Winner of 'On Doctor's Orders' announced! Guest judge Dr Maria Martin puts the entries in order
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!
Maria
****
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.
Follow us on Twitter
Follow us on Instagram