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For Primary Care| View from the ground

If the Shoe Were On the Other Foot

View From the Ground, by Dr Sarah Merrifield

How can we encourage a culture of mutual respect between doctor and patient?

Over the course of my 8-year medical career I have had several unpleasant interactions with patients. From the intoxicated patient in A&E who licked my face, to the patient who refused to accept what I was saying because I ‘looked like a little girl’, or even the patient who went on a social media rant against me, referring to me as the ‘stupid blonde’. I have sometimes pondered what would happen if I were to act in the same way to patients. I can only imagine this would have led to disciplinary action and potentially being struck off. Sadly, there were no significant consequences for these patients.

From our first days at medical school we are taught to put the patient at the centre of our care. We learn to deal with patients who are under extreme stress and receiving bad news. I wonder if perhaps we have allowed this to cloud our need for professional respect and action.

I have of course experienced the opposite extremes, too. The elderly gentleman who always came to his appointments wearing a suit and tie, and the couple who consistently arrived 20 minutes early as they worried about keeping me waiting. An echo of bygone days, where general practitioners were viewed as pillars of the community.

I attended a talk last week where I was intrigued to hear patients referred to as customers. The term customer, by definition, describes a person who buys goods or services from a business. I wonder if it is this sense of consumerism that has driven some patients to believe healthcare workers are there to serve them in exchange for paid taxes. Or is it perhaps the case that a different type of transaction is taking place?

The concepts of transactional analysis define a series of behaviours that people enact during any form of social interaction, with the key roles defined as child, parent, and adult. The ideal basis of course being an adult–adult interaction. The negative, name-calling behaviours I have encountered most likely represent a person in the child state, perhaps driven by a state of fear or uncertainty.

But to what extent should we make allowances for this? In a time where burnout is rife, and GPs are more stressed than ever, should we tolerate such behaviours? Many practices have zero tolerance signage but how often do we actually enforce this? I would suggest that there isn’t a one-size-fits-all approach. Rude, threatening, or aggressive behaviours certainly need to be dealt with immediately, but a gentler approach may be needed for those in times of severe stress.

Taking steps to humanise ourselves and acknowledge such comments may be the way forward. As doctors we are often perceived to be impenetrable, consummate professionals, able to deflect any negativity thrown our way. But maybe the key to encouraging a culture of mutual respect is to show our weaknesses. To display our sense of hurt or upset, rather than brushing it off.

Admittedly, I am not the best at doing this due to fear of damaging my relationship with the patient. Having recently spent time at a number of wellbeing events, I’ve come to realise that a doctor’s own health is as important as that of our patients, if we are to be effective in our role. This should bolster even the most passive among us to react to such behaviours, although it may feel counter-intuitive.

Only by communicating adult human to adult human can we move forward.

Dr Sarah Merrifield

GP Trainee