BMJ  2006;333:305 (5 August), doi:10.1136/bmj.333.7562.305-b

Letter

Doctors and patients need to hunt together

EDITOR—In the outcome of the interactive case report of his case, Neville vividly describes his frustration with the failure to explain his symptoms: the awareness of the ebbing away of doctors' sympathy, the wish that investigations would find something—anything—wrong, and so end the uncertainty.¹

Failure to find a cause for a problem is frustrating for doctors and patients, but it helps no one if doctors protect themselves from their failure by distancing themselves from the patient. We all know the frustration of failure to find a cause for a problem, if only when the engineer comes to look at the washing machine. When telling a patient the result of an investigation it is surely more helpful to say what the investigation rules out than just to say that it is normal. "This test shows that your problem is not due to kidney disease, cancer, or a fracture, but it has not given us any leads towards what is causing your symptoms" is both more true and less undermining.

As Peile points out in his commentary, no patient is every fully investigated. Patients often believe there is a test for everything, and doctors are better being honest about the limitations of medical knowledge and admitting the shared frustration. Thinking widely requires a relaxed and open mind and cannot be achieved if the relationship has become implicitly, even if not explicitly, adversarial. In this hunt doctors and patients are on the same side.

Caversham Group Practice, London NW5 2UP judith.harvey{at}btclick.com

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Competing interests: None declared.

References

1. Fox M, Young A, Anggiansah R, Anggiansah A, Sanderson J. A 22 year old man with persistent regurgitation and vomiting: case outcome [with commentaries by K Neville; E Peile; SA Azer; S Dosani; D Macauley; and R Logan]. BMJ 2006;333: 133-7. (15 July.)[Free Full Text]

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Relevant Article

A 22 year old man with persistent regurgitation and vomiting: case outcome

Mark Fox, Alasdair Young, Roy Anggiansah, Angela Anggiansah, and Jeremy Sanderson
BMJ 2006 333: 133. [Extract] [Full Text] [PDF]