Soundings Soundings

Patients' fears

BMJ 2000; 321 doi: (Published 11 November 2000) Cite this as: BMJ 2000;321:1233
  1. Kevin Barraclough, general practitioner
  1. Painswick, Gloucestershire

    If I read Balint, or some other such navel gazer, I'm told that I must understand my patients' hidden fears in order to empathise and deal with them. Like so many of the observations in such books, it seems so self evidently true that to state it at all seems almost a redundant use of words.

    I seem to be able to read books on consultation technique, agree with everything that is said, and have no recall whatsoever of what was in the book five minutes after putting it down.

    Unquestionably it is true that it is the timid—those who expect little of life and fear the most—who predominate in the waiting room. They are people who keep their heads down and hope that the monumental storms that sweep the landscape of the world will pass them by. And in the process they watch their symptoms carefully, waiting for a malevolent god to strike.

    So we are told that we must delve down into our patients' hidden agendas and empathise with their fears. But isn't there something a touch patronising in this view? The picture emerges of the doctor, mighty in his or her comprehension, identifying the fears that even the frightened little patients don't know that they have. Cynthia Green has come in asking me about her muzzy headache, but I know that the real reason is that she's afraid that her husband will leave her.

    And yet surely we're deluding ourselves? On those days when I stride into the surgery like a colossus (sort of), I am immortal. Expecting me, at such times, to really understand Mrs Green's fragile world view is like asking Pete Sampras to empathise with the deficiencies of my tennis service. But at three o'clock in the morning, fretting about my daughter's confidence at her new school, my wife's fatigue at working too hard, and the large cluster of lymph nodes I've just found in my neck—at such times I'm right there with Mrs Green—the world scares the shit out of me.

    It's not that I think it's a bad thing to try to understand patients' fears. But I do wonder if it is a trifle smug to assume that we can. I think in future I'll just accept that my insight into patients is less than perfect, and fight back the temptation to psychoanalyse them.

    But isn't there something a touch patronising in this view?

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