Intended for healthcare professionals

Fillers A patient who changed my practice

Northern Ireland weather

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.313 (Published 08 February 2003) Cite this as: BMJ 2003;326:313
  1. Kishor A Choudhari, consultant neurosurgeon
  1. Royal Victoria Hospital, Belfast

    With my appointment as a neurosurgeon in Belfast, I realised that most patients desired some personal and informal interaction. They also wanted to know more about me. Being rather reserved, I found it difficult to engage in long conversations. Also, not being a native of Northern Ireland, there were few subjects in common to talk about. After pleasantries and discussion of the medical condition, I was usually at a loss to extend the conversation further. I was aware of the sectarian troubles, but patients avoided such sensitive topics. Soon, I discovered that one topic was popular, uncontentious, and universally discussed by Protestant and Catholic alike—the weather. Good weather was an exception rather than the rule. None the less everyone enjoyed talking about the weather.

    The most common question put to me by the patients was “Doctor, how do you like it over here?”

    My standard answer was “It's good, especially since the troubles are over. I like it here, except for the bad weather—always cold, wet, and windy.” Patients appreciated my remarks and sympathetically shared my disappointment. This weather talk not only helped me get over my initial introversion, it also enabled me to keep patients distracted during their neurological examination. On a rare sunny day I learnt to manoeuvre the dialogue impressively by saying, “It's a lovely day, isn't it?” Within a few weeks, by using the “weather card,” I mastered the art of communicating effectively with the local population despite my different religious, cultural, social, and ethnic background.

    Then one day I came across Mr Smith at my outpatient clinic. He was in his middle 50s with longstanding trigeminal neuralgia, a condition in which patients have intermittent severe facial pain. After the usual introduction and neurological examination, the expected question came up: “Doctor, how do you like it here?” By now I was well rehearsed with the answer. I explained how, over the years, I had come to feel at home in Northern Ireland. Mr Smith listened with interest, occasionally nodding with approval. I went on to describe the inclement weather and how difficult I found it coming to terms with it. Mr Smith was quiet and did not seem to be as appreciative as before. I continued, saying how depressing the winters were, and the summers too, with the constant rain. Mr Smith now seemed a bit disturbed. I carried on, however, relating how depressing it was to see the television weather forecast invariably showing clouds and rain over Belfast.

    By now, Mr Smith was overtly restless but remained seated, more through respect than interest. I sensed that something was wrong, and, changing the subject, I said, “Mr Smith, yours doesn't seem to be a Northern Irish accent. Where are you from?” With a calm face, he stated that, although he was originally from Belfast, he had spent some 20 years abroad. He had been in Leningrad for 10 years, but found it very cold, as the temperature often dropped to −40°C. Then he spent 10 years in Brisbane, but found it too hot, with the temperatures sometimes reaching 40°C. Consequently, he opted to return home because he liked the weather in Northern Ireland. With a smile, he said, “The weather here is always pleasant, moderate, and with a lush greenery all year round.” He then shook my hand, said he was pleased to meet me, and left the room, leaving me speechless.

    Unable to disagree, I found myself back at square one, searching for a new topic for conversation.

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