5th February 2017
It’s tricky to judge when orders are required to achieve the outcome of improved symptoms, better understanding or longevity. Ordering implies an authoritarian relationship with one party knowing ‘what’s best’ for the other and, more sinisterly, expects obedience of the other.
Most doctors nowadays are trained to work collaboratively with their patients, to communicate clearly and empathetically so as to enable people to make informed decisions for which they, not the doctor, are accountable.
Using even more sophisticated cognitive psychological techniques, a practitioner may lead their patient to a ‘guided discovery’ of their thoughts or behaviours, often not obvious initially, that are affecting their symptoms or experience.
Some of the stories demonstrate how the power of an authoritative trusted position such as that of a doctor can use the relationship with the patient to achieve a personal or political goal. In contrast, in other stories the ‘order’ was often a simplified representation of the consultation they might have had with a doctor, eg to take a holiday, to drink orange juice, or to get a prescription. In these stories the ‘order’ came to be both a very literal undertaking for the character, but also a metaphor for the complexity of the change in their health, behaviour or mood they hope to achieve.
And yet, ‘doctor’s orders’ prevails. ‘If it were you doc, what would you do?’, ‘if you think it best, I will take them, you’re the doctor!’ For some the anxiety that comes with facing no simple ‘order’ but a self-made decision can itself require intervention!
In a cynical twist, the character in the winning story longs for his life before following his doctor’s order, a time when he did not take responsibility for his behaviour, his health or his economic contribution, thus expressing how burdensome being a mediocre sentient being can be. This dark, though comic view, avoids all sentimentality and offers us something closer to the true complexity of human experience, not just polar views of functional and dysfunctional.
Adding the strange phenomena of hypnosis into the relationship between doctor and patient of course makes a mockery of accountable decisions. The thriller of the revengeful hypnotist is very entertaining.
Lastly, the description of a young man’s experience of being given a prescription for an antidepressant evoked in me an empathy for the character, feeling his embarrassment, his paranoia, his vulnerability as he realises that depression could happen to him too. It felt a very accurate description achieved with simple observation and communicated subtly.
I suspect that often my collaboratively communicated advice evolves into a ‘doctor’s order’ when relayed by patients. As a dermatologist my advice to avoid excessive hand washing to improve hand eczema becomes ‘I am not allowed to do the dishwashing or cleaning’, to people with some inflammatory skin diseases for whom I might recommend sensible ultraviolet light exposure, ‘the doctor said we should have a sunny holiday this year’.
Thank you for all your stories. Keep writing – it’s an order!
About the Judge
Dr Maria Martin is a General Practitioner in the NHS in Cumbria, England where she consults patients and manages a practice with her colleagues. She runs a community dermatology service as a GP with Extended Role. Her other clinical interests are sexual health, mental health and cognitive behavioural therapy.