Find episode 1 here at ‘Do You Wish You Were Dr Incognito?’
Find episode 2 at ‘Never Trust A Skinny Chef, Or a Sick Doctor?’
As a doctor, I see people at their most vulnerable. It’s a precious and trusted position to guide, counsel and care for people during what can be their darkest hours. When you see many patients a day, week after week, it’s easy to forget the stress, anxiety, fear and worry that can hang over someone as they sit down in the chair next to your desk.
When I reflect on my own (I’m sure often disgraceful) behaviour during personal stressful times, I find it easier to empathise. People act at the extremes of acceptability when in extreme situations. For this reason, I strive for my consults to be non-judgemental – I believe that by understanding the context of a patient’s presentation, and understanding their emotion, will ultimately greatly improve your ability to help them. So, when a patient raises their voice in frustration, or swears in a consult, or is sullen and angry after waiting to see the doctor, I tend to try and roll with it and use what those behaviours tell me to connect better with my patient.
However, there are obvious limits to my hippie-love-in attitude. It’s not all peace love and understanding – if a patient gets physically violent, or particularly threatening or vindictive in their speech (no matter what the context is), then this can’t be tolerated for the sake of my safety, and the safety of other staff and patients. At these times, we say quite clearly to people – that behaviour is unacceptable and it cannot be tolerated.
It’s not just for these kinds of dangers that doctors will speak up though. We correct and educate regarding medical matters all the time. It’s our job, and a professional responsibility. A few I can think of from recent consults include:-
- No, the influenza immunisation cannot give you the flu.
- Yes, 12 paracetamol a day definitely is too many
- You most certainly can get pregnant the first time you have sex
- It’s not just how much sugar you eat that contributes to your risk of diabetes
- Benzodiazepines (sleeping tablets) have significant risks – if it was your decision whether you took them or not, you could buy them in the supermarket!
- And my favourite – you breath IN from your IN-haler device, you don’t blow into it!! (In a patient who had struggled with COPD control for several years…)
In fact, if we don’t give our patients this advice, then we are failing to perform our professional duties, and can potentially be in quite a bit of hot water over it. The extent of our responsibility to act in these matter has been tested recently with a well-publicised case regarding a doctor who didn’t do ‘enough’ to advise and encourage a patient to lose weight. (It’s important to note that this decision has since been overturned) I don’t want to open this can of worms today, but for an interesting perspective have a read of my colleague and erstwhile Indigenous health / Twitter / blogging mentor Tim Senior here.
But how far does this responsibility to speak up extend past matters of medicine or personal safety?
Doctors are respected members of our communities, we are role models, and in the great position of the privilege of a significant amount of higher education. Should our role as teachers be limited only to medical matters, or should we speak up at other times too? There are arguments either way here – get into too much of (for example) a discussion about topical politics, and you really run the risk of losing the focus of your consult – which is, of course, provision of healthcare. But despite this, I believe there are some instances when it’s very hard, and perhaps even inexcusable, not to speak up.
All of the above has essentially been a long-winded way to work around to the title of this post, and how it relates to the subject. Perhaps the number one comment that I find it extremely difficult to let slide is…
‘I’m not a racist, but…’
Now, I’m sorry, but if your sentence starts like that, there is an astronomical risk that you are about to proffer a profoundly racist statement. Just like when I said ‘I’m sorry’ a minute ago, and I didn’t really mean it, nor do you truly mean that you’re not racist. In fact, whether or not your comment is racist is probably not in the realm of your own determination. (Highly recommended for further reading on the ‘fauxpology’ is Luke Pearson at his blog AboriginalOz.)
Thankfully, working at an ACCHS means that my exposure to this particular comment has plummeted…
Other situations that spring to mind include:-
- The similarly offensive ‘I don’t have a problem with women, but…’
- Anything involving the preposterous suggestion that asylum seekers have a good deal in life in any way, shape or form
- Bad-mouthing my other colleagues in medicine and healthcare (Seriously? That just prove to me that you’re likely to do the same about me. (See point number 10 at The Doctor’s Dilemma )
The list can really go on….
So I do speak up, selectively, on non-medical matters when my social conscience tells me that it would be folly not to set things straight.
How do you manage these moments as a doctor? Should we voice opinions in these circumstances? Do my non-medical readers encounter these dilemmas too? Would love to hear your thoughts below.