Copperfield criticises media reporting of patients being ‘fobbed off’ by GPs and doctor-bashing headlines
This week, GPs have mostly been rubbish at diagnosing endometriosis. Nothing unusual there. Except for the novel slant on GPs’ attitudes who, allegedly, ‘laugh off’ endometriosis fears.
And yes, it’s true, the symptoms of menorrhagia, dyspareunia and infertility are hilarious, if you’re a psychopath, yet quite a few of the GPs I know aren’t. But at least it makes a change from the usual vernacular of ‘fobbed off’ (patient-speak) and ‘dismissed’ (journo-speak).
‘Fobbed off’, of course, actually means, ‘Didn’t do what I wanted’. As in, ‘I wanted antibiotics but he fobbed me off with a careful history, a proper examination, reassurance, safety-netting and an explanation of the usual course of minor, self-limiting viral upper respiratory tract infections’. Yep, and I didn’t laugh.
When things actually go wrong (as they inevitably will sometimes) or when things are perceived to go wrong by those with no medical knowledge (as they are, often), and the papers get hold of the story, the GP-bashing inevitably escalates to the doctor ‘dismissing’ the patient.
This suits the lazy journalistic stereotype of GPs, who are consistently portrayed as compensating for their ignorance by being authoritarian, arrogant and uncaring. But I genuinely don’t know of any GPs who act like that, even the few that think like that. And it’s a caricature so outdated that when I conjure up the image, it’s automatically a male in a pinstriped suit with a massive ego in black and white, which I realise is Sir Lancelot Spratt. Who wasn’t even a GP.
That said, some kind of dismissal system might be a good idea, perhaps using yellow and red cards. Two yellows, say, for a list followed by a demand for an X-ray, contractually obliging me to point to the door. Or a straight red for, ‘Anyway, that’s not why I came,’ which would also incur a four-consultation ban.
In the meantime, being GPs, we just have to continue to suck it all up under increasingly impossible conditions. Which means dutifully carrying on dispensing reassurance, empathy and rational treatment, misinterpreted by patients and misrepresented by journalists as being dismissive.
I’ve become so frustrated and furious about how this translates into doctor-bashing headlines that I’ve written to the nationals about how ill-informed, destructive and demoralising this is. But they dismissed me as being just a GP with a low moan threshold. I reckon they were laughing at me, too.
Dr Tony Copperfield is a GP in Essex
Dear Dr Copperfield,
As ever your observations are correct but you haven’t accepted the ‘Stockholm’ effect on our vulnerable patheticness.
I fobbed off a patient the other day. He walked into my room and said “doctor, doctor, I feel like I’m a key.”
Oh, Dr Copperfield, you are showing your age now.
It is not an ‘fob’ andy more – it is an ‘FIT’ now !
Though what use it is in endometriosis, is not reported in the ‘Pathway’ we were sent !
I’m really glad you wrote this. I enjoyed it a lot. I read the BBC article walking from the car into work (I had to park up the hill by the church) and wondered how a patient had managed to find 2 GPs who had both independently laughed at them (the patient) and also said that they have a very low pain threshold….? The real kicker was the suggestion that we spend more time exploring symptoms and offering more than the pill or an IUS. Maybe GnRH with add-back Tibolone and then a laparoscopy the week afterwards will be part of the gynae neighbourhood plan I’m looking forward to being revealed next week like the paediatrics one was this week.
Then again, a smug but sweaty journo came to see me pointing to his arm saying “doctor, I’ve had these pains in my radius bone.” I couldn’t help but laugh out loud in his face, “that bone’s not the radius, that’s humerus.”
People have always been quick to criticise
“Doctors are men (and women) who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”
That probably sounded even more contemptuous in the original French
Quite so. The verb to Fob Off is now almost uniquely applied to doctors and their questionable practices. Peak Fob for me is to achieve a proper and good-going fobbing incognito, without the patient actually realising they are being fobbed off. First – be certain there is no potentially serious diagnosis going on (some skill required). Second – make up some total BS that explains the patient’s symptoms in terms that sound highly scientific but which you actually made up on the spot (deadpan face required). This actually does work in many cases. Patients like explanations. It helps them get better. A bit like a placebo. Oh dear I’m being too worthy, Not very Peak Fob anfter all.