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The bad doctor: an explanation
  1. Philip Berry
  1. Correspondence to Dr Philip Berry, 31 Pentlow Street, Putney, London, SW15 1LX, UK; philaberry{at}hotmail.com

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I am a hospital doctor, one grade below consultant—a Registrar. Last week, on arriving home, I said to my wife,“You know, today I really earned my money!”

I had worked with sustained energy and efficiency. I made no mistakes, I may even have saved a life. But I knew, from the resigned expression, unimpressed gaze and perceptible shrug marking the end of several consultations, that a good proportion of my patients thought I was rubbish.

Here, I explain why.

I arrived at 08.45 to find that our in-patient list had grown to 32, following a busy day on-call. The House Officer handed me three sheets of paper stapled together in one corner, apologising as she did so. Already the task ahead, that of seeing every one of them, confirming the diagnosis and making an individualised plan, appeared intimidating.“Nine o'clock to one p.m. Four hours…that's about 7 minutes each. Let's crack on.”

We began. First the ‘sickies’, those who remained on the acute admissions ward or were attached to cardiac monitors. Leading the ward round I breezed into the bed spaces with energy, took focused histories, conducted ultra-focussed examinations, and dictated the findings and conclusions to my team. I was positive, actively empathetic and successful, I think, in creating an atmosphere of caring. There was little space for genuine communication, however. It was important that each patient reveal their overriding symptoms and their main concerns, but the shape of each brief visit had already been determined: confirm the disease, ensure a clinical response, exclude complications, check the drug chart and laboratory results, try to ensure that the patient understands where they are headed and why.

Several ‘real sickies’ impeded our progress, and we lost time. But that didn't matter; these patients needed …

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