Thursday, 11 March 2010

'First do no harm'

For medical doctors this well known phrase is often attributed to Hippocrates and his oath, however it is likely that it has other origins although no-one would dispute it's value.

I spoke to a lady today who had gone to her GP for the first time in 5 years. She did not find it a good experience. When asked why she had attended she haltingly opened with, "just a couple of things" (she told me that she was struggling to find the right words to describe what she wanted to say and so just used this rather vague opening, to warm her up as you might say. Before she could go any further the doctor informed that she only had a 10 minute appointment. This completely flawed the patient who had had to to summon up courage to go to the doctor at all. The 'two things' were in fact just two symptoms related to the same problem. Nothing was resolved and the consultation lasted about 5 minutes.

We do not only harm our patients by the drugs we use and the surgery we perform but also with that lethal weapon, the tongue. Good ears are more use to a doctor than an active tongue. Listening is such an important part of doctoring. I know it can be frustrating if the patient simply has too many issues to resolve at one consultation, but it's best not to jump straight in with a time check before gaining some idea of the ideas concerns and expectations of the patient. Peter Tate has written expertly on the subject. As it says in the old English churchyard

Beneath this stone,
a lump of clay,
Lies Arabella Young,
Who, on the twenty-fourth of May,
Began to hold her tongue

Being 'slow to speak' (James 3.19) remains excellent advice.

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