Liam Farrell: The Trump-Brexit consultation model

There may be a perfect world out there somewhere, in an alternative universe, where perfect consultations happen. A world where E coli urinary tract infections are sensitive to trimethoprim, where bendrofluazide reduces blood pressure, and where hypnotics are used on a short-term basis only.

But our's is the real and very imperfect world and I am a real family doctor. I'm out there at the coalface, on the streets, with the kids, a kind of gangsta rappa.

When I hear hoofbeats at the window it ain't a zebra (unless I’m in the Serengeti) but it probably ain't a horse either, nothing so clear-cut, maybe some guy with coconuts making a clippety-clop noise. And the perfect consultation, like the most exotic sex, is unattainable, but trying your hardest to achieve it (the consultation, that is, not the exotic sex, though why not?) remains a source of personal and professional satisfaction.

At least that’s what we were taught when I was a lad, but things have changed, utterly changed. Instead of the Stott and Davis model of the consultation, identifying and managing the presenting problem, modifying help-seeking behaviour, managing continuing problems, and providing opportunistic health promotion, we now have the Trump-Brexit model, straight out of the F*ck You School of Medicine.

Step 1; tell a pack of lies, and appeal to the patient’s fears.

'Omigod, you have an awful cough; it might be… pneumonia!!!!'

Step 2; blame outsiders, especially if they are vulnerable.

'You might have picked something up from those Polish plumbers that live next door.'

Step 3; employ 'paralipsis' ('to leave to the side'), a rhetorical device that allows a speaker to effectively say two things at once, giving emphasis by professing to say little or nothing about a particular subject.

'I hear people saying it was them that caused the banking crash as well, you know, them and the Syrian refugees, but I’m not going to bring that up now.'

Step 4; offer simplistic, superficially attractive, yet useless solutions. 'You need a strong antibiotic.’

And finally, Step 5; promise the earth and moon, with grandiose yet illiterate Trumpisms.

'You’ll not just be better, you’ll be Bigly Better.'

'You’ll be Great Again.'

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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