Haslam D. Fictional doctors do us no favours. Practitioner 2012; 256 (1754):35

Fictional doctors do us no favours

20 Sep 2012

AUTHORS

Professor David Haslam CBE FRCGP
National Clinical Adviser to the Care Quality Commission, Past President BMA, Past President RCGP

Article

Don’t you find docs on the box intensely irritating? I’m not talking about the real doctors who pop up on factual programmes putting minds at rest, nattering to presenters, giving an instant update on whatever medical condition has come to the fore overnight.

It can’t be easy, getting a call asking you onto breakfast TV to discuss the ins and outs of Rocky Mountain Spotted Fever, just because some minor celebrity has been diagnosed with it on holiday.

In fact, it’s just about as straightforward as doing an average morning surgery when patients can descend and ask anything and everything and you don’t even get a moment’s notice.

Nevertheless, it is distinctly challenging when you know a couple of million people are watching you, even though my personal experience of television was always the same. Whenever I did a TV interview, patients who saw it would say things like: ‘I liked your shirt, doctor,’ or ‘You looked tired this morning,’ but never ever had a clue what I had been talking about.

But, as I said, it’s not those docs on the box who irritate me. It’s the fictional ones. They are the ones who do us no good at all.

Points of irritation abound. For instance, fictional doctors always give an answer when asked the question: ‘Give me it straight, doc. How long have I got?’ And even worse, they are typically right. Whereas in real life, we usually have absolutely no idea and our predictions turn out to be entirely useless. The docs on the box never ever prevaricate.

Neither do they ever have problems parking. Whenever they do a home visit, which is typically often and rapidly, they pull up outside the patient’s house to find an ideally spaced parking slot ready and waiting. In real life, we find ourselves trailing up and down adjoining streets until we give up, double park, and get a ticket.

They are so irritatingly good at making diagnoses. Not for them the uncertainty implicit in, ‘We’ll run a few tests and see you again next week,’ which is best described as using time as a diagnostic tool.

They peer at tongues – something that in my entire career never gave me a diagnosis other than thrush or thirst. Then confidently announce that this is Von Wipplestrapper’s syndrome, and ‘Thank God you came today. We’re just in time.’ And it’s not just you Dr House that I’m talking about – diagnostic acumen is a hallmark of every doc on the box.

Fictional doctors never arrive at a house call having forgotten a vital piece of kit like a nebuliser, otoscope, or stethoscope. I’ve managed all three of those – though not on the same day. They never have the wrong set of notes when talking to a patient, and spend ten minutes on completely the wrong tack, while being looked at with ever increasing puzzlement by the patient concerned.

When they meet patients in the street, or in the pub, or in the supermarket, they always, but always, remember their names.

I worked out long ago that the all purpose response of ‘How’s it going?’ covers everything – whether they are complex patients, acquaintances who think they are friends, or people you simply can’t place. But it doesn’t work so well with members of your own family.

Most bizarre of all is their skill when dealing with death. They are almost always able to predict the time of death to the nearest hour while simultaneously flirting with the glamorous police officer who called them and looking suitably rugged or attractive, whatever time of the day or night the call happened to come.

I guess that’s why they are fictional. Real life is just so much less predictable.