Alida Baxter

Renowned London journalist and author

View from Soho

- How Doctors

Communicate with

Patients

Recently I was talking to Gastroenterologist, when he said, The trouble is, we don't know what causes IBS. (Irritable Bowel Syndrome)

You may be surprised to learn that I could have kissed him. I'd better draw a veil over what I'd have done if he'd produced a miracle cure, but there isn't one, and after decades with the condition I know that as well as he did. My gratitude was for his frankness, because (like most patients) I'd far rather that doctors didn't adopt an I'm a God and you're a peasant attitude, and admitted when conditions perplex them, or are desperately hard to treat.

The truth is always preferable to a load of flannel, and when I think back to various crucial medical moments, what's made them stick in my mind has always been sympathy and honesty or the lack of it. Let's start with one of the worst.

I was visiting my mother in a hospital ward when a consultant made his rounds, accompanied by a group of young people in ill-fitting white coats. The consultant radiated superiority from every stitch of his Savile Row suit. He stopped at the next bed to my mother, where an elderly lady was waiting for news. She'd been very ill for the few days since her admission, and I knew she was worried. Well, we think you can go home, beamed the consultant. You'll be more comfortable there.

Relief spread over her face like sunshine, and she thanked him over and over as he moved away. But, at a distance, he murmured to the young people, and a boy detached himself from the group, shuffled, scarlet faced, to the lady's bed and began to draw the curtains around it. Only when I heard her cry out and start to sob did I really believe what was happening. The young man had been delegated to tell her what the consultant apparently didn't consider worth his attention that she was dying, and there was nothing that could be done for her. A nurse came rushing with tea, and I caught the words possibly - hospice.

I have hated people in my life, but rarely those I did not know. I make an exception for that consultant, whom I hated and still hate like poison. If you're a doctor and you're reading this, behave better than he did or, be warned, I'll start making a wax image right now.

The ones who are honest get my commendation, although how they're honest may still need some work. On another occasion, in a ward heaving with patients, I waited for a consultant to talk to me about my mother's condition (she was due to have a biopsy). He came tearing down the ward and the only way to speak was to run along beside him. It's cancer! he shouted, before diving out of sight.

I stood, all the activity whirling around me, and felt as though I'd run into a wall. My mother hadn't even had the biopsy yet, and she was so funny, so vital . I was appearing on television, fleetingly, at the time, and supposed to be witty. Witty? The brain cells for that had gone numb.

When I found her, my mother was brilliant, compared to me. Faced with that peculiarly hospital-bound dilemma the food that someone else has ordered two days ago and which is all yours now, while they're back home with chocolate and chips - she seized a fork. She'd just been questioned by a teenage houseman about what contraception she used (she was in her seventies, and my sex life was her constant worry) and was facing a plate of stone cold baked beans and sodden toast. Why don't I just commit suicide now? she said calmly. And formed an immediate friendship with the French woman in the next bed.

That consultant gets an A Star for honesty, but not for the sympathy or empathy that might have convinced him to communicate with us. When my mother was discharged from hospital after a lumpectomy, we were still horribly ignorant. I changed the dressings on her wound (although I hadn't been told how to), and neither of us knew anything about the medication she'd been put on. She ended up in A and E a few weeks later with a thrombosis, and the medication was to have horrendous side-effects for the rest of her life.

Don't give up, though - it's nice to be able to quote some heart-warming contrasts. Following my second, major, spinal operation, I developed bladder problems. But from the very first moment I was seen in the Urologist's Clinic, I knew I was on to a good thing. And this is something I've observed time and again that a really good consultant means a really good team. People copy, and learn by example, and if the top man treats patients superbly, so will everyone else.

Going over my symptoms and tests, a young doctor said, Please don't worry, you don't have bladder cancer. And I could grin at him. I never thought I did for a minute, I said. And I hadn't. All I needed was a minor operation, but my conversations with the consultant were wonderfully thorough and reassuring.

Most telling of all, one day while I was waiting to see him, I heard him talking to another patient in the next room. Neither of us could help the thinness of the walls, or the fact that he was having to raise his voice for someone who was deaf.

It soon became clear that the patient was a frightened and confused elderly lady, who was so scared that she was finding it hard to understand what he was offering her. Without a trace of impatience, he repeatedly explained the options, the treatment he recommended and why, and the results she could expect. Always polite, always kind, the repetition went on, again and again, and, marvelling at what I heard, I realised that her quality of life would be vastly improved, and he didn't seem to care how long it took before she understood and stopped being afraid.

In case you're wondering, this was happening in an NHS Clinic, not a private hospital, and if ever a consultant demonstrated how to communicate with a patient, he did. I wish he gave lessons throughout the country. My own brief stay in hospital, under his care, was one of the best I've ever had. Why haven't you asked me for anything? chided the Staff Nurse on night duty. I'm not having you lying there in pain! And I felt like weeping at being spoken to with such kindness I was only in the mildest discomfort, and when I'd been in utter agony in another hospital, having been virtually sawn in half, the nurses wouldn't even give me what the Pain Relief Team had prescribed!

That Urology consultant led an incredibly caring team of doctors and nurses, but none of them behaved any better than he did and probably that was the whole secret.

Of course it's no secret to some - the very best - people. When she was in her eighties, my mother was seen by an eminent ENT surgeon. Following a bad knock to the bridge of her nose, she hadn't been able to breathe normally, and had been panting through her dry mouth for ages. The only response from the GP's surgery had been tell her to put Vick up her nose but, raging, I managed to get a referral for her, and eventually we sat and waited in a packed Clinic. At this stage of her life she'd become somewhat childlike, and said exactly what she thought.

Finally admitted to the Presence, she took one look at the consultant and wailed, My bum hurts!

Those benches are hard, aren't they? responded the great man gravely, and proceeded to examine and question her. He sent her for immediate X-Rays, which he studied in front of us, having waited at the Clinic. (A first, in itself.) Then, There are absolutely no airways, he told me, his mouth tight. He would have to operate, but the surgery would solve her whole problem. Even I could see that bone was in the wrong place, and Vick wouldn't dissolve that Honesty? Sympathy? He was the living embodiment of both. Her operation was scheduled very quickly, for a Monday morning, and I took her to the hospital on a Sunday afternoon. As we sat in the ward, I watched dumbstruck while a cheerful Staff Nurse stripped a bed and washed every inch of its frame and waterproof mattress. (I've lain in a hospital bed and had a cleaner brush the dirt off the frame and on to my face.) The nurse remade the bed for its new occupant, while my mother drank good tea from a china cup, and every time I visited after that a kettle was singing in the ward kitchen.

Infections? There? You'd have to be joking. The nurses were outstanding, just like the Consultant, who performed the operation on my mother's blocked airways, was patient and sweet with her, answered all questions, and quietly gave me the name of a nursing home, saying that if the time came when I couldn't cope.

I will never forget him, or those who worked with and for him. They are scattered to the winds now (their hospital was closed, like many others in the West End of London, despite a prolonged and heartfelt campaign) but they will have taken their attitudes and standards with them, and patients, wherever they encounter them, will have cause to be grateful. Hurray for doctors who communicate not only with their patients, but with the teams they lead and let's, please, have many more of you.

© Alida Baxter

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