General Practice

“Explain in simple words—ensure the words are understood”

BMJ 1995; 310 doi: (Published 06 May 1995) Cite this as: BMJ 1995;310:1178
  1. W St C Symmers

    The old man in the bed next to mine in the mixed gender customer care facility (ward) woke me with his sobbing, quiet but continuous and infinitely distressing. I hobbled to his bedside and asked what troubled him. “Damn youse men, keep quiet,” said the old lady next along the ward. At first the man ignored me, weeping on, his face and the pillow wet with his tears. I held his hand and dried his face, and he turned his eyes to me. “It's you, doctor?” he asked. It had become known to my fellow patients that I was medical. “There's nothing you can do for me—or for my woman, but thank you,” and he turned away from me.

    “What's with your wife, then?” I asked, for she had seemed a bonny character, full of vitality and good sense, when she had sat with her husband on the first days after his operation. “She had this kirnel [lump] in her bubby [breast] and our doctor said it should be taken out to see just what it was, in case it was something bad. So the surgeon cut it out past Tuesday and yesterday the doctor called at the house to tell her what it was she had.” And he began to wail, but quietly. “And what did the doctor say?” I asked. He hid his face in the pillows as his body shook again with the sobs.

    When he looked at me next there was fright and distress in his eyes. “Benign,” he said, his whisper so faint that I scarcely heard the word, and so I doubted at first what it was he had said. “The doctor says it's benign. That's what the two of us both feared it would be,” he added, his voice flat and dull, his eyes now staring far into the night beyond the ward. “What is the use of all this operation on my heart if she is gone and I live on?”

    So it was. Benign. The primary care provider (family doctor) had called on the old woman at her home to tell her this good news. She did not look at him as he spoke, and she missed the satisfaction and relief that must have been in his expression. To her, “benign” was a word outwith her own vernacular, perhaps not even heard before. So it was to her man also. A doctor's word, strange, frightening, mistaken to be cancerous in meaning, and so bringing the old couple the opposite of the good news that the doctor had thought he was offering when he added, “So there's nothing more to be done about it—it's all finished.”—W ST C SYMMERS (SENIOR) is a retired professor of pathology in Peebles


    • * W W D Thomson, professor of medicine, Belfast, 1923-50.

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