The Good Enough Doctor

‘How old is she?’ said the doctor to her ophthalmologist colleague. She was examining my eyes and not more than half a metre from my face as she asked the question. Both doctors were engaged in discussing my potential diagnoses. I was at the eye clinic of the local hospital. A routine eye test that morning had resulted in a referral from a conscientious optician who suspected that I was on the brink of a retinal detachment.

The previous day I was leaving a holiday island hotel where staff members were, without exception, good-humoured, kind and attentive.

In less than 24 hours, I was transformed from a healthy holidaymaker to a medical puzzle to be solved and was on the receiving end of ‘the engineering model’ of medicine. ¹ I was an object of ophthalmological interest and the doctor ‘an applied scientist’. I had been transported from what Susan Sontag calls ‘the kingdom of the well’ to the ‘kingdom of the sick’. ² I was inducted to a new lingo which was as alien as the local language on the holiday island. My symptoms were translated to the exotic-sounding potential diagnoses of ‘bilateral scintillating scotoma’, ‘ocular migraine’ and, the more familiar, ‘glaucoma’.

As my concern about my sight increased, the first doctor asked me questions about my general health and reassured me that I was not going blind. After asking ‘how old is she?’, she went on to say ‘We should really ask you this’. When she left the room, the second doctor continued to examine my eyes and to focus on his computer as he composed a referral letter. He asked a few questions but seemed uninterested in the responses.

In our field of ethics and care, the personal is seldom far removed from the professional. In addition, then, to a personal interest in diagnosis and treatment, there is a professional commitment to making sense of care-related experiences. I was mindful also that I was soon to deliver a talk regarding virtue and clinical practice.

So what should I have expected of the doctors who examined me? What virtues did and should they have demonstrated? And should this have been different to what I expected from the hotel staff? Did the latter care more for the quality of my experience than the doctors? Did the doctor fulfil that oft-cited mission of medicine ‘to cure sometimes, to relieve often, to comfort always’? ³

I was impressed by the clinical competence of the doctors and the fact that an expert peer had been invited to verify the diagnoses. I was impressed also by the speed of response which reminded of the value of the wonderful UK National Health Service. Despite the pressures on services, I was seen on the same day by two specialist doctors. Gratitude on the part of this particular patient was felt and demonstrated.

So what professional virtues were evident and which appeared lacking? The doctor asking for a colleague’s advice suggested a certain humility. The behaviour I was on the receiving end of suggested little in common with the hotel staff who were good-humoured, kind and attentive. However, perhaps we should be content with ‘good enough’ doctors and not expect them to be all things to all people? Perhaps it is sufficient that they are clinically competent? I would be interested in readers’ views on this.

Interestingly, as I checked out of the hotel and thanked staff for their good service, they suggested I complete a TripAdvisor ⁴ review which I was happy to do. I can’t help wondering if a similar evaluation process might work as we journey through our healthcare services…