Nine years ago the BMJ s Tessa Richards underwent thoraco-abdominal surgery for adrenal cancer, followed by further surgery to remove metastases. Now the senior editor in charge of the journals patient partnership agenda, she reflects on how her own experience of illness and recovery, and of joining the ranks of patients who survive the odds, have shaped her understanding of the patient perspectiveDoctors arent good at assessing their own symptoms. They either leap to diagnose serious disease or, more commonly, go into denial. They are slow to accept that they are ill and slower still to seek help. Take the following case, for example.In autumn 2003 I developed sharp intermittent back pain when driving or sitting for any length of time. I was also troubled by headaches. Some days I felt inordinately tired and found it difficult to work. My family advised me to go to my general practitioner. I did not follow their advice. Worse, I consulted myself.What would you do, I asked myself, if you were a GP (as I was once), and a woman over 50 came in complaining of backache, headaches, and tiredness? A silly question, of course. Consultations are not formulaic. In 10 minutes its impossible to take a detailed history and conduct the full examination that such symptoms theoretically warrant. In the absence of obvious disease doctors have to act on clinical instinct after what is often a cursory initial assessment.The symptoms I had were common, their severity difficult to gauge. I doubted that my GP would find anything amiss if he examined me or that investigations would show anything. Go for self help, I concluded: osteopath for the back, paracetamol for the head.Three months on and life was becoming a struggle. Friends sympathised. We all feel like that,
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