Saturday, 15 January 2011

Heartsink Doctors and Dr Google - a Patient Opinion

I am grateful to Dr Philyerboots for his post on "Heartsink" patients, for it opened my eyes.  I think most patients - if they know the term exists - regard heartsinks as the moaning hypochondriacs who plague a GP practice on a regular basis - I did, that is, think that, not plague a doctor!

But this is not only the case; a heartsink is also "...the most common one is of patients under my care who steadily deteriorate despite all that I and modern medicine can do", it is the "very few I object to on a personal level", it is "the patient that has consulted Dr Google before coming", it is "those who ask the same question, again and again an again.  It is as if they ask the question often enough that I will tell them that I have a miracle cure", it is "the insane", it is those "who seemingly just want a chat" or those "who have complaints about BGH, or about my colleagues or their GP..."

I think that most of us, as patients, regard doctors as super-human who are void of negative emotions.  If they are cool/cold with us - it offends us - it certainly offends me!  We are the patient - they are the doctor.  Forget the heartsink patient who is the eternal hypochondriac and let us think of ordinary Joe who visits the surgery with perhaps, a minor complaint.  He has a minor problem which he wants nipped in the bud.

Say Joe has not visited the surgery for three years - he is a seldom attendee - and he has a wart on the end of his nose and wants it removed.  Request over - he is met with a barrage of questions required to meet the QOF.  He is asked if he smokes - yes he does - but he thinks what the hell has this to do with the wart on my nose? and internally, becomes angry.  He then has his BP taken and it shows he is hypertensive (white coat and anger) and he is asked to return and have his BP rechecked and his bloods ta\ken.  He leaves the surgery in a state of angst.

After three visits to check his (white coat) hypertension he is commenced on meds and also meds for high (who says - Big Pharma?) cholesterol, and suffers side effects which are viewed as another problem and he is prescribed meds for this and that, and this no meds man suddenly takes home a carrier bag full of drugs from the chemist all due to the wart on the end of his nose.

But this entire aside, what if the patient is Jessie who has multiple comorbidities?  She likes Dr Smith for he is kind to her and treats her with compassion.  She needs to see a doctor, but the only doctor available is Dr Jones.  Nobody, but nobody wants to see Dr Jones, for he makes a patients heart sink.  Dr Jones meets the definition of a total w*nker!

Yes!  There are doctors that make a patients heart sink!  Whether in a GP or hospital setting,  patients leave thinking what the hell did I do to deserve to be treated like that!?

Then there is Janet who is also a seldom attendee who visits her doctor as she knows that something is not right.  She doesn't know what it is as she is not a doctor.  She has all the usual investigations and nil is found.  She is told she is anxious - for after all she is a woman - and is left on the outside looking in.  But she knows that something is wrong and consults Dr Google - for that is all she has left.  He does not listen - but he talks to her in the written word.  She is not stupid and discounts all that does not apply to her.  But then, she finds her illusive dx and consults her GP with a printout - bad move - for a sure sign of hypochondria!  She also takes a list of symptoms as NHS sites suggest that she should - but GPs and hospital docs hate lists and must take control of same and a list is another sure sign of hypochondria!  But months down the line - after much professional abuse (?) by doctors - she is proved right.

I need two pairs of hands to count the number of close family or friends who after routine investigations have been told there is nothing wrong with them, only to discover later down the line that there is - at times with terminal consequences!

Doctors are not perfect and neither are patients.  We need to meet in the middle!

Rant over!   I love doctors really!

Anna o]


Alcoholic Daze (ADDY) said...

Totally agree. I've been in at least one of those situations! My daughter is trainng to be a doctor and now they are putting more emphasis on how to be a good doctor and interact with your patients rather than the put-yourself-on-a pedestal-i'm-a-god school of medicine.

Stafford Ray said...

Book me in for a check-up. No, not me.. I want to check up on the doctor!

Anonymous said...

I don't deny that there are heartsink doctors too. The Internet is easy to misinterpret, including my own site. I always take my patients opinions seriously, even when they are misinformed, it is where they are and the starting point of their therapy. Being a GP is more tricky than specialising in a fairly small field than me, with the full backing of a hospital.

Dr Phil

HyperCRYPTICal said...

Thanks for your comments folks.

I am not entirely happy with the post as I lost direction, so plan to do a more in depth one, which hopefully - with a bit of research thrown in - will be more interesting!

Anna :o]

Linda said...

Sometimes it's easy to forget that we are all just human. Just as there are difficult doctors, there are difficult patients. I believe we are all trying to do the best job we can either as doctors or as patients. I once had a dr tell me that he didn't know what was wrong, but that if I helped him, we would figure it out together. What a great partnership!

Anonymous said...

It is not uninteresting as an idea, the heartsink Doctor. Different medical styles suit different people. I have some patients who prefer to be told what to do, I have some who want to weigh up every option. I have some colleagues who are brilliant technicians, but with all the charm of an industrial estate on a wet day in January. I have some others with the charm of the devil, but sadly also the ethics of the devil also.

There is much talk of choice in medicine, but if choice is to be real then that has to include a choice of doctors, not just of health care providers.

I have it easy in that my work has been seived by GPs, so that most have something significant. Gp's have it much harder, they may see 5 headaches a day, but only one brain tumour a decade. Which one is it? They may see 20 in a week with backache, but which one has the myeloma? Being a GP is a much harder job than mine. Why some hospital doctors look down on GPs escapes me, I am full of admiration.

Manzanita said...

Dear Anna,
I am learning what you'r all about by following your blog. It's interesting to see what makes people follow a certain pattern of life. Thank you for educating me. You are a fine writer.
Peace and love,

HyperCRYPTICal said...

Thanks for your comments.

Linda - I totally agree that honesty is the best policy, but I realise docs have to base this on their knowledge of the patient - but what if they don't know the patient? Possibly different situation here than in the U.S?

Dr Phil - I realise that a conditon may be unformed and has yet to evolve into something recognisable - but the patient has to be given something apart from the catch-all of anxiety; for if they receive this and it is not so - it is a betrayal of trust and totally unforgivable.

Manzanita - what can I say bar that you educate me on the joy of life. Much admiration!

Anna :o]