Neil Chanchlani: Why composite patients just won’t do

Whenever I read a story or novel about doctor and patient interactions, I’m often bewildered. Primarily out of interest, but also because I feel like I’ve been short changed.

How come I’ve never come in contact with a pregnant evangelical Christian who requests her obstetrician to cut her fallopian tubes during a C section so that she can no longer have kids? Or similarly, why I have I never met an elderly, demented patient who has an extensive and valuable art collection, but has been swindled by her maid and is now left penniless?

Novelists, writers, and journalists often write about composite patients. Recently, I attended a conference where author and Telegraph columnist Max Pemberton and Mail on Sunday medical writer Ellie Cannon spoke about how the patients in their columns aren’t identifiable because they’re made up of “dozens of patients who present in such a way, or along similar lines.”  

This doesn’t cut it.

In medical publishing, which I think should include not only academic journals, but also health sections of broadsheets and magazines, authors and editors aim to educate and inform. Why then should we make up patients? Doing this dilutes the accuracy of the situation. If I am ever faced with an ethical dilemma, I can’t replicate what authors who write about composite patients have done in similar situations. Why? Who knows if they actually did what they said they did? Or if their patient’s situation was slightly different than how they actually wrote it on page?

To the lay reader, composite patients may not seem bad. They may be a peg to introduce an important or topical clinical scenario (ie – vaccinations or screening). But for those of us who read stories and articles about patients and doctoring, why not just tell the truth?

Most patients are happy to give consent to publishing details about their clinical scenarios (so long as their identity is relatively preserved). And we shouldn’t condone changing details to avoid asking their permission. After all, it is their story and not ours.

Neil Chanchlani is student editor of the Student BMJ