Treating patients as equals has much to commend it, but how many of them know their oesophagus from their elbow?

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The Independent Online
Of the many high points in the life of an academic GP, my favourite is coffee and Chocolate Hobnobs at 10.45 on a Friday morning. It's not just the Hobnobs (although they are a mighty fine biscuit, it has to be said) but the chance to reflect with some of my more cerebral colleagues on the issues of the day. Last week's debate was on how information technology is going to revolutionise the way people use doctors. As an increasing number of Brits become computer-literate and "get connected", doctors will no longer be the keepers of information, but mere servants enabling patients to interpret the information they've stumbled across on the Irritable Bowel Website.

All this assumes, of course, that the British are remotely interested in their bodily workings. Back in 1970, a medical student called Charles Boyle compared doctors' and patients' knowledge of simple anatomy and common medical terms. The results were not encouraging: 38 per cent of patients and 4 per cent of doctors didn't know where the heart was; 40 per cent of patients were misguided about their bladder, although all the doctors could locate it.

The percentage of patients who failed for the other organs were: kidneys, 54; stomach, 80; lungs, 50; and thyroid, 88. "How can you have an informed clinical debate with patients when 80 per cent don't even know where their stomachs are?" we chuckled.

The interpretation of common medical terms was equally distressing. Nine per cent of patients defined heartburn as "the passage of wind through the mouth", 11 per cent said jaundice was being "generally sick and unwell - with yellow vomit" and 8 per cent defined a medicine as "a tablet or liquid to relieve constipation". And there's more. Six per cent thought piles were "any pain at the back passage" (eg a Hoover nozzle) and 10 per cent equated flatulence with "a sort of chest pain". How we laughed.

Well, not all of us. Some introspective GPs tried to use this information constructively, and clarify the patient's understanding of every word they used. A sample consultation might have gone ...

"Doctor, I've got dreadful stomach cramps."

"Mmm, what exactly do you mean when you say the stomach?"

"Come again?"

"Well, where do you think it is?"

"Are you taking the piss?"

"Not at all. Now, are your stomach cramps above or below the diaphragm?"

"No idea."

"I see. Now, do you realise what your stomach does?"

"I don't have to take this."

"I suspect you think it's a bag for holding food, don't you?"

"I might."

"Well, if it's just a bag, how can it give you cramps?"

"You tell me, you're the doctor."

"OK. But first, what exactly do you mean by 'cramp'?"

This rigorous approach has much to commend it, but alas is widely credited for starting the avalanche of aggression against doctors. Of course that was all 25 years ago. Long before Dr Hilary, Dr Mark and that smug, ginger git who does "Trust Me, I'm a Doctor" tried to educate the nation to take more interest in bodily matters. Surely today's health punters are much more clued-up?

A colleague of mine recently saw a solicitor who'd developed back pain while clearing the snow. He was aware that this was probably the cause, but also that kidney disease can cause back pain and he wanted reassurance that this wasn't the case for him. As part of the explanation, the GP produced a plastic model of the lower back to show the likely anatomical structures that might be causing his pain. The solicitor was completely dumbfounded and said: "I gave up science when I was 12 and had no idea there was all that stuff in a back."

That's just an anecdote but the prevalence of bodily ignorance is borne out by a Leicester doctor who last year decided to repeat the "guess that organ" experiment by comparing 500 Asian patients with 500 non-Asian patients. Both of the groups scored badly for most organs, with the liver known only to a quarter. Significantly more non-Asians than Asians knew where their lungs were (64 per cent vs 56 per cent) but the Asian patients were far more likely to be able to point correctly to their stomachs (64 per cent vs 42 per cent).

There is, however, light at the end of the tunnel. One organ alone achieved above 90 per cent site recognition in both of the sample groups. The brain.