Ever wondered if doctors are frightened of catching what you've got? What their notes really mean? Or how to get round their receptionist? We asked five doctors to spill the beans
- The Guardian,
- Monday February 4 2008
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Dr Everything General practice
Dr Child Paediatrics
Dr Cancer Oncology
Dr Gynae Women's health
Dr Mind Psychiatry
When are the best and worst times to be admitted to hospital?
Dr Cancer Worst time: junior doctor handover in the first weeks of February and August.
Dr Mind Worst time is Friday and Saturday night when the drunken kids are out beating themselves up, crashing cars and overloading hospitals.
Dr Child A&E is very unpredictable. Urgent situations will be dealt with quickly, regardless of how busy the department is.
Dr Everything Best time is when there is no alternative. Worst time is on Christmas Eve or Good Friday with an unknown condition. Hospitals are understaffed over weekends and bank holidays. Usually cover is arranged for junior staff, but consultant rounds are rare and haphazard.
If I go to a major teaching hospital, will I get a better doctor?
Dr Everything You will get more learned [specialist] consultants who can distinguish between dermatofibrosarcoma [a potentially malignant skin tumour] and a mole, but you might not get an experienced generalist who can quickly assure you that the dizzy spells, shortness of breath, tingling in your lips, hands and feet are the effects of a panic attack, as opposed to those of phaeochromocytoma [adrenal gland tumour], without inserting certain probes.
Dr Cancer You will generally get better junior doctors looking after you, which makes all the difference.
Dr Mind Many teaching-hospital doctors are preoccupied with research, publishing papers and advancing their academic careers. Watch out for these.
People complain that hospitals are dehumanising. Are they?
Dr Gynae Lack of privacy and poor food are problems, but the real crisis is shortage of nurses.
Dr Cancer When you see the effort that goes into some patients, you would say no. However, parts of the NHS with high throughput are always going to be slightly dehumanising.
What's the strangest thing you've ever seen in a hospital?
Dr Mind In my first six months as a doctor, a young man on his honeymoon came in with a wedding ring trapped round the base of his penis. In the end we got the dentist to drill it off and we saved the penis.
Dr Child An unfortunate man who had managed to insert a whole jar of lubricant into his rectum. Sadly, a major operation was required to remove it.
How can you speed up getting an appointment with a busy consultant?
Dr Cancer Phone up their private secretary and offer to see him/her as a private patient. The patients who get seen the quickest are either the nice, friendly ones or the really aggressive ones (who kick up a fuss until they are seen). The former get the best care.
Dr Gynae Call their secretary, and say you will take a last-minute cancellation. On a typical clinic list of 20 patients, three or four won't arrive, and some will cancel in advance.
Dr Child Choose and Book (chooseandbook.nhs.uk) should allow the patient to determine the approximate waiting lists of different consultants, and pick shorter ones. Hassling the consultant's secretary by telephone is unlikely to make you popular.
Dr Everything GPs are sympathetic to patients' clinical needs - and specialists' interests. If an elderly, otherwise able lady is crippled with arthritis in her hips, her GP may try to expedite her appointment with an orthopaedic surgeon with an interest in hip-replacement surgery. However, if a fit middle-aged gentleman has painful feet and is seeking assistance with the New York Marathon ...
Why do patients have to sit for so long in waiting rooms?
Dr Everything In general practice it may well have to do with a number of factors, such as the GP starting late or the GP dealing with emergencies. And not all problems can be shoehorned into a 10-minute consultation. Many are complex - mental-health issues, grief, cancer and sick children to name but a few. Some GPs teach their patients to book double appointments if their problems are tricky, while others may have queues of patients checking about the flu.
Dr Gynae Patients are often given appointment times of 15 minutes earlier than their actual appointment to compensate for parking problems at hospitals.
Dr Child Doctors often arrive late at clinic because of work commitments on the ward or elsewhere, or following a desperate bid to squeeze in lunch. Some clinics have a crazy system whereby everyone arrives at once and is seen on a "first come, first served' basis. This is worth complaining about.
Dr Cancer Usually because someone has allocated too-small time slots, or because members of the team are away. If you have had to wait, don't berate the doctor as it only slows things down even more.
How can you ensure that a doctor takes you seriously?
Dr Cancer Bringing someone with you can help.
Dr Mind Be clear about what you want and don't spend a long time telling him or her about irrelevant things.
Dr Gynae Everyone who sits in front of a doctor is nervous and vulnerable, and it is our job to take all patients seriously. Of course, some are swinging the lead, and very busy doctors, GPs especially, will be less tolerant of time-wasting.
Dr Everything Write a note to your doctor; tell them all your concerns and what impact the problem has had on your daily activities; don't get up from the chair until you've had an answer to your concerns.
Is it a good idea to buy your doctor a thank-you present?
Dr Everything I don't feel comfortable with gifts. A good way to tell your doctor how you feel is a note or card. This also helps your doctor at their appraisal when they have to persuade other doctors that they don't suck at their jobs.
Dr Child There are strict guidelines as to what a doctor can accept, and anything of significant value should be declined. Chocolates or biscuits go down well because they can be shared among the team.
Dr Mind I like gifts when they're appropriate. Medicine is very personal and it's great to be thanked for doing something good for a patient.
Dr Cancer Doctors will appreciate a token such as a card and a box of chocolates.
Dr Gynae I receive a lot of lovely cards, and it gives my day a lift to open one. I get some chocolates and wine at Christmas, but gifts can actually be a nuisance - I'm very busy and must find time to reply.
Have you ever had to fire a patient?
Dr Gynae No.
Dr Everything Some longstanding GPs have, but so far I have not. Patients get fired for repeatedly failing to attend appointments, violence, verbal abuse, drug misuse and deliberately misleading or manipulating staff.
Dr Mind Certainly I have, particularly when patients become overattached or excessively demanding.
Dr Cancer No, but I've been tempted at times.
Are doctors unduly influenced by drug companies?
Dr Everything This one doesn't believe she is. Not all doctors have the time, knowledge or inclination to keep abreast of the latest research, and so we have Nice (National Institute for Clinical Guidelines and Excellence) and other protocols. Also, many GPs' surgeries write their own protocols to ensure their patients obtain uniform care in line with the best evidence and value for money.
Dr Mind Yes, sadly they are, more and more, and something must be done to stop it.
Dr Cancer It is a two-way relationship in oncology. Drug companies organise conferences, but most experienced consultants do not allow personal preference to overrule scientific data.
Have you made mistakes, and if so, how do you deal with them?
Dr Gynae We all make mistakes - we're only human. The crucial thing is to explain clearly what has happened. We must also prepare for a possible investigation, which is why hospitals have such huge complaints departments.
Dr Everything I keep a spreadsheet of problems during the course of a day. These can include failure to inform the nurse of the exact blood tests to take, failures of communication, letters not being written, missing a major diagnosis, or prescribing a medication to a patient known to be allergic. We have quarterly clinical governance meetings where we discuss recurring and serious errors.
Dr Child There is no doctor who has never made a mistake. As a new doctor I was asked by nursing staff to prescribe some strong painkillers for a patient who was being looked after by another medical team. Although I checked with the patient what painkillers he normally took, I did not read through his medical notes. He subsequently had a reaction to the painkillers and ended up having a near respiratory arrest. Luckily, he was fine. I was devastated at the time but it was a valuable lesson.
Dr Cancer Yes. I try to make it a learning exercise for the whole team.
Are most doctors good at what they do?
Dr Everything I believe so. After all, they all passed punishing tests.
Dr Child There are very few "bad" doctors out there. But obviously there is variation between individuals in terms of theoretical knowledge, practical abilities and bedside manner.
Dr Gynae Most are better than good, and striving to be better. Problems only tend to occur alongside personal difficulties such as depression, divorce or alcohol, at which point colleagues and partners must be aware and report.
What's the most common mistake that doctors make?
Dr Cancer Not really listening to what their patients are saying.
Dr Mind Assuming that they've summed up the patient early on - and then failing to review this.
Dr Everything The insurance companies tell us it's lack of communication.
Dr Child Probably either failing to wash their hands between patients or drug-prescribing errors. The latter is a particular issue in paediatrics when doses are based on weight.
Are you annoyed when a patient wants a second opinion?
Dr Mind I welcome second opinions.
Dr Gynae I am slightly irritated if it seems the patient has a lack of confidence in me.
Dr Cancer No. I think it is important for the patient to have complete trust in their doctor and their treatment.
Dr Child If the request comes in the context of genuine concern, that's fine. Most patients here will be seen by more than one doctor anyway.
Dr Everything Definitely not. If I am proved right, that can be an ego rush; but the most valuable times are when I am wrong, and I can figure out how it could have gone better and what I didn't know. Good patient relationships have come out of me replying honestly about where I think things went wrong and what I would do to improve the situation.
Are doctors arrogant?
Dr Everything Of course not!
Dr Cancer A lot of doctors use a veneer of arrogance as a means of hiding their own feelings of inadequacy. A bit of arrogance helps protect you from becoming roadkill, but when it seeps into how you handle your patients, it is dangerous.
Dr Gynae Doctors are used to making decisions, and decision-makers plough a different furrow to most people. "Arrogant" is too derogatory a term for this.
Do men or women make better patients?
Dr Mind It is unfashionable to say so but I find men as good as women at being patients.
Dr Everything Women argue but take advice; men accept advice but rarely follow it.
Dr Cancer I've seen good and bad examples from both sexes.
Does the threat of malpractice suits make you a better or worse doctor?
Dr Cancer Worse, because you can usually spot the potentially litigious patients. You bring in witnesses whenever you see them and write copious notes afterwards. At this point you are practising defensive medicine, which is overcautious and damages the patient.
Dr Mind Medicine practised to avoid malpractice suits damages the thrust of medical care, which should be to help the patient.
Dr Everything Both. I keep an eye on myself more but it can mean you can waste time and resources overinvestigating someone.
Dr Gynae Better. It makes doctors more particular when informing patients about things such as the side-effects of drugs. It's made the health service safer.
Is it annoying when patients have researched their symptoms online?
Dr Gynae No. It means we can discuss the situation at a more informed level. That said, many patients get the wrong end of the stick, and think they have some rare complication.
Dr Cancer When patients come in with cuttings from the Daily Mail or reams of paper from the internet, it is quite annoying, particularly if the content is some unscientifically proven herbal cure.
Dr Mind I am delighted when patients come with their own opinions, so long as they're not based on ridiculous websites written by people who know nothing.
Do you believe there is a rational scientific explanation at the bottom of every ailment you see?
Dr Child Yes, although obviously some "rational scientific explanations" will involve psychological or social factors.
Dr Everything It depends if you believe that psychology constitutes a rational scientific explanation, and even if there are rational scientific arguments for every ailment, we don't know them all yet.
Dr Cancer Yes, for most ailments. It is not practical to seek to get to the bottom of every ailment expressed by a patient, unless that ailment is worsening despite therapeutic attempts to reverse it.
Do doctors worry more about their health than non-doctors?
Dr Everything No, less.
Dr Cancer It's difficult to generalise. Some doctors are complete hypochondriacs; others think they are above poor health. Generally, doctors are more likely to think that a simple symptom is a manifestation of something more sinister. Also, if you are a doctor looking after a doctor, it is scary. Not only do doctor-patients ask lots of annoying questions, but they invariably seem to have a more stormy course during their illness than non-doctors.
Dr Gynae They don't have time. They're more likely to drop dead because they never got round to being screened.
Dr Child I don't think so. Often doctors are blase. They very rarely take sick leave, for example, since they know that this will leave colleagues in the lurch. Doctors ought probably to take their own health and welfare more seriously than they do. There is still a culture that doctors are invincible and don't get ill.
Do stoic patients get worse treatment?
Dr Mind I fear stoicism may work against them.
Dr Gynae By the time they make an appointment, they have stopped being stoic. Men are less likely to access healthcare early, though whether this is stoicism is moot.
Dr Everything Stoic patients may get fobbed off by overprotective receptionists. The doctor is likely to take stoics seriously since they will not be saying, "The headaches, the headaches, I must have a brain tumour."
Do you think that hospital staff are doing enough to fight superbugs?
Dr Mind Definitely not. The superbug epidemic is catastrophic, most of all because it is preventable. I certainly fear for my patients.
Dr Gynae The situation is taken seriously, and has hugely improved, in terms of hygiene and screening.
Dr Cancer Yes. Hospital staff do a lot to fight superbugs, and I think the press has given almost hysterical coverage to the whole issue. Many patients now think that contracting a superbug is inevitable if they are admitted, and are refusing to come in, even if they need to.
Do you ever worry about catching diseases and infections off your patients?
Dr Cancer I had one virus after another when I worked in casualty. I assume this has strengthened, not weakened, my immune system. I would only worry about contracting a superbug if I had an open wound and was examining a patient with MRSA. We are careful to wear gloves and gowns and liberally spray our hands with alcohol before seeing any patients at risk of MRSA or C.difficile
Dr Gynae Yes. I'm terrified of catching hepatitis C, for which there is no vaccination, and which would end my career. Throughout history, thousands of doctors have died saving lives - take Dr Carlo Urbani, who identified Sars, and died of it.
Dr Child Generally, no, although almost everyone who starts in paediatrics goes through a period of catching minor viral illnesses. I got impetigo. Superbugs are not really a problem for healthcare workers - the main concern is the possibility of spreading infection to patients. MRSA bacteria can live on your skin or up your nose without causing problems until they get into surgical wounds or affect immuno-compromised patients.
Do doctors have a healthier lifestyle than non-doctors?
Dr Child I very much doubt it, judging by the number of doctors that smoke or drink to excess. As we all know only too well, knowledge about the beneficial effects of lifestyle changes rarely ensures that those lifestyle changes actually happen.
Dr Cancer I think doctors drink more, which may be a legacy from medical school. Different branches of medicine have different habits. It is unusual to find an oncologist who smokes, or a dermatologist who sunbathes.
Dr Gynae Impossible to generalise. Many drink, and a number take drugs because they have access, but on the whole, doctors' lifestyles aren't better or worse than non-doctors'.
Do you practise what you preach?
Dr Mind Yes.
Dr Gynae Yes.
Dr Everything Well, I try not to preach. I try to tell patients about current knowledge and possible consequences of their behaviour, but not to take it personally if they don't change. I haven't always taken my own advice about healthy behaviour, but have about psychological ideas.
Dr Cancer Mostly. At one stage I smoked socially, and found myself telling patients off for doing the same.
What are the most important factors in someone's health? Their family history, their diet, or the amount of exercise that they take?
Dr Everything Still an evidential whirlpool. However, in my opinion, it is family history, followed by smoking and alcohol, followed by diet, followed by exercise.
Dr Cancer In oncology, the family history is pretty important, diet and exercise less so.
Dr Mind Genetics are enormously important in our health and we can't do much about it.
Dr Gynae Diet and exercise are hugely important, and they are the things to focus on.
Do you smoke or drink?
Dr Gynae I don't smoke, and I drink two units per day.
Dr Child No, and minimally (most of the time!).
Dr Cancer I gave up social smoking and I drink about 14 units a week.
Dr Everything I quit smoking 10 years ago and drink in moderation.
Would you suggest alternative therapies such as homeopathy or acupuncture to a patient and have you ever tried them yourself?
Dr Mind Yes, I have recommended alternative therapies to patients.
Dr Child No, and I'm unlikely to recommend them. I'm prepared to believe that acupuncture might benefit some chronic pain conditions, but find the pseudoscientific explanation for homeopathy completely nonsensical.
Dr Everything I have used reflexology often and refer patients routinely for acupuncture, which has some possibly weak evidence for use in chronic back pain. I don't refer for homeopathy as I believe there is no good evidence for it.
Dr Cancer I have not used them, but acupuncture and aromatherapy both seem to help with cancer symptoms. I am less keen on faith healers and homeopathy. With a disease such as cancer, about which there is so much we do not know, there seem to be a lot of "alternative health therapists" offering false hope, usually at a price. It is heartbreaking to see patients put all their faith in a spiritualist, travel miles to see a psychic surgeon or spend a fortune online on a drug "used successfully on thousands of patients", all to no avail.
I definitely think we should integrate complementary medicines into our routine clinical practice to address the spiritual welfare and morale of the patients undergoing often very gruelling therapy and facing their own mortality.
However, some alternative therapists give the patients the incorrect message that their disease is somehow controlled by them (mind over matter), and so patients are left with a feeling of guilt if their disease advances despite therapies. I think patients with cancer need more regulated spiritual, psychological and just plain moral support during therapy.
Will the proposed centralised database of people's medical records ('The Spine') compromise patient confidentiality?
Dr Cancer Doctors do their best to maintain patient confidentiality. The database raises the obvious concerns about hackers and viruses. Overall, though, the centralisation of patient data can only be advantageous, as any patient who transfers from one hospital to another can tell you.
Dr Child There are inevitably concerns but the notion of making medical records electronic is eminently sensible. The amount of time wasted at the moment in trying to find notes is ridiculous. It's like when banks had paper ledgers for each customer account, and you could only withdraw money from your own branch. There are big questions about who will be allowed to access this data. Certainly for legitimate medical use it will be a huge advantage. Inevitably, however, with the need for coding, invoicing and data analysis, lots of access will be for non-medical reasons and this will need to be tightly controlled.
What do you usually have for lunch?
Dr Cancer Sandwich, diet coke, bag of crisps.
Dr Child Typically, an overpriced and unexciting sandwich from the hospital cafe.
Dr Everything Until recently, very little. Lately though, homemade soup or chicken salad.
What's your exercise regime?
Dr Child Do as little as possible.
Dr Everything Walking as much as I can.
Dr Cancer Yoga and brisk walks around the hospital.
Dr Mind Regular and energetic.
Dr Gynae I exercise three times a week on the treadmill, for 30 minutes each time.
Are you concerned about what your patients eat while in hospital?
Dr Cancer Yes, particularly as cancer patients have higher nutritional requirements than many others. Hospital food is generally pretty bad so it's a good idea for relatives to bring in extra food. We often refer at-risk patients to hospital dieticians to make sure they are given supplements.
Dr Mind I pay attention, but there is little to be done. Systems are frequently archaic, designed to save money, and the patient suffers.
Do you buy so-called 'superfoods' and organic food?
Dr Everything I don't buy much "superfood", but I do believe, for example, that blueberries help avoid dementia and spinach helps avoid macular degeneration. I suspect organic food doesn't have transfats, which may be detrimental to health, as well as pesticides, though I don't go out of my way to use organic exclusively.
Dr Cancer I am not convinced that organic food is more healthy and do not spend money on superfoods (which usually have in common their ludicrous cost and revolting taste). I think there is a massive industry out there catering to the neuroses of the "worried well" and I don't want to partake in it.
Dr Child No.
Do you find conflicting health news stories saying that coffee/chocolate/red wine are good and bad for you as confusing as everybody else?
Dr Cancer The ones relating to cancer interest me, because that is my job. But normally, these scary news bulletins are followed, a few years later, with a scientific study disproving them. Unless the evidence is incontrovertible, I don't change my eating habits on the basis of a news item.
Dr Everything I follow the studies as far as I can. I try to see the original studies and critically appraise them. Studying numbers, design and interpretation of results can have quite profound effects on what constitutes evidence. If a definite trend is set, especially if endorsed by other experts, I start to recommend treatments. Sometimes I have to do a U-turn, such as with HRT, which I stopped prescribing for a long while. Now I have more information and can recommend more rationally.
Dr Child I tend to ignore such stories.
Do you take any nutritional supplements?
Dr Cancer Not usually.
Dr Child Certainly not.
Dr Gynae Not at all.
Dr Everything Yes, vitamin C and iron.
Dr Mind Yes.
Do you avoid chemicals in soaps or antiperspirants linked to cancer, such as sodium laureth sulphate?
Dr Cancer No. The data linking the two is scanty.
Dr Everything No.
Dr Child No.
How many glasses of water a day do you drink?
Dr Cancer About three.
Dr Everything Three.
Dr Child Usually none - generally there is little time at work for tea breaks or drinking.
Do you sunbathe/use sunbeds?
Dr Cancer I have fair skin that burns and then peels, so a tan developed over weeks lasts about one day once I get home. I have given up sunbathing as a result.
Dr Everything No.
Dr Child No.
Do you do detoxes?
Dr Cancer No.
Dr Everything No.
Dr Child What's that? No
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