Whose health is it anyway ?

Daniel Goleman in his book, Emotional Intelligence, explains how typically if you go into the doctor's surgery with, say,  3 questions, you may be lucky to get 1 or 2 questions answered in a way which you properly understand.

It is the patient who actually owns the body being treated so he or she should be able to control what happens through informed consent. It is not sufficient for a doctor to just depend on his or her original training. They should grow, developing and modifying their understanding through clinical experience, keeping in touch with latest research, and feedback from patients and other doctors.

There is sorely needed to be an informal clinical feedback procedure for doctors from patients and other doctors. In a recent survey many doctors felt scared to tell fellow doctors of any errors made even if that error resulted in the death of a patient. Mistakes made by doctors is one of the most common reasons for death. We are all human and it is positive thing for a doctor to acknowledge an error or any shortcomings so he or she can take it on board so the same error is not endlessly repeated with other patients. Doctors with good emotional intelligence would be open minded and grateful for the feedback. Doctors may have qualified decades ago but there is generally no mechanism for periodically checking the competence of that doctor in a formal way so any shortcoming can be worked upon.

Here in the UK there are generally huge doctor shortages so the main priority is to get doctors to fill all the available posts which may, for example, mean encouraging retired doctors to stay working. So there is little motivation for the government to recognise poorly performing doctors where there is such a shortage. A flawed doctor is seen as better than no doctor at all. Most doctors have at least some shortcomings that could be constructively improved upon but the government feels that active criticism of doctors may be taken personally by some doctors and may discourage some doctors from working at all. Even if there were no shortages, vested interests may discourage too much patient power anyway. The concept of "patient-centred" health and choice is acknowedged by the government as a worthy aim but there is a huge way to go before realising this. Health policy could be shaped by direct patient input rather than by remote civil servants.

Far more information should be available about the treatments that are actually provided in hospitals. Information could then be studied at the patient's leisure rather than having to depend on what the doctor said in a rushed consultation where the patient may be also be in a stressed state. More information also ought to be available about the doctors.

Complaints procedures are currently very limited. When it comes to complaining about clinical decisions, there is little short of full adversarial legal action with all its inherant risks. For the patient it may be very difficult to get a doctor to support the patient's complaint against the original doctor as doctors generally "close ranks". More effective informal complaints procedures are urgently required to try to reach a constructive outcome for all parties involved. This would be an example of good emotional intelligence in practice.

A good doctor patient relationship depends on the doctor being able to relate to and have empathy with the patient's situation.

Ideally health care should be "patient-centred". It helps the patient take responsibility for their own health and do things to avoid becoming unhealthy in the first place. They will also feel more motivated to persevere with treatment if they are fully involved and understand it. These days patients can find out a huge amount about their own condition from the internet, something that the doctor may not have the time to do.

Years ago the universal approach was "doctor knows best". But that isn't really the case. Different doctors often have different opinions. Ideas of what is a valid medical condition and how each condition is treated vary in different countries. Doctors may often be fixed in their ways and unwilling to accept that they are wrong, out of date or there are other valid opinions. This is the psychopathic "we know best" attitude. Often it is the patient who knows best as it is they who are actually experiencing the symptoms. Some doctors actually believe that "a little knowledge is a dangerous thing" for patients ! Patients for whom a doctor can't neatly apply their understanding of a valid  diagnosis are often dismissed as being mentally ill as a catchall. There are many parallels between the doctor/patient relationship and the employer/employee relationship in the way that control is top-down and it should be more bottom up. Also 360 degree assessments of doctors would be useful in a similar way as workplace managers.

There is the caricature of the narcissistic bullying consultant doing his hospital round with an entourage of doctors and nurses hanging onto his coat tails not daring to say a word out of line.

Ironically for the health service, which is supposed to be a caring profession, there is a lot of abuse and bullying, between staff and staff on patients. Patients are often in a vulnerable position, in mental institutions for example. The existence of abuse of patients by psychiatrists is also well known. There is a serious shortage of midwives but the bullying of midwives is common place. Consultants are often arrogant and narcissistic, bullying other staff such as junior doctors and nurses. One reason why there is a shortage of nurses is that they are often subject to bullying thus badly raising stress levels.

Of about the ten dentist I have encountered in my lifetime, only about three have seemed to have solid integrity and honesty. Most have tried to claim work that didn't exist and most of those who made mistakes tried to covered them up or just use "weasel words" or "blanket denial". So in my experience the general level of emotional intelligence is seriously lacking in the dental world. There are currently no provisions to check a UK dentist's "fitness to practice".

Specialist doctors can only be seen by referrals from a general doctor. This is itself questionable but bizarrely the general doctor writes to the specialist doctor and he writes back again without you seeing what is being written about you. This even applies in private medicine where you are paying for the specialist doctor's services.

It would be an excellent idea if doctors or dentists occasionally had open days so people could learn more in an unstressed situation. There should be patient input into training courses for dentist and doctors. The content of the training courses should be made more public.

See the book Medical Errors and Medical Narcissism by John Banja.