Haslam's view: My polymyxoflagia deception
Ever since it happened I have felt vaguely guilty. maybe the time has arrived for me to own up, to confess, to share my behaviour with my GP colleagues.
Perhaps I will feel less guilty if I do, though I certainly don't expect to achieve ‘closure'; not that I have ever had a clue quite what this ‘closure' is that obsesses so many of our patients after traumatic events. In the same way I've never been entirely sure what a ‘chill' or ‘gastric flu' is, or what the Read code for a ‘nervous breakdown' might be. Neither have I quite worked out how counselling might deliver ‘closure'.
I guess I'm just in denial.
The source of my guilt is perfectly straightforward. I deceived a patient. The patient had just registered with the practice and, by some extraordinary fluke of organisation, I actually had her medical records by the time she made her first appointment. Glancing down her problem chart I saw that she suffered from ‘polymyxoflagia'.
No – I hadn't heard of it either, so I went rapidly to my books and found that it was an extraordinarily rare condition, with only seven recorded cases in the world. I glanced down the list of distressing symptoms and then went to the waiting room to fetch the patient.
Before we go on, let me tell you straightaway that you can stop worrying about your ignorance. There is no such condition as polymyxoflagia: I just made it up. But my patient's actual condition was exactly that rare – seven cases in the world – and if I were to use its correct name there is a chance that my nearly unique patient could be identified.
Anyway, the patient came into my room.
‘I am so sorry to trouble you doctor,' she said, ‘but I've come about my polymyxoflagia.'
‘It must be terribly distressing,' I said. ‘Presumably the pains you get in your hands keep you awake at night.'
And with that she burst into tears. Tears of relief.
‘Oh, thank God,' she said. ‘I've never before met a doctor who had even heard of polymyxoflagia. Thank you so much.'
So, doctor, what should I have done at this point? Should I have owned up that my knowledge was less than five minutes old, and thereby crushed her newfound relief and faith? Or should I have kept quiet and let her talk? You will have come down very firmly on one side of that divide the moment I told the story.
I kept quiet. I never told her. Not once, in the ten years that she was my patient, did she ever doubt my ability to care for her.
I recently shared this event with two experienced GPs. One was convinced that this was quintessential quality general practice. The other was certain that I was a patronising deceiver.
Polymyxoflagia is a condition with no known treatments, but every six months my diary reminded me to check out the latest research and contact my patient with what I had found. By the time of her death reported cases had reached double figures, so you can imagine how many researchers were sitting up till the early hours trying to find a cure. Precisely none.
But I do still feel vaguely guilty about this. Like you, I believe in openness, honesty and patient-centredness. I also believe in the powerful benefits of trust and the importance of patients being cared for by someone who makes them feel safe.
My patient felt safe with me.
Tricky, isn't it?Author
Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser
to the Healthcare Commission; and visiting professor at de Montfort University, Leicester