When you are that patient

Which patients do you find the most challenging, if not slightly dread?

We learn early in our careers not to show it but I think we all have a mental list of those who are ‘difficult to deal with’, or who we would rather avoid. And for some of us, this list includes doctors.

This might seem strange. We hope patients will have an insight into their conditions, we want to be able to communicate well with them. When it’s a fellow doctor in front of us, then that’s a head start isn’t it?

Actually, there is a hatful of potential pitfalls. These have been identified in academic studies and may well ring true with your own experience.

Our medically qualified patients might feel patronised by our reflex to explain complex issues in simple ways, although I would note this doesn’t only happen when one is treating doctors – I had a patient rather tersely ask if I could ‘please say atrial fibrillation’ rather than refer to an irregular heartbeat.

Some doctor-patients are overly economical with their complaints and concerns; they know how busy we are, and they don’t want to bother us.

Sometimes, when we treat them, we leave the therapy adjustments and follow-up needs to them, which may well save on clinic time, but the responsibility is still with us as the treating doctor and our doctor-patients might over-estimate or underestimate their needs.

One way of addressing this, some think, is to act as

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This has a simplistic fairness to it, but I strongly believe it’s not practical. We want our patients to take an active interest in their conditions. It makes no sense to encourage all other kinds of ‘expert patients’ but ignore this type.

The biggest argument against it is that it feels plain wrong. I discovered this with a new GP a few years ago (my current GP, Dr Jothi, is however excellent). He was too engrossed with his screen to look up as I entered the consultation room, and mostly to fill the silence I introduced myself and mentioned that I was a physician.

‘Yes, I’ve got your details here,’ was his welcoming response. That was perhaps less a carefully planned attempt to de-medicalise the patient than someone too preoccupied to notice even if smoke had been pouring from my trousers. But it felt wrong, and not because I was desperate to flaunt my years as a consultant but because it was part of my identity, and possibly relevant in terms of how I related to medical information.

We need to acknowledge when our patients are doctors. Professional courtesy doesn’t mean preferential treatment. Assume nothing, perhaps use it to mutual advantage in their care and their understanding of it, but always acknowledge it. While there may be words that patients and doctors sometimes shy away from, ‘doctor’ should not be one of them.

Radhamanohar Macherla, now retired, was for more than 20 years a consultant physician with Barts Health NHS Trust

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