I have drafted a letter to the Editor of The Times (London, UK) in response
to the latest in a series of satirical articles by a doctor under the
pseudonym Dr Tony Copperfield: Inside the mind of a GP, which is especially
contemptuous of M.E. and it's sufferers (link below my signature)
If anyone wishes to add their name as a co-signatory either as a
representative of an M.E organisation, or as an individual, (For example,
John Smith, M.E. Group, Name of Country, or region of country; or Mary
Jones, ME Sufferer etc.).
I will accept advice on minor additions or changes of text and grammar but
the priority is to dispatch it within 24 - 48 hours.
I have made a special effort to ensure that larger charities in the UK have
sight of this letter and the opportunity to co-sign, if they wish but I urge
you to forward and repost for maximum impact, globally. I would prefer
people to receive duplicates rather than miss an opportunity.
Furthermore, I urge as many people in the M.E. community, as are able, to
write an individual letter even if they also co-sign this letter. The e-mail
address is letters@thetimes.co.uk
Remember, this is published in The Times in the UK but, since they sell the
paper worldwide and since other doctors may also think like this, replies
from any country are equally welcome.
Cheers
John
drjohngreensmith@mefreeforall.org
*Letters to the Editor*.
Sir,
Another dose of vitriol from the pen of Dr Tony Copperfield (*Why GPs
sometimes get it so wrong, The Times, 2 February 2008*), in the series
"Inside the mind of a GP", moves us to raise some questions for all parties
affected.
Firstly, since Dr Copperfield is so frustrated by his job, is full of
contempt and lacks compassion for his patients, does he not think he is unsuited to it and should consider a change of career, as we believe he should? We should be grateful if you would forward our enquiry, since he
hides behind an alias and leaves no contact details.
Secondly, do you, Sir, wish to continue to publish this material after we
tell you of the devastating negative impact it has upon people with an
incurable disabling illness like M.E. (*Myalgic Encephalomyelitis*), which
Dr Copperfield disdains so much. You will not hear from the vast majority of
offended chronically ill patients because they are not able to respond. It
would be a shame if the number of copies your newspaper sells because of his
contribution were the only, or primary, deciding factor for continuing to
employ him.
Thirdly, we wonder how representative the inside of Dr Copperfield's mind is
of his fellow GPs and whether they wish to be associated with him or not. We
shall be canvassing doctors' associations and the profession's specialist
publications to discover the answer.
Finally, we believe that the doctor aka Tony Copperfield may have a case of professional misconduct to answer before the General Medical Council because insulting remarks, such as "pond life", in print, are as equally abusive as if they were delivered verbally to a patient, while being examined. We are writing to the GMC for their opinion.
Yours sincerely
John Greensmith
drjohngreensmith@mefreeforall.org
Dr John H Greensmith
ME Free For All. org
http://www.timesonline.co.uk/tol/life_and_style/health/our_experts/article3288380.ece
From The Times
February 2, 2008
Why GPs sometimes get it so wrong
DR COPPERFIELD: INSIDE THE MIND OF A GP
Two stories this week will have prompted the same question. Specifically,
why are we GPs so dumb?
One involved a young boy whose nine years of deafness was not, as his
doctors had suggested, caused by wax. This became apparent when the tip of a
long-forgotten cotton bud popped out of his ear, completely curing his
problem. The other reported the case of a 40-year-old woman who had been
told by her doc that her symptoms were the menopause. Only hours later, she,
too, found something popping out of somewhere. But it was a 5lb 6oz baby,
and it didn't emerge from her ear canal.
So, a foreign body misdiagnosed as ear wax. And a new body misdiagnosed as
the menopause. How is it that GPs can get it so wrong?
Believe me, it's easy. Take those two examples. The offending cotton bud
would have been fossilised in a nine-year sediment of wax, cruelly
misleading the GP. Besides, the child couldn't respond properly to the key
question – "Could you have got a cotton bud stuck in your ear?" – on account
of being, well, deaf.
As for the menopausal child-bearer, consider the symptoms of tiredness,
bloating, absent periods, weight gain and emotional wobbliness. See?
Pregnancy or the menopause? It's the toss of a coin, really.
Besides, you have to consider the sheer volume of cases dealt with by the
average GP. I see about 40 patients every day, many presenting multiple
problems and some smuggling in relatives beneath the receptionist's radar to
bypass the appointment system. That's about 9,000 clinical dilemmas posed
each year and on a distracting background of en passant gripes about the
waiting room decor, moans about GPs no longer doing out-of-hours and
toddlers puking on the carpet.
It's like trying to win the Speed Su Doku championship while being poked
with a cattle prod. Given that a diagnostic cockup is only ever a misled
doctor or a misheard symptom, the surprise is not that there are so many
"Dumb-ass GP" headlines but that there are so few.
Then, of course, there's the fact that we GPs see illness at its earliest
stages, when it's most difficult to diagnose. So, "I'm worried about my
child, she's vomited twice in the last ten minutes," poses a problem and not
just because I've got to clean my carpet again. It's more that the list of
possible diagnoses encompasses just about every condition known to man.
Hence the "It's probably a virus" mantra. Unfortunately, Mum inevitably
forgets the "probably" bit and also the "contact me if she gets any worse"
addendum, which is why, when the classical symptoms appear later and the
whitecoated hospital heroes cure her daughter's meningococcal septicaemia,
I'm left looking like a negligent numbskull, as the local paper will
describe me.
But you patients have to take some responsibility, too. Histories that boil
down to "I've been feeling iffy for some time" do little to narrow down the
list of pathological possibilities. And the opposite extreme –
self-diagnosis – is equally misleading. Patients who claim that they're
depressed are inevitably just unhappy, those who fear they're demented are
inevitably depressed, and those who insist they have chronic fatigue
syndrome are inevitably shown the door before I snap.
The classic self-misdiagnosis, though, is the heart attack. If you think
you're having one, you probably aren't. But if you protest that "It's just a
bout of indigestion", I'm dialling 999 before you can pretend the antacids
have worked. After all, most of my working day I'm fighting off demands and
exaggeration, so the time you underplay your symptoms is when I start
panicking. The other being when you phone to ask if it's normal for the HRT
I've been prescribing to cause odd kicking sensations in your abdomen.
Dr Copperfield is a GP in Essex. He also writes for DoctorPortal.co.uk Mark
Henderson is away
(c) Copyright 2008 Times Newspapers Ltd.
***
One reason there is so much misdiagnosis is because, as noted in Dr. Groopman's book, doctors interrupt the patient after 18 seconds. If they would listen carefully to the full recitation of symptoms, they might get to the right diagnosis.
I am not a doctor, but even I know that there's a surefire way to tell the difference between menopause and pregnancy ... you go to the drugstore and buy an EPT test kit. The fact that some doctor missed pregnancy entirely proves that he diagnosed by stereotype: she's middle-aged, therefore it must be menopause, cannot possibly be pregnancy, because 100% of middle-aged women go through menopause, but only 1% have babies.
Unfortunately, that scenario is so commonplace that Dr. Groopman addressed Diagnosis By Stereotype at length in his book.
One of my doctors firmly believed that all middle-aged divorcees are depressed, and can have nothing else wrong with them. His explanation for missing a diagnosis which had already been made by two specialists and presented to him in writing was "nothing you said made sense." Of course not: he was looking for the symptoms of depression and I was describing the symptoms of CFS. What I told him would not make sense in the context of common depression symptoms, because they are textbook symptoms of CFS, but he chose to sledgehammer my square peg symptoms into his round hole diagnosis and then blame the patient for being too stupid to know what her own symptoms and decade-old diagnosis were when he couldn't make them fit the diagnosis he wanted.
Dr. Copperfield also blames the patients, and not the doctors, for what boils down to the doctors not asking the right questions.
I agree with Dr. John that any doctor who cannot treat the patients with respect and compassion, and allow them to describe all their symptoms before interrupting, should find a new profession. It's the constellation of symptoms that differentiates CFS from other cases of fatigue and from depression, but a doctor who hears "fatigue" and instantly thinks "depression" is going to misdiagnose.
And, in my case, there is absolutely no defense to the doctor's choice to ignore a written diagnosis from a specialist -- this was not a case of accidental misdiagnosis, it was intentionally ignoring expert opinion because it conflicted with the doctor's own prejudices about divorced middle-aged women. No questions about my emotional state were ever asked, he simply "knew" that I was miserable being divorced. It never even crossed his mind that I initiated the divorce or that my life and finances were greatly improved after getting rid of my albatross; hearing that wouldn't fit his prejudices, either, that all men want to date 20-somethings and therefore, a 40-ish woman must be sitting home dateless and crying all the time.
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