Dr Joe Baker
The 2016 North and East Otago Literature is Therapy Society (NEOLIThS) conference was held in the seaside village of Karitane last February. The keynote speaker was Professor Ivor G. Rudge who believes many patients are unhappy with their health providers but are unwilling to complain. Professor Rudge asks patients to write down their grievances. The process of transcribing their thoughts to paper is therapeutic for the patients and allows them to take more ownership of the issues. Professor Rudge also believes that disseminating patients’ concerns can inform health providers about what really irks patients. Professor Rudge presented various case studies. The first was a patient describing a typical encounter with his GP who we have called George (not his real name).
I had arrived 15 minutes early. I always arrive early. George, my doctor arrived 20 minutes late. He always arrives late. It took another 20 minutes before he called me in. I feel sure I heard him make himself a cup of coffee during that time. I would never dare be late for my appointment. I’ve been told if you’re just two minutes late, Anne the receptionist/rottweiler will admonish you and send you on your way. Being late and keeping the patient waiting is a power thing. That’s what our patient advocacy group says.
I spent the 55 minutes in the waiting room reading TIME magazines from five years ago and listening to some morose baroque music. The music was terrible. I saw patients, whose doctors were also late, come in smiling, sit down, listen to the music and enter a deep depressive state—just like that. Children were weeping. I must have a word with George I thought.
Eventually George called me in. I told him the problem. He asked if I had poked something in my ear. Whenever I have something wrong with my ear he asks if I’ve poked something in my ear. Then comes the expected, and oft heard lines: “A bit of advice. Don’t put anything smaller than your elbow in your ear.” George smiles when he says this. He always smiles when he says this. Surely George must remember he’s told me this a thousand times before. I play along with him. I feign incomprehension for a couple of seconds. Then I smile as though I’ve just understood what he has said. Then I give a little laugh. Not too loud, mind you.
It’s the same with my dentist. “Don’t forget,” she’ll say, “only floss the teeth you want to keep.” I feign the same temporary incomprehension, smile the same feigned understanding, then give the same little laugh. Yet, and this is what really annoys me, when I try to make light of anything, George, or my dentist for that matter, looks at me as though I’m quite odd. And it’s dangerous when your health provider thinks you’re a bit odd. It’s a power thing this unidirectional banter.
George asked if I wanted to sign up for the patient portal. I asked what benefits there would be.
“Well you could look at your results from home for a starter,” he said. He opened up my results file on the computer. “You’d have full access to all your records.”
I looked at the screen and asked what the numbers in red meant.
“They’re abnormal results,” he said.
I told George I’d been told all my tests were normal.
“Well they are normal, “ he said.
“If that’s the case,” I asked, “why were there some red ones?” I was worried.
George replied, “Oh, that’s just statistics. If you do twenty tests then just by chance one of them is likely to be abnormal.”
I asked him why didn’t he just stick to doing nineteen.
“Oh you don’t understand.” He sounded patronising. “In medicine, we use what’s called the 95% normal range. I mean look at height, I’m six foot four, and so I am outside the normal range. But you wouldn’t call be abnormal would you?”
I didn’t answer.
“Would you?” he asked again.
I wasn’t quite sure what he wanted me to say. He seemed to want reassurance. He wanted me to reassure him he was normal. He looked at me pleadingly. I relented. I confirmed I thought him normal. He looked relieved. He looked even more relieved when I told him I wouldn’t be using the patient portal.
I asked George if I could have my repeat prescriptions and whether I really needed to see him each month for these.
“It’s important to check the drugs are working,” George said, “and that you’re not suffering any side effects.”
I said, “ And it’s important you rort as much money out of me as possible.” I didn’t actually say that but I wanted to.
“So any headaches or dizzy spells?” George asked.
I told him no.
“And how’s the .. how shall I put it … how’s the old fella?” he asked.
I was a little surprised with the question to be quite honest. I hesitated, thinking what to say. “Not so good,” I eventually offered, and added, “Won’t rouse til late morning.”
“That’s very frank of you,” George said.
“There’s no use beating about the bush,” I added.
“That bad?” he replied.
I told him I didn’t follow him.
“It must be bad if there’s no use beating about the bush.”
I was totally confused. However these surreal conversations with my doctor were becoming part of the norm. I had to think of something to say. “Melanie wonders if a pill might help,” I volunteered.
“You mean a pill like Viagra?” he asked.
“Melanie’s father doesn’t need a pill like Viagra,” I replied. I was confused.
“Melanie’s father doesn’t need a pill like Viagra?” he echoed my words.
I read somewhere that GPs use this echoing device when they’re a bit stumped.
“No he doesn’t,” I said.
Then we just stared at each other. I’m good at staring. I was very good at staring games as a child. We would often challenge each other not to blink for as long as possible. I could have gone on to be a regional rep at staring games if such things had existed. I knew I could outstare George even though he was a GP. My patient advocacy group tells us GPs are trained to stare at patients for long periods of time. I gazed intently into his eyes. He was up to it to start with but not good enough for this great starer. At 47 seconds he broke. He restarted the conversation.
“And… you…. call ….. Melanie’s dad….the…. old…… fell….ah?” He sounded as though the was sluggishly working is way through a logic puzzle.
“Yes” I replied. “Duh,” was what I thought
“And Melanie’s dad has great difficulty getting out of bed in the morning?”
“Yes,” I said. “Duh,” I thought. .
“And Melanie thinks a pill might help her dad get out of bed?”
“Yes,” I said. “Duh,” I thought.
“Well I totally agree, a pill like Viagra won’t make one jot of difference. I’ll come and visit him later in the week.”
George turned his attention back to me. He did a bit of an exam on me. He actually said, “I guess I should do a bit of an exam on you.”
I have read that patients are less likely to complain if their doctor has done some sort of exam. I’m sure that’s the only reason George did some sort of exam.
He sent me on his way. To be honest, I’m always impressed how George usually gets me out of his room in such a diplomatic way but today was different. “Look I’m running really late. Please go. ..Now!… Quickly!” he said.
I walked up to the reception desk and saw Anne the receptionist/rottweiler asking old Mrs Jenkins if she needed help. I was pretty sure this was a ruse on Anne’s part, she’s never that nice normally. Mrs Jenkins was using a walking-frame. I was surprised to see such a deterioration in Mrs Jenkins’s health. The last time I had seen her Mrs Jenkins said she had some pain in her hip but she was pushing the lawn mower around her lawn, climbing up a ladder to prune her apple trees, and putting the bins out; that had only been the day before! I think she realised the incongruity of her presentation.
She blurted, “Seeing the doctor about my hip.” Then she whispered, “Apparently you’re more likely to get on the waiting list for a replacement if you have to use a walking frame, so I borrowed old Ethnie’s. She lends it out to all of us oldies.”
The morose music was even more morose. I turned to see my fellow sufferers. Tears were still flowing. One young man got up and ran out screaming, “I can’t take it anymore.” I knew how he felt. I thought I really must tell George about this, perhaps next time.
I paid the extortionate bill to Anne at reception, making sure my hands were outside her biting range. “Dr George has indicated he wants to see you next month,” she growled.
I reluctantly agreed to the proposed day and time and headed off down town to pick up my prescriptions. The pharmacist looked at the script and raised her eyebrows. She looked at me in a disparaging manner. She always does this. I’m sure she does it on purpose. It’s one of those power things. I would have to wait, she said.
Dr Joe Baker is a GP in Dunedin, New Zealand.