Personal Views

The caring doctor is an oxymoron

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7109.687 (Published 13 September 1997) Cite this as: BMJ 1997;315:687
  1. Graeme M Mackenzie, general practitioner
  1. Maryport, Cumbria

    My title is the opening hypothesis for what I see as one of the problems with medicine and general practice, especially in Britain. I would like to challenge the basis of how we work: the relationship between doctors and patients.

    Personal care is always seen as a lofty aim. But overpersonalising care can result in poor delivery of appropriate medicine. I can write only about general practice but I think the problem is most rife in primary care.

    I have recently decided that being a doctor is a lot less about being caring and a lot more about the hard headed organisation of information with a view to making a decision. Overegging the caring pudding of general practice interferes with the process of decision making, with inherent dangers that the wrong decision is made or perhaps the more likely outcome that no decision is made.

    Isolated consultations are an interesting, challenging assimilation of information with a view to making a decision. Attach to that consultation the baggage of long term relationships, heartsink feelings, overfamiliarity with medical history, personal feelings of inconvenience at dealing with particular problems at particular times and we spoil what in essence is an important, useful, and fascinating process: deciding what, if anything, is wrong with …

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