The Resourceful Patient

2: What do doctors do all day?

Much attention has been given in the last decade to providing patients with more information about their health problems - about, for example, cancer, or depression, or psoriasis. This is obviously essential, but in addition to helping people understand disease we also need to help them understand clinical practice - how doctors think and make decisions, and how they interact with patients. Interaction is of particular importance because doctors interact with patients in a way that mechanics do not interact with machines, and this has an influence not only on the patient but also on the clinician.

Understanding disease and concepts such as cancer or atherosclerosis is obviously of great importance in improving communication, but nouns like 'cancer' and 'atherosclerosis' derived from the vast terminology of medicine have little connection with the consultation and the interaction between clinician and patient. The issue about how clinicians diagnose cancer or more subtle health problems like depression requires an understanding of the clinical process, what we may refer to as the grammar of medicine, as opposed to the vocabulary. In this section of the book the grammar of clinical practice is set out and the description of what doctors do all day gives an outline of what is happening in every consultation and every clinical decision. The various dimensions of what doctors do each day is described by analysing the clinical task in the way set out below.

2.1 'Let's open this chest fast'
2.2 The doctor as watchmaker - making a diagnosis
2.3 The doctor as watchmaker - appraising options
2.4 The doctor as tailor - applying research to the individual
2.5 The doctor as adviser - communicating information without framing
2.6 The doctor as witchdoctor - allaying anxiety
2.7 The doctor as St Peter - approving access to illness
2.8 The doctor as drug
2.9 The clinician as healer