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No wonder GPs act like parents when patients act like children

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It was a hot day at the end of September, and particularly uncomfortable in my room. I couldn’t open my window very far, as I didn’t want cigarette smoke drifting in or the sounds of my consultations drifting out. My last patient was an extra. We were both hot and flustered.

‘I’ve had this sore throat doctor for, like, two days,’ she began, and I nodded apologetically, but I knew what was coming next.

‘I’m supposed to go on my summer holidays tomorrow. I only get two weeks off a year,’ she continued.

I let her talk as I recalled something my kids had said the weekend just gone.

Dad, remember those sweets  you bought us? It’s the weekend, why can’t we just eat them all?

‘I was hoping you might prescribe me some antibiotics, like the last doctor did, you know, just in case?’

Mum let us have some sweets just before bedtime last week – didn’t she tell you? Oh come on, Dad!

‘You don’t want me to have a spoiled holiday, do you? Are you listening, doctor?’

I spluttered into life.

‘So you’ve had a cough and sore throat, but no fever, and no painful glands up in your neck…?’

She nods her head as she realises I’m not buying it.

‘Let me take a look in your throat,’ I grumble, even though I know there will only be the merest hint of mild pharyngitis. But it gives me time to think.

As I removed the wooden spatula from her mouth and tossed it into the bin, she swallowed, coughed and spoke again to try to rescue her lost cause.

‘Oh go on,’ she wheedled, ‘aren’t you supposed to be the nicest doctor in the practice?’

‘Look,’ I replied, ‘you’ve got a viral illness and sw- antibiotics will do no good. It’s for your own good.’

She got up to leave. 

‘I’m sure you’ll have lovely holiday,’ I added.

It’s hard to not be paternalistic when some patients act just like my own children.

Dr Samir Dawlatly is secretary of the RCGP’s adolescent health group and a GP in Birmingham. 

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Readers' comments (20)

  • Sounds like you got off lightly there. LOL

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  • Snooze.......

    How do you know that your examination didn't just result in the findings you wanted to find (to fulfil your paternalistic vision of yourself) rather than what was actually there?

    Feel sorry for this woman - she bore the brunt of your paternalistic stereotyping approach. She deserves better.

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  • "Just like the last Dr did" ; waste of a spatula; patients as 'extras' - consultations of deceit. What happens in medical school ?

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  • anonymous 00.42

    you are obviously not a health professional so why are you on the site. please restrict access pulse to avoid trolls like this. however i have found that educating patients works best and being empathic results in much better outcomes. it takes a bit longer and hopefully effects some peoples help seeking behaviour - that is until they see another Dr who gives in and prescribes!

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  • Just give antibiotics to everyone and give them what they want. Better still let them buy them over the counter. No, prescribe them for free. The patient is always right, after all. Same goes for sleeping pills, sick notes, referrals for the one day old twinges in the knee and a note to get out of PE lessons because running makes you feel tired. Hows that 00.42? Feel suitably listened to?

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  • Ah but surely we should be using the secret "this medicine cures a none specific self limiting viral illness by mutating the virus into a bacteria thus rendering it sensitive to antibiotics when you present 2 days before your holiday".

    You know I think we should use it more often especially when people have had enough of feeling unwell and something must be done for 7 days of a viral illness.

    obviously we also should do this via skype, or e-mail, or home visit, or telephone consultation or any other requested route of communication as well as offering same day or pre-booked appointments for any registered or temporary patient who wishes to have an appointment for any condition or indeed query that they may or may not have, for a symptom of any duration or severity, with or without any self management prior to seeking medical advice.

    And of course we need to be far far more reasonable about providing our services and time for form filling, assessments, letters to this that and the other ,and so on and so forth for none NHS services. I mean why should we charge for work we are not paid for which we have to do in our own time.

    And of course after 12 hrs of doing this it really is an outrage that we are not then contactable 24 hrs a day for any query of any urgency that any patient (or relative, representative, carer, interested party, school....) may wish to make. I mean how can we as doctors be so up ourselves as to offer an opinion which challenges the current use of these precious interactions and the seeming value society places on them.

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  • It's always disappointing when any doctor treats his/her patients like they are the problem. It is as much GPs prescribing antibiotics to fob them off as it is patients trying to get magical antibiotics. It also isn't patients' fault that antibiotics have traditionally been portrayed to them as a cure all. Patient education rather than paternalism (and the freedom to deal with rude and aggressive patients the way they deserve, because that is part of it too) are what is needed.

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  • We really need some better science on this topic - if there is I have either forgotten it or found it not to be helpful. Somewhere in the back of the prescriber's mind is a nagging doubt that it could be bacterial otherwise we would never ever prescribe an antibiotic in the same way as we would not prescribe amoxicilin to someone with a verrucca. The problem is the uncertainty. The presence or not of glands and exudate etc etc - does it really mean bacteria - I'm happy to be educated. Even if it is a strep throat - do antibiotics make a lot of difference.

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  • Risky strategy. this would lead to poor patient feedback and a possible complaint. astonishing how some people insist people will somehow magically listen to you if u tell them abx are not needed. some people demand abx so it is given by doctors on the threat of receiving a complaint if they do not give them. nobody will help you if you are hauled before the gmc. will the expert witness support you or the patient? it might make you choose a different decision

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  • 9:06 what a tremendously egotistical reply to 0:42. His story did not prove the patient acted "as a child" ~ what arrogant condemnation of her. She wanted to prevent a spoilt holiday. She may very well have been in the wrong, but when did physicians become gods, or the "parents" of patients. Does it matter she was an extra? She was a patient who requested a consultation, and seemingly left when told no. Doctors are not gods, nor should they behave like parents. Patients are still the "employer" His story shows his disrespect in that he allowed his mind to wander as she spoke and yet, the patient is called the child? 5:44 stated it correctly "Patient education rather than paternalism are what is needed" Patient respect is due as much as Physician respect. There appears to be a great deal of anger and probably exhaustion stress in these replies....as demonstrated by the satirical jibe from 4:08. We MUST remember who the customer is: the patient. Unless that specific patient is known as an abuser of the services, then they deserve to be treated with respect. "Paternalistic" and "Holier than Thou" attitudes do not speak well of the profession. Patient attitudes go with the territory. Respect them, and educate them if necessary. I saw nothing in the original story that suggested she "acted as a child"

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