Personal views: Conversations, observations, and exclamation
Authors: Gerald Levy
Journal: BMJ (2001)

About three and a half years ago, I started to feel unwell. The following day—a Sunday—I took myself off to see the emergency GP. She suggested, rather forcibly, that I should go straight to hospital. From this point I have developed an interesting relationship with some of the doctors I have seen. The majority of the two dozen or so doctors have been professional, supportive, and amicable. My GPs have, without fail, been exemplary.

There have, however, been conversations with other doctors that provide alarming insights into the self perception of some members of the medical profession. As an ethnographer (a sort of psychologist) I relate some of the conversations.


The duty consultant (after a very brief examination) on being first referred as an emergency: “Young man, I can find no evidence whatsoever of what you are saying is so. I don't know why you were sent here. Go home.”


As you have probably guessed, you have multiple sclerosis



Two days later my GP came to see me—I was now bedridden: “I think you need to see a consultant neurologist straightaway. I have arranged for you to go to his clinic this afternoon.”

Two hours later, the consultant neurologist at the local hospital: “I think we need to have you in the neurology centre now.”

Then, at the neurology centre: “I know they are not very pleasant, but a lumbar puncture would be useful.”

“You are not claustrophobic are you? MRI scans can be a bit enclosing. We will put you on . . . for the pain.”

“Doctor, can you give me some idea of what is wrong, how long am I going to be off sick?”

“Difficult to say, could be a while. Let's sign you off for a couple of months and see how we go.”

Still in pain.

“I know they can be a bit uncomfortable, but, a second lumbar puncture would be really helpful.”

“I had a fax from the emergency doctor. Sorry to hear you were in such a state after the last lumbar puncture. Don't worry, I won't ask you to have another.”

About nine months pass, lots more consultations, still in pain.

“Doctor, I feel I have aged 40 years, and I am still in awful pain, please tell me what you think the problem is.”

“As you have probably guessed, you have multiple sclerosis. I will refer you to the pain specialist.”

An aside from the head of the human resource group at the university where I taught: “Oh, MS, that's yuppie flu isn't it?”

At the first pain clinic: “Not having much luck with this pain issue. I will give you some pethidine. Come back and see me in six months' time.”

Another doctor, another conversation: “Have you tried cannabis?”

Upon referral to another pain clinic in a centre of excellence: “Ignore those people (referring to four anonymous men sitting behind me), they are researchers, just look at me.”

Speaker at a conference for patients and families with MS: “As a doctor, those patients who I respect are the ones who will put some effort into their lives. Some just give in to it.”

Same doctor: “Pain is an indicator of neurological degradation.”

Another visit to another clinic, still in pain: “I see you are a psychologist. What did you do to get that?”

“A PhD.”

“Good, good, well let's see what we can do for you, Mr Levy.”

Second and (final) visit to the above doctor: “Oh yes, you're a sort of doctor aren't you, Mr Levy?”

Another conversation with another doctor: “You are coping very well, Gerald. I don't know how I would handle it if I were in your situation. Thought about cannabis?”

Two years on, now referred to the local hospice. Doctor with stud in eyebrow: “We can get the pain under some sort of control, at least so you can have some quality of life and get some sleep. Don't worry, we will just keep at it until we find an answer.” “I think I did mention that this may give you some hallucinations.”

And do we all live happily ever after?

To date the efforts and persistence of my studded doctor continue, with some improvements.

As a patient I demand an instant cure to all my ills. As a grown up I realise this is not to be. As a grown up patient, however, I am disappointed that some of my fellow humans who practise medicine fail to be aware of (or care about) the need to treat patients with the dignity normal in adult relationships. This is even more true when doctors can offer not clinical, positivist treatment, but rather advice on management of symptoms. The doctor and patient relationship becomes the medication; trust and respect become all. It seems that the irascible, pompous demagogue as portrayed by James Robinson Justice lives on, but his continued existence is paid for by patients and colleagues.