At work blog



Brief encounters

‘How many of these will you have to do today?’ she asks.

‘Four,’ I reply.

‘All day?’

‘No, this afternoon I’m going to do a ward round at another hospital.’

‘You see so many patients,’ she mused.

I was excising her mole. It was a 45-minute slot in a morning list, a small part of my working week, a routine procedure. Yet for her it was a much bigger part of her life.

From the other side of the therapeutic relationship, our everyday clinical activities are major events. Every clinic appointment, procedure or conversation is held on to, our words committed to memory, our letters carefully filed.

And from my experience as a patient, I know that I am no different. I replay in my mind interactions that occurred years before: the paediatrician telling me that there were no guarantees that my tiny little baby would be normal.

Or the geriatrician who thought he could keep my grandmother alive for my wedding but that she probably wouldn’t make Christmas; every year, for the next seven years, he received a Christmas card informing him of her continued survival, until she finally passed away two weeks before her 98th Christmas.

And I can still remember our family GP on a home visit to see me when I had the measles. His tall frame filled the doorway of my parents’ living room. Taking one look at me sitting on the sofa, his impulsive reaction was articulated in a single syllable of disgust: ‘Yuck!’

Off the top of my head, I have no idea how many excisions I have done. For the patient, often it’s a one-off, the mole is benign, and we wave them goodbye. If it turns out to be a melanoma, then it’s different and it’s the start of a long-term relationship.

Looking at my patient’s mole today, I don’t think that we’ll be seeing her again. You can never be sure, but I reckon her mole looks OK, somewhere in the spectrum of atypical moles, but I don’t think it’ll turn out to be a melanoma.

As we say goodbye, I’m still thinking about our earlier conversation. I will forget her, but her memory of me, like the scar I have given her today, will be with her for ever.

Susannah George is a specialty trainee 4 in dermatology in Brighton

Posted in:  Foundation doctors General practice

Tags:  General practice junior doctors specialist training


  • S Parker

    12 September 2012

    I agree with the broad gist of this article, however the suggestion that medical students spend time in a wheelchair is somewhat flawed.

    Near the beginning of the clinical phase of my medical school training we were given a day of "disability awareness" in which we had to put on blindfolds, try being in a wheelchair, wear glasses with prisms in, etc, and were told that it was so that we could experience what being disabled was like. Having empathy with disabled people is important, but putting a blindfold on for 20 minutes does NOT give one an insight into what being blind is like - when we got fed up we could simply take the blindfold off, which of course someone who is visually impaired cannot do.

    Before attending medical school I volunteered with after-school and respite care groups for children with learning difficulties, and also sailed on the tall ship Tenacious, where crew members of different physical abilities work alongside one another.

    What the Paralympics has shown us is real disabled people achieving amazing things. If we want to train doctors who have an understanding of disability politics and an awareness of the ways in which societal structures disable people with impairments, then I think that spending quality time with disabled people will provide deeper and more empathetic learning than having to spend a day in a wheelchair.

  • nusuevtu

    3 February 2014