 most difficult patients (plus two on the bench). After a murderous consultation, the doctor will run out to the coffee room and replace yesterday's heart-sink with today's. It's a marvellous way to de-stress doctors without harming the unwitting clientele of Sunbanks Surgery, 124 Maryvale Rd, West Thursley.

Of course, there's far more to acting than disguising emotions. You have to learn to take on a variety of roles. Some patients want you up on a pedestal, others like an equal partnership and an increasing minority want to dominate you. Alas doctors, like lovers, learn a particular pattern of behaviour early on in their careers and stick to the same role for life. Patients visiting a group practice soon suss this out: Dr Clements is the practice bastard; you won't get much sympathy but you'll be in and out with your antibiotics in 30 seconds. Dr Hughes you have to book three months in advance but she's very good with emotional disasters. How much easier it would be if every doctor offered several roles for you to choose from. So for this term's course, I'll be teaching doctors to consult in the roles of a fit Mother Teresa, a fit Ruud Gullit, a bad Olivier and a burnt-out, divorced, alcoholic bigot. If you feel I've missed anyone out, please let me know before the timetable goes to print on Friday 13thn