"You must treat every patient politely and considerately." Well, bugger me. I thought it was my duty to be rude and inconsiderate

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Indy Lifestyle Online
Do doctors need to be told how to behave? As I opened my General Medical Council renewal certificate (yes, I am a proper doctor), I chanced upon a summary of "the duties of a doctor" on the inside cover. I'm not sure who compiled them, but I suspect it might have been the Professor of Common Sense at the University of The Blindingly Obvious. Eg, "As a doctor, you must treat every patient politely and considerately." Well, bugger me. Until this morning, I thought it was my duty to be rude and inconsiderate. Thank you GMC for setting me straight.

Other musts for doctors include "be honest and trustworthy", "make the care of your patient your first concern" and "don't shit in the wound".* Did anyone ever argue otherwise? I suspect the GMC is hoping that if every doctor took a quick peep at the inside cover every now and then, it would provide a quick attitudinal spring clean and wipe away the cynicism, self- interest, boredom and burn-out. Will it work? Is the Pope a catheter?**

Why do doctors behave badly? Who we recruit, what we teach them and how long they go without sleep are important factors, but the simplest answer is "because we can". We can insult you while you're buck naked in stirrups, and you can't do it to us, Yahboo sucks. In fairness, I don't know many doctors who set out to be deliberately rude to patients, but the few I know of are unlikely to be swayed by a must-do tick-list.

But that hasn't put off the educationalists. In the field of medical communication, there are hundreds of guidelines ranging from psychobabble attitudes ("you should have unconditional positive regard for your patients") to simplistic behaviours ("always smile appropriately"). When is a smile appropriate? Does it depend on the number of teeth bared or the emotion of the moment? In truth, only patients can judge appropriateness - but how do we get the truth? "Mrs Pemberton, you may have noticed I'm smiling at the moment. Does it seem appropriate?"

Even if we could teach every medical student to smile appropriately, would it make them better people? "A man" as Hamlet observed, "may smile and smile and be a villain". We like focusing on simplistic surface skills because it gives us things to count and papers to publish ("studies have shown, a successful doctor smiles 3.4 times per consultation") but without a deeper understanding of what doctors are about such an approach is pointless.

Another tactic is to disregard the academics and develop your own guidelines based on a focus group of punters. Thus the Maudsley User Group have come up with "Recommendations for the Conduct of Ward Rounds" for doctors working at Bethlem and Maudsley NHS Trust. Eg, "Explain the purpose of the ward round." Tricky one, this. To massage the ego of the consultant while his minions arselick in his wake?

"Introductions are essential. The patient should be told the name and discipline of each person, and why they are present. " Hello, I'm Piers, I'm a medical student. I've got a stinking hangover and I'm here to learn.

"Sensitive matters should not be discussed in a ward round." Alas, it's left to desensitised doctors to decide what's sensitive or not. "What we're going to do is put ten fingers in your back passage and stretch you up..."

Simplistic guidelines aren't completely useless, especially when used as an antidote to panic. The good folk at Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry have been sent a fascinating guide on how to respond to a bomb threat. You don't, apparently, shit your pants, drop the phone and run. You ask these questions.

1. Where is the bomb right now? 2. When is it going to explode? 3. What does it look like? 4. What kind of bomb is it? 5. Did you place the bomb? 6. Why? 7. What is your name? 8. What is your address? 9. What is your telephone number?

If 9 is fruitless, try automatic number reveal. Then phone 999 and report it. Jot down your best guess at the sex, nationality and age of the caller. Was the "threat language" well spoken, foul, irrational, incoherent or taped? Was the voice calm/nasal/ rapid/hoarse/clearing throat or lisp? If the voice sounded familiar, who did it sound like? Finally, were the background noises street/house/ motor/booth/office or animal?

I'm not sure who compiled these guidelines either but should the situation arise, I'm sure they'll have a profound effect on my behaviour. Well done, Oswestry.

* I made that one up.

** No.

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