A smile and a little small talk can go a long way in the doctor’s office, writes David Hill.

The ramshackle structure called my neck means I’ve seen a lot of waiting rooms and medical experts these past months: GP, radiologists, otolaryngologist, orthopaedic surgeon. I’ve lain supine for an osteopath, prone for a chiropractor, on my side for a physiotherapist. I’ve accumulated invoices featuring entire alphabets of degrees and diplomas.

Generally, I’ve been treated with skill and courtesy. But I’ve also been reminded what a nuanced, imperfect business the relationship between patient and health professional is. Which leads me to ask the following questions.

Does your doctor or specialist look at you?

OK, there are screens to be checked, notes to be jotted, records to be looked up. But any appointment is an interview, surely? How can you conduct an interview if you’re looking elsewhere half the time?

I’d suggest that eye contact is a great diagnostic technique; that a patient’s facial expression and body language can be rich with unvoiced information. I remember how stressed I felt while trying to talk to one specialist, who when they weren’t sitting side-on at one screen, was sitting with back to me at another. I was being treated as an object, not as a person.

Do they ever touch you?

A tricky question, especially in these social-distancing and socially sensitive days.

But up until Covid 19 arrived, my excellent GP always shook hands with me when I entered his rooms. He’d give me the occasional pat on the back as I left. My wife Beth’s splendid woman doctor would rest a hand on her arm, even hug her occasionally.

Both Beth and I felt better for those touches. They acknowledged us as individuals. They conveyed warmth and concern. I’ve read how doctors a few generations back were taught to place a friendly hand on the patient’s shoulder, if it could be done without any impropriety.

There’s something comforting, reassuring about such physical contact. The King’s Touch? A Laying On of Hands? Maybe. Mostly it’s simple, compassionate communication.

Do they invite questions?

A patient comes to a medical professional. The latter asks questions. That’s appropriate. That’s essential. But how often does the professional ask if the patient has any questions?

Only one of the experts I’ve visited did so. It made a remarkable difference. I was able to raise issues that concerned or puzzled me. I left feeling more empowered and valued. I’d been acknowledged as a participant in the process. Of course a health professional’s time is limited and valuable. But inviting a few questions might save some of that time in the long run.

Do they say this?

“Not my field.” Two professionals have said this to me. It’s true. It’s also dismissive and depressing. Surely they can follow it with a suggestion of whom, what, where the patient might consider trying.

Do they play that?

Most waiting rooms have music. It’s nearly always this month’s top pop songs or else “classics”, as in last year’s top pop songs. Whichever, they’re interspersed with gabbly commercials for products, plus “public notices” aka commercials for events.

How many patients actually like this background noise? A lot of us are over 50. Significantly over 50. Maybe we’d prefer something a little more…. grown up? Try RNZ National, or RNZ Concert. Try a few CDs. Even try a little silence. Fifteen minutes of being assailed by pop and pap, and I enter a surgery with blood pressure up and emotional reserves down.

How long do they keep you waiting?

Consultations can run over time. That’s inevitable. Patients are prepared to wait. But waiting with no idea of when the summons may come is frustrating, stressful, even humiliating. It doesn’t bring patients into the surgery in a relaxed and responsive state of mind.

Does your doctor or specialist ever apologise for being 20…30….40 minutes late? Ever say “Sorry. Had some folk with a few issues to sort” or suchlike? It’s the sort of basic courtesy you’d expect and get from any other profession. It accepts that the patient also has a timetable to keep. It rather cleverly gets him/her onside, implies we’re all in this together.

One consulting room I visited had a notice: “Please ask at reception if your appointment is more than 30 minutes overdue”. Another had a whiteboard: “The visiting —–ologist is running X minutes late.” In both cases, I felt informed and acknowledged. I could prepare and employ myself. I entered the surgery in better shape.

Do they acknowledge the power imbalance?

Medical professionals are authority figures, while patients are partly informed at best. Meetings happen on the professional’s territory. They mostly determine information and time; is in a prestigious profession, which Gold Card-age patients were brought up almost to revere. The whole ambience of consultation tends to turn a patient into a supplicant.

Does your doctor or specialist try to redress this imbalance? Use first names (if appropriate)? Offer a few sentences about weather, parking, the Black Caps batting collapse, anything to establish a human connection? Amazing how such trivia starts a consultation off on a more relaxed note.

Here ends my questions. Random? Indeed. Uninformed and puerile? Very likely.

But Hippocrates of the medical oath wrote “It is more important to know what person the disease has than to know what disease the person has.” How do the medical professionals in your life stack up against that?