Yes, that’s what would YOU personally do, if you had the problem the patient is presenting with. Have you ever been asked this by a patient? Surprisingly, during a quick poll of a group of about ten medic friends, only three had ever been asked this. They were all used to being asked a similar question by family members and friends, but, in a professional capacity, it seems that not many people ask their doctors this. Perhaps they feel it’s too personal and not appropriate, or perhaps they automatically assume that the answer would be no different to the advice the doctor is giving them, and that a doctor would naturally follow ‘best medical practice’ for their own care.

Think back to the last time you felt ill, whether it was a headache, back ache, viral illness or something else. How did you go about treating it? You probably didn’t follow the advice you give patients, such as resting and taking time off work if needed because you felt too guilty leaving your colleagues with that extra on-call shift or leaving those clinic letters unfinished. If you took over the counter analgesics, maybe you didn’t follow the dosing advice and wait the recommended time between doses because you knew that if you didn’t take some more now you may not get another chance through the night shift. In a more general health sense most of us probably don’t follow the guidelines we give on healthy eating and exercise all of the time.

With all of these situations though we ‘know’ we are doing the ‘wrong’ thing for our health, but we are going for the convenient option, or the option to help other people, or the path of least resistance, just as many people who know they should stop smoking don’t stop, or people who know they should drink less don’t do so. In all of these situations we are still giving the patient what we believe to be the best advice – it’s the advice we know we should also follow, and try to, but life gets in the way.

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It’s the situations where we make a conscious decision not to follow ‘best medical practice’ for ourselves, but advise patients to follow this guidance that are interesting, and may make us think twice if someone asks ‘what would you do, doctor?’. I have come across a few examples of these in recent conversations with medic friends and colleagues. In each situation the doctor concerned experienced a health problem for which there are certain referral guidelines but chose not to go down this route of care themselves.

One experienced some gynaecological bleeding on a few occasions outside of her normal menstrual cycle over a few months. If we saw a patient with this in GP we would refer them, but she decided these were irregular periods because she was stressed about exams and she would wait and see what happened when the exams were over and the problem resolved. Another had a breast lump that lasted for a couple of months and decided to wait and get a referral if it got bigger or changed but luckily it went away. Another had a persistent cough with some mild haemoptysis on one occasion and he decided to leave this symptom and it resolved and no problems continued. 

Of course, these are just a few examples of people that had symptoms which resolved as most symptoms do. I’m sure we all know of people who were not so lucky and I am not saying that they necessarily took the right course of action in deciding not to access medical care and of course if any of them had turned out to have a serious condition they would wish they had acted differently, and followed referral guidelines. However, all of them thought through the referral procedures and decided that, based on their own research of the facts and figures of the prevalence of these symptoms and the chances of having a serious condition, that they would rather not go through invasive investigations, which carry their own risks, at this stage. All felt that if their symptoms had worsened or changed they would do this, but their own personal opinion on when to access medical care was different to the guidelines.

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As doctors, if we heard these symptoms and this course of action from a patient we would be concerned, and think the risk they took was dangerous. We want to investigate symptoms as much as we can, because we know that earlier detection of many conditions improves the chances of survival and we are also worried about the legal situation of not referring people. We would worry if a patient told us that they had come to the decision not to investigate a symptom because they had read facts and figures about it and decided that this was their preferred course of action based on the risks and benefits. We assume people want referrals and I think that, more often than not, this is the case, and we are often the gatekeepers to the referral system, keeping out the people who have read horror stories on the internet about the underlying causes of a cough. What we tend not to think about is what we would personally do if we were ill, and if we might ignore something or take a different medicine to the recommended one and feel this is based on good judgement, surely it is not unreasonable that someone else might also?

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So, what do you do if you are asked ‘what would you do, doctor?’ and actually, what you might do, is differ from the guidelines? I think all of us, whatever our answer is,  would recommend the evidence based guidelines to patients as we have a duty of care to investigate appropriately the symptoms people present with according to good medical practice. I think most of us would agree that we shouldn’t suggest our own decisions or views on patients, but treat people according to the current evidence based treatments and their wishes. I think most of us dread that question, and luckily for us, it doesn’t seem to come up too often. I don’t want to be asked that myself at work, but I think if I had a medical problem it’s something I may want to ask the doctor!

So, what would You do, doctor?