You see, the problem is that I don’t really do data.
There are some doctors who are able to quote you the statistics relating to different tests and treatments; numbers roll of their tongues; like silken numerologists, they are able to say… the p value is below the level of significance… or, the 2012 study in the Lancet showed the non-inferiority of x over y.
I have never been that kind of doctor.
I am sorry.
I don’t know if my inability to recall such information has resulted in any direct or indirect harm to patients.
I am not saying that I don’t know my stuff, it is just that when it comes down to numbers I am often at a loss.
The reasons for this probably relate more to my perception of doctoring than an inherent inability to count – although I was never a natural at maths, more the realisation, or, perhaps, my perception that numbers don’t really matter.
I know, in the days of evidence-based medicine, this is probably enough to get me struck-off, but there you are. Beyond innumeracy, honesty is another flaw.
You see, I have always felt that in these studies, the ones that really count, what the number-guys call ‘statistically significant’ require so many people that the individual is usually lost.
Sure, if you have medicine A and two people take it and one person lives and the other dies, that is something, but it could be chance; if 20 take it and one dies who would otherwise have died, that is statistical significance. It’s great, unless you are that one who dies.
We aren’t meant to mix our statistical metaphors, yet, I can’t help myself.
To me, a patient is a patient and moreover they are a person.
They are that one who lived or didn’t.
Sure, in these days of economics and large-scale change we need to look at populations, we need to be sure that the money is invested in the right places, again, that doesn’t help Doris, struggling to reach her front door because the Zimmer-frame is slightly too wide for her doorway.
It is all the individual.
That is perhaps why I have become so mesmerised by the work I have recently undertaken; the shift from hospital, where the buzz, the chaos, the insanity of percentage bed availability, national targets and waiting times rules, to the community, where it is me and my patient.
We sit one on one, confidentially, quietly, our time is ours and we can concentrate; there isn’t someone listening-in behind the curtain in the next bed, their bottoms are not exposed, there is a sense of the importance of the individual that hospitals struggle to contain.
My mum’s old catchphrase from her many visits to the Southern General and the Vicky in Glasgow was, ‘You leave your dignity at the door,’ I never really knew what she meant until I became a doctor and saw the goings-on.
My family at the moment is caught-up in a healthcare ?mess. A 90-odd year-old relative has been stuck in hospital for over two months after falling at home.
Last night she fell in the rehab hospital and was taken to the nearby A&E for assessment; I can picture the scene – Saturday night chaos, stretchers, desperate staff and patients all doing their best; radiographers, porters and healthcare assistants battling, an old woman amongst many waiting, waiting.
She was discharged and returned to the rehabilitation ward at three in the morning; after finding the front-doors locked and gaining access she and her daughter found that all her belongings had been bagged-up;
Managers looking at efficiency, focused on length of stay or bed occupancy rates would potentially be delighted at the efficiency of the service – no acute admission, no bed taken-up, even for the few hours she was in the A&E limbo she wasn’t even an inpatient.
It is this dehumanisation that makes me afraid of the numbers.
For me, it is one person at a time.
Moments pass and it is still the same person.
Their suffering, their experience is that of the individual.
The indivisible person that is not a statistical fragment, a shard of data.
And so too the staff who bend under the weight of the pressures placed upon them, where often it is easier to go along than challenge, stand-up to the bed-manager who at two in the morning is chasing their own tail.
The dehumanisation of healthcare that starts with the data-mongers ends with little a old man or woman, young doctor or nurse, stripped of their identity, boiled-down to happenstance.
Perhaps I should take pride in my resistance to the numbers.
2 thoughts on “Am I a bad doctor?”
So true. What you say is based not only on feeling and empathy but also knowledge and experience. Your opinion is therefore a valid and reliable one and helps prove person centred care is at the core of good medical practice.
You have to genuinely care to be able to provide good care. People instinctively trust those who listen to and strive to understand them. I think that to be this sort of doctor is a privilege ( and awards job satisfaction).
Thanks, Rod. Another illuminating commentary.
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