Medicine
Secret service
John Rowan Wilson
A common complaint about the Health Service is that the doctors, especially in hospitals, are offhand and never tell you anything. A friend of mine gave me an example the other day. Her little boy was taken into hospital for unilateral deafness and came out forty-eight hours later with his deafness cured. She gathered from the doctor that some kind of blockage had been removed, but when she asked for further details, he brushed her off saying, "Please don't ask me that. You wouldn't understand even if I told you."
I imagine that what the boy was suffering from in this case was a chronic obstruction to the Eustachian tube, a duct which leads from the back of the nose for the ear and which needs to be patent if we are to hear properly. The removal of such an obstruction is a relatively straightforward procedure, and patients tend to be very grateful for the improvement in symptoms. The surgeon in this case had achieved the difficult feat of performing an easy and highly successful operation while at the same time attracting, instead of the usual gratitude, the deepest possible resentment.
Of course, surgeons are busy men. It's one of those job where one never really catches up with the work. Surgeons have no time for business lunches and leisurely office discussions; they do their committee work in the evenings and their reading in bed. They die early and earn less money on an average than the pilot of a commercial aircraft. Also, they have bad days just like the rest of us, when everything goes wrong and they feel a sense of grievance against patients, nurses, administrators, Sir Keith Joseph, and the world in general.
'Many of them are not good at explaining themselves, A talent for operating is not necessarily allied to a gift for communication, and I have known excellent surgeons who found it extremely difficult to explain themselves to their own colleagues, let alone to patients. Oddly enough, some of the most eager com.municators are the least skilful. I knew one surgeon who fancied himself as an artist and used to draw diagrams of the patient's operation to explain it to him.
Some of these were so realistic and alarming that the patients put on their clothes immediately and walked out of the ward, never to be seen again.
A large proportion of patients do not want to know the details. This is a difficult fact for middleclass intellectuals to accept, but believe me it is true. They resist explanation; you can see them turning their minds away from it. What they want is to be able to trust the surgeon and leave the whole worrying business to him. They behave, in fact, in exactly the same way as I do when something happens to my car. So a surgeon who insists, as a matter of principle, on explaining every operation to every patient, is not thinking of the patient at all. He is thinking of his own image as a progressive and forward-looking doctor. And that isn't good medicine.
But when a patient, or the close relative of a patient, does show a positive desire to be enlightened, the surgeon's duty is clear. He must explain, in the clearest and simplest possible terms, exactly what he is proPosing to do — or has done. He has to try to do this patiently and courteously and he has to try to express it in terms that the patient can understand — remenibering always that he himself is just as uninformed and naive on questions outside his own field of specialised knowledge. Explaining things in such a way is a skill that can be taught, and should be taught, in the medical schools, preferably in small groups at the bedside.
The trick is to realise how much people really want to know and to give them that — no less or they will be dissatisfied, no more or they will be bored and confused. One shouldn't make the same mistake as an accountant I know who was asked by his small son what the abbreviation Ltd signi fied. He embarked on a fairly lengthy lecture on company structure, tax provisions, cor porate liability and so on After a quarter of an hour of this the boy interrupted. "What you're really saying is ' Ltd ' is short for Limited?" " Yes. I suppose I am." "That," said the lad coldly, "was .all I wished to know."
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