Bullshitting

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http://bmj.com/cgi/content/full/327/7407/171-a

 

BMJ 2003;327:171 (19 July)

reviewsSOUNDINGS

Bullshitting I remember that we were sitting in a room analysing videoed

consultations. The registrar on the video sat the patient down. " You have

sacroiliitis, " she said.

We all finished watching the video, consultation technique was discussed, and

then someone pointed out that the registrar couldn't possibly say that the

diagnosis was sacroiliitis. All that one could say on the information presented

was that the patient had mechanical low back pain.

" Oh, well, " someone else said, " We all do that. " I assumed by this that they

meant that we all made up diagnoses of spurious diagnostic accuracy to keep the

patient happy.

There was a pause, and then a colleague said in a slightly embarrassed tone:

" Well, I don't do that. " There was an awkward silence and then we moved on to

discuss the knotty question of whether the registrar had empathised with the

patient.

This episode occurred several years ago but it has stayed with me. I suspect

that I was probably guilty of the same sin—of dressing up diagnostic uncertainty

with an impressive, but spurious, diagnostic accuracy. I have avoided doing it

ever since.

There is quite a lot published about why patients trust some doctors and not

others. The reasons for trust, or the lack of it, are undoubtedly multiple. As

junior doctors we assume that the patient will distrust us if we seem uncertain,

and that may be true.

The risk is that the bullshitting learnt as a junior may persist. And the odd

thing is that it is tolerated. " We all do it. " But I suspect that most human

beings are rather finely attuned to picking up the minor levels of deceit in

such a practice, which may explain part of the spectrum between trust and

distrust that patients feel.

I recently had to fill out a form for appraisal, which asked me about my

" probity. " I remembered the story of Evelyn Waugh visiting the United States.

The entry form asked him if any part of the purpose of his visit was to

" subjugate the government of the United States. " He wrote, " sole purpose of

visit, " and was detained for a week. Maybe my appraisal form should, more

profitably, have asked me if I bullshitted to patients. It would at least have

caused me to examine my conscience.

Now, instead of saying to patients that they have sacroiliitis, I tell them that

they are allergic to candida.

 

 

Kevin Barraclough, general practitioner

Painswick, Gloucestershire

 

 

 

 

 

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