A grateful patient

An ageing Irish farm labourer entered my consulting room, sat down by my desk, and extracted a £5 note from his wallet and placed it before me saying, “Doctor, that's for you. Do you remember me?”

Well, yes, I …


Comment
We found the prevalence of bullying to be lower than previously reported, but the question we used was framed to include only behaviours that were persistent, had a negative effect on respondents, and had occurred in the current post. London has a higher concentration of teaching hospital trusts than other areas of the country, but as we found no correlation between type of trust and the prevalence of bullying, these results are likely to be representative. Most of the negative behaviours were perpetrated by other doctors, in a pecking order of seniority, although nurses and midwives were an important source for junior grades. For bullying to be tackled, trainees need a safe means of complaining. They also need to be made aware of the impact that their own behaviour may have on colleagues. It should be recognised that some of the behaviours that erode trainees' professional confidence or self esteem may be attempts by trainers to improve their performance. 5 An educational rather than a punitive approach is needed to help trainers develop effective ways of encouraging better performance without becoming a source of distress to junior colleagues.
We thank Ray Flux of CivilEyes, who conducted the survey.
Contributors: EP planned the study, analysed the results, and drafted the paper; she is also the guarantor. MA managed the survey and collected the results. AH and JF-C commented on the plans and helped with the final draft.
Funding: No external funding.
Competing interests: The London Deanery is reponsible for quality assurance of training in the area concerned.

A grateful patient
An ageing Irish farm labourer entered my consulting room, sat down by my desk, and extracted a £5 note from his wallet and placed it before me saying, "Doctor, that's for you. Do you remember me?" Well, yes, I did remember him, although I had seen him only once before, about 18 months previously, when he had consulted me about a back injury at harvest time. He had fallen from a corn stack, and continuing pain had made him query an initial diagnosis of simple strain and seek another opinion. I had referred him to our local orthopaedic unit, where an x ray showed a crushed lumbar vertebra. He was treated with bed rest and later discharged to his home in Ireland.
"But," I protested, "I didn't do anything to deserve this." "Doctor," he said quietly, "when I came to you, you arranged for me to have an x ray, and because of what that showed I was entitled to compensation. I got my compensation a few weeks ago, and, doctor, that's for you." During my time in practice, I received many gifts from patients but, to me, nothing so precious as this Irishman's note.
Robert Milne retired general practitioner, Perth