The BMJ Today: What good are doctors?

Call it an exercise in reflective learning or a sign of deep insecurity, but articles like Richard Smith’s latest blog (“I hate going to the doctor“) always make me (mentally) replay my most recent consultations as a GP. I can’t always be certain that seeing me helped those patients, although I know that many have made an impact on me.

Much of what we do is about connecting with people, and results aren’t always tangible. Brian Secemsky recounts one such encounter, where further followup, rather than an early, quick fix, led to much more than a useful solution for his patient. He concludes, “perhaps outcomes wouldn’t have changed and costly resources wouldn’t have been utilized,” but “the amazing relationship that has evolved . . . would not have come to fruition without going beyond the automated pleasantries of etiquette based medicine.”

Another memorable patient was patient advocate Jessie Gruman, who described receiving news of a serious diagnosis “like a healthy person who has been accidentally drop-kicked into a foreign country . . . where you don’t know the language, don’t know what is expected of you, and don’t have a map.” Her achievements include developing such a map for patients—and healthcare providers—as well as setting up a centre advocating health behaviour research, and a news service to help journalists report such research.

Navigating healthcare is certainly no easy task when you have a complex chronic problem, such as spasticity. This disorder can not only stem from serious conditions—ranging from multiple sclerosis to stroke to brain injury—but may itself have devastating effects, with associated pressure ulcers, pain, and contractures, to name just a few.

Doctors often feel ill equipped to do anything, but this Clinical Review and Podcast aim to make us less helpless: the practical approach outlined in both includes how to be alert to triggers for worsening spasticity and, above all, how to relieve discomfort, prevent complications, and improve function and self esteem. But, as always, it’s a team approach that involves not just doctors, but carers, “physiotherapists, occupational therapists, orthotists, nurses, and wheel chair engineers,” with the patient front and centre.

Mabel Chew is practice editor, The BMJ.