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At the heart of general practice since 1960

Evolution vs expectation

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It was through the publication of Charles Darwin’s book The Origin of Species in 1839 that the term ‘natural selection’ was introduced and the notion of apes evolving into human beings was postulated. The Industrial Revolution led to the most rapid evolution of humans due to advances in farming techniques resulting in better nutrition for the general population. Surprisingly, modern  humans continue to evolve by gradually losing vestigial structures such as wisdom teeth or the plantaris foot muscle. Lamentably, recent human evolution has not resulted in the growth of extra arms, the ability to teleport or mind reading - all of which would be very useful in my working life. Alas, the idiosyncracy of highly developed cynicism seems to be a trait not suited for real life compared to work life.

We live in a busy 24/7 society where everything is accessible, cheap and disposable and where information can be reached instantaneously through the swipe of a touch screen and where I suspect the general public expect to recover from injury or illness at once. Why?

Patient expectations.

Due to the high levels of junk food consumed by one section of the population and the high levels of exercise performed by the other section of the population (leaving an Average Joe like me in the middle), considerable strains are being put on our bodies every day. But we have not evolved so rapidly that we can cope with gross obesity or muscle injury - so why do patients expect their body will heal instantaneously?

Patient expectations.

Advances in medicine and surgery together with some clinicians poor ability to give any information about recovery times has led to high patient anxiety and the expectation that doctors and antibiotics can cure everything. I know it’s tiresome, but giving patients a ‘ball park’ figure of how long they may take to recover might reduce anxiety, expectation and in turn demand. I suspect we clinicians are only part of the issue. Dr Google and the plethora of hospital dramas and reality programmes have made our job harder.

I remember watching ‘Holby City’ as a medical student and laughing at the ludicrous things that would happen, such as patients surviving cardiac arrests and being able to talk straightway or doctors being able to order CT scans instantly with the radiologist being so obliging rather than obstructive. But I suspected that the general population felt that what they saw was normal and so were surprised when things take time eg. recovery from a viral illness.

Managing patient expectations might be an uphill battle, but it’s a lot easier to deal with than waiting for human evolution to catch up. Scientists have however made some predictions of what traits future human beings may possess, such as weaker immune systems because of dependence on antibiotics and possible resistance to diabetes and heart disease due to dietary adaptations

In the meantime, I will continue to refine my viral illness spiel and give exercise sheets and analgesia advice to patients so they go away with some new knowledge and possibly slightly lower expectations next time… or maybe not…

Dr Avradeep Chakrabarti is a GP locum, living and working in Bristol

Readers' comments (2)

  • Deep sorry mate it gets worse once you progress from locus life trust me on that , stay smart get a good locum salaried portfolio and join a company and patients are always correct always right it's too much of a political suicide to agree empathise with doctors
    It's been some time bro one should have stuck in the big brick building --you were right--called hospital medicine
    Anyway keep up the good work

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  • "Scientists have however made some predictions of what traits future human beings may possess, such as... possible resistance to diabetes and heart disease due to dietary adaptations"

    Not plausible. Type 2 diabetes and heart disease are problems of later life. Since they rarely affect an individual's ability to survive long enough to reproduce there will not be significant evolutionary pressure to avoid these conditions.

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