Legitimising personal experience

What have a qualitative study of how general practitioners approach bereaved patients, a Career Focus article on managing doctors as patients, and an editorial on the departure of yet another medical editor got in common? All provide an opportunity for reflecting on where doctoring meets the rather more messy business of being a human being.

Eric Saunderson and Leone Ridsdale’s qualitative study explores how general practitioners respond to death and bereavement among their patients (p 293). They unearth guilt when patients die unexpectedly and inconsistencies in doctors’ approaches to bereaved patients in their practices. They found that few of the doctors they interviewed had any training in managing bereavement, and their approaches stemmed from personal experience. “I’ve been to their house many times, but this time I am not a medical man … my feelings are those of a human being.”

In his accompanying commentary, David Jewell calls for the legitimising of personal experience: “our lived experience … is probably one of the most valuable resources, helping us to a more immediate understanding of human illness than any medical textbooks” (p 296).

When it comes to illness, however, doctors’ experience is fraught with extra complications, as Walter Anderson describes in his article on “Doctoring doctors” in this week’s Career Focus (Classified supplement, classified.bmj.com/careerfocus). He sets out guiding principles for doctors looking after patients who are also doctors, and, as important, for being a doctor-patient. These include: never take any medicines that a lawyer could not buy over the counter and “follow the protocols that protect non-doctor patients.” Yet J O’Neill’s personal view shows that it may not be that simple (p ). He recounts his struggle to get effective pain relief in his father in law’s dying days in a general hospital: “I dread to think what a similar patient without medical relatives would have suffered.”

Jerry Kassirer is to depart from the New England Journal of Medicine after eight years as its editor. As editor he has written strongly about doctors remaining as “pure” advocates for their patients and not getting sullied by the “business” of health. The same approach in dealing with his owners seems to have accounted for his early departure from the journal. As Richard Smith says in his editorial (p 272), such conflicts are not confined to editors and their owners: they potentially affect many doctors in their relationship with managers of healthcare systems. The long term hope for resolving these sorts of conflicts, he argues, lies in the slow building of trust.