The consumerist
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b445 (Published 04 February 2009) Cite this as: BMJ 2009;338:b445
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The term "medical consumerist and the concepts which follow from that
are useful. What always amazes me about such patients is that they lack a
normal response to ineffective interactions with health care. Usually in
life if you interact with something and it does not deliver, you do not
return to the same place. Now it may be argued that they have nowhere else
to go but they do have the option to learn that the system is not
relieving their "symptoms". Every practice has had its recurrent chest
pain patient. Scores of admissions mount up every year. At no point does
the patient seem to argue to himself, "on the last admission they seemed
disinterested and discharged me after a few hours, perhaps I do not need
admission". This is also true of patients described by Des Spence. They
never seem to get so dissatisfied with the system that they stop coming.
This would be the normal functional response. Indeed clever medics can
work with this normal response to discharge patients, who are probably
well, by deliberately not being effective.
Of course this lack of normal response is because there must be a
secondary gain to the whole process of attending the GP, being referred
and going through the out patient and investigation process. It returns
one to a child like state of being looked after. It is highly addictive.
One can understand these patients in psychological terms but that
often can increase the resources they draw on as they enter psychological
therapy. Of course they are often clever enough to work out that if they
get better, all the addictive attention from the health care system will
stop.
I have no answers but they resources they consume can be
astronomical. I have seen patients single handedly demoralise several GPs
in a practice. Now that is just not good for anyone.
Competing interests:
None declared
Competing interests: No competing interests
Doctors and delay in their treatment
Doctors and delay in their treatment
Des Spence writes with his usual eloquence on the problems engendered
by the consumerist patient (February 7th). There is however the
other side of the coin, the human being that is reluctant to seek medical
aid and unduly procrastinates. This particularly applies to the medical
profession itself and especially to doctors married to each other and
perhaps even more so if they are practising or have practised in the same
speciality. We are told that the worst doctor ever is yourself and the
next worse is your nearest and dearest.
My medical parents delayed diagnosing appendicitis in my young sister in
1937. She very nearly died. A well known surgeon was summoned from
London. I believe that a Ryle’s tube was part of starting her recovery.
I thought my wife’s arrhythmic pulse was only multiple extrasystoles,
rather than paroxysmal atrial fibrillation. And about ten years ago I
reassured her that her herpes was under control. I left for a week at an
OU summer school, returning to find her in the middle of complicated
treatment for ophthalmic herpes. Fortunately vision eventually was
unaffected. Just recently my efforts to persuade her to seek attention
for a severely infected sebaceous cyst which I call a carbuncle have
failed. Refusal to visit our GP is due to the belief that any antibiotic
is liable to cause rupture of the one sound Achilles tendon, or upset her
cardiac rhythm. And the local hospital must have MRSA! Yet my nearest and
dearest has implicit faith in her octogenarian husband, who has been
retired for sixteen years. My instruction that to test for glycosuria was
perhaps indicated has been ignored.
So nature takes its course and the inflammatory response will I hope
result in speedy resolution. This refusal to seek medical attention for
problems considered self-limiting may be part of the medical spouse’s life
style. Its dangers are obvious although all doctors do tend to keep away
from their colleagues until medical attention is mandatory. I was taught
this not at medical school but by my medical parents who qualified in the
1920s. They were like Des Spence citizens and graduates of the city and
University of Glasgow.
Alan M Smith (retired gynaecologist)
Competing interests:
None declared
Competing interests: No competing interests