{"id":3075,"date":"2010-07-20T10:22:20","date_gmt":"2010-07-20T09:22:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=3075"},"modified":"2010-07-20T10:27:09","modified_gmt":"2010-07-20T09:27:09","slug":"richard-smith-can-you-ask-a-patient-anything","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/07\/20\/richard-smith-can-you-ask-a-patient-anything\/","title":{"rendered":"Richard Smith: Can you ask a patient anything?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/home\/icons\/bmjh7648e.jpg\" alt=\"Richard Smith\" width=\"160\" height=\"110\" align=\"left\" \/>Can a doctor ask a patient anything? In the Netherlands the answer seems to be \u201cyes.\u201d Doctors tend not to think so, but at a meeting between doctors and patients in the Netherlands the doctors found that the questions they thought impossible to ask, the patients were happy to answer. Unfortunately the meeting wasn\u2019t written up, and there isn\u2019t research to show that it is possible to ask patients anything.<!--more--><\/p>\n<p>I learnt this in a spirited conversation with senior GPs from the Netherlands, Norway, and Britain. The conversation grew out of me asking why doctors don\u2019t ask about domestic violence\u2014even to the point of not asking an injured woman how she got her injuries. I\u2019ve blogged about this before: <a href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/02\/12\/richard-smith-why-is-the-health-service-so-hopeless-with-domestic-violence\/\">https:\/\/blogs.bmj.com\/bmj\/2010\/02\/12\/richard-smith-why-is-the-health-service-so-hopeless-with-domestic-violence\/<\/a><\/p>\n<p>We moved onto whether you could ask a patient about their sexuality. My thought was that somebody\u2019s sexuality is an important part of them, and the whole idea of being a family doctor is that you get to know your patients as well as you can. In the Netherlands it seems to be no problem at all. Indeed, patients might be put out if you didn\u2019t ask\u2014they\u2019d think that you weren\u2019t interested in them as people. Similarly the doctor can ask about anal intercourse, anything.<\/p>\n<p>In Norway it\u2019s fine to ask about sexuality, although asking about alcohol consumption is difficult. The feeling of the British GP was that it was difficult to ask about sexuality and didn\u2019t matter anyway. The British GP also felt that he had to have a chaperone with him whenever he did an intimate examination of a woman, and he wasn\u2019t sure why it was that lesbian doctors didn\u2019t need a chaperone. The women from the Netherlands and Norway said they preferred not to have chaperones present when they were examined\u2014the fewer people present the better.<\/p>\n<p>Then we discussed whether GPs ought to openly discuss their values when talking to a patient, something else that I\u2019ve blogged about:\u00a0\u00a0 <a href=\"https:\/\/blogs.bmj.com\/bmj\/2009\/06\/17\/richard-smith-on-how-to-improve-your-interaction-with-patients-by-50\/\">https:\/\/blogs.bmj.com\/bmj\/2009\/06\/17\/richard-smith-on-how-to-improve-your-interaction-with-patients-by-50\/<\/a>\u00a0 In that blog I describe how I was thought ridiculous when in a role play I said to a patient that giving her powerful drugs for minor acne made me feel uncomfortable. The message of that meeting was that doctors should introduce their values into consultation\u2014because they are there anyway and if not made explicit may illegitimately trump the patient\u2019s values. But to tell a patient that she made you uncomfortable was to go too far, and\u00a0was unprofessional. Yet in the Netherlands it would be completely normal, the Dutch GP said.<\/p>\n<p>What did I conclude from this conversation? The British are more uptight than the Dutch, particularly about sex. There seem to be considerable cultural variations in what is acceptable. Neither of these conclusions is surprising, but I was left thinking that British doctors may be overcautious in what they ask patients. And seeing that it\u2019s a maxim we are all taught that if you give patients enough space and ask enough questions they will \u201ctell you the diagnosis\u201d I fear that British reticence may reduce the quality of British medicine.<\/p>\n<p><strong><em>Richard Smith<\/em> <\/strong><em>was the editor of the BMJ until 2004. <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Can a doctor ask a patient anything? In the Netherlands the answer seems to be \u201cyes.\u201d Doctors tend not to think so, but at a meeting between doctors and patients [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/07\/20\/richard-smith-can-you-ask-a-patient-anything\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-3075","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: Can you ask a patient anything? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/07\/20\/richard-smith-can-you-ask-a-patient-anything\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: Can you ask a patient anything? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Can a doctor ask a patient anything? 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