With Dr Peter Hall
I’ve written a collection of short stories about a GP in a small town. Most of them will never be published because any resemblance to actual persons, living or dead, is not coincidental. But writing has served as a creative outlet and a way to process the emotional side of the doctor-patient relationship.
You probably don’t think of your doctor as a normal human being, but I can tell you that beneath the professional composure there is a full range of reactions, some of them quite deep and challenging. Doctors get tired, have family problems, worry about money, feel failure and everything else that is common to humanity. And we definitely like (or dislike) some patients more than others. There wasn’t a lot of insight into this until a couple of journal articles were published about 40 years ago. One was provocatively titled “The hateful patient and his hating attendants”.
As you can imagine it caused quite a stir. A conversation was started which led to greater insight into why the therapeutic relationship can become toxic and laced with negative emotion. Sometimes it happens for reasons of dissimilarity – different culture, different personality, different values. Sometimes the doctor has prejudices or lacks self-awareness. Sometimes the patient is just plain difficult.
So how does this work out in practice? I think that most doctors provide the same level of care for their challenging patients as they do for their favourites. We try to be nice to everybody, but in reality we can’t always match Will Rogers’ claim of never meeting a man he didn’t like. And I admit there have been times when I’ve employed avoidance strategies or been rather glad when they decided they didn’t like me either, and moved on.
For the most part though, we recognise the principle that the patient’s needs are paramount even if the doctor has to suck up his own feelings to meet them.
And what about the situation where a doctor likes his patient too much? The Medical Disciplinary Tribunal reports are littered with cases where a doctor risked his or her career, family and reputation because of an inappropriate relationship. This strikes me as staggeringly dumb. Surely they would have recognised that something was out of order and pulled back from disaster? Maybe the doctor was isolated or vulnerable? In any case, we have an open discussion about these issues when we introduce new doctors to general practice. There are usually warning signs, and a willingness to be honest about one’s own feelings and to share them with a trusted colleague provides a level of safety for everyone.