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I met Evelyn, a 43-year-old obstetric patient, when I was a medical student. Two of us were asked to conduct a full history and examination with the perennial student attraction being ‘an interesting patient with a hole in the heart’. She was great and talked about the straightforward birth of her seventh child and how well her heart continued to cope. Of course we examined her cardiovascular system and assessed her condition as an atrial septal defect. When asked about how her husband felt about having yet another child she replied that she wasn’t married but that Terry was the father of all her children. She could sense that we looked bemused and added, ‘When I was very young my doctor said that with your heart you should not get married—and I have followed his advice to this day.’


This extraordinary story highlights the importance of being careful of what you say and how you say it in giving advice to patients. The days of the authoritarian, all-powerful doctor have long gone, although I guess we have all had experiences of present-day patients hanging onto our words and advice. It adds further support to the importance of providing patient education handouts to supplement the spoken word.


Mrs A and Mrs Y were good friends. Each was married with children. The gap in their ages was not great and both had what might be described as artistic and intellectual interests.

Mrs A was a patient of mine. If she came to the surgery, it was nearly always to bring one of her two boys, delightful kids, still at primary school.

After a year or so Mrs A had occasion to see me on her own account. She was deeply distressed. Her husband had announced his intention of leaving her. It was not another woman: it was simply that he felt their marriage was at an end in every practical sense and he wanted his freedom. She felt shocked, hurt and humiliated. The news had come as a bombshell and she had no wish to break up the marriage.

He moved out of the house shortly after this. He would call by arrangement and take the boys out. At other times, to her surprise, she would suddenly hear a key in the front door and he would come in, sit down and blandly suggest that she might like to make him a cup of coffee. While she did not object to his formal outings with the children, these casual ‘drop-ins’ vexed her greatly. We had a number of long talks in the surgery during which I did what I could to alleviate her distress.

It must have been about three months later that Mrs Y consulted me as a ...

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