Doctors and Patients: A Relationship Examined

Recent changes in the NHS brought to mind this remarkable book, which describes in critical detail the personal and professional relationship between doctors and patients. Hodson wanted to call it I Swear by Apollo (the opening of the Hippocratic oath), but that title was already in use. This book is not based on Michael Balint’s teachings, which were popular at the time; it is an intelligent and humane examination of what is possible when general practitioners know their patients and ask themselves, “What help is this person seeking?” It is based on the author’s open minded experiences. He regarded impersonal medicine as being like a veterinary procedure and pitched his own professional practice between that and being overly involved—something “more than a bedside manner and something less than psychotherapy.”

Hodson discusses the importance of minor illnesses as being the ostensible reason for the visit to the doctor and gives case histories of other problems solved by active listening when the presenting symptom was minor. It is notable that he appointed a counsellor to his practice in 1965—and not just as an “extra pair of hands.” She had more time for the patients than the doctors could afford, and from her they learnt new insights into their patients and how to make the most of their own consultations.

Another of Hodson’s themes is even more relevant today: that communication is an essential part of relationships among medical staff. He explains the importance of the general practitioner as the patient’s guide to the medical service and therefore of good communication between general practitioners and consultants. When referral is to a team, any personal contact is in danger of being lost.

The distinction between personal and impersonal doctoring is well defined. Doctoring that is too personal may actually encourage ill health by favouring a rather infantile dependency on the doctor. Excessive paternalism on the doctor’s part can do just this. Hodson describes impersonal doctors as those who make it clear, by impatient gestures and inattention, that they do not want to spend a moment longer with the patient than is necessary. Not only doctors but overly officious staff, inefficient appointment systems, and medicine “by the book” can all have the same effect.

This book is about the practical advantages of listening out for and recognising a patient’s anxieties. Hodson shows how such a relationship, far from encouraging dependence, can restore confidence and independence. With clear observation and without dogma he examines a variety of relationships, including that between general practitioners and the legal profession, parents and children, and dying patients and their relatives. The last chapter on the care of the dying perceptively deals with the family and carers as well as the patient. The author, a young man, was dying of cancer when he wrote it.