Trust deficit - A prescription for failure.

I'm 40, and over the years I have had many different doctors at a fair number of different surgeries. During that time, relationships that we the patients have with our GP's have changed a fair amount, and that has not always been a bad thing. In the past, doctors were very likely to prescribe us something, not really explain what was happening, and seemed to many of us to be somewhat aloof and apart from us the patient. Today, they are less likely to simply send you home with pills, mostly will explain more about what is going on, offer advice and in the main, more of us feel more in control of the whole process, these are all changes that most of us are happy with. 

There are some basic things that our relationships with our 'healers' need in order for the relationship to work and ultimately give positive outcomes. The most important one is trust. Without trust, the entire relationship simply fails. We have to trust doctors on more than one level. We have to trust that they are competent and knowledgeable, that they provide treatments for us based on what is the best solution for us and not one that has been biased by third parties such as drugs companies, and that they respect us as patients who by necessity have to put our faith in them. If you cannot trust that your doctor, then it becomes impossible for you as a patient to be treated by them. 

Thankfully, there are things in place to help us ensure that our doctors are competent, there are always a few who fall through the safety nets, but in the main we can be confident of that. There are undoubtedly doctors who are more influenced by certain treatments than others, but again, there are guidelines and safeguards which although not perfect, do give us some confidence that at the end of the day, we will be making an informed decision about our treatment. 

Lastly, is the whole question of knowing that your doctor respects you as a patient and as a person. That your concerns for your health are going to be listened to and accepted, and that no matter what you symptoms or illness, that your doctor will do their best for you. This at its heart, comes down to the professionalism and attitude of the doctor and their willingness to have a proper professional and respectful relationship with you, the patient, the person. We have to take on trust that when we go to see a doctor for say chest pains, and he sends us home and tells us to take 2 paracetamol and not to worry, that he knows that it is simply an infection which will get better by itself and not warning of an impending heart problem. 

But, if you have a mental health issue, it is critical to your condition and your treatment that you can have trust in your doctor. If you felt that the doctor felt you were simply a malingerer or that your condition was not a genuine one, then how could you feel able to go and see that doctor and talk to them about your condition? Many mental health issues leave the person with little self esteem, they have little or no confidence in their own judgement and may also have feeling of paranoia. It is enough of a challenge in that state to go to your doctor and bare you soul to them, to then feel that your doctor will ridicule you to his friends and peers is something that would stop many of them from trusting their doctor and seeing them. 

It was shocking then, to learn of this article in The Pulse, a magazine for medical professionals in general practice.  For those without a subscription, the text of the article is below;

I’d thought, hoped even, that the recession and the inevitable cuts to frontline services that will follow might rid us of hare-brained ideas that do nothing except chomp away at the NHS cake. But then I came across a scheme designed to lift the spirits of melancholic patients by treating them to a few days out on a farm.

Anyone living within welly-throwing distance of Ipswich and feeling a bit down in the dumps can ask their GP (who is ideally placed, etc, etc) to refer them to Farmer Giles’s homestead for a few afternoons of milking and muck-spreading. Which rather ignores the obvious fact that each and every depressed patient on the books will exclude themselves by claiming to be ‘allergic to dairy’.

But that apart, what’s not to like? It might encourage the punters to take an interest in agriculture – it could even reduce their tendency to mount phobic avoidance responses at the first mention of fruit and veg. Although if a heartsink did happen to be bitten by the organic produce bug there isn’t a lot of farming to take an interest in around Basildon – not counting the ubiquitous cultivation of cannabis in the loft, of course.

‘Lettuce and lovage’ is one thing, livestock is something very different. OK, we’ve all seen the research showing that keeping a pet dog or cat is good for Grandma’s mental health. But anybody proposing that the benefits might be proportional to the size of the animal is talking complete bullocks, even when you factor in the substantial savings in follow-up costs when you replace Purrikins with a Bengal tiger.

And then there are the health risks inherent in every trip to the farm. As sure as free-range eggs are well, just eggs, at least a dozen of the participants are bound to succumb to E. Coli or Campylobacter infections after petting the cute ickle lamby-wambies or stroking the nice horsey.

Not to mention the possibility that the Wurzels might turn up, knock off an impromptu rendition of Combine ’arvester and provoke the depressed into enacting a tragic suicide pact.

You might accuse me of getting soft in my old age, but I really don’t want to see any of my serotonin-depleted melon farmers chucking themselves under the wheels of a passing tractor or into the jaws of the threshing machine in a plot line that would even make the script editors of The Archers pause for a reality check.

Why worry? It’s far more likely that I’d see them making a beeline for Ye Olde Worlde Home-Made Fudge Shoppe in the converted barn for some serious comfort food, followed by some even more serious purging and vomiting.

We could scale the whole thing down, I suppose. ‘Mrs Glum, would you prefer your repeat prescription for Prozac or a hamster this month?’

It’s just a shame that we’ll never be able to properly take it to a grander scale… include trips to the zoo, county agricultural shows or American state fairs. I can just imagine the YouTube footage of my heartsinks dodging violently-hurled chimpanzee droppings in Regents Park or wrestling grizzly bears in Wyoming.

Now, that would be worth shelling out for the cost of their hotels and transport, recession or no recession.” Dr Tony Copperfield is a GP in Essex.

Now, I have no issues at all about doctors unwinding and comparing notes with their peers about the issues they have had with some of their patients, but this article goes much beyond that. To label patients as 'Heartsinks', "Mrs Glums' and 'seratonin-depleted melon farmers" shows nothing but simple contempt. That this pseudonymous Dr Tony Copperfield claims to be saying only what most other doctors are too scared to openly admit leaves patients wondering just what is their doctor thinking about them when they visit them. Indeed, this is a quote from the publisher of one of the books published by Dr Tony Copperfield.

'Few people realise it, but underneath the caring demeanor of the nations GPs there lurks a darker side - a side which gets fed up with the frustrations of the NHS and loses its sense of vocation. GPs won't admit to these thoughts, though - and they don't have to, because Dr Tony Copperfield does it for them, even at the risk of his own career. His fearless writing, well known to readers of Doctor Magazine, gives vent to the anger and frustration which bubbles just beneath the surface of so many family doctors.'

For me, as a patient with both physical and mental health issues, this article I found to be both shocking and offensive. It is never easy to visit my doctor, and to now have a feeling that behind my back, my GP may well be branding me and my symptoms in the way that the article has done, simply makes a hard task simply much harder. To the doctors behind the Dr Tony Copperfield articles, it may simply be humour, for many of us patients it is a betrayal of trust, offensive, and unprofessional. One of the real doctors behind the Dr Tony Copperfield pseudonym is Dr Keith Hopcroft.

I know that some have already sought to defend them by saying the article was published for a select audience, but in todays world of the internet that simply was never going to be a possibility, but even that argument does not hold water when it appears that collections of these articles have been published and are available at bookshops. 

Doctors are only human, but by their chosen profession they also bear added responsibilities. They swear to do no harm, they are obliged to hold our consultations in confidence, but they also need to maintain our trust, and it is at the patients cost that they loose that trust, but ultimately, the cost may be their own.