Doctors tend to ignore patients as people, but patients' expectations are often too high, Prof Anthony Clare said at the WONCA medical conference yesterday.
The psychiatrist and medical director of St Patrick's Hospital in Dublin said patients sometimes had unrealistic expectations as a result of watching programmes such as the medical drama ER where there was "high-tech medicine, but the human aspect of the patient is retained".
Almost 4,000 family doctors are in Dublin for WONCA, the World Organisation of National Colleges and Academies conference. Prof Clare was chairing a session of the conference, hosted by the Irish College of General Practitioners, where doctors from around the world gave their personal experiences of illness and treatment in hospital.
Decades ago, Prof Clare said, doctors did have a better bedside manner. However, this might have been "all they had to offer the patient then". Now there was more high-tech medicine, with faster through-put and shorter hospital stays.
"Medical schools are teaching doctors about communication now, but unfortunately this tends to get drowned out by certain realities. Time is short. Patients that are in hospital are often in intensive care, surrounded by equipment and bleeps."
Increasingly, he said, doctors in Ireland felt that if they admitted making mistakes they were open to litigation. An aloof attitude on the part of a doctor towards a patient might be arrogance but it was often defensiveness, he said.
Dr Rita Doyle, a Bray GP, spoke of her experience of being treated for a prolapsed disc. In total she had 10 hospital admissions, nine general anaesthetics and 27 hospitalisations. As a patient, she said, there were issues of communication with her doctor which needed to be addressed. She found her doctor was not comfortable with her speaking about the psychological effects of her illness.
"The psychological effects were not to be shown, they could not cope with my feelings. It seems they could cope with my body but not with my mind."
Any sensitivity came from nursing and cleaning staff, said Dr Doyle. "The physician that I had, the sicker I got the further he moved away from the bed. He began up by my pillow but as time progressed he used to just stick his head in the door and say `Are you still sick?'. I think it was more difficult for him because I was a doctor myself."
Dr Per Hjortdahl said doctors made mistakes but did not talk about them. He said they were afraid of litigation, "but very often the patient does find out, and since the doctor has not been honest they will almost certainly take a law suit."
Dr Hjortdahl said he had been on a respirator for 21 days. "I felt I was capable of spending the rest of my life hating the doctor. I was lying with 16 different wires and tubes coming out of me. But my brain was very active," he said.
He then heard one of his friends say that his doctor had accepted he had made a mistake. "That made it easier for me to work through it."