CLOWNING AND LEARNING HOW TO BE A GP
Interview with Dr. David Wheeler
Dr. David Wheeler is a GP and trains doctors
in consultation skills at the Greenwich VTS in southeast London.
This interview follows from the article published on 7 September
2001 in The GP Journal by
Dr. David Wheeler. 4150 words
Extract
… Dr. John Launer is a particular exponent of this
work and he has just written a book about it called “Narrative-based
Primary Care”. He’s a GP based in North London and
is also a trained family therapist with the Tavistock Centre.
Narrative Medicine looks at the patient’s background and
biography, so instead of being totally focused in a medical way
on the person’s problem, you think about their story and
it asks if this is a family story and what it means. What John
Launer would say is that there are things we can learn from therapy
that we can bring in into our consultation to make the consultation
more effective. That is something I now teach to registrars because
when they come in into General Practice they learn to totally
medicalise problems and find medical solutions to problems they
meet. What you end up with so often are two conversations in parallel
– the doctor’s medical discourse and the patient’s
personal discourse and there is a little bit of cross over now
and again, mainly in the form of closed questions – “Where
is the pain and how often do you get it?” That’s the
doctor working out their own agenda and trying to solve the problem
in their own way. Instead what I get them to do is – Stop,
listen to what the person is telling you, be curious about what
they are telling you and … that’s an interesting story,
what does that mean? Let’s go there and find out what that
means. It may have nothing to do with what’s on your mind
about their chest pain but it could, in fact, give very important
clues as to why they are there and what they are really worried
about. You just putting the stethoscope to their chest and saying
– It’s all normal – is not going to address
the problem. This is where we have got to in General Practice
– Doing the medical thing is not enough, you have to go
into the story and be curious about that.
V: Would that be where the relevance of clowning in the field
of medicine is? It isn’t about asking doctors to be clowns
in the Patch Adams way. Rather we should ask, what can we learn
as doctors from the skills that clowning requires.
D: Yes. There is always this tension in General Practice
between the guidelines, targets and medical preciseness and the
wooliness of life that we have to deal with. If you deal with
people you have to accept that things just don’t fit in
boxes as we are led to believe. That’s why I am a GP because
I was bored with dealing with things in boxes and I like the challenge
of the unknown.
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