1.1 A resourceful patient

It was to be the consultant physician's last visit and Dalgliesh suspected that neither of them regretted it - arrogance and patronage on one side and weakness, gratitude and dependence on the other being no foundation for a satisfactory adult relationship however transitory. He came into Dalgliesh's small hospital room preceded by Sister, attended by his acolytes, already dressed for the fashionable wedding which he was to grace as a guest later that morning. He could have been the bridegroom except that he sported a red rose instead of the customary carnation. Both he and the flower looked as if they had been brought and burnished to a peak of artificial perfection, gift-wrapped in invisible foil, and immune to the chance winds, frosts and ungentle fingers which could mar more vulnerable perfections. As a final touch, he and the flower had both been lightly sprayed with an expensive scent, presumably an aftershave lotion. Dalgliesh could detect it above the hospital smell of cabbage and ether to which his nose had become so inured during the past weeks that it now hardly registered on the senses. The attendant medical students grouped themselves round the bed. With their long hair and short white coats they looked like a gaggle of slightly disreputable bridesmaids.

Dalgliesh was stripped by Sister's skilled impersonal hands for yet another examination. The stethoscope moved, a cold disc, over his chest and back. This last examination was a formality but the physician was, as always, thorough; nothing he did was perfunctory. If, on this occasion, his original diagnosis had been wrong, his self-esteem was too secure for him to feel the need for more than a token excuse. He straightened up and said:

'We've had the most recent path. report and I think we can be certain now that we've got it right. The cytology was always obscure, of course, and the diagnosis was complicated by the pneumonia. But it isn't acute leukaemia, it isn't any type of leukaemia. What you're recovering from - happily - is an atypical mononucleosis. I congratulate you, Commander. You had us worried.'

'I have you interested; you had me worried. When can I leave here?'

P.D James, The Black Tower

Toughened by the death of his wife and son, not to mention the exigencies of his gruesome job, Adam Dalgliesh must have developed competence, resilience and confidence to a degree that few other patients could match. Few of us would have the resolve or speed of thought to respond to the consultant physician's patronising statement so trenchantly. Even such a powerful personality as Dalgliesh would, however, have made little permanent impact on the confident carapace of the consultant who would continue to dominate his consultations, although even he, one suspects, would in future probably be more circumspect about his phrase 'you had us worried'.

Fortunately, the description of the consultation seems dated, even for the publication date - 1975, a throwback perhaps to the 1950s when the consultant, especially in a London teaching hospital, exuded power, and the patient was submissive and subservient.

The very word 'patient' has two definitions in the Shorter English Dictionary, namely: 'one who is under medical treatment' and 'one who suffers patiently' or 'a person … to whom something is done', but there is no need for a person who is suffering to be powerless, and the shift of power from patient to physician occurred relatively recently, during the second half of the twentieth century. In the first decades of the 21st century, the balance of power will shift back from physicians and clinicians to patients as the benefits of patient empowerment become clear.

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