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Do as I'd do, not as I say

Patients always ask what we would do in their place, says Copperfield, but they should be asking what they would do if they were doctors

Patients always ask what we would do in their place, says Copperfield, but they should be asking what they would do if they were doctors



'No decision about me, without me, my arse! Come on Doc, what would you do if you were me?'

We have all heard that, or something very like it, thousands of times.

Now that everybody has three top-grade A-levels and a university degree, we're expected to dodge the question by providing the information patients need to make decisions for themselves, just like the Patients Association says.

Its thinking, if that's the word, is that we hand over our copies of Kumar & Clark's Clinical Medicine, Muir's Textbook of Pathology and the latest BNF, point the patient in the direction of the online National Library for Health and encourage them to get on with it.

And so what if I actually give them a printout from patient.co.uk, a cutting from the Daily Mail and the patient information leaflet from a packet of Tesco's own-brand antihistamine tablets? I'm still doing my bit.

But the reality is that patients still ask us for advice. They either can't be bothered to do the research themselves, can't find the answers in the tabloids' health pages or cling on to the unfashionable belief that GPs have got stethoscopes and prescription pads because we know a shed load more about medicine than they do. And we're expected to be objective.

Obviously, it's all about risk and benefit. Mrs C describes me as 'risk averse', which is patent nonsense. She drives as if she's in a never-ending funeral cortege and is unfailingly polite. I drive it like it's stolen and I'm incredibly rude to patients twice my size.

So maybe the question shouldn't be, 'what would you do if you were me, Doc?' but, 'what do you recommend, bearing in mind that you aren't actually me, after all?'.

If my patient was confronted by an alpha-male gorilla, would I advise they grab it by the bollocks? The answer might vary with the individual – but in the main, I would not.

But if I were confronted by a really angry gorilla, imagine if I dealt with the situation by administering a sharp and painful testicular tweak, think of the acclaim if the ploy succeeded. No longer, Dr Tony Copperfield, GP in Essex and occasional columnist, but: 'The man who had King Kong's knackers in the palm of his hand.'

And this is how doctors actually behave. A study of around a thousand GPs and hospital doctors asked them how they would advise a seriously ill patient to proceed if they had a choice between a procedure that carried a decent survival rate but a significant chance of long-term complications, or one that carried a high risk of death, but a good quality of life afterwards.

Then, and here's the good bit, they asked the doctors what they'd do if they were the patient themselves.

Doctors tended to advise patients to go for the long-term survival option; to escape with a beating from the big ape and risk living on with a troublesome limp. Choosing for ourselves, we tended to opt for the full-on gorilla's gonads solution, with a lower survival rate but a better long-term outlook for those who lived on.

So should the question be: 'What would I do if I were a doctor like you?'

The boffins say there's no right answer. If you ask me, it's a real monkey puzzle.

'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books

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