Further Confessions of a GP

Once a year our surgery sends out hundreds of anonymous patient satisfaction questionnaires. It always makes me feel a little under scrutiny, but overall I can’t dismiss the potential value of finding out what my patients really think about me. Some of the questions are about general matters, such as telephone access and how long it takes to get an appointment. Others are more directly targeted towards the patient’s interactions with the doctor, and contributors are specifically invited to comment on the experience of their most recent consultation.

When the collated results are emailed to me, I eagerly read them through. Being a good doctor isn’t just about being popular, but I can’t pretend that I wouldn’t feel thoroughly demoralised if all my patients reported in their questionnaires that they hated me!

This year, the first question asked whether the doctor helped them feel at ease. Phew, 85 per cent of my patients felt I had done this. The second question was whether the patient felt that their concerns had been listened to: 83 per cent scored me highly on this one. A further 88 per cent of the respondents were impressed with my ability to communicate with them. It was a relief that I was scoring well, but I was only reaching the average scores that most GPs achieve on these standardised surveys. Despite the regular pounding we get in the media, overall satisfaction in GP services remains consistently high.

The final question asked if the patients felt that their last consultation had helped lead to an improvement in their physical or mental health. On this I scored 40 per cent. Ouch! That meant for the majority of my patients, although they were put at ease, had their concerns listened to and were well communicated with, their actual health was no better off after seeing me than it was before.

This might seem like an epic failure, but actually it is a very accurate description of what a doctor does. The famous French writer Voltaire said that ‘the art of medicine consists in amusing the patient while nature cures the disease’. I would add that nature sometimes makes them worse too, but ultimately our role is often to offer a distraction while time and the miraculous natural healing abilities of the human body work their magic. Some of my patients are very aware of the limits of my therapeutic abilities, but others seem to feel that I should be performing miracles. Regardless of their expectations of my curative powers, every patient expects me to be nice to them.

It sounds obvious really, and of course it is, but a huge proportion of complaints against doctors aren’t about medical errors leading to ill health, but rather about doctors communicating poorly or not listening. One of my colleagues in A&E tells me that he always makes an effort to be ridiculously attentive to his patients however exhausted or frustrated he feels. Regardless of how rude, demanding and ungrateful the patient, he makes a huge show of bending over backwards to be gregariously charming. ‘Speaking to patients is like acting,’ he told me. ‘The only difference between me and a film star is that I’m too short, fat and bald for Hollywood.’ I try to follow his advice, but often my acting lets me down. It can be hard to be incessantly charming for an entire 12-hour night shift, but when I do manage it, my patients love me, regardless of how little I actually improve their health. This is why medicine is so often described by those in the profession as an art rather than as a science.

Having established the overwhelming importance of good communication skills when interacting with patients, it can be astonishing to witness some health-care professionals doing it so badly. Most catastrophic is when they have absolutely no idea how bad they are. Perhaps the oddest example I ever came across was as a student sitting in with a vascular surgeon. A nervous-looking gent in his 60s shuffled in with some smoking-related damage to the arteries in his legs. The very pompous surgeon asked him if he was still smoking. Defensively, the gent reassured the doctor that he had cut down from 20 cigarettes per day to just five. ‘Hmm,’ said the surgeon. ‘That’s hardly the greatest of achievements now is it? If I was a rapist who used to rape 20 women a day, but I had just recently cut down to raping just five women a day, I’d still be a horrible little rapist now wouldn’t I?’ The poor patient simply nodded aghast and I meanwhile had to pick my chin up off the floor. Perhaps it helped the patient in question give up those last five cigarettes, but even so, I’m not sure it could ever be recommended as a suitable technique for offering health promotion.