Favourite patients, shame and redemption (it takes time)

Jonathon Tomlinson, an “ordinary GP” in Hackney, writes in a recent blog post on “A Better NHS” about caring for patients who are ashamed. He writes against the backdrop of two books, one fictional, one fact, about dealing with shame brought upon by childhood trauma.

We are very grateful to @mellojonny (on Twitter) for granting us permission to reproduce extracts of his article on our website, and for giving us the opportunity to reflect for a moment on what brings these favourite patients to our doors, and why there is often no “quick fix” when they do seek help:

Extract from Shame and Redemption, a blog post by Jonathon Tomlinson:

“Almost every GP I know is overwhelmed with caring for adults who suffer from shame, many of whom have been abused. They present with chronic pain, medically unexplained symptoms, anxiety and OCD, paranoia, fatigue and drug and alcohol addiction. We label them with medical syndromes, psycho-somatic, psychiatric and personality disorders. We refer them for medical investigations, specialist opinions, psychiatric assessments and psychotherapy. They leave us shattered, demoralised, burned out. They are chaotic, exhausting, and also among our most loved patients.

I’ve recently been doing work with old and young GPs about our favourite patients. For young doctors, favourite patients are friendly, cooperative, honest, and grateful. They present with symptoms that lead to a diagnosis and a cure or failing that, a good death. Gratification is quick. Dreaded patients are the opposite of all these things.

I asked four experienced GP trainers each to describe one their favourite patients to a room full of trainees. The patients they described were hard to form relationships with, took time and hard work to get to know, they were argumentative, dishonest, chaotic and disruptive, unwilling partners in care. For some it took years, decades even to reach a point of mutual trust and respect, but eventually they were rewarded with the kinds of relationships that can only come with going through and overcoming hardship together.

Evidence about resilience of doctors who work in challenging areas concluded that they were sustained by a deep appreciation and respect for the patients they cared for. Gratification with challenging patients comes slowly. Those who frustrate us most will eventually be the ones that sustain us, but only if we preserve the continuity of care that we are in grave danger of losing in an increasingly transactional NHS.”

Read the complete article on:
https://abetternhs.net/2016/11/21/shame-and-redemption

More reading:

A qualitative exploration of favorite patients in primary care. (Lee et al) 2016
https://www.ncbi.nlm.nih.gov/pubmed/27378080