Dear Editor
Hamish Duncan’s thoughtful response is a reminder that over the past half century or more, many colleagues and observers of primary care have pointed out that attempts at establishing and maintaining a useful dialogue with patients is becoming more difficult.
The Balints wrote extensively on the need for doctors to use and understand their own intuition while listening and watching attentively, for double entendres, perhaps even the silences of the person they were with. Without such careful attention and understanding, nurtured still in Balint Groups, how many consultations were, and are, empty of real meaning ? (1)
Oliver Sacks wrote to The British Clinical Journal - long since disappeared - in 1974. In thanking the editor for his kind words about ‘Awakenings’ Sacks wrote that “..a sensitive physician, one who feels with his patients, cannot suppress a certain fear at the Juggernaut advance of contemporary medicine, its intoxicated onrush of technological power; the sense that it may be mistaking its means for its ends, forgetting its past, and denying its roots; and above all, the feeling that it least recognises or tolerates what it most ungently needs - a pause for thought, a look at itself, a humanisation of its power - before it is too late. “ (2)
Ivan Illich sounded many alarms about the nature of medical care and its increasing subservience to technological advance, from his non medical standpoint. (3)
Within the memory of many doctors is the birth of the computer age. Most patients were and are fortunate, thereafter, to receive a glance from their inquisitor, whose eyes remain fixed on the screen.
Roger Neighbour (4) and Brian Kaplan (5) were insightful listeners and had the humility, and good sense, to point out that patients, encouraged to talk, often provided their own diagnosis. Their followers will rue the disappearance of continuity, even though those regular consultations, courtesy usually of the NHS, sometimes demanded an NHS, booked, longer session. Nowadays such longer sessions are, for various reasons, all but impossible.
Hamish Duncan may agree with the final words of Oliver Sacks, above. Perhaps it is already too late ?
1 Michael & Enid Balint. Psychotherapeutic Techniques in Medicine. Tavistock 1961
2 Oliver Sacks. Letter to the Editor of The British Clinical Journal, February 1974.
3 Ivan Illich. Medical Nemesis. Calder & Boyars, 1975
4 Roger Neighbour. The Inner Consultation. MTP Press 1987.
5 Brian Kaplan. The Homeopathic Conversation. Natural Medicine Press. 2001