Doctors and their medical practices

Once again I’m writing something else before writing about women’s issues. I felt pressed to write this first because I see that the first episode of season 6 will be aired in the UK on Monday night at 9 pm. I noticed in the trailer that was released that Doc Martin’s bedside manner (or lack thereof) is once again a major concern and I really want to discuss that.

Doctors in the US have a saying that patients are most concerned about the 3 As: first affability, next availability, and finally ability. Of course, this is simplistic, but it says a lot about what patients often use as a guide when dealing with doctors. Throughout this show Doc Martin’s gruffness, rudeness, and all around anti-social behavior have been a topic of conversation. At the same time, his complete dedication to doing the best job possible and his amazing ability to determine what is causing a patient’s symptoms have been topnotch. Over the 5 seasons he has diagnosed all sorts of unusual medical problems and often without anything more than his own keen observation and examination. I have been more than impressed that the show includes examples of Sjogren’s, Cushing’s, Addison’s, Reiter’s, Methanol poisoning, and Trimethylaminuria. There have been cases of HRT therapy leading to the growth of male breast tissue, glaucoma, allergic reactions galore, poor diabetes control leading to the person slurring her words and being accused of excessive alcohol use, and even the mixing of medications that can be dangerous if combined. Could one doctor be this capable of recognizing all these disorders? I think so, and I think the show does a good job of making Doc Martin’s ability incredibly believable. (I don’t want to neglect to mention that this doctor shows remarkable willingness to call an ambulance and that he is fortunate that this small village has such access to emergency services. It’s great to see a doctor who has no hesitation to call for help and that is another sign of a very capable physician.)

I do not think that all doctors are as knowledgeable as Doc Martin, but I think that there are some who are. I also believe that there are doctors who care as much as he does about medicine and devote themselves to their practice like Martin does. Many doctors are on call (or available day and night) at least some part of every week. I don’t see them running down the street to get to a patient in need very often, but they will meet a patient in the ER or their office when necessary. There are few doctors in America who will make house calls like Doc Martin does regularly, but they’ll talk to you on the telephone and make time for you at all hours of the day. And that brings up another part of being a doctor that accompanies this availability: interruption of their personal lives. Yes, in the show it’s amusing that Martin’s phone often rings at the most inconvenient moments, but that really happens in doctor’s lives all the time. Do people actually come up to doctors at the most inappropriate times to ask medical questions? YES! My husband has been disturbed at concerts, in restaurants, at the fitness center, almost any place he goes. Maybe the weirdest was while he was with one of our children while they were in the middle of a swimming meet. In a small town the problem is worse because it’s impossible to go anywhere without bumping into patients. One reason Martin may not want to go out is because of the hassle of encountering patients. Just look at what happens when Martin meets Louisa for dinner (or doesn’t get through dinner because of a patient), or wants to have a drink with her only to be taken aside by someone else. His directive to make an appointment may sound brusque, but it’s the best way to set some boundaries.

As far as bedside manner goes, establishing rapport can be important, but it’s probably more important in a large city where it’s harder for patients to get to know their doctors. In a small town where the patients are familiar with their doctors there’s a little more leeway. Nevertheless, Louisa makes a point of telling Martin that the people of Portwenn like having a doctor who becomes a part of the community and there is clearly a concern that doctors in England pay special attention to getting along with their patient population. Witness the “doctor’s friend” Gavin Peters who appears in season 2, episode 9 and says he’s a liaison between practitioners and the local medical committee. From what I can gather, all doctors in England are supposed to register with the General Medical Council and then be subject to reviews of their services. I’m sure most doctors don’t like this supervision and Martin is no exception. Gavin tells Martin that patient care is not only about proper diagnosis but that doctors also have a pastoral duty. I don’t know about the necessity of a doctor to minister to a patient, but the most important part of creating a good connection with one’s patients is being able to elicit information from them that can help in their care. Doc Martin seems to know the right questions to ask and generally manages to get a good read on what’s going on with his patients. His observational skills are his best tool. The one time he would have been been better off being more sympathetic was when Phil’s wife Helen dies suddenly in season 2, episode 5, and Aunt Joan let’s him know it. A patient’s death or serious setback requires some kindness from the doctor, I think. But don’t forget that Doc Martin several times keeps people from dying and a few of those cases are people he isn’t too thrilled about, e.g. Danny, Eleanor, and even Holly. Saving their lives demonstrates how doctors treat anyone in need no matter their personal feelings. You might think that Martin is simply treating the medical problem and not the person, but you have to expect him to have some thoughts about who he’s rescuing.

The other thing that’s significant is how much he believes in patient confidentiality. That point is driven home time and again when he refuses to discuss a patient with anyone else. In such a small town maintaining confidentiality is particularly paramount since pretty much everything that people hear gets spread around quickly, e.g. his hemaphobia, or that Phil Pratt is gay. Besides, doctors are expected to keep their patient’s problems private and most follow that dictum wholeheartedly.

What Doc Martin lacks in people skills he more than makes up for in diagnostic skills. And he does care enough to literally tramp through the woods in search of a sick patient, or climb a ladder and risk his own safety to reach a patient, or, worst of all, rappel down the side of a cliff to help a patient. Ok, there is some humor in seeing him go to these lengths, but at the same time, he is totally committed to taking care of these people. When Martin has outbursts where he yells at patients, it’s primarily a sign of frustration that he’s trying to help them and they won’t allow him to complete his exam or treatment of their problem. Once again most doctors experience this frustration; they just don’t run after the patients yelling epithets. However, they’re probably thinking exactly what Martin actually says. Furthermore, using the internet to diagnose one’s symptoms is something I believe doctors universally deplore. I think we all want to look up what might be going on with us, but there is a lot of information on the internet that is unreliable or simply wrong. When patients come to a doctor convinced that their symptoms are one disorder or another, doctors have to conquer preconceived notions as well as do their own exam. It often adds an unhelpful layer of complexity and Doc Martin’s disgust with this practice is very much in line with the approach of most doctors.

Ultimately, the people of Portwenn know they have a doctor who is dedicated to their care and I’m pretty sure his ability is more important to them than his affability.(Dr. Dibbs provides a counterpoint to this issue of affability versus ability. When she arrives in town, some patients she treats find her very pleasant and are quick to consider her a welcome change; however, it’s not long before her lack of ability becomes apparent, and by the end of her brief stay in Portwenn, the people are very glad to have Doc Martin back. Dr. Sim may have been just like that too – the people liked his affability, but his ability was sorely lacking.)

Originally posted 2013-08-31 02:58:12.

2 thoughts on “Doctors and their medical practices

  1. just a doc

    Hello:
    I wanted to make some comments. First, I am a big fan of Doc Martin. i have enjoyed every season and look forward to new ones. However, unfortunately, there are some interesting but predictable inaccuracies in the final episode of Season 6 “departure” as well as the earlier episode “hazardous exposure” that are typical of medical TV shows and movies. For the life of me, I don’t know why these shows don’t get consultants who are more informed in some areas — one area in particular which is my area- radiology. One of the most common errors one sees is the depiction of doctors being able to do any procedure imaginable, even ones way out of their training, and with confidence and perfect outcomes. This is highly unlikely to happen in real life. Dr. Ellingham does incredible things all the time that are pretty unlikely to be in his skill set. However, let me tie this to radiology as is the case in these 2 episodes. FIrst, Doc reads some obviously copied hard copy xrays in his office of a man’s chest in “hazardous exposure” and diagnoses hypersensitity pneumonitis. Not likely. In one brief moment one gets a glimpse of one of the films and there is a large upper lobe mass present. This is much more likely lung cancer than Martin’s diagnosis, which the average surgeon would not likely be competent to diagnose on a chest xray. The next is Louisa’s near fatal AVM in her head in “departure”. FIrst, I don’t believe Martin is a neurosurgeon. I think he is a vascular surgeon (they work outside the brain), and so he would not be great at picking up AVMs on MRIs particularly in these circumstnces. Also, the idea that a hospital would release a patient without post-gadolinium images being cleared and interpreted (which I believe was done in this episode) would be a very grievous error and quite unlikely. This problem is really within the expertise of neuroradiologists. Further, the procedure Martin performs on Louisa (an embolization) is done in real life by interventional neuroradiologists, which requires considerable expertise and training. I see inaccuracies like this a great deal. People commonly have no idea that a lot of neat stuff they see on TV is what radiologists or radiologic technologists do. I recall once on “House” (the TV show with Hugh Laurie) one of his clinician minions was running an MRI scanner. That is simply impossible. Even most radiologists are not really trained to run the scanners. Technologists do that. Radiologists, however, have the training for setting up scanning protocols and interpreting the images. The technologists are valuable members of the team too. Their expertise is in the actual running of the MRI machines to get the images and then transporting the images to databases to be interpreted. I understand though — this is not exciting enough for most script writers! Much easier to have the main character, who is likely a surgeon, ER doc or internist do everything in the interest of drama! There are alot of people out there who do amazing stuff (nurses, pathologists, and others) who too often don’t get depicted performing the vital service they provide. Maybe some of this artisitic license may have something to do with the unrealistic expectations that people have of doctors in general??

  2. kjacobson@mindspring.com Post author

    Thanks for your input. I certainly agree that so much about medicine is misrepresented on TV. I wrote about the AVM treatment in my post “Medical Questions Related to Episode 8.” I did not get into the radiology issues to the extent that you do, and I’m sure your points are well taken. I guess despite their assertions that everything to do with medicine has to be accurate in UK, there are many medical events in this show that do not follow proper practice. (I also remember the show “House” and how absurd it was to see his Fellows doing MRI scans and all sort of other procedures they would never be allowed to do or capable of doing under most circumstances.) I suppose we have to fall back to the position that we’re watching a TV show and we have to give the writers, et. al. dramatic license and suspend our disbelief. In DM we are exposed to so many medical conditions, and I find it interesting that they bring in so many esoteric ones, but I sure hope very few viewers relate to these on a personal and practical level.

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