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In hospital, the doctor’s concerns and the patient’s don’t always match up. The doctors are worried about Mr Harris’s metastatic lung cancer; he is worried about who is looking after his dog. We’re worried that Miss James has an abscess that needs surgical drainage; she’s worried about having any more time off work and, given that she’s now feeling better, why can’t she go home?
I was worried about my patient’s unresolved anaemia; she didn’t care – now that she’d had a transfusion, she just wanted to get out in time for her best friend’s wedding. I sat beside her bed and we explained things to each other in tones that implied that we each feared the other was a simpleton. “I’m worried your blood count is very low, and we really do need to know why, and try and fix it, because it can be dangerous,” I said. “I am the maid of honour,” she said. “We’ve had the dress picked out since March. It’s all arranged.”
As a hospital doctor, you belong – for an unusually large part of the week – to the hospital. If you trained by the traditional route you may have done little else but go to work since the age of 22 (hobbies, social events and holidays must contend with the rota). Hospital jobs tend to involve arriving early, leaving late, and spending your time in the surroundings that make patients so disoriented: a shortage of windows, a surfeit of heating, an absence of weather. “It’s like working in a bakery,” one of the junior doctors said, “or a prison.” It was six in the morning. Outside it was pouring; inside, the ward was brightly lit and ferociously hot. The clock said it was 10 past 12, as it had done all year.
Institutionalisation may account for some of the disconnect between doctors and patients. If your brain has become so packed with blood counts and fluid charts that you can no longer imagine life from any other perspective, it’s worth keeping a list of common anxieties in your head so you can at least take a guess at what’s making your patient upset. Anything to do with bowels or bladder appears high on this list, as do concerns about pain, sleep, family and work. Your patient may not have understood the severity of their medical situation – or they may not care about it in quite the same way as you. And if you’re planning to do something medical or surgical to someone, they’re often less interested in the statistical outcomes and more worried about what’s going to happen to their independence, mobility and appearance.
Of course, the best way to find out what’s troubling someone is to ask – or at least leave an encouraging pause at the end of your dissertation on oesophagoduodenoscopy. “What’s worrying you the most?” one of my consultants used to ask, a man with a bedside manner that made words almost unnecessary. He relied on a baritone “Hmm” instead, which he would shorten or lengthen according to the context (“Hmmmmmmm” for anything awkward or difficult; “Hm!” to signify receipt of a new or interesting fact).
I once looked after a man who spent 23 weeks in hospital after an operation that went wrong. A poster hung on the wall near his bed. “Buy them something they’ll really love,” it suggested: “a television subscription card”. Alongside his pain, his fear and his disappointment, our patient was gnawed by less dramatic miseries too. “Newsnight is going to bankrupt me,” he said. “And the parking.”
Sophie Harrison is a hospital doctor in South Yorkshire. This column appears fortnightly