‘I thought I was lying to help my patient – but it was really for me’

Highly commended in the ‘Lies I tell my patients’ category, Dr Toni Munno recalls an early-career consultation which taught him how important it is for the GP to properly listen to their patients’ needs – and not their own

The chipped nail polish. That’s what caught my attention. 

Her black business suit gave the impression of a confident executive but as she pinched and twisted her fingers in her lap, I saw chipped scarlet nails and sensed a frightened child pretending to be a grown up.  

‘How are things?’ 

She stared at her hands.  

‘Not good.’ 

She told me of her sadness, her struggle with emptiness and hurt: the story of growing up with a mother who had withdrawn into chronic pain and a father pushed away to start a new life with a new family.  

In my mind the story settled as an image of a child standing in the dark, in the rain with her parents turning their backs and walking away. I felt the cold and the pain, and that’s when I lied. 

‘Your mum always speaks fondly of you,’ I said to break the silence. 

She knew I was her mother’s GP and that her mother saw me frequently to review her medication and pain. My statement wasn’t true, but I wanted it to be. I wanted something to offer. A blanket for an abandoned child. 

It was early in my career. The lie came from a good place. To the young GP it was a white lie to demonstrate compassion and to alleviate suffering. As the old GP looking back, I can see it was misguided and wrong. 

What I see is that my need to make ‘an offer’ was exactly that – my need. It came from me worrying about me and wanting to do something to ease my own discomfort. As doctors we believe we are there to offer solutions, fix things and if we can’t it’s a short step to thinking we are no good.

This feeling of having to make an offer is a familiar pattern from my early years as a GP; it didn’t feel right for a patient to leave the room with nothing: here is a leaflet, here is a prescription, here is a referral to a colleague, here is a wise word. But the wise words were often platitudes, and like the leaflets and scripts were a way of bridging a gap, an awkward silence.  

Over time I came to I realise that silence itself is perhaps the most precious offer. I am listening, I value what you have to say, this is your time.  

I thought I was supporting a vulnerable patient but really, I was supporting a vulnerable doctor. By talking to myself I had stopped listening to the patient. 

Dr Toni Munno is a salaried GP in Bedford