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A difference in expectations


Does doctor know best?
Harold Lambert Physician
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I think there is a certain thing about doctors thinking of patients as slightly below, and I think it comes up as a question of manners, of civility and politeness. I think you often see... I suppose, as a student rushing into a room with a lot of people and a lot of things you see, and I'm sure I must have been as guilty as the next man of it, were to do with of civility and, of course, the patient is the underdog. How much more of an underdog can you be if you're in fear of your life and, and your health or your fam... or your loved ones? I mean, you know, Virchow, Rudolph Virchow, the founder of cellular pathology, was a great social reformer and he said, I don't actually, remember the exact quotation, but something to the effect that doctors are the natural attorneys of the poor, which is that thought, really. So I think, but I think truly, although that is a point and, as you know, from various things I've sounded off about, I think doctors could be a hell of a lot more polite, quite apart from the official care, but I think the, the much bigger issue is the whole business about communication and how doctors and patients understand each other, which is huge and maybe we could go into that a little bit. I think the misunderstandings are immense. In fact, in my gloomier moments, I think most of doctors and patients is to do with misunderstanding actually, it's so vast. And I think there's, there's a bit where people do get it slightly wrong, which is that everybody knows the emotional blocks, or they should do. People are afraid going to a doctor is... I mean, I'm not talking about trivial illnesses. I'm talking about existence or fear of bad illness. Actually, I don't believe in the word trivial about illnesses but... old Alec Cooke, who's the, who just missed his 100th birthday, had a lovely saying which is that a minor operation is one done on somebody else. I think a trivial illness is somebody else's illnesses. And I think really that's quite true. What was I talking about? About misunderstanding, and they, the emotion box... denial, fear, anxiety, I mean, not wanting to go to this awful thing of, the awful thing about hospital is the awful escalator you tread on with great trepidation, including you and me, I would imagine... and that's all known about. I don't think I need to expand it. We all know about it. The question is how you tackle it and the, the thing, the enormity of the thing when it's really bad that it's so terrible for the patient to be at these risks... all of us, any of us... that I think is quite understandable that doctors and hospitals do become slightly detached, depersonalising places because I think it's the only way they can handle it and it's the balance between that and, you know, being au fait with what the patient's experiencing. So I don't really feel very critical when... I think doctors are better now. I think we were a bit arrogant when I was a young doctor and student. You didn't really, and I suppose you are much younger, you don't feel, feel death, I suppose, to knowing about it, and I think probably we didn't really take on board this huge difference between our situation and the patient's as much as the young doctors do now, I think, because they're told about it.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: manners, politeness, civility, student, misunderstanding, patient, doctor

Duration: 3 minutes, 42 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008