...and the devolution of bedside manner
On the phone to the doctor's surgery, I speak with a receptionist.
'I have a repeat prescription, but I have to come every three months to renew it. I wonder if I could have it on a six-month repeat?'
The dragon at the gate shoots me down with the flames she breaths.
'Definitely not. You're lucky to get a three-month repeat. Usually we ask patients to come every month.' I shrink back from the receiver at the thought she might revoke the privilege but I'm too puzzled to stop.
'Why is that? A doctor has never once asked to see me about this prescription, to monitor me, not in several years.'
The receptionist replies with a little puff: 'The NHS wastes millions of pounds on drugs because people die with their bathroom cabinets full of medicines. Then their relatives bring in bags of unopened drugs, and all we can do is throw them away.'
As someone with cancer in remission, I'm stunned into silence. Perhaps she hears the echo of her words in the pause, before she says, 'I'm not saying you're going to die, necessarily. But we can't go giving six month-prescriptions to people with terminal diseases.'
And there it is before me: the uncertainty of my life weighed up against the brutal certainty of the NHS official line, spouted by a member of staff who might benefit from a course on bedside manner.
While bedside manner is mostly considered the domain of medics, it's relevant to many staff beyond. Over the last twelve years, I have been initiated and confirmed as a regular patient with doctors and support staff in several fields. From oncologists and surgeons to obstetrics, plenty of GPs, nurses, porters, emergency doctors, paediatricians, cosmetic surgeons and dozens of operational staff on the way, I've met a lot of people with many variables of bedside manner at several hospitals.
There was the consultant who delivered my first completely unexpected diagnosis of cancer with his head bowed to his shoes. He told me I would never have children. There was the pregnant intern who stood belly-to-belly with me when I was actually pregnant but also had cancer, just after a mastectomy, and she wiped the optimistic smile from my face with pitying remarks about my bleak outlook. There was the nurse who tried to issue a post-surgery injection but refused to tell me what it was for, so a scene fit for a horror movie ensued in which I refused to submit to his needle. And so many more.
Over this time I learned that any member of hospital staff, however influential or menial, has the power to make a frightening experience either manageable or unbearable. I became the evidence of how a doctor's attitude towards his or her patient can trigger an early self-discharge from advised hospital care, or prompt a regenerative slumber after a reassuring conversation post-surgery. I learnt from both bitter and grateful experience how a doctor can humiliate or empower a patient, and how valiantly skilled a doctor must be to employ sympathy and gentle guidance when his or her patient doesn't know best.
The consideration of bedside manner, sometimes referred to as 'the Art of Medicine', is as ancient as the concept of medicine itself. Its place in medical texts dates back to the 4th century BC with the Hippocratic Corpus, the original Ancient Greek medical works associated with the physician Hippocrates. Back then, a doctor's manner was the essence of a patient's treatment. The ancient words, still pertinent today, tell it best:
'The physician ought to be confidential, very chaste, sober, not a winebibber, and he ought to be fastidious in everything... He ought to have an appearance and approach that is distinguished... Be solicitous in your approach to the patient, not with head thrown back (arrogantly) or hesitantly with lowered glance, but with head inclined slightly as the art demands.
'He ought to hold his head humbly and evenly; his hair should not be too much smoothed down, nor his beard curled like that of a degenerate youth. Gravity signifies breadth of experience. He should approach the patient with moderate steps, not noisily, gazing calmly at the sick bed. He should endure peacefully the insults of the patients since those suffering from melancholic or frenetic ailments are likely to hurl evil words at physicians.'
In Arizona, USA, one doctor has taken a step further in training medical students in bedside manner. A fascinating programme known as Horses for Healers is a system that uses the way horses mirror body-language to teach trainee doctors to communicate with their patients more sympathetically.
Dr Allan Hamilton, MD, FACS, is a Professor of Neurosurgery , Professor of Radiation Oncology, Psychology, and Computer and Electrical Engineering at the University of Arizona. A recipient of many awards and honors, Dr Hamilton has life-long experience of horses and owns a ranch through which he and his team facilitate various healing and teaching programmes.
He says: "Doctors would be far more respectful of their body language and bedside manners if their patients all weighed 1,200 pounds; horses help medical students and professionals learn non-verbal communication skills demonstrating the powerful voice of our body's language."
While some things haven't changed since Hippocrates issued his advice more than 1,700 years ago, the dawn of self-diagnosis in the era of the internet really has tipped the balance of power and complicated the relationship between doctor and patient. Like those horses at Hamilton's ranch, we have all our own peculiar history, own levels of knowledge and our own expectations.
At regular follow-up appointments with my breast cancer surgeon, I often reported worrying abdominal pains. He listened patiently, questioned me about their nature, and monitored them. And then, at my last appointment, he put his hand on my knee in a conspiratorial way, and said with the skill of a doctor who had clearly taken the time to understand me through three surgeries and many years:
'Well, it can't be cancer, can it, because if it were, you'd be dead by now.' We laughed, I went home reassured, and the pains disappeared.
If I were one of Hamilton's horses, I may well have stampeded over some of the individuals who have played a part in my medical care. But my surgeon, I'd have been eating out of his hand.