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Dr Smith, the intensive care consultant, has a running not-quite-joke that my specialty admits the ‘worst’ patients – difficult, complex ones who often fail to make satisfying recoveries.
My team has several patients in the intensive care unit today, and Dr Smith goes rapidly through the plans for each one, checking what investigations and treatments are needed.
‘And what about that hopeless dribbling lump in bed seven?’ he asks. ‘One of yours?’
She isn’t, as it happens: Maria is in with a chest infection this time but I know her well. She’s a regular attender with cerebral palsy and severe learning disabilities.
‘Hopeless,’ in the sense that her underlying condition is incurable, and ‘dribbling’ is factually accurate but even so I bristle at the description. It must show, too, because Dr Smith quickly backs off and changes the subject.
Dr Smith is an excellent clinician. He has helped me out of a number of tight corners with unwell patients, and I happen to know he’s helped Maria out of some even tighter ones. I haven’t the slightest doubt that he would always give her the best medical care, and he’d never refer to her disparagingly in earshot of her family.
So, does it really matter what he calls her in private? Isn’t this kind of black humour something we medics rely on to survive the routine grimness of our job?
Yes and no. You need a certain kind of thick skin to work in critical care. You need quick wits, strong instincts and a head for detail, but you also need to be able to pour all your skill and care into a patient, and watch them die anyway, and then come back to work a few hours later and do it all again.
It’s natural that certain sensibilities end up a little blunted: natural, but not necessarily harmless. By allowing ourselves to dehumanise patients – always easiest with those who are visibly very different from us, and especially those who cannot speak – we gradually lose our ability to see them as people at all, and the decisions we make for them will be subtly altered as a result.
The last thing we need is more people policing our language. Doctors will always speak among themselves with a freedom that, now and then, crosses the line into poor taste. That’s OK. But we should all fear the day when we come into work and look at vulnerable patients and really do see nothing but hopeless, dribbling lumps. The day we can no longer see our patients’ humanity clearly is the day we know that our profession has begun to erode our own.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter and on Facebook
Is it any more dehumanising than just referring to the patient as "Bed 7" that happens everyday in critical care?
Thought police insipidity and creep into our practice lives.
1). Work for the GMC.
2). Let real doctors do a real job.
3). Keep your political correctness to yourselves. Bore each other limpwristedly.
I feel disgusted that an adult with cerebral palsy and learning disability is addressed in this manner. Doctors may be stressed but that does not mean that we refer to the less able people in society in this manner in a private conversation.
It’s the value judgements linked to the description that make this such an unkind comment. And in private (or in public) its still an Incredibly disrespectful comment. No place for it anywhere, but especially not from a senior doctor to a junior doctor.
Moreover, we know that people with learning difficulties have much worse health outcomes than their peers. How incredibly unwise to utter such a negative comment in a clinical environment. It’s the kind of thing that makes headline writers run their hands together with glee.
I think the consultants remark was unfortunate, but I would not be judgemental.
I suspect it comes from a degree of empathetic fatigue, perhaps not uncommon in the challenging clinical environment.
I’ve been an acute speciality hospital clinician for 35 years. I don’t believe we need to deliberately over-insulate ourselves from patients problems, it’s the price we have to pay to maintain engagement.
Gallows humour is understandable and can be helpful for morale, but dehumanising descriptions are not really acceptable.