Q J Med 2003; 96: 387-388
© 2003 Association of Physicians
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All Greek to me
The consultation was difficult from the start. The patient appeared to speak some English, but it was barely adequate. She had come into my surgery clutching two pieces of paper. She opened the first, which was a calendar of the past year. There were circles around almost every date, some in red biro and others in black. Some of the dates were annotated in her handwriting, in her native Greek. She was evidently trying to tell me about her periods. They were too long or too short, too frequent or not frequent enough—I was not sure which. I wondered if she was trying to get pregnant, or perhaps trying not to get pregnant. So far, it was hard to know.
She opened the second piece of paper. It was picture from a pelvic ultrasound. I thought I could make out the uterus and a right-sided ovarian cyst (no great technical feat here, as they were labelled in English, for some reason). The cyst looked as if it was probably a fairly small and innocent one, maybe a corpus luteum cyst, but I was very far from certain.
She was flustered. She wanted to explain lots of things to me, and I guessed that she probably wanted me to explain lots of things to her too. She hadn't let us know in advance that she might need a lot of time or someone to translate. Reluctantly, I phoned through to the office and asked them to get a Greek interpreter on the line. By the time the call came through I was already running late, and I knew that my decision would make the whole session, and my mood, bloody.
Having a phone interpreter made things better, but not hugely. At least we managed to establish that the woman's periods were infrequent but prolonged. Also she had no wish to get pregnant, and she gasped with horror when the interpreter explained that I hadn't been sure. Apart from that, the story got more confused.
Through the interpreter, she explained that she was sure it was the cyst that was making her periods too long. A professor of gynaecology in Athens had told her so. Every time she had a long period, she explained, he used to give her injections of antibiotics to bring it to an end. There ought to be a word for the stories that patients tell about their previous encounters with doctors, especially the very common kind like this that have no perceptible relationship to recognizable diseases or familiar treatments, and that pile up ‘non sequiturs' nightmarishly on each other. I wasn't sure whether (a) the patient had misunderstood what happened in Greece, (b) the doctor there was a quack, or (c) there was something I didn't know about single cysts, prolonged periods and antibiotics. I got even hotter under the collar at the thought of trying to unscramble the rapidly escalating muddle.
There are consultations that go very well and harmoniously and leave you with a nice warm feeling about what a caring and attentive doctor you are. There are other consultations where you wonder why you chose medicine as a career. Suddenly, you recall all those trivial and arbitrary circumstances that led to such apparent inevitability, and you find your mind wandering to all the paths in your life that you never took: novelist, traveller, philanderer, tycoon. Fighting off such thoughts with diminishing success, I tried desperately to ask a few more questions through the interpreter to establish even the most tenuous commonality between this woman's understanding and mine. Each question failed. Each answer seemed to open up a new and previously unimagined conceptual chasm.
Reader, I lost it. I stopped remotely trying to understand her problem, let alone to solve it. Instead, I hectored her (it certainly felt to me like hectoring) about the impossibility of dealing with complex problems in haste. I reproached her (it certainly felt like a reproach) with giving me inadequate notice of the time and facilities that would be needed. I confronted her (it certainly felt like a confrontation) with the fact that much of her story seemed either incomprehensible or implausible to me. I rounded off this tirade (it certainly felt like a tirade) by pointing out that I wasn't her regular doctor anyway and it would make far more sense to book next time with the doctor who knew her best, giving enough notice to the receptionists and so on and so forth...
I knew already that this was the kind of consultation that would later leave me wincing with secret shame at the recollection of my unprofessionalism towards this patient, let alone the appalling impression I must have created on the interpreter. This was certainly not an encounter that I could ever report to colleagues, let alone commit to print. And so it would no doubt have remained, had it not been for her response: ‘You have been very kind, doctor, and I should like to see you next time.’
I was speechless. I would certainly not have named kindness among the emotions I had been struggling with during the previous twenty minutes. How on earth could she have perceived me as kind? Perhaps she been struck by my willingness, albeit grudgingly, to call in the aid of an interpreter. Maybe she experienced my prolonged ranting at her about resources as entirely proportionate to the scale of her need. Or was she responding to something rather more intangible?
Time and again, we have to re-learn in this job that what patients seem to value in us is not usually technical expertise and certainly not charm. It may be the thing that we fear the most: being ourselves.
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