Giles Dawnay is a GP and writer living in Herefordshire
‘How are you Doctor?’
I’m fine. Thanks.’
The consultation has already started on a potentially disingenuous footing.
As part of human interaction, we naturally ask each other how we are. However, as many an exasperated anecdote will attest to, we don’t always want to know the answer. British culture values politeness as part of its code of conduct. ‘How are you?’ being one of its many call signs. ‘I’m fine. Thanks’ being part of the necessary closure to the question.
Yet the consultation room is not an even power balance. The patients come to tell us how they are but not necessarily to find out how we are. How many consults begin with this familiar greeting?
British culture values politeness as part of its code of conduct. ‘How are you?’ being one of its many call signs.
I’ve heard that consultations tend to become much harder if our own problems feel greater than those of our patients. Friends and family sometimes ask what it’s like to try and see so many people in such short time frames. If I’m feeling mischievous then I occasionally reply that what makes it so hard is that it takes almost ten minutes to finish talking about my own inner world before we can even get started.
What if we were to answer their initial question with any degree of honesty? What if we were to let the patient into our own inner world; of battling against the clock, the relentless stacking up of admin that occurs in real time as the consultation progresses, the unusual blood results that have just come back, the death of a recently well known patient who we were not able to say goodbye to. What if we were to divulge that we are concerned about our aging parents, the lack of time in our relationships at home, our children who do not seem as respectful of our advice as our patients possibly are? I name but a few.
Herein lies our essential and often irreconcilable paradox. Our patients want us to be human so they can relate to us, yet they also prefer it if we are strong so they can believe in us. Empathy requires a capacity to relate; to show the patient we are like them that we too are affected. Yet uninvited vulnerability has the capacity to corrode trust and belief that our patients feel safe in our care.
Herein lies our essential and often irreconcilable paradox. Our patients want us to be human so they can relate to us, yet they also prefer it if we are strong so they can believe in us.
There are days where the job feels the genuine privilege that it is. Normally when I have slept well and my personal life has no major issues to attend to. But there are other days where the job feels like a genuine effort to bring my best self to the next patient. As the day goes on fatigue levels naturally increase. With accumulated tiredness, afternoon patients can sometimes seem older and more complex, so not running late becomes harder. Uncertainty builds as the clock ticks. By the end of the day most of us are at saturation point. Yet with each new consultation, if the patient happens to ask how we are, they are met with the same well practiced smile and steeled response.
Finally, the day is over, the clinic letters written and what can be done today is ticked off. Ideally the desk is clear for tomorrow. On the commute home the mind thuds and pulses with micro flashbacks of what did and didn’t happen that day.
Then home to whatever state family life happens to be in.
‘How was your day?’
Where do I even begin?
‘Fine. Thanks.’
Deputy Editor’s note – for a review of Giles Dawnay’s book of reflections and poetry see: https://bjgplife.com/waitingroombook/
Featured Photo by nikko macaspac on Unsplash
