funny old ward

"The trouble with medicine is that there's too much information around these days," a consultant physician confided to me between cigars. "Some of it's true, most is biased, but all of it just serves to confuse. British patients just aren't programmed to deal with it."

The after-dinner conversation of doctors is depressingly predictable (medicine or medicine), and this is even more true of senior doctors (how much more enjoyable medicine was in the old days). Much of the enjoyment came from being treated with deference by everyone lower on the evolutionary tree and from being the sole source of information. Doctor knew best because doctor was the only one who knew anything.

Now any sad anorak can surf the Internet and come up with 10 causes for his painful red eyes or the latest treatment for irritable bowel. I've even got a patient who taps into the home page of the British Medical Journal (http://www. bmj.com/bmj/ if you're interested). As most doctors never get beyond spotting career openings in the BMJ's obituary columns, it's very useful having a patient who can precis the salient points in the two minutes* it takes me to transilluminate his hydrocele (or, if you prefer, shine a torch through his scrotum). He chooses to spend his free time surfing medical journals and as yet it doesn't appear to have damaged his brain, although his hydrocele has grown by an inch.

Having the BMJ thrust upon you is an altogether different matter. A doctor colleague took the 8 June copy to his National Childbirth Trust class because it had an interesting paper on breech babies. The upshot was that these babies seem to have an increased incidence of neurological problems, perhaps as high as 20 per cent, whether they're born by breech delivery or Caesarean section. But it was only one paper, it's too early to say for sure, more studies are needed etc, etc. Predictably, the three couples in the class whose babies were lying head up at the time went spare. As one mother put it: "Why did you have to bring medicine into it?"

Some would argue that the parents still had the right to know this information, and had it been presented in the right way it would have been less distressing. Possibly, but what is the right way? - "I've got a potentially distressing paper here about breech babies. Would you like me to read it to you?" The doctor's job is to contextualise the information, to provide some perspective, but no matter how good your communication skills are they won't stop raw emotion stampeding over rational thought. The BMJ can ruin your pregnancy.

Information can even cause pregnancy. The final birth toll of those who were frightened off their Pill by the Government's announcement of a doubling of the teensy clotting risk has yet to be finalised, but the scare resulted in more than 4,000 abortions. True, the announcement was managed with all the sensitivity of a dead skunk, but even the best communicators in the world would have trouble convincing a nation of scientific illiterates. Science tries to minimise risk, but it can't eliminate it and so sharing information invariably means passing on the uncertainty. The risk may be small (only 1 in 77,000 women die as a result of the Pill), but a single sad-but-rare media story can send the nation into a frenzy of Femodene flushing. Emotion beats logic again.

Even reassuring information isn't necessarily reassuring. Ted-the-hydrocele cited a BMJ paper about patients with symptoms of heart disease whose investigations were normal. Apparently, just telling patients that the results were fine did nothing to reduce the anxiety of some. Could the tests be wrong? If it isn't my heart, what is it? Why can't you just give me a bypass anyway, just in case? Much of a doctor's time is spent trying to reassure the worried well, and we don't seem to be very good at it - especially when we're not too sure what's going on. Scientific medicine falls to pieces when you can't find a pigeon-hole for a patient's symptoms. Thank God for stress and viruses.

There is plenty of evidence that further down the line, patients really do benefit from more information. Studies have shown that those with serious (ie life-shortening) illnesses suffer less psychological distress and pain if they've had a full discussion of the treatment options and feel involved in the decision-making. This works best if they have access to nurse counsellors who can deal with the emotion the information unleashes. For doctors without such training, the best option may still be to keep mum. "Forget the information super highway," pleaded my dinner companion "and give me back my cul-de-sac."

* including undressing