Dr Stuart Flanagan: Challenge my diagnosis. But don’t scorn expertise

The tragic case of Charlie Gard has seen a private tragedy played out as a public spectacle. A process about an extremely complex case erupted into a very public, emotional and political battlefield. Baby Charlie and his heart-broken parents, Chris Gard and Connie Yates (pictured above), were most acutely affected, and they will have to deal with the fall-out of how this case has been publicly played out. There are no positives in this story.

But damage has also been wrought on the hardworking staff at Great Ormond Street Hospital (GOSH), who have faced harassment and abuse in recent weeks. Confidential medical advice and care plans from GOSH specialists have come under intense scrutiny and condemnation from a media and public who often have no clear idea of the medical and legal facts.

Is society getting sick of experts on our health?

In a society that is gravitating towards easy accusations of alternative facts and fake news, are we getting sick of experts on our health? Should healthcare professionals be expecting more difficult consultations simply because patients just don’t trust what we say?

In my patient consultations I aim for dialogue rather than a diatribe. More and more of my patients are coming to me after they’ve first checked via Google as to what may be going on, to provide me with a list of things they think that rash or cough could be and how it should be treated. I’m pretty sure that for some of my patients I’m offering a second opinion, after the first has been sought out online.

I don’t think that’s such a bad thing. Patient education and interest in illness is really important – well-informed patients are much more likely to have a positive outcome.

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But what happens when Dr Google and I disagree? What about when I disagree with another colleague about a course of action? The old saying is that when doctors differ, patients die. Should you be worried about trusting your doctor? Maybe you should you be challenging them more often?

Luckily for me medicine remains the most trusted profession in the UK with 89 per cent of people trusting doctors to tell them the truth, according to the annual Ipsos MORI poll. But there’s no doubt that medics have been rocked by a series of undermining health scandals in recent years, such as serial killer Harold Shipman, the heart surgery scandal at Bristol Royal Infirmary, and perhaps most damaging of all, the MMR scare.

The old saying is that when doctors differ, patients die

Each of these chipped away at public trust in the medical profession having patients’ best interests at heart. The lingering sense of an impenetrable authority, a paternalistic attitude and a lax approach to safety among medics is something doctors of my generation have worked hard to leave far in the past.

We’ve had to nourish a culture of candour, transparency and understanding of what trust between healthcare professionals and patients should be. Good communication is just the starting point. Clarity on what everyone’s expectations are is really important. The good doctor or nurse will listen to what you say, respond with empathy, explain their thinking and involve you in the decision-making.

Questions and challenging authority is important – it’ll make your doctor think twice about their decision-making. That’s not to say we always get it right – if those symptoms just aren’t improving another opinion should be recommended rather than dismissed.

But there will always be the tough conversations, and things our patients don’t want to hear (“stop smoking” is still the most common). I can remember one consultation when a patient threatened to punch me if I didn’t give him antibiotics for what turned out to be a virus (nifty footwork got me out of that one). Fortunately, that’s extremely uncommon but I am hearing more questions, more evidence being sought and more justification. And those are the conversations I embrace.

I want to be challenged by my patients – after all it’s their health and their bodies. I want to be sure about my care plans and treatments. I want to make accurate and sound diagnoses, and I need my patients to help me with that. It’s extremely rare for a doctor-patient relationship to go to the courts for arbitration but when society seems to be empowering expert antipathy, we medics will have to work a bit harder to keep our patients’ trust.

A great doctor doesn’t know everything but they know where to check and who to ask. They can make sure advice comes from years of expertise and weight of evidence. So when you next see me, challenge me about what the diagnosis is – but forgive me if my first referral isn’t to Dr Google.

Dr Stuart Flanagan is a broadcaster and NHS specialist in sexual health | @Dr_Stuart