Doctors Make The Worst Patients

That is not because we worry about the rare diseases we learned at medical school (although this is a well-known problem seen in medical students), but because we don’t worry enough.

As doctors we see thousands of patients with tens of thousands of symptoms, many of which will not have an identifiable cause despite thorough investigation. We call these ‘medically unexplained symptoms’. They don’t worry us too much – we know there is no serious underlying cause, and we know they will not get any worse or threaten our patients’ lives.

So rather than worry that our symptoms are caused by cancer, like many of our patients (especially the ones who check Google before coming to see us), doctors have a tendency to think that our own symptoms will be nothing serious. There are countless stories of doctors who have put off going to see their own GP until it was almost too late.

One of my clinical supervisors had pain in his chest for months. It was not bad enough for him to think it was a heart attack, so he just put it down to stress, or maybe a bit of heartburn. Eventually after the pain worsened and he started to feel feverish, he went off to see his own GP and was diagnosed with pericarditis – inflammation of the sac that surrounds the heart. He was off work for two months after that.

My advice to everyone is to see your GP as soon as possible if any symptom is something which you notice regularly and it bothers you. Even if it doesn’t bother you but it just doesn’t seem quite normal, I would much rather see you early on and tell you that it is nothing serious, than be faced with something that is already well developed and therefore much harder to treat.

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I am one of few white men to have seen beneath the burka – what I saw made me sad.

As a doctor I am in an extremely privileged position: I get to see people at their most vulnerable. And sometimes my patients see my vulnerabilities too.

I worked for a while at a practice in the area of Manchester that has the highest number recent immigrants of all nationalities. The people may be ethnically diverse, but they are universally poor. The area is one of the most deprived in the country and is home to a large Muslim population. It was rare for me to see a white British patient when I was there, but those I did see were almost all struggling with one sort of addiction or another. It was clear that Muslim patients were struggling too, but at least you could see that they were trying to make a better life for themselves. Children wearing grammar school blazers would come in to translate for their Urdu-speaking parents.

I remember clearly one time when a woman wearing a burka came in to see me because it was rare, even for an area with such a large proportion of Muslims. I immediately began to feel uncomfortable but it wasn’t through fear or embarrassment.

When I see a patient for the first time my eyes start searching for diagnostic clues as soon as they step foot in the door. Even before that I can tell a lot: if it takes a while before I hear a knock, I know that their mobility is poor; if they need me to shout “come in” twice, they might have some hearing difficulty.

My eyes search my patients’ faces and bodies for anything that might help me piece together the diagnostic jigsaw: a clenched fist can indicate pain; a twitch of the mouth can convey unspoken doubt. I watch how they move, how they breath and how they react to my smile. You would be amazed just how much a doctor can learn about you before you even speak. Most of the time they will have formulated a fairly accurate diagnosis within the first 30-seconds of meeting you.

The burka took away all of my usual visual clues. I felt lost and out of control. Was she pleased or worried to see me? Was she in pain? Was she depressed? All I had were her eyes. They were piercing (maybe because they were the only things I could see) but I could not read them.

I took a breath to steady myself and asked her what I could do for her. She told me that she had been having problems with a rash on her face. It might have been obvious that I started thinking about how I was going to go about asking to see it. However, without a pause she unclipped one side of the veil. It was like she had switched on a light and my puzzle fell into place. I could see that she looked sad, and I could also see that she had acne.

It was bad. Large spots on her on her jaw, chin and cheeks – and in places it had left scars. She told me that acne was one of the main reasons that she had started to wear the veil in the first place. Whenever she went out without it people would stare – judging her for something she could do nothing about. At least when she wore the veil she felt some control over what other people saw. It gave her the confidence to go out and interact with others that she otherwise didn’t have.

acne-free-1.1-1
An example of severe facial acne

Before you have an opinion of the burka you need to understand that there are many different reasons why a woman might choose to wear one. And as one of very few white men to have seen beneath it, I can assure you that the only thing under there is a woman, just like any other.