• OMSG Editor

Trust Me, I'm a Doctor

Updated: May 15, 2021

Eniola Awodiya

Black women are five times more likely to die from complications surrounding pregnancy than her white female counterpart, will you look into this?

There’s no need, just trust me, I’m a doctor.

BAME patients are at greater risk of dying from Covid-19, why is that?

Don’t worry about it, just trust me, I’m a doctor.

The headlines, they’re full of police brutality against people who look like me, how do I know you’re not the same?

Just trust me, I’m a doctor.

“Trust” – the firm understanding and belief in the veracity of a person or thing. It is something usually earned, once earned usually valued and it is something, we all peripherally know, that is needed to accompany vulnerability of any kind in our interactions. Vulnerabilities such as inherent power imbalances between a patient and their doctor. Perhaps the founding tenets of the National Health Service is what beguiled the nation into giving a commodity as valuable as trust with relative ease. After all, it promised to meet the needs of everyone; to be based on clinical need and not one’s ability to pay, and to provide free care at the point of delivery. An idyllic set of goals – one that quickly made it and still to this day, makes it, the “beating heart” of the Nation. But what happens when one begins to suspect that it can no longer deliver? What happens when one begins to doubt whether, say, it does indeed meet the needs of everyone, equally? What if, one day, austerity means it can no longer always be free at the point of delivery? When on the delicate path to these possible truths, how does the “beating heart” of this country maintain its illustrious position?

A key change that has occurred within medicine during the last 70 years, is that posited by Linda and Ezekiel Emanuel in their four models of the patient-doctor relationship. The first of the four models, is the “paternalistic” relationship, which points towards the previously accepted approach that “the doctor knows best”. If there was a choice between a red pill and a blue pill for treating a given condition, the doctor would simply instruct the patient to “take the red pill” and that would be the end of the consultation. Contrast this to the second of the four models – the “informative” doctor. This is what modern practice has moved towards and involves the doctor in the role of informing the patient on the varied treatment options available and allowing the patient to choose. Increasingly, even, students are taught to consider “I.C.E.” in a consultation: the ideas, concerns and expectations of a patient concerning a treatment option, to further inform decision making. When we take these steps to hand back this level of autonomy to the patient, it’s almost as if along with it, we hand back the right to independent thought within the consultation room. And with that comes the very real possibility of “rejection”.

It’s no longer a given that the patient will accept the doctor. The title, in this case, is no longer alone enough to earn the trust, and you are not so easily off the hook anymore. The public can demand answers for any data that doesn’t match up with the expectations laid out. The public can question motives, ethics and practice. If the doctor’s given answer is unsatisfactory, “trust me, I’m a doctor” won’t cut it. Because, now there exists the right to revoke that gift of trust.

Perhaps in any other profession, that would be a less than ideal but nonetheless manageable outcome. But in medicine, I’d argue that lives, quite literally, depend on it. Massive discrepancies can be seen in medical outcomes, as seen in the aforementioned statistic that a black woman is five times more likely to die from complications surrounding pregnancy compared to a white woman. The answers given to address this statistic, and even the drive to look into the answers initially, are less that satisfactory. It follows naturally, that people will begin to question whether the founding mandate, to “meet the needs of everyone”, is really true.

A BBC article discussing the report, shared the experience of one black mother – an experience that though was spoken by one, was corroborated by many – who soon after giving birth by caesarean section expressed how she felt “worse than she should”, only to be dismissed. Hours later, she was returned to hospital for potentially fatal septicaemia. This is only one example of many, affecting more than just this one segment of the British population. But one example is enough. It shows us how groups begin to feel marginalised; begin to feel as though their concerns aren’t equally valid; that reports into discrepancies are half-hearted at best and that the “National Health Service” perhaps isn’t quite as “nationwide” as once thought. When this occurs, what follows are statistics of disproportionately high negative outcomes, and only then do we pause to question why. Of course, multiple factors play into why statistics present as they do, and this is by no means to say that there is one blanket answer as to why. Rather, a suggestion that perhaps a more intentional approach to building and maintaining essential trust between the NHS and the population it exists to serve, will bode for a more hopeful future.

So, in practice, how may this “intentional” approach look? To start, simply awareness can go a long way. An understanding that this idea of trust is something worth investing in and defending amidst concerns such as those described. A mere turn from implicit ideals that the patient is expected to rely on to explicit ones that can be held to account if the patient feels one falls short. That takes courage and courage in turn requires the justification that such a move is necessary. The other suggested approach is to educate and be educated. For future doctors to be made aware of the sheer diversity that exists within the British population. To know that this diversity can manifest in language, culture, attitudes and beliefs – all of which can be inextricably linked to health or the loss of it in a consultation room, and can influence how a patient presents along with the standard pathophysiology. To know of this diversity is a step in itself to prepare for it. So that when inevitably a patient presents, who doesn’t fit the singular mould you were taught to expect, you may pause a beat before writing it off. You may look a little deeper and see things in a new light. You may see a patient in front of you, in need of care, instead of just a future statistic.

Edition: 69 (2020-2021)

Correspondence to: editors@omsg-online.com