Monday, 24 September 2007

The Royal We

I've started talking in the plural.

"We've decided to do this test", I hear myself explaining loudly. "We should try this drug". "We need to get you to pass wind".

I'm not entirely sure how this started. Nor am I clear who's included in this fictional group, or why I need their support.

My subconscious seems to have assessed my medical knowledge, and found it inadequate. Subconscious Worm decided that no sensible medical governing body would licence me to take potentially life-changing decisions on my own.

Ipso facto, X-factor, all my decisions need to be group ones. Safety in consensus.

The Royal We is comforting, for me and the patient. It says there's accumulated wisdom behind my seemingly random choices, method in my madness. Multiple physicians agree with my diagnoses; they're just busy doing other things at the moment, so you can't see them.

Sometimes I wish there was more of a real group dynamic with my patients. Having to talk to people - or still worse, get near them - on my own can be truly horrifying. Tom, an A&E regular, was not a pleasant one-on-one interaction. He smelled so bad, I actually retched as I tried to take his blood. When he finally told me, "f**k off, I need to sleep off my hangover", it was a relief.

At other times, having someone else there makes a bad situation worse.

On call, I was asked to insert a catheter for a guy who couldn't pass urine.When I put in some local anaesthetic so that the catheter wouldn't be painful, his nether regions responded to the cold gel, like a toddler in a swimming pool. Instant wee, all over my (gloved) hands. Having his wife there, as well as another doctor, wasn't quite the mental group hug I was looking for.

Ultimately, you stand alone with your medical decisions. No-one else can take responsibility for the prescriptions I write, the tests I order or what I tell my patients. But I'm getting more comfortable with that - maybe I won't need the Royal We much longer.

I'm even getting ready to hold my hands up in the air and admit it when I make mistakes. Let me just clean the wee off them first.


Elaine said...

Keep up the blogging, worm. As every interaction between doctor and patient involves two people, any decisions are the responsibility of two people (although one probably knows more than the other and needs to explain things, the WE is not royal but actual

Dr Grumble said...

Elaine is right. 'We' can mean you the patient and me the doctor deciding together. If it's used that way and the patient does not misunderstand it's rather nice.