The power of doing nothingBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4409 (Published 09 July 2013) Cite this as: BMJ 2013;347:f4409
- Des Spence, general practitioner, Glasgow
I recently booked a ticket on a sleeper train from Glasgow to London, and it was surprisingly cheap. At the station, I realised why; I had booked a seat and not a bed on the overnight train. Sleeping in an upright chair—velour seats, stained headrest, other people’s sweat—gave a flashback to my childhood in the 1970s and the overnight train journeys to London I took many times with my brothers. I was always scared, but I learnt much about life (although I never received a Duke of Edinburgh award). Whenever I was fearful, my brothers reassured and comforted me. These experiences toughened me up and made me cope and face my fears.
Medicine is about comfort and reassurance, not about diagnostics, big machines, and glass fronted hospitals. In medicine, most patients present with anxiety, for the fear of illness is far, far greater than the risk of illness. These unfounded fears are whipped up by a thoughtless public awareness campaign, a celebrity “illness” splash to aid a fading career, insensitive comments of a relative, or Googled minor symptoms that always suggest: “consult your doctor, you may have cancer.” Anxious patients know that they have blown things out of proportion, but they just can’t shake off these worries.
So every patient has an agenda, often hidden for fear of seeming foolish. But with experience, respect, and humour, these unfounded anxieties of cancer, heart disease, or the weird and wonderful world of internet misdiagnoses spill forth. This is the opportunity to reassure and take away the fear; “you’ll be ok” is the only phrase anyone ever wants to hear. Even in terminal situations, our role is to reassure, tell everyone that they are doing well and that it’s all OK, soak up the angst and anxiety, and take away the fear. Reassure not refer.
Regrettably, at undergraduate and postgraduate level, every medical text spectacularly fails to understand this. We do not select doctors on their ability to effectively reassure and communicate. Concerns and patients’ agendas are missed and the opportunity to reassure is lost. An uncertain doctor suggests investigation under the pretext of reassuring the patient, but in fact this is only to reassure themselves. So a patient who previously felt foolish now feels that there “must” be something wrong. Of course, investigations lead to spurious results, referrals, and endless health anxiety. A system clogged with now fearful patients and dissatisfied doctors. Doctors must face their fear of uncertainty and learn to reassure—the power of doing nothing with style.
Cite this as: BMJ 2013;347:f4409
Follow Des Spence on Twitter @des_spence1