Posted by: Witch Doctor | January 9, 2012

The “choice” collusion


A very long time ago The Witch Doctor learned an important lesson as she sat as a trainee observer during a patient’s consultation with a dermatologist.

It was an NHS consultation although the outcome would surely have been the same if the same dermatologist had been seeing the patient privately.

The patient was a young woman who came with her husband (who was a doctor in the same hospital) to the clinic. She had a big bag with her. It contained numerous bottles and jars of creams, lotions, shampoos and perfumes and she emptied them all on the desk. The consultant picked a few of them up and looked at the ingredients and as he did so, the patient elaborated on the various ways each lotion and cream was harming her skin. She pointed to the damaged areas of her face and the dermatologist examined her skin carefully.

Her doctor husband sat quietly in the background and contributed very little to the conversation. He probably had heard it many times. For all we knew, he may have been fed up hearing it. He might even have been at the end of his tether hearing it.

The patient was a pretty, young, well-groomed woman and to The Witch Doctor’s dermatologically untrained eye had a perfectly normal skin.

After spending a significant amount of time listening to the patient (for she was a patient – she was disturbed about her skin), the dermatologist quietly but firmly told her and her husband that, as a dermatologist he could do nothing to help her apart from some giving advice about some simple and cheap preparations that would do the job just as well. He told the reason he couldn’t help her was  because her skin was unflawed and the problem was that her own perception of her skin was faulty. He did not give them a return appointment.

Afterwards, the consultant explained to The Witch Doctor that cosmetic companies thrive on the discontent that patients have about themselves. Dermatologists could thrive also if they chose to. To collude with the patient risked the possibility that matters would worsen. The way this particular dermatologist operated was to ensure he did not become part of the play.

He would not collude with the patient.

He said that such collusion would be difficult to stop. Furthermore he felt it was unethical.

When Michael Jackson died, the Witch Doctor wondered how much pain he suffered due to repeated cosmetic surgery procedures.

She doesn’t know the answer to that, but she does know that chronic, severe, pain is a terrible thing and worse still when it interferes with sleep. She also knows that the drugs used to treat chronic severe pain can have a profound effect on everyday living and performance.

A doctor has been jailed for manslaughter over providing improper treatment of his patient’s pain or insomnia or both.

Was that doctor colluding with the patient?

Were there many doctors before him also colluding as the patient requested more and more cosmetic surgery?

Was Michael Jackson’s death the tragic finale of a play driven by repeated collusion like that the dermatologist all these years ago warned The Witch Doctor about?

Would that dermatologist, had he had been a cosmetic surgeon today, colluded by inserting foreign bodies into normal breast tissue unless there was a very clear medical indication to do so?

Would he have found himself caught up in the current breast implant fiasco.

The Witch Doctor thinks not.

Perhaps UK doctors were wiser then.

All these years ago.

Before the mantra of “patient choice” blurred the margins of collusion and professionalism, and sanitised commercialism within the healthcare industry.

The Witch Doctor – Link to a random page





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  1. […] A very long time ago The Witch Doctor, learned an important lesson as she sat as a trainee observer … Written by admin in: Michael Joseph Jackson News | […]

  2. Dear WD

    There are a few rogues in any walk of life. Your dermatologist could be seen as uncomfortably paternalistic for the modern era, but there is a big difference between what patients want and what they need.

    I have a pretty hectic week but have some time to think on this and mull over some ideas.

    Dr Phil

  3. No, I don’t think this particular consultant was at all paternalistic even if it seems that I might have portrayed him in this way. He just had a bottom line he would not cross. I knew others who were very paternalistic though. Maybe will blog about a couple of them some day.

  4. […] was still room for optimism. It also brought to mind some blogspots from my blogging colleagues: the Witch Doctor, Anna Gramme, Dr No and the Jobbing Doctor. We are all concerned to some degree and from different […]

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