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PRACTICE: Kenneth Neville and Mark Fox Patient's view BMJ 2006; 333: 134 [Full text]

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The doctors and the patient need to hunt together

Judith H Harvey   (22 July 2006)

The doctors and the patient need to hunt together 22 July 2006
Judith H Harvey, salaried GP Caversham Group Practice NW5 2UP Send response to journal: Re: The doctors and the patient need to hunt together	Mr 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. Failure to find a cause for a problem is frustrating for doctors and for 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, even if it only when the engineer comes to look at the washing machine. When telling a patient the result of a 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/a fracture, but it has not given us any leads towards what is causing your symptoms' is both truer and less undermining. As Peile points out in the subsequent article, no patient is every fully investigated. Patients often believe there is a test for everything, and it is better if doctors are honest about the limitations of medical knowledge and admit 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. This is a hunt on which doctors and the patient are on the same side. Competing interests: None declared